Disclosure. Introduction 5/15/2016. Technician Academy. Strategies in Reducing Drug Costs to Patients and Increasing Adherence.

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1 Technician Academy Strategies in Reducing Drug Costs to Patients and Increasing Adherence Presented by: Bridgett Edgar - CPhT Dianna Fish - CPhT Disclosure None Introduction Bridgett Edgar CPhT Dianna Fish CPhT Talent Acquisition Specialist Fred Meyer Pharmacy We are both currently working in community pharmacy so most of what we are presenting in this meeting is from our experience in community pharmacy. We are hope this becomes a discussion so everyone s experiences can contribute and give us all some insight into other areas in pharmacy. 1

2 Let s talk about you Who are you? Why did you join WSPA? What do you hope to get out of this meeting? We want your input and your ideas What topics would you like to discuss at our next meeting? Will you share your knowledge? Can we reach out to you to present? Objectives Recognize how financial barriers effect patient compliance Develop strategies to build trust with patients Discover ways to help reduce medication costs Find resources on line and in your community to help with medication costs. 2

3 Introduction Unfortunately, millions of Americans cannot afford medical treatment. Many of them die a premature death, that could have been prevented. Resources exist to help patients, but many are unaware of them. Pharmacy Technicians have an opportunity to decrease out-of-pocket costs & improve patient outcomes In the United States, some 3.8 billion prescriptions are written every year, yet over 50% of them are taken incorrectly or not at all. 1 3

4 In a survey of 1000 patients, nearly 75% admitted to not always taking their medications as directed. 1 A study of over 75,000 commercially insured patients found that 30% failed to fill a new prescription, and new prescriptions for chronic conditions such as high blood pressure, diabetes, and high cholesterol were not filled 20%-22% of the time. 1 Definitions Adherence means "sticking to" or "being faithful to Compliance means the action or fact of complying with a wish or command. Medication adherence is defined by the World Health Organization as "the degree to which the person s behavior corresponds with the agreed recommendations from a health care provider. 2 Though the terms adherence and compliance are synonymously used adherence differs from compliance. Compliance is the extent to which a patient s behavior matches the prescriber s advice. Compliance implies patient obedience to the physician s authority, whereas adherence signifies that the patient and physician collaborate to improve the patient s health by integrating the physician s medical opinion and the patient s lifestyle, values and preferences for care. 2 4

5 Effects of Medication Non-Adherence Progression of the diseases Disease state complications Increase medical bills Hospital Visits Testing Death Reasons for Patient Non-Adherence Adverse side effects Not understanding why they are taking the medication Reduction of Symptoms - patient stops taking Forgetfulness Especially when stressful situations come up Age related Cost Patient skips doses or cuts pills in half to save on cost Transportation The 4 steps to Adherence Receive the right prescription Fill the prescription Make it through the first 6 months on the medication Continue to take the medication as intended (infinitely) 5

6 Signs that a patient can t afford to pay Non-Verbal Communication Body language Verbal communication Patient says That is too expensive I can t pay for that Some off handed comments to listen for: Wow that puts a dent in the budget I m feeling better so I cut my dose in half I don t feel any different with the medication so I stopped taking it 6

7 Signs of Non- Adherence Not refilling prescription Infrequent or sporadic refills Asking about OTC items to replace their current prescription Saying they feel better without the medication Making Medications Affordable Pharmacy Technician s Role Offer resources Offer solutions Empathy I understand. Let me see what I can do to help. Hospital setting Assess before discharge Access during transitions of care Be proactive Too Expensive? Now what? 7

8 Strategies to Decrease Patient Cost Changing the Prescription Discount Cards Manufacturer Assistance Local Resources Switching to Generics Change the Prescription Pharmacist review patient profile & current medication regimen If appropriate, pharmacist contact prescriber and suggest an alternative, less expensive option Request a higher strength and cut in half Will patient understand? Are they able to cut in half? Discuss with the patient the cost prior to requesting a change May have tried alternative in the past with no results May be willing to pay a higher out of pocket Can require a longer wait time, sometimes a day or two. Discount Medication Cards Most Programs are Free to the patient Readily available County, Bank, AAA etc. Use In Store Discount card Not all pharmacies accept them High fee s to pharmacy Check with your employers policy Cash may be less expensive Disclosing patient information to an outside source (drug shows patient disease state, age, and zip code) 8

9 Manufacturer Assistance Coupons Free of Charge No specific eligibility requirements I call this free money Coupons Auto attach to a prescription claim (check your transaction details) Dropped or mailed by manufacture Available from your wholesaler Available at the drug website Vendor site visits Most times, patients and techs do not realize a coupon is being used Easy to forget that they are available Online list brings you to manufacture website Some instant, some require patient specific questions Coupons Cannot be used with governmentfunded insurance (Medicare/Medicaid/etc.) Brand Name Drugs only Coupons have many variables Co-Pay only Coupon amounts change without notice Card expires, or only good for 6 uses Has a quantity limit Max of 60 tabs/30 days 9

10 Patient Assistance Programs (PAPs) This is a Manufacturer program in addition to specific drug coupons Usually for Uninsured (sometimes the underinsured) Have income restrictions Patient Assistance Program Programs are drug specific multiple medications require several applications Medication is shipped to the patient s home or the prescriber s office (occasionally the pharmacy) Patient or patient representative must apply Application process is lengthy & cumbersome Requires documentation to support eligibility Requires a prescription Can take several weeks not for urgent fills May need to find another resource for 1 st fill. Because mail order, request refills timely Program can change at any time with no warning (common when a medication becomes generic) Require reapplication yearly (or more often) Application normally requires a physician signature Local resources Resources vary in a community Gather resources Volunteers of America Local food bank Church Homeless shelter Police station?? What else? Make a list that is available to patients 10

11 Resource Change Prescription Income requirements Generic or Brand Insurance limitations Notes None Both None *Requires Prescriber approval *may not be cheaper options ½ tablet dosing None Both None *not appropriate for all medications *requires clear patient understanding Discount Cards None Both None Can t be used WITH insurance Cash price is occasionally lower Can have fees that the pharmacy pays Manufacturer Coupon None Brand *sometimes limits quantities Can t be used with government funded insurance (Medicare/ Medicaid) Coupons Change Patient Assistance Uninsured or *underinsured Brand Yes *varies Takes time to gain approval & ship A lot of paperwork May also require US Citizenship Questions Does the Patient Need to Activate coupon or enroll with company to use? Is there a savings limit? Are only Specific NDCs covered? How many times can a patient use the coupon? Details Can take up 30 minutes to activate & only by the patient. This step is sometimes missed Some only pay Up to amounts. Sometimes card says $30 copay but the pay up to is only $50, so high copays make true coupon unpredictable. Some, yes (bottle count) Varies some single use, some no limitations. Some have lifetime limits, but allow a new coupon when fill limit has been reached. Switch to Generic Be proactive When a new generic comes out run reports (if possible) and switch patients to generic prior to them coming to pick up instead of making them wait 11

12 Websites *note:.org to help navigate options Rx Assist Needy Meds Partnership for Prescription Assistance (fav) Assessment Questions What cost-saving strategy provides free or low-cost brand name medications to patients who meet income and insurance eligibility criteria? A. Patient Assistance Programs B. Discount Cards C. Manufacturer Coupons D. Local Medication Assistance Programs True or False Cost reduction strategies are only available for brand-name medications. A. True B. False 12

13 True or False Patients with Medicare Part D are not eligible for assistance through manufacturer coupons? A. True B. False True or False? The website can be used as a comprehensive database to identify all community specific resources available to help decrease medication costs? A. True B. False Sources Cited 1. Why Are So Many Patients Noncompliant? Medscape. Jan 16, Noncompliant.pdf 2. Jimmy, Beena, and Jimmy Jose. Patient Medication Adherence: Measures in Daily Practice. Oman Medical Journal 26.3 (2011): PMC. Web. 3 May

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