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

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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

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One of the most popular sections of the NeedyMeds website is our listing of Free, Low-Cost, and Sliding-Scale clinics. As health care has become more and more expensive, the need for low-cost health care has increased. Many people living in more rural parts of the country have a very limited number of options to see a doctor, and depending on their insurance status the number of available “in-network” doctors is even lower. Many people do not regularly see their doctor, only seeking help when a more serious condition arises. It can be a scary situation to be uninsured and have an unforeseen medical problem come up.

Free, Low-Cost, or Sliding Scale?

We list three different types of clinics on NeedyMeds.org. The first are free clinics which are of no cost to the patient (self explanatory). The second are low-cost clinics which usually have a low flat-fee for all patients or types of visit. The third are sliding-scale clinics. The price for these clinics is based on the patient’s ability to pay, and is usually derived from their income and family size as it relates to the federal poverty level.

What

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Treatment and other diabetes-related costs can be expensive.   According to the American Diabetes Association the total costs of diagnosed diabetes was  $245 billion in 2012, with $176 billion in direct medical costs.  “People with diagnosed diabetes incur average medical expenditures of about $13,700 per year, of which about $7,900 is attributed to diabetes. People with diagnosed diabetes, on average, have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes.”

Here are 5 ways available to find help with these costs on the NeedyMeds website.

1.     Apply for free or reduced prescription medications through a Patient Assistance Program (PAP).
How they work:

→ PAPs are run by pharmaceutical companies and provide free or discounted medicines to those who qualify.

→ Eligibility and application requirements vary from program to program, usually based on income and insurance.

How to find them:

→ To find out if there’s a PAP available for your medication, click on the Brand Name Drugs or Generic Name Drugs links and look up your medication alphabetically.

→ If you do find your medication, click on it and you will be able to look over any assistance programs that are available for that medication.

How to get enrolled:

→ Most PAPs require that you fill out an application,

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The Children’s Health Insurance Program (or CHIP) is a national program available in every state. Many families find themselves above the income limit to be eligible for Medicaid but still unable to afford health insurance. CHIP aims to assist these families in getting healthcare coverage by providing children under the age of 19 whose family income is too high to qualify for Medicaid with health insurance at low or no cost. The program is available throughout the nation but requirements vary by state, and the program goes by various names as well. The income limits vary by state and range from as low as 175% of the Federal Poverty Level (FPL) to as high as 300% of the FPL. States operate CHIP as either an expansion of Medicaid, a separate program entirely, or as some combination of the two.

Financing

  Signed into law in 1997, CHIP is funded jointly by the federal government and individual states. The federal government matches a percentage of the amount each state funds. This percentage is

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