A new health insurance work-around could endanger patient health in an attempt to cut costs for employers. It’s known as an “alternative funding program.”
Under these programs, third-party vendors advise employers to exclude higher-cost specialty medications from their employees’ benefit plan. The vendors then guide employees to get their medication by applying to patient assistance programs, which are designed for people who are uninsured or have limited financial means.
Alternative funding program vendors like to pitch these programs as a win-win. In reality, however, several problems can ensue along the way.
High Costs to Patient Health
Misusing charitable programs, offered by patient assistance nonprofits or a drug manufacturer’s private foundations, creates problems logistically, medically and financially.
Applying and getting approved for patient assistance takes valuable time that patients may not have. If treatment is delayed, patient health may suffer. Chronic conditions may worsen, and symptoms that were previously controlled may re-emerge. For some conditions, like cardiomyopathy, denial of treatment even for a short time may cause heart attack and sudden death.
Patients may also face added costs. Because alternative funding programs operate outside of patients’ health plans, any money that patients pay for their medication does not get credited toward their annual insurance deductible. As a result, they may pay more out of pocket than usual over the course of the year.
Added Risks from Alternative Funding Programs
Patient assistance doesn’t always come through.
In those scenarios, some third-party alternative funding program vendors may source drugs from outside the United States, in defiance of FDA regulation. Patients may be exposed to medications that do not carry the same safety and efficacy guarantees they have come to expect.
The Bottom Line
Patients need timely access to the treatments their clinicians prescribe. Alternative funding programs complicate treatment by introducing avoidable delays – while also straining financial assistance programs designed for truly needy patients. Employers may avoid the cost of expensive prescription drugs, but they still must pay alternative funding program vendors. All the while, the bloated drug pricing system becomes still more complex.
Insured patients deserve the access they expected when they enrolled in their health plan. The “alternative” proposed by third-party vendors simply won’t do.