PAP, PSP, CAP and DTP: A PAP addresses price. A PSP addresses everything except price. A CAP supplies patients who have no other route. DTP is a delivery model that can sit on top of any of the three.
In APAC, affordability is the binding constraint. Across a 52-program portfolio in six markets, 75% are PAPs and only 10% are PSPs. In markets with strong national coverage the ratio inverts. A Western PSP-first program design imported into Asia solves the wrong problem.
The same molecule needs a different program in every market. Reimbursement status, registration, dispensing channel, consent rules and pharmacovigilance formats all differ. One immunology biologic in this portfolio runs as three separate programs in three countries.
The important functions that have to work: enrollment, eligibility, entitlement calculation, dispensing, adherence, pharmacovigilance, reporting, governance. AI helps with the high-volume rule-bound parts, not the clinical judgement.
Software cannot fix a badly designed program, replace the nurse, create regulatory permission, or transfer accountability. Access programs are a bridge to reimbursement, not a substitute for it.
Patient access programs are manufacturer-run schemes that help patients start and stay on prescribed medicines they could not otherwise obtain or afford. In Asia-Pacific (APAC) they take four main forms: PAP, PSP, CAP and DTP. Across Southeast Asia, patients pay for roughly a third of their own healthcare directly out of pocket, and medicines are the largest line item in that bill. The pattern extends across Asia-Pacific more broadly, with wide variation between markets. For a patient starting a targeted cancer therapy or a biologic for severe psoriasis, the gap between what a doctor prescribes and what a household can afford is often the entire treatment. Patient access programs exist to close that gap.
This guide covers the four program types that dominate patient programs across Asia-Pacific: PAP, PSP, CAP and DTP. It sets out what separates them operationally, where the categories blur in practice, why the same drug often needs a different program design in every country, and what these programs cannot do. It draws on data from an active portfolio of 52 patient programs across six APAC markets.
Running these programs at scale is now largely a systems problem: enrollment, eligibility, entitlement tracking, dispensing and safety reporting, replicated across markets with incompatible rules. Zelthy is built for exactly that. It is an AI-native platform-as-a-service with pre-built modules across the patient program lifecycle, used by Roche, Bristol-Myers Squibb, AstraZeneca, MSD, Servier, Novartis and DKSH.
Why patient access is a different problem in Asia-Pacific
In most Western markets, a patient support program sits on top of an insurance system that already covers the bulk of the drug cost. The program's job is to smooth the edges: help with copays, chase prior authorisations, and remind people to take their medicine. (For how that model works, see how patient support programs work in the US and EU.)
In much of Asia-Pacific, there is no such foundation to sit on.
Out-of-pocket spending across Southeast Asia averaged 31% of total healthcare expenditure in the most recent years measured, against an OECD average of 19% (OECD/ADB, Government at a Glance: Southeast Asia 2025). The regional average hides an enormous spread. A WHO analysis of the South-East Asia region put household out-of-pocket spending at roughly 47% of current health expenditure on average, ranging from 10% to 74% depending on the country (WHO Bulletin). Thailand, which reached universal coverage in 2002, brought its own share down from 34% in 2000 to about 9% by 2019 (World Bank). These are not one market.
The consequences are measurable. Across eight countries in the WHO South-East Asia Region, 242.7 million people spent more than 10% of household expenditure on health, and 58.2 million were pushed below the extreme poverty line by health spending. Medicines were the largest component of out-of-pocket costs in most of those countries (WHO Bulletin).
The picture is starker for the therapies these programs typically cover. A longitudinal study following newly diagnosed cancer patients across eight Southeast Asian countries found that within twelve months, 29% had died, 48% had experienced financial catastrophe, and only 23% were alive without it (ACTION study). A separate seven-country study of patients hospitalized for acute coronary syndrome recorded mean out-of-pocket costs of US$3,237, with catastrophic expenditure reported by 66% of uninsured patients and 52% of insured ones (WHO Bulletin).
