Prescription costs can create financial pressure for employees even when they have health insurance. Deductibles, copayments, formulary restrictions, and coverage changes can all affect what a worker ultimately pays at the pharmacy. Employer patient assistance programs can provide an additional resource for eligible employees facing high costs for certain brand-name prescriptions.
Employers do not need to manage medication assistance applications themselves. Instead, they can make employees aware of available resources and provide appropriate referrals when prescription expenses become difficult to manage.
Recognizing when employees may need prescription assistance
Employees may not always feel comfortable telling their employer that prescription costs are becoming difficult to afford. Some may delay refilling a medication, skip doses, or look for ways to reduce their pharmacy expenses.
Employers can create a more supportive environment by making information about assistance resources easy to access. A benefits guide, employee resource page, or private HR conversation can allow workers to ask about available options without requiring them to disclose unnecessary medical information.
Health insurance also does not guarantee that every prescribed medication will be affordable. According to HealthCare.gov, health plans use formularies to determine which prescription drugs they cover and what patients may pay for them.
The employer’s role is not to determine whether an employee qualifies for a particular program. Rather, the goal is to make workers aware that additional resources may be available.
Explain how patient assistance programs work
Patient assistance programs for employees may provide another option for workers who have difficulty paying for eligible prescriptions. Depending on the program, eligibility may involve income, insurance status, residency, and whether the individual has a valid prescription.
Some programs are available only for specific brand-name medications, so employees should not assume that every prescription qualifies. Requirements can also differ between programs.
Employees can begin by reviewing their existing prescription coverage. Their insurer or benefits administrator may be able to explain whether a medication is covered, whether prior authorization is required, or whether another coverage option applies.
Additional resources may also be available for eligible individuals with Medicare. For example, Medicare’s Extra Help program can assist qualifying individuals with limited income and resources with certain Medicare prescription drug costs.
Make prescription assistance information easy to find
Even a useful resource can go unnoticed if employees do not know it exists. Employers can include information about prescription assistance programs in benefits materials, onboarding resources, annual enrollment communications, or internal employee portals.
The information does not need to be complicated. A short explanation can tell employees that assistance may be available for certain medications and that individual eligibility requirements apply. Employers can then provide contact information for a qualified assistance provider that can explain the next steps.
This can be especially useful for employees managing chronic conditions or taking expensive medications over an extended period. HR teams should not have to become experts on individual medication programs when an appropriate outside resource can help employees navigate them.
Employers should also make clear that seeking assistance is voluntary and that employees should submit personal information directly to the appropriate program or provider.
Coordinate assistance with existing employee benefits
Prescription assistance does not necessarily replace employer-sponsored health insurance. Instead, it can complement existing benefits when an employee encounters a medication expense that their coverage does not adequately address.
For example, an employee may have insurance but still face a substantial out-of-pocket cost for a particular brand-name medication. Depending on the medication and the employee’s circumstances, an assistance program may provide another option worth exploring.
Employers can encourage workers to understand their existing benefits before seeking additional resources. The U.S. Department of Labor provides health plan resources that explain aspects of employer-sponsored health coverage and employee benefits.
Other employer-sponsored arrangements may also help with qualifying healthcare expenses. HealthCare.gov provides information about Health Reimbursement Arrangements, which can allow certain employers to help workers with eligible medical expenses.
Protect employee privacy during the referral process
Employers should avoid collecting unnecessary medical information simply because an employee asks about prescription affordability. A better approach is to provide general information and refer employees to an appropriate resource that can evaluate their individual circumstances.
This is particularly important because assistance applications may require personal, insurance, and financial information. Employees should generally provide sensitive documentation directly through the applicable program or assistance provider rather than submitting it to their employer.
Employers should also explain that a referral does not guarantee approval. Each assistance program establishes its own eligibility requirements, and employees should continue working with their healthcare providers and insurance plans regarding their prescriptions.
Help employees explore prescription assistance options
Providing information about patient assistance for employees can be a practical addition to an employer’s benefits communication strategy. Employers do not have to become experts in medication assistance programs to help workers discover that additional support may exist.
The RX Helper works with employers and eligible U.S. citizens to help identify applicable prescription assistance resources. Their team assists with connecting qualifying individuals to available programs and navigating the enrollment process when prescription costs create financial challenges. Employers looking to provide employees with another resource for managing eligible medication costs can contact The RX Helper to learn more.
