Alternative funding programs delay patients' access to needed, often lifesaving medications, and may increase annual out-of-pocket expenses.
 

Ask your lawmaker to investigate and take action to introduce legislation to curb the use of harmful alternative funding programs.
 

What is an alternative funding program? 
Alternative funding programs, or AFPs, are programs designed by companies and offered to employer-sponsored, self-funded health insurance plans to save the insurance company money.  

AFPs only affect people with commercial, or private, health insurance. 

How AFPs prevent access to medication.
AFPs could hurt patients' access to specialty medications and increase their out-of-pocket medication costs.  

Specialty medications are expensive prescription drugs that treat rare, complex, and chronic health conditions. Even if a healthcare provider prescribes a specialty medication that is the best course of treatment for a person's condition, their health insurance plan may deny coverage and then require them to choose between enrolling in an alternative funding program or paying in full for the medication. 

Ultimately, this delays or denies access to medications, and increases out-of-pocket costs for patients with rare and chronic health conditions. 

How AFPs increase out-of-pocket expenses? 
If the AFP is successful in receiving financial assistance from a patient assistance program, that patient will be able to use that support.  

However, the plan will not count the value of this assistance towards a patients' annual out-of-pocket cost-sharing limit. This means that they could end up paying more out-of-pocket for the year. 

Ways AFPs negatively impact patients.

1. Alternative funding programs delay patients' access to needed, often life-saving medications, and may increase annual out-of-pocket expenses. 
2. If denied by a patient assistance program, your healthcare provider may receive a request from the AFP to switch your medication. Switching to another medication may not meet your medical needs.  
3. When enrolled in an AFP, your health plan will not count the financial assistance you receive to pay for your medication toward your annual cost-sharing limit.
4. And you may need to pay a lot for your medication.  
5. Use of patient assistance programs by AFPs reduces the amount of financial assistance available for people who meet their eligibility criteria and are in financial need.
6. Obtaining medications through importation may not be safe for patients.  
    

Take action now! Email your Members of Congress and urge them to investigate and take action against AFPs.  

Want to know if your health plan uses AFPs?
Visit PAN's Alternative Funding Education Hub to learn more about how AFPs prevent access to care and how to recognize them in your health plan.
 
Have you been affected by an AFP?
Share your story with the PAN Foundation.  Your experience can help convey the negative impact AFPs can have on patients and their health and help lawmakers understand the negative impact AFPs can have on individuals with commercial insurance across the U.S.