CBI Scene Blog

How Healthcare Reform Will Affect Your Patient Assistance Strategy

Posted by Amanda Batstone on Mar 1, 2013 1:54:00 PM

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The past year has been a monumental one for Healthcare Reform and changes affecting manufacturers and patient advocacy organizations. We’ve been faced with the June 2012 SCOTUS decision on the individual mandate, the November 2012 re-election of the Obama Administration, and the January 2013 inauguration, representing the beginning of the daunting implementation stage that will impact the federal, state and local levels.

We at CBI understand that these looming uncertainties have led to many questions and concerns around how PAP (Patient Assistance Program) professionals may have to recalibrate their PAP strategy moving forward. Last October, we conducted a survey at our Critical Update Forum on Patient Assistance and Access Programs Post-Reform, asking our attendees to fill us in on their concerns for the coming year – how PAPs will be impacted by healthcare reform, how organizations are planning ahead, and how they can partner with other types of organizations in planning the future for PAPs.

Reasons We Collected This Data

Insurance Expansion and Shift to Underinsured

The Supreme Court decision around the Affordable Care Act was announced on June 28, 2012 with important implications for PAPs based on the constitutionality of the individual mandate, implementation of health insurance exchanges, Medicaid expansion and leftover coverage gaps. The Supreme Court upheld the individual mandate that all patients must have some sort of insurance, which subsequently resulted in dramatic insurance expansion and a shift in the patient population from uninsured to underinsured. How might co-pay foundations and PAPs work together in light of these changes?

Implementation of State and Federal Health Insurance Exchanges

States need to determine if they will enter into the exchanges and health plans need to determine essential health benefits. What will the essential benefit package look like and cost? Will health insurance exchanges be treated like commercial or government programs? PAPs need to know how patient access may change and how they can continue to reach and benefit customers.

Medicaid Expansion

States must also make critical decisions around Medicaid expansion and new eligibility criteria. How will patients who are eligible for Medicaid be educated on how to enroll? Are PAPs set up to address these needs in certain locations, on a state by state basis?

Report Details

The survey was distributed on October 17, 2012, before the presidential election. We included the following disclaimer: “This survey assumes throughout the questionnaire that the Health Reform legislation will not be repealed and will remain intact.”

Based on the survey results, we compiled a benchmarking report for your benefit. The results are based on 41 total responses from individuals representing 20 pharmaceutical companies, 6 patient advocacy organizations and 15 companies characterized as “other”. It includes key percentages and quotes full of insight about the shift in patient population, the legality of co-pay assistance, coverage gaps, eligibility requirements, enrollment assistance and more.

How We Can Continue to Help

Are all these changes weighing you down? More than 400 PAP professionals are convening in Baltimore from March 13-15, 2013 at our 14th Annual Patient Assistance and Access Programs Meeting to share valuable insight around how patient access programs are evolving. With more than 50 dynamic speakers representing manufacturers, patient advocacy organizations, co-pay foundations, law firms and more, as well as interactive workshops and three customized tracks, this is the go-to event to benchmark with your peers and share ideas about moving forward in a dynamic, albeit challenging, healthcare market.

(Image Courtesy of  e-MagineArt.com Flickr Creative Commons)

Download Benchmark Report

Topics: Patient Access