Financial eligibility criteria and medication coverage for independent charity patient assistance programs
JAMA Aug 14, 2019
Kang SY, et al. - Through a cross-sectional study involving 6 independent charity organizations and 274 patient assistance programs in 2018, researchers investigated the eligibility criteria of the independent charity patient assistance programs and the drugs covered by them. The total revenue in 2017 varied from $24 million to $532 million, and expenditures on patient assistance programs varied from $24 million to $353 million, signifying, on average, 86% of the revenue. A total of 168 of 274 patient assistance programs offered by these organizations gave only co-payment assistance, and the most prevalent therapeutic area covered was cancer or cancer treatment-related symptoms. Two hundred and sixty-seven programs needed insurance coverage as an eligibility criterion. The most prevalent income eligibility limit was 500% of the federal poverty level. The median annual cost of the drugs per beneficiary covered by the programs was $1,157 vs $367 for the noncovered drugs. Off-patent brand-name drugs and their generic equivalents were covered by a mean of 3.1 and 1.2 patient assistance programs, respectively. Therefore, in 2018, the bulk did not grant coverage for uninsured individuals. In comparison with those that were not covered, medications that were covered by the patient assistance programs were generally more expensive.
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