By Amanda Bowes, Associate, Health Care Access and Viral Hepatitis, NASTAD
The treatment landscape for both HIV and hepatitis C (HCV) is evolving in exciting and dramatic ways. This excitement is often curbed, however, by high priced drugs and/or restrictive insurance practices that impacted populations face in accessing health care services.
Patient assistance programs (PAPs) and cost-sharing assistance programs (CAPs) provide additional and necessary support for access to treatment for people living with HIV and/or HCV.
As illustrated in the first installment of this two-part blog series, treatment access barriers exist for both HIV and hepatitis C (HCV). We applaud pharmaceutical companies for establishing and improving patient assistance programs (PAPs) and cost-sharing assistance programs (CAPs) that help provide access to their medications. NASTAD and the community work to ensure that these programs meet the needs of individuals as part of broader treatment access issues.
Patient Assistance and Cost-Sharing Assistance Programs for HIV and Hepatitis
A patient assistance program (PAP) is a program run through pharmaceutical companies to provide free or low-cost medications to people with low-incomes who do not qualify for any other insurance or assistance programs, such as Medicaid, Medicare, or ADAPs. A cost-sharing assistance program (CAP) is a program operated by pharmaceutical companies that offers cost-sharing assistance to people with private health insurance (including plans purchased through the Affordable Care Act (ACA) marketplace) to obtain drugs at the pharmacy.
In collaboration with the Fair Pricing Coalition, the National Alliance of State & Territorial AIDS Directors (NASTAD) maintains fact sheets that provide background on what patient assistance programs and cost-sharing assistance programs are, how to apply for them and an overview of programs’ contact information, drugs covered, limits of coverage (e.g., $6,000 per year in cost sharing assistance) and financial eligibility criteria. The fact sheets also include lists of additional resources and information on foundations that provide access to care assistance for people living with HIV and/or hepatitis. The fact sheets are updated as needed to reflect the most up-to-date information.
With the support of the Department of Health and Human Services (DHHS), NASTAD also maintains a common patient assistance program application (CPAPA) form to help low-income individuals who are living with HIV apply for patient assistance programs (PAPs). The CPAPA form can be used by both people living with HIV and their providers (e.g., doctors or case managers) to apply to all HIV PAPs with one form, thus reducing the application paperwork and time. There is no comparable system for HCV patient assistance programs.
NASTAD and the Clinton Health Access Initiative (CHAI) also recently launched HarborPath which also further streamlines access to HIV PAPs. HarborPath is an online portal that allows providers to input the information requested on all PAP forms and then allows a single process to obtain all the HIV and HCV medicines on the HarborPath formulary for eligible clients. Without HarborPath, individuals living with HIV/AIDS must obtain their medications from each PAP individually once they qualify. Clinics must be enrolled with HarborPath in order to participate in the program.
NASTAD encourages health department staff to review and share this information with other stakeholders including people living with HIV and/or hepatitis.
To learn more about how patient assistance programs and co-payment assistance programs can increase access to HIV and HCV treatment, please check out the resources below:
- Fact Sheet – Pharmaceutical Company HIV Patient Assistance Programs and Cost-Sharing Assistance Programs (PDF)
- Fact Sheet – Pharmaceutical Company Hepatitis Patient Assistance Programs and Cost-Sharing Programs (PDF)
- Common Patient Assistance Program Application (CPAPA) Companion Document (PDF)
We want to hear from you! Tell us about your experiences in accessing PAPs and CAPs by leaving a comment below.