Now layer on the drugs themselves. A year of a modern immuno-oncology agent, a CDK4/6 inhibitor for breast cancer, or an anti-IL-17 biologic for psoriasis is priced for markets where a national payer negotiates and absorbs it. Where reimbursement lists are narrow, slow to update, or absent for a given indication, the price lands on the patient.
This is the gap patient programs fill. Because the gap looks different in every country, the programs do too. A drug reimbursed in Taiwan may be entirely self-pay in Vietnam. A biosimilar with a national tender in Australia may need a compassionate supply route in a neighbouring market. The molecule is the same everywhere; the access problem is not.
The same molecule can face three different access problems, and each calls for a different program. Proportions are illustrative.
PAP vs PSP vs CAP vs DTP: how the four program types differ
These four acronyms get used loosely, and often interchangeably, which causes real problems when teams try to design or budget a program. These are not four different names for the same thing. They differ in who pays, who qualifies, how long the support lasts, and what the operational burden looks like.
Below is a functional comparison of each.
Patient Access Program (PAP)
A patient access program (PAP) is a manufacturer-funded scheme that makes a prescribed medicine affordable when reimbursement does not cover it. In the US the same model is usually called a patient assistance program. The most common structure in Asia is a cost-share arrangement: the patient buys a defined number of cycles or months, and the manufacturer provides the next tranche free or heavily discounted. Variants include income-tested free supply, capped annual spend, and first-cycle-free starts.
The operational core of a PAP is eligibility and entitlement tracking. Someone has to verify the patient qualifies, count what they have purchased, calculate what they are owed, authorise the free supply, and document every step for audit. Get the arithmetic wrong at scale and you either give away product you shouldn't or deny a patient support they have earned.
Patient Support Program (PSP)
A patient support program (PSP), sometimes called a patient services program, helps patients start and stay on a therapy they can already obtain. It covers everything other than price: nurse education, injection training, home administration support, adherence reminders, side-effect management, refill coordination, transport and logistics help. For a deeper look at how these programs are built, see our complete guide to patient support programs.
PSPs typically run where the drug is already funded, through national reimbursement or private insurance, but where the therapy is complex enough that patients drop off without help. Self-injected biologics are the classic case. The drug is paid for. The problem is that a meaningful share of patients stop taking it within a year.
The operational core of a PSP is longitudinal patient engagement: structured contact over months or years, delivered by trained staff, with every interaction logged and every adverse event reported within regulatory timelines.
Compassionate Access Program (CAP)
A compassionate access program (CAP) supplies an unapproved or unavailable medicine, usually free, to a named patient with a serious condition and no alternative treatment. Regulators may call the same route compassionate use, a named patient program or special access. It covers pre-approval access, named-patient supply, and post-trial continuation for patients who responded in a study. (For the US version, see how expanded access and compassionate use work under the FDA.)
CAPs are the smallest programs by volume and the heaviest by governance. Each case is individual. Clinical justification has to be reviewed, regulatory permission secured under the local named-patient or special access framework, import and supply arranged, and the whole chain documented. Timelines matter clinically, because a patient waiting on compassionate supply is usually out of alternatives.
Direct-to-patient (DTP) is a distribution model in which the manufacturer or its partner delivers therapy to the patient's home rather than through a hospital or retail pharmacy: home dialysis solutions, cold-chain biologics, chronic infusion supplies.
DTP is less a funding model than a distribution model, and it can sit alongside any of the other three. What makes it distinct is that the program now owns physical logistics: scheduled deliveries, temperature control, inventory at the patient's home, returns, and disposal. A missed delivery is not a customer service issue. For a dialysis patient it is a clinical event. That is why a direct-to-patient dialysis delivery program in Singapore is measured on its on-time delivery rate.
The operational core of a DTP is reliable, scheduled, temperature-controlled last-mile fulfilment.
PAP, PSP, CAP and DTP compared
These categories overlap in practice. A single program can begin as compassionate supply, convert to a cost-share PAP once the drug is registered, and carry a nurse-support PSP throughout. Portfolios usually contain hybrids, and the label a program carries internally often reflects how it was budgeted rather than how it runs (Table 1).
