Medication Assistance. Bess Quint CIRS-A Medication Assistance Program Coordinator Centegra Health System

Transcription

1 Medication Assistance Bess Quint CIRS-A Medication Assistance Program Coordinator Centegra Health System

2 Sources For Medication Assistance Community Resources Townships Faith Based Organizations County Organizations Doctor s Office State Program Medicaid Il Cares RX ADAP Federal Programs Medicare Part D Social Security Extra Help VA

3 Sources for Medication Assistance Cont.. Pharmaceutical Manufacturer Programs Programs for people with no insurance Programs for those with insurance Co-Pay Assistance Programs For Self Administered Medication For Non-Self Administered Medication Other Patient Assistance Options Grants Diagnosis Based Funding Discount Cards Pharmacy Programs

4 Community Resources There are many community resources available to assist with emergent medication needs. Some programs are available based on where a patient lives, some on the type of medication needed and others on household size and income. Most community resources limit the number of times a patient can use their program or limit the amount of money available. Examples of these would be Townships, Faith Based Organizations (Salvation Army, Catholic Charities, St. Vincent De Paul), County Organizations (Mental Health Board, Health Departments, these programs are available for certain types of medications).

5 Community Resources Cont Doctors offices can also be a resource for short term supplies of medication. Often they have samples of the newer more costly medications. These sources are generally short term, and are good for temporary needs or emergent situations. They can also be a good option to use while setting up a long term solution. Patients should be prepared to supply Proof of Identity, Proof of Residency, Household Income, and Information on Prescription(s) needed. Other Information may be requested based on the program requirements.

6 State Programs The State of Illinois offers a few options in regards to lowering the cost of prescription medication. Medicaid covers the cost of most prescription medication for it recipients. Some medications have restrictions or require a Prior-Authorization. You can obtain the formulary, restrictions and authorization information at the following website. To be eligible to receive assistance thru Medicaid you must meet certain criteria set by the State of Illinois. All recipients of other assistance programs must be screened for Medicaid.

7 State Programs Cont Another option offered by the State of Illinois is IL Cares RX. This program is offered to residents of Illinois who are seniors or disabled. To be eligible recipients must meet income guidelines and are required to apply to the Social Security Extra Help program. ADAP or the Aids Drug Assistance Program offers assistance to patients that have been diagnosed with HIV / AIDS. This program is administered by the IL Dept. of Health.

8 Federal Programs Medicare Part D is available for Medicare recipients. There are several different plans available based on a patients specific needs. Medicare offers a once a year open enrollment period for those who are eligible, however there are special election periods available to those who meet certain criteria. Plan choices should be based on what medications the patient is taking, choice of pharmacy / mail order, ability to use plan locally or nation wide, cost, and coordination with other assistance programs available.

9 Federal Programs Cont Social Security Extra Help is a program offered by the Social Security Administration to assist low income Medicare Beneficiaries with the cost of Medicare Part D. Eligible individual must meet income and asset guidelines. Veteran Administration Assistance is offered to eligible current and retired service personnel. Individuals must apply thru their local VA.

10 Pharmaceutical Manufacturer Programs Many pharmaceutical companies offer Patient Assistance Programs that offer free or low cost medication to patients There are two types of programs ones for those without insurance and ones for those with insurance. Both types will send the medication directly to the patient or doctors office, certain programs will send the patient a card to use at the pharmacy in order to obtain the medication. There are also programs that will provide medication to patients that are given in a hospital or doctors office. Both types of programs generally required certain criteria to be met including income guidelines, household size, valid prescription and physician information.

11 Pharmaceutical Manufacturer Programs Cont Programs for those with insurance require additional information including insurance information, and proof of money spent out of pocket. These programs are designed to assist those with large out of pocket costs or Medicare Beneficiaries in the coverage Gap. While they generally take a little longer to set up they can be very beneficial to the patient. The eligibility for these programs usually last one year, with refill paperwork due every three to four months. Since the programs are offered thru different companies, the application requirements vary. Delivery times range from one week to eight weeks.

12 Co-Pay Assistance Programs Many pharmaceutical companies also offer Co-Pay Assistance Programs to those patients who have commercial insurance. Many patients with insurance still have difficulty paying their portion especially if they take many medications or have high co-pays. These programs are offered for medication that is self administered and for those given at a hospital or doctors office. Many of these programs have no other criteria than that you must have private commercial insurance.

13 Other Patient Assistance Programs There are other options available for patients that have difficulty accessing their medications. There are public and private grants that will offer assistance to individuals meeting their criteria, however these can be hard to find and access. There are grants based on diagnosis to assist with medication and other cost these programs generally only assist with the cost associated with that diagnosis. There are many discount cards available thru television and internet, some can truly alleviate cost while others are gimmicks, so be aware of the rules and cost associated with these cards. There are also pharmacy programs, that offer low cost generics, free antibiotics and diabetes medications. These programs have all made accessing medication easier for patients.

14 Questions?????