Background/Purpose:

Uninsured rheumatic disease patients are at risk for inadequate treatment due to issues with access to care, such as medication costs that average at least $1659/patient/10 weeks (Costs for medications obtained using government prime vendor pricing). Pharmaceutical companies created patient assistance programs (PAPs) as one way to address these barriers. However, the process of getting assistance is resource-intensive because eligibility requirements are not standardized across these foundations. This study aims to understand one aspect of direct care costs in a community health clinic population.

Methods:

A clinical team was created to aid patients needing assistance for high-cost biologics. Patients were followed for about a year. We determined the rates of successful PAP approvals and stratified our analysis based on a diagnosis of Rheumatoid Arthritis (RA) or Other Autoimmune diseases (OTHER). We also catalogued reasons why some patients were unable to renew enrollment.

Results:

Data collected from 6/2016-5/2017 revealed a 94% PAP success rate for our patients with identified need (Table 1). RA patients had a 93% success rate.  Success rates were higher in OTHER patients. PAP denial was often due to inadequate income documentation.  Delay was often due to eligibility for Medicaid/Medicare.

Table 1. Biological Therapy Access Rates 

Furthermore, analysis of patients enrolled in PAP from 6/2016-5/2017 revealed a 68% renewal success rate. Reasons for lack of renewal were: newly acquired health insurance, personal choice, insufficient income documentation, and enrollment in Medicare. Overall savings for our patient population, was estimated to be $1.2 million per year. Our teams invest in counseling time with the patient, phone time with sponsoring foundations, computer resources for implementing a program renewal database, and pharmacy handling of infusion medications.

Conclusion:

This study addresses the impact of a dedicated effort, within a community clinic setting, to expedite access to medications through a streamlined PAP.  Outpatient drug costs for rheumatic diseases are important to target when containing overall direct health care costs. Our observations take this further to show a dedicated health care team can assist limited resource patients with accessing high cost biologics. Benefits from our program extend beyond immediate financial relief – there is educational value for rheumatology trainees and protected free time for clinical pharmacists which can used for teaching, clinical oversight, and academic scholarship.

In conclusion, investing resources to support individuals with limited resources in securing of assistance is a successful endeavor. Further research is necessary to capture the downstream benefits of this effort.