PAP
PSP
CAP
DTP
Primary purpose
Make the drug affordable
Keep the patient on therapy
Supply where no route exists
Deliver therapy to the home
Who bears the cost
Manufacturer shares with patient
Usually reimbursed or insured
Manufacturer, fully
Varies; funding is separate
Typical eligibility
Income test, purchase history, diagnosis
Anyone on the therapy
Individual clinical justification
On the therapy, home-suitable
Duration
Defined cycles or annual cap
Length of therapy
Until reimbursement or trial end
No constraints
Volume
High; the bulk of programs
Medium
Low; single-digit cases common
Low to medium
Regulatory weight
Moderate
Moderate, PV-heavy
High; special access frameworks
Moderate; GDP, cold chain
Hardest operational part
Entitlement accounting at scale
Sustained engagement over years
Speed without cutting governance
Last-mile reliability
Fails when
Free-goods reconciliation breaks
Patients stop answering the phone
Approval takes too long
A delivery is missed
Table 1. PAP vs PSP vs CAP vs DTP
What 52 APAC patient programs show: program mix by type, market and therapy area
Definitions only go so far. What mix appears in the field is the more useful question.
About this data. The figures below describe 52 active patient programs run across six APAC markets on behalf of 19 pharmaceutical companies, spanning oncology, immunology, cardiovascular, nephrology, hematology, respiratory, neurology and ophthalmology as of Sep 2026. Shares are rounded to the nearest whole percent.
Program types are not evenly distributed
With affordability programs at 75% of the portfolio (Table 2), the data indicates that price remains the primary barrier to treatment across these markets. In markets with strong national coverage the ratio inverts, and PSPs dominate because the drug is already paid for. In this portfolio, Australia shows the reverse pattern; it is the one market where most prescription medicines are subsidised through the Pharmaceutical Benefits Scheme.
That shapes how a program operating model should be built. If PAPs are the bulk of your volume, your system needs to be excellent at entitlement logic, free-goods reconciliation, and financial audit trails. Adherence dashboards are secondary. Teams that import a Western PSP-first design into Asia tend to build the wrong thing well.
Program type
Programs
Share
PAP — Patient Access Program
39
75%
PSP — Patient Services Program
5
10%
CAP — Compassionate Access Program
3
6%
Sampling programs
3
6%
Combined PAP & PSP
1
2%
DTP — Direct to Patient
1
2%
Table 2. List of active patient programs across six APAC markets
Volume concentrates in a few markets
Thailand and Malaysia together carry nearly two thirds of the programs (Table 3). Both have mature private healthcare sectors, established specialty pharmacy channels, and reimbursement systems that cover a good deal but leave specialty medicines exposed. Real purchasing power plus a coverage gap at the expensive end is what makes a patient access program viable.
Australia's profile is different, and the difference is instructive. It has the fewest PAPs and the most PSPs and CAPs in the portfolio. With the Pharmaceutical Benefits Scheme covering most listed medicines, affordability support is largely redundant. What manufacturers need there instead is help getting patients onto and keeping them on therapy, and a route for patients who fall outside a listing. The program mix follows the payer structure, not the therapy.
Market
Programs
Share
Thailand
18
35%
Malaysia
15
29%
Australia
8
15%
Taiwan
6
12%
Singapore
3
6%
Vietnam
2
4%
Table 3. Market-wise (APAC) distribution of active patient programs
Oncology dominates, but not to the exclusion of everything else
Oncology and hematology account for more than four in ten programs (Table 4). High-cost targeted therapies, urgent clinical need, and reimbursement systems that cannot keep pace with approvals make oncology the natural home of the PAP. (see an oncology patient support program on Zelthy.)
The other 56% is where the design questions get harder. Immunology programs, covering biologics for psoriasis, atopic dermatitis, inflammatory bowel disease and rheumatoid arthritis, make up nearly a fifth of the portfolio and behave very differently. These are chronic, self-administered therapies where the patient stays in the program for years, injects at home, and drops out quietly if nobody is paying attention. Cardiovascular, nephrology and respiratory programs share that long-horizon shape.
