We’ve been getting a lot of questions from our readers about how the resources we list on our website, especially the pharmaceutical patient assistance programs, will be affected by the Affordable Care Act. While we are still far away from having all the answers, we do have some additional information we can provide you after attending a recent PAP Conference. The overarching consensus is that PAPs will continue to exist to help those in need that fall into the gaps.  Here is an overview of what we learned at the CBI PAP 2014 Conference, held in Baltimore on March 6-7.

Background

→ There are currently no shared processes between programs.

→ Open Enrollment ends March 31st

  • Negative image of Affordable Care Act in the media.
  • For those working with the disabled – visit the National Disability Navigator Resource Collaborative for resources http://www.nationaldisabilitynavigator.org.
  • Many advocates are having trouble enrolling the population that has been uninsured for a long time, as they are not informed about how health insurance works at all.

→ Medicaid Donut Hole

  • In the states that have not expanded Medicaid, there are going to be folks too poor to be eligible for subsidies under the marketplace and not poor enough to qualify for Medicaid in their states.

→ Not everyone between 100% and 400% of Federal Poverty Level are eligible for subsidies. This, for example, can depend on age.

Pharma Priorities and Considerations

→ Priorities are to contain costs, increase quality, encourage innovation while enhancing patient access.

→ Legal Considerations.

  • Anti-kickback statute – always a legal issue for companies. Pharmaceutical companies cannot induce (or even appear to induce) patients to use a certain drug.
  • November 2013
    • HHS Secretary Kathleen Sebelius wrote a letter saying that plans purchased on a state or federally run market place are not counted as government sponsored programs.
    • Absent further guidance – these plans are going to be treated as private plans by Patient Assistance Programs (PAPs), foundations, etc.

    → Lingering question – what happens when someone doesn’t pay or defaults on their premium? There is currently a grace period to

    Read more

It’s February 5, 2014, and the Affordable Care Act is still here.

There have been lots of changes over the last few weeks, in a few different areas:

  • Marketplaces pushed back the deadline to enroll in a Marketplace plan for coverage to December 23, in order for coverage to begin on January 1.  And some states went even further!
  • Marketplaces have pushed back payment deadlines (allowing people more time to pay their January premiums).  For example, California’s Marketplace pushed back the payment deadline to January 15.  Some health plans are also deciding on their own to give people more time to pay.

So, check with your marketplace or your health plan for your own specific deadlines.

And two weeks ago, the U.S Department of Health & Human Services (HHS) announced that people, who have health insurance coverage through the Pre-Existing Condition Insurance Plan (PCIP), can now keep their plan through March 31, 2014.  These plans were originally supposed to end on December 31, 2014.  However, HHS wanted to give people more time to find a new plan in the Marketplace.  For more information, click here.

If you are on a PCIP plan and want to move to a Marketplace plan before your coverage ends on March 31, then you need to sign up for a Marketplace plan by March 15, in order for your new coverage to begin on April 1.

And for those of you who want some light reading and desperately want to know what a “Risk Corridor” is or who a “Dual Eligible” might be, visit this Affordable Care Act dictionary!

Disclaimer

This post originally appeared on

Read more

Healthcare related costs are a major problem for many Americans who are uninsured and underinsured, even if they are relatively healthy. For people with a serious medical condition these financial problems can be even worse. One diagnosis that finds many patients in an expensive position is HIV/AIDS. A diagnosis of HIV or AIDS comes with a hefty price tag, according to study on NBC news, “An American diagnosed with the AIDS virus can expect to live for about 24 years on average, and the cost of health care over those two-plus decades is more than $600,000, new research indicates… The researchers estimated the monthly cost of care at $2,100, with about two-thirds of that spent on medications.” For patients without insurance these costs are extremely daunting. Luckily, there is a program to help uninsured and underinsured AIDS patients – the Ryan White HIV/AIDS Program, formerly known as the Ryan White CARE (Comprehensive AIDS Resource Emergency) Act.

Who was Ryan White?

Read more
<!-- _

About 1 in 8 U.S. Women will develop breast cancer in their lifetime, with an estimated 232,340 new cases this year according to breastcancer.org. Cervical Cancer was responsible for 4,030 deaths in the United States in 2013. The National Breast Cancer and Cervical Cancer Early Detection Program (NBCCEDP) is a national program available in every state that provides free or low-cost breast and cervical cancer screenings via the Center for Disease Control and Prevention (CDC). There are some restrictions, based on age and income. The program originated when Congress passed the Breast and Cervical Cancer Mortality Prevention act of 1990, which directed the CDC to create the NBCCEDP.

Qualifying – Who it Serves

The program does have specific eligibility requirements that are the same in each state. Financially patients must be at or below 250% of the federal poverty level and be uninsured or underinsured. For breast

Read more

The Children/Youth With Special Health Care Needs (shortened as CSHCN or CYSHCN) is a program in each state that provides medical care and other related services for special needs children. These programs are funded by grants from the U.S. Health Resources and Services Administration (HRSA), commonly referred to as Title V, Maternal and Child Health Services Block Grants. Similar to the Children’s Health Insurance Program (or CHIP), the programs are federally funded but operate independently at the state level. It was originally enacted in 1935 as part of the Social Security Act, and converted to a Block Grant Program in 1981.

Who it Serves

The program assists with the cost of medical care specifically for special needs children. The HRSA defines special needs children as “those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required

Read more