It’s a choice no one should have to make: Pay rent and buy food, or get prescriptions filled. Yet all too often it is a choice that Americans, particularly older Americans, do have to make.

Over 40 million Americans just can’t afford health care, and, if they can, they don’t have the money to buy their medicines.

Patient assistance programs

There is help available for many people who can’t afford their medicines. These programs, frequently called patient assistance programs, are designed to help those in need obtain their medicines at no cost or very low cost.

Many, but not all, pharmaceutical companies have PAPs. The manufacturers who have programs do so for various reasons. Some believe they have a corporate social obligation to help those who can’t afford their products. Others believe it’s a good marketing tool. As one PAP director once told me, many people who can’t afford their medicines now go on to obtain some type of coverage. And when they get this coverage, the companies want the patient to remain on their products.

Last year, PAPs helped more than 6 million people. The programs filled 15 million prescriptions with a total wholesale value of more than 4.2 billion dollars.

The basics of the programs

All PAPs are designed to help those in need obtain their medicines. Since each pharmaceutical company establishes its own rules and guidelines, all are different. All have income guidelines, but they vary considerably. Each company selects which drugs are available on their programs and how long a person can receive assistance.

How PAP’s work

Although no two programs are exactly the same, most require that the applicant complete an application form. The amount of information required varies. Some programs require detailed medical and financial information, others very little. All require a doctor’s signature. Certain programs require the doctor complete a portion of the form while others only need a signed prescription.

Most send the medicines to the doctor’s office for distribution to patients, while others send the medicine to a pharmacy. A few send a certificate the patient gives to the pharmacist.

Some patients need drugs for a long time. Most programs that cover medicines used to treat chronic diseases offer refills, but not all programs.

What medicines are covered

The pharmaceutical companies decide if they will have a PAP and if they do, which of the medicines are available through the program. Some include many or all of the medicines they make while others include only a few. The reasons for their decisions are not something they reveal. None include generic medicines in their programs.

Sometimes a medicine or a certain dosage of that medicine will be on a program, then off, and then back on again. Or one dose of the medicine will be on the program while a different dose won’t be.

How to learn about PAPs

Your doctor is not the best source of information on PAPs. Surprisingly, many doctors don’t even know PAPs exist. The same applies for pharmacists. Many social workers know about the programs. Any books in the library on PAPs are probably outdated before they are printed.

The best place to learn about PAPs is the Internet. There are a number of Web sites that have information on these programs. Many pharmaceutical companies have information on their patient assistant programs on their Web sites. Unfortunately, it’s often hard to find the page that describes their PAP.

Next week we will continue our column on this very timely subject which has been draining consumer finances for far too long.

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