Coordinating Patient Assistance Programs with Medicare Part D: A Manufacturer s Perspective June 5, 2006
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1 Coordinating Patient Assistance Programs with Medicare Part D: A Manufacturer s Perspective June 5, 2006 Karissa A. Laur Director, Prescription Assistance Programs
2 Background Over the past 28 years, AstraZeneca has worked hard to better understand the needs of patients and the health care system so that our programs can make a difference. AstraZeneca offers a variety of patient assistance programs: AstraZeneca Foundation PAP, Caring Partners Program, Together Rx Access and PPARx. As a result, in 2005, through the AstraZeneca patient assistance programs, we provided more than $751 million in savings to more than 712,000 patients without drug coverage throughout the US and Puerto Rico.
3 Value of Medicare Part D Coverage for both brand name and generic prescription medicines. A choice of prescription plans that offer savings on a variety of prescription medicines right at the pharmacy counter or through a mail-order pharmacy. People with limited incomes who qualify for extra help have continuous drug coverage and pay only a small amount for each prescription. Coverage for future medication needs and protection against increased drug costs.
4 Value of Medicare Part D Beneficiaries who had limited or no drug coverage prior to 06 nearly 21 million people now have access to multiple medicines through Part D According to the Kaiser Family Foundation, most beneficiaries will save money by using the Part D benefit Approx. 64% of beneficiaries are expected to reduce out-of-pocket spending by an average of $919 (excluding premiums)
5 Patient Assistance in Part D: Who May Need It? Low-income populations (<150% FPL) that do not qualify for extra help due to assets and do not qualify for other assistance that counts towards TrOOP Approx million Part D estimated enrollees below 250% FPL expected not to receive the lowincome subsidies About 4.3 million of those are expected to reach the Part D initial coverage limit About 40% of the population that reaches initial coverage limit, or 1.7 million, are expected to reach catastrophic coverage
6 Variety of Factors to Consider Recent surveys report most patients pleased with the benefit/savings Part D plan designs and pharmacist incentives heavily favor generic utilization for patients who experience cost challenges Recent OIG opinion created an opportunity for manufacturers to reassess their views on Part D enrollees participating in traditional PAPs CMS comments and guidance is supportive of manufacturer efforts to help Part D enrollees
7 AstraZeneca Offerings in Support of Part D Broad access philosophy to Medicare contracting Industry leading Medicare Part D Education and Outreach Enhanced PAP program for patients Supporting LIS enrollment Offering choice for low-income patients who choose not to enroll Interim assistance for those enrolled in Part D experiencing financial challenges Developing assistance solution that works at the pharmacy
8 AstraZeneca Approach to Patient Assistance Provide a more meaningful patient experience for all program enrollees For Medicare eligible patient Focus on the near-term, but create options that allow us the flexibility to adjust the process Provide substantive assistance to help the patient through the Part D transition process Take particular care of our existing patient population Develop sustainable solutions
9 AstraZeneca PAP Enhancements Expand PAP FPL to 250% Individual = $24,500 Couple = $33,000 Family of four = $50,000 Streamline application process Expand temporary enrollment Provide case management services for all patients
10 AstraZeneca PAP Enhancements Apply a three-pronged approach for Medicare eligible patient assistance as an interim solution LIS-eligibles Develop a front-end interface for PAP to case manage LIS-eligibles through the SSA process Part D Non-Enrollees Allow those that are NOT eligible for LIS and that have NOT enrolled in Part D to continue to use PAP Part D Enrollees Allow those that are enrolled in Part D and experiencing a financial challenge in affording their medicine to use PAP on an interim basis
11 Exploring Viable Long-Term Solutions AstraZeneca exploring our ability to offer a pharmacy-based model for patient assistance Pharmacy counter is where many will experience a financial burden that prevents them from getting their medicines We also have been working with other companies on a potential multi-company approach that works at the pharmacy counter
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