Patient Assistance Programs Overview

Virginia Department of Health

HIV Care Services Unit November 2010

Objectives

1. Describe how to help clients navigate and access these programs.

2. Understand what Patient Assistance Programs (PAPs) are, the various eligibility requirements, and how to use them.

3. Identify medication access options during current AIDS Drug Assistance Program (ADAP) funding crisis.

PAPs-What are they?

PAPs provide free or low-cost drugs to individuals who cannot otherwise afford them.

There are multiple options and companies.

Each pharmaceutical company has specific criteria and eligibility requirements for each program.

What’s next? How do I get medications?

First Step – Refer all clients to Patient Services Inc. (PSI) to apply for ADAP, verify eligibility, and place on waitlist if appropriate.

Who can access PAPs?– A physician can register as a provider– An individual can enroll on their own; however

they will still need information from their provider/physician

1-866-392-1309

Resource tool

Resource tool provides information from all PAPs including non-antiretrovirals (non-ARVs) removed from the formulary:– Drug company/drug– Eligibility– Turnaround time– Medication delivery method– Refill method– Length of enrollment

Application Overview

All applications will require:– Patient name, address, phone, date of birth– Provider name, address, phone, fax, drug

enforcement agency number (DEA)– Prescription information– Financial information– Insurance information (Y/N, ADAP waitlist)

Overview of Low Cost Generics

A list of available low cost generics for medications that have been removed from the ADAP formulary has been compiled. (see resource tool).

Low cost generic medications are available at several retail pharmacies throughout the state and cost approximately $4 each for a 30-day supply.

If a patient is denied for ADAP, could they be eligible for other Ryan White (RW) services?

Potentially, denied clients may be eligible for core and support services and are encouraged to apply for RW.

However, RW Part B funds may not be used for the financial support of medications removed from the ADAP formulary.

Please note: if a client is denied for ADAP, RW Part B funds cannot be used to purchase medications on the ADAP formulary.

Challenges

Client may be on multiple medications from different drug companies. May be delivered at different times.

Some drugs may be delivered to patient, some may be delivered to provider. A card/voucher may also be sent to the client.

ADAP stakeholders have a variety of experience utilizing PAPs.

Tips for a smooth application process

Review the application and make sure it is complete and that all documents are attached.

Keep a copy of application package for your records. Follow instructions for each program since they are

all different. Follow up with the company if you do not hear from

them in 2-3 weeks.

Who do I contact?

Each pharmaceutical company has individual requirements for PAPs; it is best to contact each company directly.

Most companies have a designated website or toll-free number to receive information regarding PAPs.

Lessons Learned from other states using PAPs

Educate stakeholders as early as possible on PAP process and medication access.

Develop comprehensive tool with PAP resources for antiretrovirals (ARVs).

Encourage case managers to communicate with the local health department ADAP staff and vice versa.

Include links to PAPs on ADAP website.

PAP Resources

NeedyMeds- http://www.needymeds.org/

(also for HCV drugs and vaccines)

Partnership for Prescription Assistance- http://www.pparx.org/

RxAssist Patient Assistance Program Center-

http://www.rxassist.org

RxHope- https://www.rxhope.com/home.aspx

Virginia Health Care Foundation (VHCF)

Provides medication assistance through free and community health clinics across Virginia.

Utilizes a software program that finds PAPs for all of patient’s medications

www.vhcf.org

Welvista Patient Assistance- http://www.welvista.org/adap_how.php

Covers six ARVs (Abbott, Merck & Tibotec)-Norvir, Kaletra, Isentress, Crixivan, Prezista and Intelence

Only available for clients who are currently on a waiting list for a state ADAP.

Other Patient Assistance Programs

Other Resources

www.HIVCaseManager.com A free, innovative online resource directory

designed to help front-line HIV service providers meet their client education needs.

Links to more than 200 national, state and city HIV/AIDS organizations and resources.

Additional information needed?

Please contact:

ADAP Coordinator:

Rachel Rees

804-864-7919

Rachel.Rees@vdh.virginia.gov

ADAP Operations Specialists: Jennifer Flannagan804-864-7360Jennifer.Flannagan@vdh.virginia.govOrKate Cooke804-864-8019Kate.Cooke@vdh.virginia.gov

Or HIV/STD/Viral Hepatitis Hotline1-800-533-4148