A portfolio built only for oncology will handle a 6-cycle treatment course well and a 5-year biologic journey badly.
Program mix across 52 active programs in six APAC markets.
Therapeutic area
Programs
Share
Oncology & Hematology
23
44%
Immunology & Inflammation
10
19%
Cardiovascular & Metabolic
6
12%
Nephrology
4
8%
Multi-category portfolios
3
6%
Respiratory
2
4%
Neurology
2
4%
Ophthalmology
1
2%
Addiction Medicine
1
2%
Table 4. Therapy-area-wise distribution of active patient programs in APAC
Why the same molecule needs a different program in every market
The access problem differs by market, even for the same molecule. Reimbursement status, registration, dispensing channel, consent and data-residency rules, pharmacovigilance timelines and patient-communication rules vary across APAC. A drug reimbursed in Australia may be self-pay in Vietnam and unregistered elsewhere, so it may need a PSP, a PAP and a CAP in three markets.
One pattern in the data breaks multi-country program plans more often than any other.
In this portfolio, a single immunology biologic runs as three separate programs in three markets. A single anticoagulant appears both as a patient access program in one country and as a physician sampling program in another. The same oncology molecule sits inside a bundled multi-brand program in one market and as a standalone program in the next.
Same drug. Same manufacturer. Three different program designs.
This is not disorganisation. It is a rational response to markets that differ in multiple ways (Table 5).
The usual instinct is to build one global program platform and roll it out. That fails in a specific and predictable way. The shared core is fine; every market then needs its own eligibility rules, consent text, approval workflow, reporting format and dispensing integration. Teams either fork the system per country, losing all consolidated visibility, or force markets into a template that does not fit their regulations. (We cover the consolidation problem in unifying multiple PSP vendors under one data layer.)
The workable answer is a shared platform with configurable country layers. Common patient model, common audit trail, common reporting spine, with market-specific rules for eligibility, consent, workflow and integrations. Programs deployed on Zelthy follow this pattern: one tenant per client, configurable program logic per market, with compliance controls and audit trails applied consistently underneath rather than rebuilt each time. The same approach supports monitoring patient programs across countries from one platform.
A shared core keeps one audit trail and one portfolio view; per-market configuration handles the rules that differ.
Configuration takes weeks. Forking takes months and never stops costing money.
Factor
What varies across APAC markets
Reimbursement status
Reimbursed, partially reimbursed, or entirely self-pay, often for the same molecule in different indications
Registration
An indication approved in one market may be unapproved next door, pushing the program from PAP into CAP territory
Dispensing channel
Hospital pharmacy, retail pharmacy, specialty distributor, or direct-to-patient, each with different data access
Patient data rules
Consent requirements, cross-border transfer restrictions, and local data residency obligations differ by country
Pharmacovigilance
Local reporting timelines and formats vary; a global template rarely satisfies every authority
Promotional rules
What a manufacturer may say to a patient directly is tightly restricted in some markets, permissive in others
Language and identity
Multiple languages and different national ID formats affect enrollment, deduplication and verification
Table 5. Variations in patient programs across APAC markets.
The eight functions every patient program runs on
Whatever the label on the program, the underlying machinery is largely the same, and the success of it depends on how the following functions work.
Enrollment. Getting the patient in, with valid consent, verified identity, and a confirmed prescriber. Multi-language, often paper-originated, frequently incomplete on first pass.
Eligibility verification. Confirming the patient qualifies: diagnosis, line of therapy, income band, insurance status, prior purchase history. This is where PAPs live or die.
Entitlement calculation. Working out exactly what the patient is owed under the program rules, at what point, and tracking it cycle by cycle. Rules differ per program and change mid-flight.
Dispensing and fulfillment. Authorising release, coordinating with the pharmacy or distributor, confirming the patient received the product, and reconciling free goods against inventory.
Adherence and engagement. Scheduled contact, refill reminders, missed-dose follow-up, nurse or counsellor interactions, logged rather than merely performed.
Pharmacovigilance. Capturing adverse events at any touchpoint and routing them to safety within the regulatory window. Non-negotiable, and a common audit failure point.
