Genentech, Inc., South San Francisco, CA.
Partnership for Health Analytic Research, Beverly Hills, CA.
J Manag Care Spec Pharm. 2024 Nov;30(11):1308-1316. doi: 10.18553/jmcp.2024.30.11.1308.
Alternative funding programs (AFPs) seek to reduce health plan sponsor costs, for example by excluding specialty drugs from a beneficiary's plan coverage and requiring patients to obtain medications through alternative sources (typically, the manufacturer's patient assistance programs) via an AFP vendor as a third-party.
To describe patients' experiences and specialty medication access with AFPs.
A survey method consisting of 26 optional single-choice and multiple-choice questions with branching logic divided across 5 sections (related to patient challenges with AFPs) was administered to patients recruited from an experienced AFP online patient panel and a patient advocacy group. The survey assessed patients' awareness of AFPs from their employers, experience with the patient assistance program application process via the AFP vendor, timeliness of medication access (if granted), and/or the health impact of delay in access. All descriptive and exploratory subgroup analyses were conducted by disease area and reported income levels; statistical analyses were carried out for the exploratory analyses.
The final sample included 227 patients. Most patients (61% [136/223]) first heard of the AFP as part of their health benefit when trying to obtain their medication. Of 198 patients, 88% reported being stressed because of the medication coverage denial and the uncertainty of obtaining their medication. More than half of patients (54% [115/213]) reported being uncomfortable with the benefits manager from the AFP vendor. On average, patients reported waiting to receive their medication for 68.2 days (approximately 2 months); 24% (51/215) reported the wait for the medication worsened their condition and 64% (138/215) reported the wait led to stress and/or anxiety. Patients who indicated the wait time negatively affected them had considered a job change or left their job at a 3-5-fold higher rate than those who reported no impact from wait time. A significantly higher proportion of patients with hemophilia and other bleeding disorders reported receiving their prescribed medication less often than patients with other conditions (63% [19/30] vs 81% [52/64]; = 0.022), whereas more patients with lower incomes (<$50,000 vs >$50,000) reported not receiving any medication (12% [7/57] vs 5% [7/129]; = 0.657), although these differences were not significant.
Most patients who obtain their specialty medicines via AFPs reported being uncomfortable with the process and experiencing treatment delays, which may have been linked to disease progression, worsened mental well-being, and consideration of a job change. Employers should be aware of the potential downstream impacts on employee health, retention, and the employee-employer relationship when considering implementing an AFP into their health plan.
替代资金计划（AFP）旨在降低健康计划赞助商的成本，例如将专科药物排除在受益人的计划覆盖范围之外，并要求患者通过替代来源（通常是制造商的患者援助计划）通过 AFP 供应商作为第三方获得药物。
描述患者使用 AFP 的体验和专科药物的可及性。
采用调查方法，包括 26 个可选的单项和多项选择题，以及 5 个部分的分支逻辑（与 AFP 相关的患者挑战），对从经验丰富的 AFP 在线患者小组和患者权益组织招募的患者进行调查。该调查评估了患者对雇主 AFP 的认识、通过 AFP 供应商申请患者援助计划的经验、药物获得的及时性（如果获得）以及/或药物获取延迟对健康的影响。所有描述性和探索性亚组分析均按疾病领域和报告收入水平进行；对探索性分析进行了统计分析。
最终样本包括 227 名患者。大多数患者（61%[136/223]）在试图获得药物时首次从他们的健康福利中听说过 AFP。在 198 名患者中，88%的患者表示因药物覆盖范围被拒绝和获得药物的不确定性而感到压力。超过一半的患者（54%[115/213]）表示对 AFP 供应商的福利经理感到不舒服。平均而言，患者报告等待接受药物治疗的时间为 68.2 天（约 2 个月）；24%（51/215）的患者报告说，等待药物治疗使他们的病情恶化，64%（138/215）的患者报告说等待导致压力和/或焦虑。表示等待时间对他们产生负面影响的患者考虑换工作或离职的比率是那些表示等待时间没有影响的患者的 3-5 倍。患有血友病和其他出血性疾病的患者报告说，他们接受规定药物的频率低于其他疾病患者（63%[19/30]与 81%[52/64]；=0.022），而收入较低（<50,000 美元与>50,000 美元）的患者报告说他们没有服用任何药物（12%[7/57]与 5%[7/129]；=0.657），尽管这些差异并不显著。
大多数通过 AFP 获得专科药物的患者对该过程感到不适，并经历了治疗延迟，这可能与疾病进展、心理健康恶化以及考虑换工作有关。雇主在考虑将 AFP 纳入其健康计划时，应意识到这可能对员工健康、保留率和员工-雇主关系产生潜在的下游影响。
