US Financial Assistance Programs Market Analysis

US Financial Assistance Programs Market Executive Summary

The US Financial Assistance Programs Market is at around $11,902.5 Mn in 2023 and is projected to reach $27,315.6 Mn in 2030, exhibiting a CAGR of 12.6% during the forecast period 2023-2030.

The aim of drug manufacturers' patient financial support is to minimize or remove out-of-pocket cost sharing as an obstacle when patients choose medications, thereby keeping them on brand-name drugs for longer. Co-pay assistance, free drugs trails, bridge programs, sliding scale programme, Coupons, Bulk purchasing programs etc are some of the widely used financial assistance programme under patient assistance programs. Patients' out-of-pocket drug cost sharing is determined by their health plans or pharmacy benefit manager's (PBM's) formulary--a list of preferred and nonpreferred prescription drugs. Preferred status is based on a drug's effectiveness, price, and the level of rebate the payer receives from the manufacturer for giving the drug preference over its competitors. Generics and preferred brand drugs are generally assigned lower patient cost sharing than nonpreferred brand drugs. As drug prices have increased, so has patient cost sharing, causing some patients to stretch, forgo, or discontinue medication that is too expensive. Drug manufacturers often seek to mitigate these effects by providing or funding various forms of patient financial support.

According to Centre for disease control and prevention, an estimated 129 Mn people in the US have at least 1 major chronic disease that is heart disease, cancer, diabetes, obesity, hypertension as defined by the US Department of Health and Human Services. Therefore, the market is predominately driven by factors such as increasing prevalence of chronic conditions, technological advancements, and increasing patient awareness where factors such as complex insurance landscape, stringent regulatory environment and budgetary concerns restrict the market

Pharmaceutical companies providing financial assistance to patient are such as Merck, GSK, Pfizer, Johnson & Johnson, Novartis among others.

Market Dynamics

Market Drivers

Patient Advocacy and Awareness: Pharmaceutical companies are recognizing the importance of patient advocacy and awareness in their financial assistance programs. By educating patients about their conditions and treatment options, pharmaceutical companies can help patients better manage their health, leading to improved outcomes and reduced healthcare costs.

Technological Advancements: The adoption of advanced technologies like AI, machine learning, and sensors in pharmaceutical manufacturing and research can lead to improved efficiency and reduced costs, making financial assistance more feasible. This can help pharmaceutical companies develop innovative medicines and treatments, which are essential for managing chronic diseases.

Chronic disease prevalence: According to Centre for disease control and prevention, an estimated 129 Mn people in the US have at least 1 major chronic disease that is heart disease, cancer, diabetes, obesity, hypertension as defined by the US Department of Health and Human Services. This increasing number of patients with chronic conditions necessitates long-term, often expensive treatments. This creates a sustained need for financial assistance over extended periods. Chronic disease management is a priority in healthcare, driving support for assistance programs.

Market Restraints

Insurance pushback: Some insurers argue that assistance programs interfere with their cost-management strategies and formulary structures. There is a growing trend where insurers are excluding copay assistance from contributing to patients' deductibles through copay accumulator programs. This resistance may reduce the impact and accessibility of assistance programs for certain patients, potentially limiting their benefits.

Budgetary pressures: Pharmaceutical companies face the challenge of balancing the costs of assistance programs while safeguarding profit margins. Economic downturns or shifts in company strategy can lead to a reduction in funding for these programs. As a result, companies may become more selective, limiting the scope of their assistance offerings.

Regulatory Landscape and Reimbursement Scenario

The Centres for Disease Control and Prevention (CDC) serves as the primary regulatory body in the United States that oversees pharmaceutical products and diagnostic tools, while also playing a vital role in raising awareness about the disease among the general public. Although the Food and Drug Administration (FDA) is responsible for approving drugs and diagnostic tests, the CDC provides guidance and recommendations on their appropriate use for chronic disease prevention and treatment.

The CDC closely monitors the incidence and prevalence of chronic diseases cases in the U.S. through its surveillance systems, and this data guides public health policies, resource allocation, and awareness efforts. Additionally, the CDC develops and promotes evidence-based strategies for preventing the spread of chronic diseases, including vaccination programs, safe injection practices, and harm reduction strategies.

Furthermore, the CDC plays a crucial role in raising public awareness through educational campaigns, community outreach programs, and dissemination of informational materials, aiming to increase knowledge about transmission, symptoms, testing, and available resources. Importantly, the CDC collaborates with state and local health departments, community organizations, and other stakeholders to coordinate prevention, control, and awareness efforts across the nation.

Competitive Landscape

Key Players

Here are some of the major key players in the US Financial Assistance Programs Market:

• Roche
• Pfizer
• Bayer
• Sanofi
• Novartis
• Merck
• GSK
• Johnson & Johnson
• AbbVie
• AstraZeneca