Connecting Patients with Financial Assistance

While therapies for patients with chronic conditions have evolved greatly, they have done so at a price. Because of the complex and often rare conditions these high-touch drugs treat, they can range in cost from thousands of dollars a month to hundreds of thousands of dollars per year. At AllianceRx Walgreens Pharmacy, we want to eliminate financial barriers to access and connect our patients with resources to help make their treatments affordable.

Before we can talk about financial assistance available to patients with rare conditions, it’s important to understand why specialty medications have such a high price tag. In this story, we explain the high costs of rare and orphan drugs, review what programs are available to help make these therapies affordable, and describe the role AllianceRx Walgreens Pharmacy plays in connecting patients to these programs.

Understanding the high costs of rare and orphan products

The Orphan Drug Act was passed in the U.S. in 1983 and set the definition of orphan drugs. This act provided manufacturers with incentives to target rare diseases, defined as diseases affecting fewer than 200,000 patients in the U.S., many of which did not have treatment options prior to these medications. Although the act was passed 39 years ago, 30% of all medications meeting this designation were approved in just the last three years. In 2019, the total number of medications approved through the Orphan Drug Act reached 564 covering 838 indications.¹

In addition to providing treatment options for patients with rare diseases, these therapies often come with high price tags. Orphan medications often require research into understanding the disease pathophysiology before medication development begins. Because of the additional research requirement, molecule development and testing, and a relatively small patient population, manufacturers place higher prices on these medications compared to traditional or other specialty therapies.¹ 

Types of Available Financial Assistance for Patients

Many manufacturers have programs in place to assist patients financially who may be underinsured. Although these programs are not specific to orphan therapies, due to their high cost and lack of alternative therapies, they have a huge impact on patients.

•    Manufacturer coupons – Normally applied after insurance coverage, manufacturer coupons provide a set amount off from a patient’s copay. Manufacturer coupons often lower the copay up to a certain amount and may have minimum copay amount. For example, a coupon may cover up to $300 with a copay as low as $5.

•    Prescription assistance programs – Often referred to as “PAP,” these programs are provided to those who are uninsured or underinsured. PAPs provide medications at no cost to patients and, similar to copay assistance, may be based on factors such as income level.

•    Bridge – A type of assistance for those with a lapse in insurance coverage or other gap that may cause the patient to miss doses. A bridge program provides medication at no cost to fill this gap until insurance coverage is reestablished. 

Patients may also find financial assistance through non-manufacturer programs. These sources of funding may be for specific diseases or for government beneficiaries. Regardless of the source, any funding may be life changing for patients.

•    Disease foundations – Disease-specific foundations, such as oncology or cystic fibrosis, that provide grants to uninsured or underinsured patients. After application and approval, these foundations help patients cover their out-of-pocket costs. In addition to financial support, these organizations often have other resources that a patient may use, such as support groups or counseling programs.

•    Charitable programs – Local organizations, such as churches or other non-profit organizations, may also assist patients in need. These organizations may assist patients financially or with other aspects of their disease, such as transportation to prescriber visits.

How AllianceRx Walgreens Pharmacy Helps Patients

AllianceRx Walgreens Pharmacy understands the patients we serve are often diagnosed with complex and life-changing diseases. Our patients are the center of everything we do, and we have an entire team dedicated to providing financial assistance to patients and their families. Our experienced patient financial services coordinators have knowledge of all programs and can guide patients on any options available. 

As many of these programs require patient enrollment, AllianceRx Walgreens Pharmacy helps by facilitating this process for our patients. Many emotions come with a specialty disease diagnosis. AllianceRx Walgreens Pharmacy strives to limit any financial worries our patients may have so they may focus on better tomorrows.

For more information on financial assistance programs, visit alliancerxwp.com/specialty-pharmacy.

Bill Trombatt, PharmD, CSP, manager, clinical programs, contributed to this article.

Sources:

¹ Aitken, M, Kleinrock, M, Munoz, E, Porwal, U. Orphan Drugs in the United States: Rare Disease Innovation and Cost Trends Through 2019. IQVIA Institute for Human Data Science. December 2020. 

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