Nevirapine Patient Assistance Program: Model for Better Administration?

The new Boehringer Ingelheim patient assistance program for nevirapine for U.S. residents may be an improvement over other programs, in that it streamlines the paperwork and administration. A patient applies once for a year -- by sending a one-page application plus proof of income. A new foundation set up by Boehringer Ingelheim promises a response in two days. Then the patient picks up the drug four times per year at the doctor's office. At the end of the year the patient can apply again for the next year -- and will be sent a reminder to do so.

It seems that the doctor doesn't have to do burdensome paperwork for this program -- only write the prescription, and hold the medicine package for the patient four times per year. This should prevent a major problem for medical staffs, and open the program to more people in public clinics.

However, the income eligibility level for nevirapine is calculated differently than for the company's non-HIV drugs, for reasons that are not clear. What should be done instead is to have uniform income levels but allow patients to deduct out-of-pocket medical expenses in meeting the income requirement.

A bigger problem may be in the interpretation of, "Be ineligible for prescription assistance through Medicaid." If a patient is eligible for Medicaid prescription coverage but that coverage does not include nevirapine, does he or she just have to do without AIDS treatment? No one eligible for Medicaid could pay for this drug out of pocket, and public programs are increasingly running out of money.

We believe the important advance here is that this program could work efficiently. Many other patient-assistance programs seem designed to get the drug only to those who have enough of a support network around them to possibly make an issue in the media if they don't get treated, while limiting expenses by denying treatment to others. The very paperwork used to restrict those programs makes them expensive to run. But this new program could control costs by delivering drug efficiently to patients who have no other way to get it, at little cost to the company.

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ISSN # 1052-4207

Copyright 2002 by John S. James. Permission granted for noncommercial reproduction, provided that our address and phone number are included if more than short quotations are used.