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Just 3% of charity patient assistance programs accept uninsured patients

Only 3% of charity patient assistance programs accept patients without insurance, according to a study recently published in JAMA.

“Independent charity patient assistance programs have grown rapidly since the enactment of the Medicare Modernization Act of 2003, which became effective in 2006,” So-Yeon Kang, MPH, MBA, of the department of health policy and management in the Bloomberg School of Public Health at Johns Hopkins University, and colleagues wrote. “Between 2007 and 2016, the total amount of patient assistance granted by the [five] largest independent charities increased by 588%.”

“However, little is known about independent charity patient assistance programs and the financial support they provide,” they continued.

Researchers conducted a descriptive cross-sectional study of independent charities that offer patient assistance programs to patients, including 2018 Medicare beneficiaries. The programs were identified by tax codes through a nonprofit database.

Six independent charity foundations that had at least $10 million in revenue throughout 2017, two of which provided a full list of the drugs they provide assistance for on the Medicare website, were included in the study. Foundations revenues ranged from $24 million to $532 million and spending on patient assistance programs ranges from $24 million to $353 million in 2017.

The six foundations offered 274 different patient assistance programs, 168 (61%) of which only provided assistance for copayments. Treatments for cancer or cancer-related symptoms were the common therapeutics covered by the programs, with 113 (41%) of patient assistant programs covering cancer treatments.

Among the patient assistance programs included in the study, 267 (97%) excluded uninsured patients and required insurance for inclusion in the program.

Most programs (259; 94%) set the income eligibility limit at 400% or 500% above the federal poverty level.

The median cost of drugs each year for each beneficiary in the program was $1,157 (interquartile range = $247 to $5,609), significantly higher than the median annual cost of drugs that were not included in the program, $367 (interquartile range = $100 to $1,500).

Brand-name drugs that cost more than $10,000 were covered by a mean 3.1 patient assistance programs, while generic versions of the drugs were only covered by a mean 1.2 programs.

In an editorial accompanying the study, Katherine Kraschel, JD, of Yale Law School, and Gregory Curfman, MD, of JAMA, noted that the findings question the role of patient assistant program as charitable organizations, because they favor insured patients instead of the more vulnerable population of uninsured patients.

“By preferring patients with insurance (which must cover the patient’s specific drug), the nonprofit patient assistance programs maximize payments to the for-profit pharmaceutical companies that fund them,” they wrote. “The findings also illustrate the way patient assistance programs drive up health care costs by providing support for more expensive specialty drugs in lieu of less expensive alternatives. In sum, these new results show that patient assistance programs provide assistance to a narrow, insured patient population to the benefit of the pharmaceutical companies.” – by Erin Michael

Disclosures: The authors report no relevant financial disclosures.