Rising Costs Drive Patients to Charity Aid as Donations Fall: Tiara Green

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Demand for charitable patient assistance is outpacing available donations as inflation drives up both therapy prices and household living costs, Tiara Green, president of Accessia Health, said. Green spoke on a panel examining patient assistance in specialty pharmacy amid the Inflation Reduction Act (IRA), policy, and inflation pressures at the National Association of Specialty Pharmacy (NASP) inSPire2026 meeting.

The session focused on “what happens between policy and the pharmacy counter,” Green said, and how changes such as the IRA’s redesign of Medicare Part D translate into patients’ real-world experiences accessing treatment. The Part D changes have helped some beneficiaries but still leave others struggling to access care, she said, and they are arriving alongside inflation and shifting benefit designs that make increasingly expensive therapies harder to afford for patients with rare and chronic conditions. “I think the question then becomes…can people actually access and stay on the treatment that is needed?” she said.

“Charitable assistance programs truly operate on donations, and so there are limited resources that we are operating with,” Green said. The average individual Accessia assists earns $52,000 a year, she noted, and with the average American spending 69% of household income on living expenses alone, few dollars remain for health care. As a result, a growing number of individuals are turning to the organization to offset their costs.

Because needs vary from one patient to the next, Accessia’s “Your Assistance, Your Choice” model, developed in 2023, lets individuals decide how to apply their assistance, whether toward health insurance premiums, co-pays for medications or physician visits, or travel. The organization also focuses on educating individuals about their insurance coverage and what is required to access care.

In this interview with The American Journal of Managed Care^® (AJMC^®), Green walks through the patient journey where these pressures converge. Patients with rare conditions may wait 5 to 7 years for a diagnosis and then struggle to find a specialist who knows enough about their condition. Once they have a prescription, they may face unexpected out-of-pocket costs, prior authorization requirements, or step therapy at the pharmacy counter, and coverage changes each year can create new barriers to staying on treatment.

Early intervention is key, Green said. Meeting with a navigator, an advocate, or a member of the physician’s office staff to review insurance coverage alongside the prescribed treatment plan can help identify a path forward before costs become a barrier. She pointed to KFF survey data showing that 43% of US adults have not taken a medication as prescribed in the past year because of cost.¹

“If we intervene earlier, perhaps we can find some additional resources for individuals to start the therapy and then remain on therapy,” Green said.

Reference

1. Americans’ challenges with health care costs. KFF. Updated September 29, 2026. Accessed October 19, 2026. https://www.kff.org/health-costs/issue-brief/americans-challenges-with-health-care-costs/