PAP Eligibility
| PAP Type | Eligibility | Benefit |
|---|---|---|
| Income-based PAP | Low income; no insurance or inadequate insurance | Free or reduced-cost drugs |
| Bridge program | Patients waiting for insurance approval | Free drugs during waiting period |
| Co-pay assistance | Commercially insured patients | Reduced cost-sharing |
| Foundation assistance | Patients with specific conditions | Financial assistance for drug costs |
PAP Navigation
Navigating PAPs requires expertise — eligibility criteria, application processes, and documentation requirements vary by manufacturer and program. A specialty pharmacy with PAP navigation capabilities can identify eligible patients, complete applications, and manage the ongoing enrollment process. PAP navigation services are typically provided at no cost to the employer.
PAP and Plan Cost Savings
IQ Insight
PAPs can significantly reduce plan costs for high-cost specialty drugs. A patient who qualifies for a manufacturer PAP receives their drug for free — the plan pays nothing. For a specialty drug costing $50,000/year, a PAP that covers the drug for one patient saves the plan $50,000. PAP navigation programs that identify and enroll eligible patients can save 5–15% of specialty drug costs.