Living with a chronic condition is costly—emotionally, physically, and financially.
Those with multiple chronic conditions have poorer health, use more health services, and spend more on healthcare overall.1 And while we tend to think those living with chronic conditions make up a small portion of the population, that’s simply not true. Sixty percent of adults in the U.S. are living with at least one chronic illness. Forty percent of adults have two or more.2
As financial barriers to care continue to rise3, employers and health plans are shifting more of the cost burden on consumers through high deductibles, coinsurance, and other cost-sharing requirements4 which can quickly drain paychecks and savings—especially for the chronically ill. The number of uninsured also continues to rise (up 7.9% in 2019 compared to 2017).5
When patients have to pay high out-of-pocket costs for their care and treatment, they’re more likely to skip optional care and delay critical care. This leads to both poorer treatment outcomes and overall health. Poor health can lead to lost workdays and potential loss of employment.4 It’s a classic domino effect and an unfortunate burden to bear for the chronically ill and their families.
Is There Help?
Yes. Patient assistance programs (PAPs) step in to provide financial assistance for treatments at little to no cost both for those with coverage gaps and for the uninsured. Ultimately, they improve adherence and therefore support better treatment outcomes by reducing financial barriers to care. PAPs can be sponsored by pharmaceutical companies (manufacturers), state/community programs, and nonprofits. In addition to financial support for treatment, PAPs can also help chronically ill patients and their families pay for utilities and other non-healthcare related items that fulfill vital needs and improve quality of life.
Here are some examples of patient assistance programs:
The Role of Specialty Pharmacy
Though PAPs are typically a really good option for those with chronic illness, there are a few critiques of these programs. The application process is generally complicated, and there are often additional steps for patients to take in order to get their needed treatment. Patients may also need the support of multiple programs if they have multiple treatments.6
This is where specialty pharmacies can help. An important role of the specialty pharmacy is to help identify co-pay assistance programs and connect patients with the right resources for enrollment. At BioMatrix, our team is well versed in helping patients find appropriate financial assistance programs. From manufacturer co-pay programs to charity-based financial assistance, we facilitate access to resources and support helping patients access specialized healthcare without breaking the bank.
BioMatrix is proud to make a difference in the communities we serve, one patient at a time.
Our clinicians and support staff offer a tailored approach to every therapeutic category, improving quality of life for patients and producing positive outcomes along the healthcare continuum. Learn more.
1. Centers for Disease Control and Prevention (CDC). 2020. Health and Economic Costs of Chronic Diseases. https://www.cdc.gov/chronicdisease/about/costs/index.htm
2. Centers for Disease Control and Prevention (CDC). 2019. Chronic Diseases in America. https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm
3. National Conference of State Legislatures (NCSL). 2018. Health Insurance: Premiums and Increases. https://www.ncsl.org/research/health/health-insurance-premiums.aspx
4. Partnership to Fight Chronic Disease. (2019). Framework to Address High Cost Burden for People with Serious Chronic Conditions. https://www.fightchronicdisease.org/resources/framework-address-high-cost-burden-people-serious-chronic-conditions
5. J Kim. (2019). Rate of Uninsured Americans Rises for the First Time Since Obamacare Took Effect in 2014. https://www.cnbc.com/2019/09/10/rate-of-insured-americans-decreases-for-the-first-time-since-obamacare.html
6. N Choudhry, J Lee, J Agnew-Blais, C Corcoran, W Shrank. 2009. Drug Company–Sponsored Patient Assistance Programs: A Viable Safety Net? https://www.healthaffairs.org/doi/full/10.1377/hlthaff.28.3.827#R13
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