The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #62399

Kristiana Raube¹, Helene Levens Lipton, PhD², Kathryn Saenz Duke, JD, MPH³, and Long Tran, MPH³. (1) Haas School of Business, University of California, Berkeley, Mail code #1900, Berkeley, CA 94720, 510-643-1399, raube@haas.berkeley.edu, (2) Department of Clinical Pharmacy, University of California- San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94118, (3) Medicine for People in Need Program, Public Health Institute, 505 14 th Street, Suite 810, Oakland, CA 94612

For safety net providers that serve uninsured people, rising drug costs are a major concern. A number of pharmaceutical companies have programs, usually referred to as patient assistance programs or PAPs, to provide some of their prescription medicines free of charge to indigent patients. To date, there have been few studies that evaluate PAPs from the perspective of the clinics that apply to PAPs on behalf of their patients.

This presentation will present findings from a California HealthCare Foundation-funded study of PAPs. We will report results from case studies of a stratified sample of 12 safety net outpatient clinics in California who are using at least one PAP, and a five-state telephone survey of safety net clinics’ use of PAPs.

From the case study interviews, we found that there is widespread appreciation for the positive impact of free drugs obtained through PAPs. Clinic staff feels good about being able to help vulnerable patients in this way, and believe that having access to medications increases patients’ medication compliance and overall quality of care. In addition, they are often disappointed by the gap between the general concept of PAPs and the reality of PAP procedures that can be burdensome or inappropriate for vulnerable patients.

In the survey of safety net clinics (n=215), we oversampled California clinics (n = 137). Over three-quarters of all respondents reported using PAPs, but California safety net providers were less likely to use PAPs (71%) than those in other states (90%). The use of PAPs was a function of whether the clinic had a pharmacist or dispensary on-site, the percent of uninsured patients, and the state in which the clinic was located. Community clinics invested a non-trivial amount of time each month participating in PAPs. On average, physicians spent 68 hours, pharmacists spent 29 hours, and other staff invested 142 hours.

The most commonly used PAPs do not require phone preauthorization and are less likely to require proof of the lack of drug insurance coverage or US citizenship. Respondents reported that the most common potential barrier to PAP use was changing program requirements without notice or requiring unrealistic income documentation. Not surprisingly, the most common suggestions for PAP improvements were standardized applications or eligibility standards across the various companies’ programs.

In summary, this presentation will detail findings from the first study of its kind of PAPs, an important mechanism for safety net providers to offset increasing drug costs and assure access to pharmaceutical therapies for indigent patients.

Learning Objectives:

• At the conclusion of the session, the participant will be able to:
• 1. Identify the specific characteristics of PAP applications that are associated with use by safety net providers.
• 2. Describe the organizational features of safety net providers that make them more or less likely to use PAP programs.
• 3. Articulate potential barriers to PAP use, as well as ways to improve PAP programs.

Keywords: Safety Net Providers, Access to Care

Related Web page: N/A

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: none
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.