What are Patient Support Programs (PSPs) and why do some medications have them, while others don’t? ESC asked dermatologist Jensen Yeung, MD, FRCPC, about PSPs and what patients need to know about their role for new atopic dermatitis (AD) therapies.
A PSP is a special service for patients, which is privately operated and funded by a drug company. A PSP helps support patients through drug treatment, including specialty drugs (e.g., injectable biologics for AD).
The main goals of a PSP are to help patients navigate new specialty drugs and to reduce delays in access to the drug. PSPs may support patients in areas such as education related to the medication and administrative support for accessing the medication. That can include help with navigating “reimbursement” – that is how a drug may be paid for by a private insurance company or by a government drug plan.
Typically, when a patient with AD is prescribed a drug like a topical medication, they leave the office with their prescription and can have their prescription filled at their usual pharmacy. There is often no wait – patients generally go home with their drug that same day. Sometimes patients have to wait a few days for the pharmacist to order the drug, but it is usually a simple and straightforward process.
However, the process is often different with specialty drugs. For reimbursement, depending on the drug, additional paperwork and/or special monitoring may be required, and this can cause delays in getting the treatment to patients. Also, some specialty drugs may require special handling (e.g., refrigeration), administration (e.g., injection), and monitoring.
Some drugs can also be challenging from a reimbursement perspective, as navigating private and public coverage can be challenging and time-consuming. PSPs help with this as well.
Not all specialty drugs and healthcare services are paid for by provincial and/or private drug plans. Some new drugs can take years to be reviewed before they are covered by provincial drug plans, and others may never be covered. Sometimes these drugs are covered through private insurance plans, but sometimes they are not. Coverage may also vary depending on the province. Coverage can vary widely between insurance providers, and even within plans at each insurance company. A PSP can help patients navigate the complexity of getting the new specialty drug and can also assist patients to stay on the new drug if their insurance coverage changes. It is important to inform the PSP of any changes to your insurance plan as they can help navigate those challenges.
PSP services are privately operated and funded by the drug company. A PSP is often run by a third-party service provider with expertise in running PSPs (e.g., BioScript Solutions, Innomar Strategies, Shoppers Drug Mart Specialty Health Network, etc.).
If your doctor prescribes you a specialty drug, they will complete a patient enrollment form, which includes the prescription and some information such as your scores on AD assessments and your previous treatments. You may even be asked some questions as part of a self-assessment, such as a quality-of-life questionnaire and an itch rating, which can impact your coverage. Take your time on these assessments to respond as accurately as possible. This information is then submitted to the PSP and a PSP coordinator will contact you to start the process, usually within a couple of days.
The PSP coordinator may also have a different title depending on the PSP, such as reimbursement specialist or field case manager. This coordinator will help you contact your insurance provider and navigate the reimbursement process. You may also be connected with other members of the PSP team as needed (e.g., a nurse to take medical history). Most of the time, you are able to pick up your medication from the pharmacy of your choice.
A PSP can vary greatly from drug to drug, and it is best to address your questions with your prescribing doctor or with the PSP directly. Any questions about medication, your treatment plan, or your general health should be addressed with a qualified healthcare professional.
Disclaimer: Information provided in this resource does not constitute medical advice and is not intended to be used as a diagnostic tool. The information is up-to-date at time of publication. All medications, interventions, and treatment plans have risks and benefits, and it is important that individuals discuss their or their child’s specific healthcare needs with a qualified healthcare professional.
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