Reporting. Program dashboards for the manufacturer, regulatory submissions where required, financial reconciliation of product given away, and evidence for the annual audit.
Governance. Who approved what, when, and on what basis, retained and retrievable for years.
Every program type runs on the same eight functions. AI helps with the high-volume, rule-bound ones; people make the approvals.
AI helps with the parts of this list that are high-volume and rule-bound rather than judgement-bound: reading and validating enrollment documents, flagging incomplete eligibility submissions before they reach a reviewer, detecting adverse event language in free-text interaction notes, and predicting which patients are drifting toward discontinuation based on refill patterns. We cover this in more depth in where AI helps in patient support programs.
However, what AI does not do is approve a compassionate access case or make a clinical judgement. It clears the queue so the people who should be making those calls have time to make them.
What a platform does not solve
Patient programs fail for reasons software cannot fix. Here are a few worth mentioning:
It does not replace the people. The nurse who talks to a newly diagnosed patient through their first self-injection is doing something no workflow engine replicates. Programs that cut human contact to save cost usually see adherence fall, and the saving disappears.
It does not fix a badly designed program. If the eligibility criteria are so restrictive that qualifying patients cannot realistically enroll, a better system will only reject them faster. Program design is a commercial and medical decision made before any technology is chosen.
It does not create regulatory permission. A compassionate access framework either exists in a market or it does not. Software can make the application faster and better documented. It cannot make it allowable.
It does not remove accountability. The manufacturer remains responsible for pharmacovigilance compliance, data protection, and promotional conduct. A platform can make those obligations easier to meet and easier to evidence. It does not transfer them.
It does not solve reimbursement. Patient access programs are a bridge, not a destination. The durable fix for an affordability gap is listing and reimbursement, and every good program should be designed with an exit in mind.
Build, buy, or configure: choosing patient access program software
The right route depends mostly on how many programs and markets are in scope. Here is how the three routes compare. Zelthy provides a configurable platform; the comparison below reflects our view of the trade-offs (Table 6).
Custom builds make sense when a single market has an operating model so unusual that nothing off the shelf fits. The cost is that every subsequent market restarts a good deal of the work, and validation and compliance are permanently your problem.
Packaged SaaS is fast to start and constrained afterwards. The trade-offs show up when a market needs a workflow the product does not support, or when per-module pricing compounds across a large portfolio. You are also dependent on the vendor's roadmap for changes local regulators may require on their own timeline.
The platform route sits between them. Zelthy's approach is to provide pre-built modules for enrollment, eligibility, dispensing, adherence, pharmacovigilance capture and reporting, configured per program and per market rather than rebuilt. Because Zelthy is built on Zango, an open-source Python and Django framework, customers keep code ownership rather than renting access to a closed product. Compliance controls for HIPAA and GDPR, multi-tenancy, and audit trails come with the platform rather than being assembled per project. See Zelthy's patient services platform.
The practical question to ask a vendor is not whether they support your first market. It is what happens when market number four needs a consent flow and an eligibility rule that none of the first three use.
Custom build
Packaged SaaS
Configurable platform
Time to first program
9–18 months
3–6 months
Weeks
Fit to local rules
Exact; you built it
Constrained by the vendor's model
Configurable per market
Adding a second market
Substantial rework
Depends on vendor coverage
Configuration
Compliance controls
Built and validated by you
Vendor-provided, vendor-paced
Built in, applied consistently
Code ownership
Yours
Vendor's
Yours (Zelthy is built on Zango, an open-source framework)
Ongoing cost driver
Engineering headcount
Per-module licensing
Configuration and support
Best suited to
One market, highly unusual model
One market, standard model
Multi-market, multi-brand portfolios
Table 6. Patient access program software comparison
Evidence from Zelthy-run patient programs
Scale and breadth. Patient programs run on Zelthy across 12+ countries, spanning oncology, HIV, vaccines, rare disease and advanced therapies, with over 300 applications deployed on the platform.
