The Alliance for Patient Access, a national advocacy group, has published a report outlining key ways employer-sponsored health plans can benefit from alternative funding programs at the expense of some patients.
"Alternative funding programs help employer-sponsored health plans dodge the costs of some specialty medicines, but only by harming patients, generating unintended consequences and exacerbating problems that already plague the health care system," the report states.
Opponents of this view say that alternative funding programs are essential for some employers to help control health plan costs while allowing their employees to become eligible to receive medications from charitable organizations and foundations as a pharmacy benefit.
However, some, including the Alliance for Patient Access, argue that this is "diverting resources away from the truly needy, as alternative funding programs generate savings for employer-sponsored health plans by misusing charitable programs."
The unintended consequences of alternative funding programs, the group argues, can range from reducing the quality of care patients receive, increasing out-of-pocket costs for prescriptions and adding further complications to what is already a complex drug pricing system, its June 12 news release states.
To mitigate the consequences, the group says transparency is key, stating that being transparent with patients about what medications and diseases may be affected by such a program and how so, is important.
"Patients should also be informed about the risks that these programs introduce for them," the report states. "In addition, policymakers should explore under what circumstances alternative funding programs constitute a breach of insurance contract. In particular, scenarios in which alternative payment programs risk patient outcomes in an attempt to lower health plan expenses may warrant further consideration. In addition, [CMS] should clarify that specialty drug coverage is an essential health benefit under the Affordable Care Act."
The group notes that additional oversight into these programs is needed to make sure they are used as intended, but if left unchecked could "continue to hurt patients, impact the broader health care system and worsen the already dysfunctional drug pricing market."