David Charles, MD: How Alternative Funding Programs Negatively Impact Patients with Chronic Illness

In an interview with HCPLive, David Charles, MD, chief medical officer of the Alliance for Patient Access, discusses the implications of alternative funding programs designed to reduce a patient’s financial risks if they need expensive medical services. Although beneficial in theory, these programs often negatively impact patients with chronic conditions and those of lower socioeconomic status, impact the broader health care system, and worsen the drug pricing market.

“Imagine you and I have health insurance and then develop a severe medical condition requiring one of these specialty drugs,” Charles explained. “The insurer would contract with a third-party vendor who selects certain medications to be excluded from coverage. If we need one of these excluded drugs, we suddenly find out we're uninsured for it and must rely on alternative funding programs. This introduces delays, anxiety, and distress for patients who require this treatment.”

Looking at this from a patient's perspective, these plans create anxiety and stress. Patients forced into this situation experience significant worry, stress, and uncertainty about how to access vital medications. Charles emphasized these programs also lead to delays in care, which is concerning for those with serious medical conditions.

Additionally, charitable programs designed to help underinsured or uninsured patients access these therapies face increased strain as individuals with insurance are directed toward these programs, depleting the resources intended for the most vulnerable populations.

Furthermore, this system may lead to higher out-of-pocket costs for patients. Their health plan's maximum out-of-pocket cost may not apply when accessing drugs through alternative funding programs, making the drugs potentially more expensive than if they were covered by their health plan. This situation disproportionately affects people with chronic illnesses and those with lower socioeconomic status, as high copayments or out-of-pocket expenses can be financially devastating for these individuals.

This transcript was edited for clarity.