Speed to launch. Because program logic is configured rather than built, compassionate access programs have gone live on Zelthy in weeks rather than the months a custom build requires. That margin matters when the patients waiting have no alternative therapy.
Public health scale. A national HIV patient monitoring program built on Zelthy for the government of India supported more than 2 million patients over the life of the program, which is the clearest available demonstration that the platform holds up under national-scale patient volume and public-sector audit requirements.
The takeaway
Patient access programs in Asia-Pacific are shaped by one fact: the payer gap is wider here than almost anywhere, and it varies enormously between markets a few hundred kilometres apart. That makes affordability programs the dominant form, oncology the dominant therapy area, and per-market configurability the dominant technical requirement. Teams that treat a multi-country program as a rollout rather than a set of related but distinct builds end up with six systems and no consolidated view.
If you are setting up or consolidating patient programs across multiple APAC markets, talk to the Zelthy team about what a configurable multi-market deployment would look like for your portfolio.
Frequently asked questions
What is a patient access program?
A patient access program (PAP) is a manufacturer-funded scheme that makes a prescribed medicine affordable when reimbursement does not cover it. In Asia-Pacific the most common design is cost-sharing: the patient buys a set number of cycles and the manufacturer supplies the next ones free or discounted. In the US, the same model is usually called a patient assistance program.
What is the difference between a PAP and a PSP?
A Patient Access Program (PAP) addresses cost. It makes an expensive medicine affordable, usually through a cost-share or free-supply arrangement. A Patient Services Program (PSP) addresses everything else: education, injection training, adherence support and side-effect management, typically where the drug is already reimbursed. In the six-market APAC portfolio analysed here, PAPs made up 75% of programs and PSPs only 10%, reflecting how much of the region's access problem is still about price.
What is a compassionate access program in pharma?
A compassionate access program (CAP) supplies a medicine, free of charge, to patients who have no other route to it: no reimbursement, no affordable purchase option, and sometimes no approved indication in their market. Each case is reviewed individually on clinical grounds and supplied under the local named-patient or special access framework. CAPs are low in volume but high in governance. In the portfolio examined here they accounted for 6% of programs.
What software do pharmaceutical companies use to run patient support programs?
Options fall into three groups: custom-built systems, packaged SaaS products such as enterprise CRM-based patient suites, and configurable platforms. Zelthy is an AI-native platform-as-a-service used by Roche, Bristol-Myers Squibb, AstraZeneca, MSD, Servier, Novartis and DKSH to run patient programs, with pre-built modules for enrollment, eligibility, dispensing, adherence and pharmacovigilance capture, and code ownership retained by the customer through the open-source Zango framework.
How long does it take to launch a patient access program?
A custom-built system typically takes 9–18 months before the first program goes live. Packaged products usually take 3–6 months. On a configurable platform with pre-built patient program modules, deployment is measured in weeks.
Why do patient programs need to be different in each APAC country?
Reimbursement status, drug registration, dispensing channels, patient data and consent rules, pharmacovigilance reporting requirements, and rules on direct patient communication all differ by market. The same molecule can require a cost-share PAP in one country, a compassionate access route in another, and no program at all in a third where it is fully reimbursed. A single global template will not satisfy all of them, which is why configurable per-market program logic matters more than a one-size deployment.
What is direct-to-patient (DTP) in pharma?
DTP means delivering therapy to the patient's home rather than dispensing through a hospital or retail pharmacy. It is a distribution model rather than a funding model, and it commonly applies to home dialysis solutions, cold-chain biologics and chronic infusion supplies. The operational demands are scheduled delivery, temperature control, home inventory management and returns handling. A missed delivery can be a clinical event, not just a service failure.
Looking for one platform to run patient access programs across APAC?
Zelthy is pharma's patient services platform, used by Roche, Bristol-Myers Squibb, AstraZeneca, MSD, Servier, Novartis and DKSH to run patient programs across 12+ countries. Enrollment, eligibility, entitlement tracking, dispensing and pharmacovigilance capture come as pre-built modules, configured per market in weeks. Customers keep code ownership through the open-source Zango framework.
