Employee participation in PAPs can reduce total employer health plan costs by up to 4%. USI evaluates vendors that assist employees in completing applications for PAPs.

We’ve estimated the financial impact for you. Feel free to update the assumptions. 

  • USI's evaluation includes PAPs sponsored by pharmaceutical companies, states, and non-profit organizations
  • Vendor facilitates employee application to the PAP by making it part of the prior authorization process

Drug manufacturers fund PAPs as part of a strategy to keep prices articifially high, which in turn earns them additional profit.

Manufacturer PAPs provide free or low-cost specialty medicine to those who do not have insurance, are underinsured, or can’t afford the medication, while also lowering specialty prescription costs incurred by the employer. There are multiple vendors that assist members in applying to PAPs, as significant documentation if often required to show that the applicant has no insurance or has a signficant out-of-pocket cost share at the pharmacy, and meets income eligibility requirements.

Each PAP has their own set of qualifications and enrollment process, but typically require participants to be a permanent, legal resident of the US or Puerto Rico, produce proof of uninsured status or that insurance doesn’t cover their medication, and meet certain income eligibility requirements. USI evaluates third-party vendors to assist employees with their PAP applications and enrollment. To ensure that employees don't miss an opportunity to apply for a PAP, the application is included in the prior authorization process for all specialty drugs. The vendor identifies eligibility and will work with the employee to submit a completed application with proof that the employee meets the income eligibility requirement and that no coverage is available or the employee's cost share is unaffordable.