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Considerations for Patient Support Programs in the COVID-19 Era

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As the economic and social impact of COVID-19 change how patients access and receive care, manufacturers and third-party suppliers must consider how to evolve their patient support programs to meet the shifting access and affordability needs of patients.

The COVID-19 pandemic continues to present significant economic impacts, including job loss and financial uncertainty for millions of Americans. In just the past 4 weeks of reporting, over 22 million Americans have newly filed for unemployment aid. As a result of the pandemic, many individuals may lose their current employer-sponsored insurance and shift into exchange plans or Medicaid, or become uninsured. These dramatic and rapid shifts in coverage, alongside other financial concerns and social distancing and stay-at-home orders, will create new types of access and affordability challenges for patients.

With greater fragmentation in sources of coverage and access, manufacturers and third-party patient support programs will need to quickly evaluate options to enhance service offerings and find innovative solutions to ensure patient access to—and continuity of—care.

Specifically, manufacturers and third-party entities offering patient support services could consider:

  • Expanded copay support and patient assistance: Many manufacturers and third-party foundations have adjusted eligibility and availability of funds to address the disruption in coverage experienced by patients. Manufacturers are expanding bridge programs, eliminating “skin in the game” through copay programs for commercially insured patients, and evolving patient assistance and free drug programs. As patients’ financial needs shift, donations via free drug and other lending are current areas of focus by manufacturers in support of patients. Moreover, as the economy and the healthcare markets rebound and patients return to their original sources of coverage, manufacturers will have to consider options and associated risks with reverifying patients for financial support eligibility.
  • Coordination of care will become even more critical: Patient support programs will increasingly need to help patients navigate different sources of insurance coverage in addition to access barriers due to social distancing and stay-at-home orders. Patients will need to understand differences in insurance benefits, available avenues for financial assistance, and options to access needed services and medications in order to avoid disruptions in care. Beyond simply providing copay or free drug assistance, a more coordinated and enhanced program approach that relies on the navigation of care and the collection and connectivity of data will help drive better access for patients. Specialty pharmacy services, hub models, and non-traditional solutions will need to innovate and change their approach to advance access-to-care strategies.
  • Ability to offer enhanced support services within current regulatory restraints: While the administration has issued rule making and guidance to increase flexibilities for healthcare stakeholders amid the COVID-19 pandemic, existing regulatory restraints around patient assistance in government programs remain. In light of access concerns due to COVID-19, manufacturers and third-party entities will need to find innovative solutions to expand patient support programs within regulatory constraints and develop strategies to engage with regulatory entities such as the Office of Inspector General to potentially advocate for new flexibilities.
  • Mobile Health (mHealth) and digital services come to the fore: With new flexibilities around telehealth services and remote physician supervision, the COVID-19 pandemic has rapidly accelerated the reliance on telehealth, mobile, and digital health services. By developing customer-facing services that utilize the enhanced capabilities mHealth and digital services provide, manufacturers may help patients and providers navigate challenges to coverage, access, and payment caused by COVID-19.
  • The “new normal” might be here to stay: As patients, providers, manufacturers, and other stakeholders try to recalibrate to the immediate changes brought forth by COVID-19, it is important to consider what changes to care delivery will persist beyond the crisis and its aftermath. Understanding how the needs, expectations, and definition of “value” evolve for patients and providers will be critical as manufacturers look to reorient their service offerings in the near and long term.

Already, we have seen certain parts of the patient support market respond quickly to these changing needs during the pandemic, with several manufacturers and third-party foundations expanding services and easing eligibility criteria to provide financial assistance to patients impacted by COVID-19. Understanding how the market and policymakers seek to create opportunities to support patient affordability and access to care will be critical in the weeks and months ahead.

Avalere continues to work with stakeholders to think through opportunities not only to respond to the mounting challenges these programs have faced in the past weeks but also to begin identifying the steps necessary to best position programs for the months ahead, including:

  • Assessing current program designs and quantifying the potential investment necessary to maintain patient access amid the COVID-19 pandemic
  • Leveraging internal utilization data and data sets that evaluate coverage changes to inform economic forecasting to model investments and impact to revenue as manufacturers deploy patient access solutions
  • Considering additional policy and regulatory flexibilities that offer an opportunity to provide support to patients, particularly for patients who are uninsured or underinsured
  • Identifying market-based affordability and support solutions where manufacturers and patient support programs can work directly with stakeholders across the healthcare financing and delivery continuum to achieve higher quality and more coordinated care for patients

To learn more about the evolving patient support space and how Avalere can your business drive access and continuity of care in this dynamic time, connect with us.

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