When Jeanne Knapp of Kentucky was diagnosed with multiple sclerosis
five years ago, her disorder threatened her family's modest lifestyle.
Jeanne's medication expenses jumped to $10,000 annually, and her husband,
Jim, lost two jobs before securing a position with an employer who doesn't
offer health insurance.
Individuals or families affected by the following disorders are eligible to apply for premium assistance from Patient Services Inc. (PSI):
PSI's program is unique. It helps the chronically ill retain complete
access to their medical care, rather than just giving away free medications
to those who qualify, as is the case with indigent drug programs. (See
Drug makers offer medications to people who can't afford them .)
They're granted assistance based on a sliding fee scale for a maximum of two years.
Run by a staff of nine, the organization handled 14,000 inquiries in 1999, according to Kuhn. "We like to think we helped everybody in some way," he says, although only 1,669 people were approved for premium assistance due to budget contraints. Applicants, who must submit financial and medical information, are told up front that acceptance always is based on need and funding availability, so there are no guarantees. PSI's income eligibility guidelines are fairly generous and based on incomes that are 250 to 300 percent above the federal poverty level, which ranges from $8,350 to $28,650, depending on the size of the family.
When applicants are approved, they're granted assistance based on a sliding fee scale for a maximum of two years - pending PSI funding. Should they need assistance beyond this period, they must submit new applications. Depending on the particular chronic illness or medical disorder, PSI can provide premium assistance payments for COBRA, high-risk insurance pools, and open-enrollment and guaranteed issue policies. In some circumstances, the program may fully or partially reimburse expensive prescription copayments.
The fact that PSI is not widely known is a double-edged sword, Kuhn
says. He fears more exposure could lead to a deluge of inquiries and applications.
On the other hand, he certainly would welcome more contributions from his
most tried and true sources - private citizens, pharmaceutical companies,
drug distributors, and corporations such as Anheuser-Busch.
"When a loved one is sick, you will give up everything to keep them alive."
Kuhn's biggest frustration has been trying to persuade drug companies to work with PSI. "They say, 'Hey, we're giving away free product to a thousand people,' " he says. "My response is, 'That's great, but there's a thousand more people you're not serving. ' " Kuhn also has appealed to executives one-on-one, telling them that a devastating illness can come unbidden to anyone. When all else fails, Kuhn supports his argument by reminding executives that they could contribute $500 monthly toward helping to pay a patient's health insurance premium, or they could just hand over the drug that costs $1,000 monthly - for free. It's an argument that gets their attention, Kuhn admits.
Kuhn's vision is that one day, the government, drug companies, and corporations will work together to fund premium assistance programs that would allow people to retain access to their health care and avoid taxing the already stressed state and government low-income assistance programs. To that end, Kuhn is constantly and carefully trying to expand PSI's programs with one eye on the budget and the other on the future. He currently is working with companies that manufacture oncology drugs so that one day cancer could be added to the list of specific diseases that qualify for PSI premium assistance.
The pitch to some drugs companies will never come easily, because there seems to be no limit to what they can charge - and get - for their products. "When a loved one is sick, you will give up everything to keep them alive," Kuhn says.
Last updated Aug. 11, 2000