Alternative Funding Programs (AFPs)

The Alternative Funding Programs (AFPs) Issue Brief addresses the growing concerns surrounding AFPs and their impact on access to critical medications, particularly for people living with HIV/AIDS (PLWHA).

AFPs are increasingly being utilized by self-insured employer health plans to reduce expenditures on high-cost specialty drugs. While these programs promise substantial savings for employers, they often create significant barriers and financial insecurity for employees, especially those managing chronic conditions like HIV/AIDS.

This issue brief describes:

• How AFPs Operate: AFPs typically exclude select specialty drugs from employer prescription drug benefits, redirecting employees to external medication assistance programs, such as manufacturer-sponsored patient assistance programs (PAPs) and copay assistance programs (CAPs). In some cases, AFPs may even refer individuals to international drug importation channels, which carry legal and safety risks.
• Barriers to Access: The brief highlights how AFPs can lead to treatment delays, increased administrative burdens for patients, exacerbation of stigma, and fragmented pharmacy care. Enrollment in PAPs is not guaranteed, as applicants may be denied if their income exceeds eligibility thresholds or if the manufacturer rejects the "uninsured" argument.
• Impact on Safety Net Programs: AFPs shift financial and logistical burdens from employers to employees and often strain already limited federal and state safety net programs like the Ryan White HIV/AIDS Program (RWHAP) and state AIDS Drug Assistance Programs (ADAPs). This practice undermines the purpose of these programs, which are designed to support low-income, uninsured, or underinsured individuals.
• Strategies for Support: The brief outlines key strategies for RWHAP providers and ADAP staff to assist clients impacted by AFPs, including reviewing plan coverage, supporting appeals, leveraging RWHAP and ADAP resources, providing education and empowerment, building partnerships, and monitoring policy changes