How to Navigate Patient Assistance Programs with Office Ally's Help

Patient Assistance Programs, or PAPs, are common within the healthcare industry. These programs are marketed as a way for the uninsured to get common medications at no cost or a lower cost. 

While this mission seems promising on the surface level, PAPs are often criticized for being complicated and challenging for patients to navigate. The application process also requires participation from providers who must submit patient information to pharmaceutical companies with varying requirements. 

Providers should use tools and implement internal policies to avoid the confusion often accompanying patient assistance programs.

What Are Patient Assistance Programs (PAPs)?

Patient assistance programs allow people without health insurance to receive common medications at an affordable rate. These medications could be obtained at a discount or for free, depending on the patients’ qualifications, the medication, and the program. Some PAPs last indefinitely, while others are finite. Some may cap the medication patients can receive in a given period.

Pharmaceutical companies often operate PAPs, but some are managed by government agencies or nonprofits. Some drug manufacturers will establish nonprofit or charitable foundations to manage their individual PAP. These organizations advertise the programs as a safety net for the underinsured who pay cash for prescriptions.

These programs cannot be combined with any type of insurance to further lower costs. In some cases, individuals get a better deal, paying less through a PAP than they would with the out-of-pocket cost offered by their insurance company. 

How Do Patient Assistance Programs Work?

Uninsured patients must apply for each individual PAP. Patients often must conduct their own research on available and relevant programs by:

• Consulting the drug manufacturer’s website.
• Searching the web.
• Searching specialized sites that maintain databases of tens of thousands of different PAPs.
• Working with a nonprofit that offers patient assistance for people with their condition.

Each program is unique to the organization that runs it, meaning requirements for application vary greatly. To enroll, patients must contact the PAP administrator via phone, email or online registration form. They will likely be asked to submit tax information and proof of residency to prove they qualify. Many programs also require participation from a healthcare provider. 

PAPs were previously challenging to qualify for, but restrictions have loosened over the years. For example, anti-kickback laws make it illegal for manufacturers to offer discounts on drugs paid for by the federal government, meaning Medicare and Medicaid patients could not qualify for PAPs. Some Medicare and Medicaid patients may qualify depending on the program and requested medication.

Why Are Patient Assistance Programs Difficult To Understand?

The healthcare industry is known for being difficult to navigate, with frequent landscape shifts, regulatory changes, and shakeups like Medicaid redetermination. However, PAPs tend to add consistent confusion for providers of all sizes. 

First, there is no standard enrollment process for patients. Every program has its own standards and requirements. For example, some PAPs require one application per person, and others require one application per requested drug. Not all PAPs share their eligibility criteria freely; most are difficult to access and understand. 

Second, for the larger population, PAPs are criticized for their unfairness to insured people. The cost of PAPs is baked into the operational budget of the organization running the program. The cost is covered by people who pay into this budget. For private insurance companies, this means their general population of customers. Patients who do not need a PAP end up subsidizing someone else’s drug costs. 

Finally, patients usually cannot complete an application to a PAP without involving their healthcare provider. The care team must usually fill out one or more forms assessing the patient’s status to help the PAP determine eligibility. Tens of thousands of PAPs are available, making it impossible for providers to keep track of everyone, let alone compare and contrast which is best for patients. 

It’s hard enough for small providers to manage PAP application requests, but things only get worse the more patients you process. A larger volume of patients, such as those who visit a hospital each year, means more diverse PAP applications for hospitals to manage.

Tips to Navigate Patient Assistance Programs

However, despite the confusion attached to PAPs, these programs help providers as they:

• Decrease medical debt, contributing to a healthy revenue cycle
• Decrease emergency visits
• Improve patient satisfaction and outcomes

It’s often in the best interest of providers to take time to implement policies and tools to navigate better and manage PAP patients. Here are five ways hospitals can better navigate patient assistance programs.

Provide Resources for Patients & Families Using PAPs

Education is a powerful tool. Patients who trust their healthcare provider enough to help them navigate PAPs are more likely to return and refer others. Many healthcare systems have a patient advocacy department or team, which should include resources for navigating PAPs.

These specialists should be well-informed on common PAPs and know how to connect patients to these programs while helping them navigate enrollment. If a patient’s medication is covered via a PAP, the patient’s financial burden is reduced, boosting the patient experience. It also reduces the hospital’s bad debt while promoting a healthy revenue cycle.

Train Hospital Staff on Patient Assistance Programs

Outside the patient advocacy team, all staff, especially those in the medical billing department, should receive some level of education on PAPs. This training should cover the basic details of PAPs, how patients can access them, and instructions to direct patients to the advocacy team for further information. Hospitals without a patient advocacy team should have more in-depth training covering common PAPs and how to help patients search for the right PAP for them. 

Establish Direct Communication with PAPs

Because providers play a role in the PAP application process, it helps to implement a patient portal for direct communication with PAP patients. This allows the patient to select their preferred method of communication (text, phone call, email, etc.) and send secure messages back and forth with the provider. 

Direct communication makes the application process easier and increases satisfaction. Office Ally’s MAPS tool with MAPS-Clear patient portal add-on can assist in automating workflows and contacting patients.

Utilize Insurance Discovery Software

An uninsured patient may have sources of coverage they aren’t aware of or didn’t report. Covering medication via insurance is a much more straightforward process for providers.

Insurance Discovery conducts an exhaustive check of available government and commercial payors to identify sources of coverage for patients. This process can allow providers to circumvent the need for a PAP in the first place while alleviating financial burdens for the patient. Get started with insurance discovery with a free assessment from Office Ally’s team of experts.

Leverage Accurate Electronic Health Records

PAP patients should be tracked to prevent them from being lost in the shuffle and ensure they receive assistance from the hospital in some way. Staff should know the patients’ names, medications, current and past PAPs, and application and approval dates. 

This information should be saved in the patient’s file. With accurate tracking, providers only need to access this file to help patients apply for PAPs and accurately fill out necessary forms. For accuracy, implement policies and procedures to collect patient information at the time of appointment or as soon as possible after entering the emergency department and verify it with the patient at check-in or shortly after emergency care. 

This policy of keeping accurate data has wide-reaching implications beyond PAPs, reducing medical claims denials and making it easier to contact patients in the future.

Software tools to navigate patient assistance programs

Patient assistance programs can be difficult for patients and providers to navigate. Fortunately, hospitals have tools and tactics that can keep things running smoothly. 

Office Ally offers a suite of professional software tools designed to help your team create a healthy revenue cycle and navigate tough challenges like PAPs. Click here for more information on Office Ally solutions price.

For questions or more information, click here to contact Office Ally and talk to one of our experienced team members.