Given the profound impact biologic drugs have on disease control, quality of life and potential reduction of long-term disability in patients with rheumatic disease, the ACR’s Committee on Rheumatologic Care released a position statement on patient access to biologics in August 2021. It states: “Patients should have affordable access to biologic therapy without undue delay.”1
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As practicing rheumatology providers, I know we all agree with that statement. However, the hefty price tags of biologic therapies create a plethora of access issues that burden providers and delay care for our patients—even those who have health insurance.
What about the 8.6% of American residents, about 28 million people, who don’t have health insurance?2 And what about the millions more who are underinsured? These people are not immune to autoimmune disease. They often delay their own care due to out-of-pocket costs they simply cannot afford, so by the time they’re in your office, their disease is likely to be severe.3
During the three years I spent caring for patients with rheumatic disease at a federally qualified health center in Austin, Texas, 73% of the patients I cared for were uninsured. Thirty-nine percent of rheumatoid arthritis patients already had erosive disease at their first visit with me.4 Based on this experience, I can share insights into how to obtain free biologics for uninsured patients via patient assistance programs (PAPs).
What Is a PAP?
Sponsored by drug companies, PAPs provide qualifying, uninsured or underinsured, low-income patients with free medications. Although no program is perfect and applications can be tedious (especially for non-English-speaking patients), PAPs are often the only means by which patients can obtain the biologic therapies they need.
In some ways, obtaining biologics via a PAP can be simpler than obtaining them for patients who have health insurance. Formulary restrictions, prior authorization headaches and step therapy protocols don’t apply to PAPs. Simply choose the therapy you feel is best for the patient and complete the application. If all required documents are received as quickly as possible, the patient could expect to be approved for a year of free drugs within a matter of weeks. Tips on how to streamline the process are discussed below.
Does My Patient Qualify?
In general, for a patient to qualify for a free medication through a PAP, pharmaceutical companies request proof of the following:
- U.S. residency—of note, immigration or citizenship documents are not required for most applications;
- Lack of health insurance or lack of adequate coverage by current plan—for the uninsured, fulfilling this requirement is as simple as checking a box to that effect. For the underinsured, additional documentation of the coverage gap is requested; and
- Income below a designated threshold—Drug companies accept a wide array of proof-of-income documents, such as tax documents, pay stubs or a letter of declaration from the patient or responsible party stating they earn X amount monthly. Income eligibility thresholds are specific to each program.
After a year of struggling to help hundreds of patients obtain medications via PAPs, my partner and I spent a day calling every rheumatology drug PAP we could think of (see Figure 1). Here, I share practical tips from that reconnaissance work: