The MetroHealth System, Cleveland, Ohio, USA. Key Contact

Transcription

1 Reducing Prescription Costs and Increasing the Use of Patient Assistance Programs for Indigent Patients by using the Electronic Medical Record: Two approaches to help reduce prescription costs Stephen Zepp, Mary Jo Slattery, Marigel Constantiner, Wayne Barry, Jay Kuhn, Kathleen Lehman, Pat Mahon, Toby Massman, Laurie McCreery, Bonnie Poprock, Colleen Royer The MetroHealth System, Cleveland, Ohio, USA Key Contact Background: MetroHealth Medical Center in Cleveland, Ohio is a large public hospital, in an urban setting and is considered the county s safety-net provider. Ten percent (10%) of its patient population has an annual household income below $20,000. Many of these patients cannot pay for their prescriptions or they take their medicines differently than prescribed to make them last longer, often resulting in adverse outcomes and possible hospital admissions. Purpose of the Study: In order to help these patients, an interdisciplinary quality improvement team established a goal of substantially reducing the prescription costs for these patients, without increasing costs to the institution. Methods: The team divided the project into two distinct initiatives: 1. Reduce the Prescription Price. The pharmacy negotiated special contracts with several major pharmaceutical companies to allow for a cost reduction for 52 high volume drugs. Under these contracts, the pharmaceutical companies provided discounts to the pharmacy that the pharmacy then passed along to our indigent patient population through a program called the APPLE program, (Assisting Patients with Prescriptions by Lowering Expenses). To qualify for the APPLE program, the patients had to have an annual household income less than 200% of the poverty level. In order to increase the

2 use of the program, an electronic notification of Alternative Selection was designed and installed into our Electronic Medical Record (EMR). (See Box 1). 2. Increase the use of Patient Assistance Programs. Most of the pharmaceutical companies offer some type of Patient Assistance Program (PtAP), which can reduce the prescription cost to indigent patients. However, to use these plans the provider must search for and locate the forms on the Internet and then print them. To simplify this process, the team captured the PtAP forms from the internet and stored them electronically in a database that was linked to our EMR system. Then the EMR system was modified to alert the providers when they ordered a drug that is included in the PtAP database. (See Box 2). Results: Both the APPLE and the PtAP programs are dynamic, growing programs. The APPLE Program grew from 3 drugs to 52 drugs. The PtAP started with 74 drugs in the database and now lists 165 drugs. The overall goal of the project was to help those patients who cannot afford their prescriptions by reducing or eliminating their prescription costs. Partially, as a result of the team s initiatives, over 3,000 prescriptions per month are being filled through the APPLE Program and patients savings on prescriptions are now over $40,000 per month. The PtAP forms are easily accessible to our providers and the PtAP database is being expanded regularly. Providers are currently downloading over 200 forms per month, which results in more patients enrolled into more programs. Conclusion and Implications: Modifications of the EMR can help reduce prescription cost by increasing the use of PtAP programs and special drug contracts.

3 Box 1 - Electronic Medical Record protocol for APPLE Program When a provider orders a medication, (Example A): 1. The EMR system will first look at the patient s financial rating, and only if the patient is rated as indigent, then, 2. The EMR will check the drug against a list of APPLE drugs that might be considered as alternatives. If there is an APPLE alternative then, 3. The EMR will notify the provider of the APPLE alternative (Example B) and give the provider the opportunity to, Accept Alternative or Continue With Original Order. Box 2 - Electronic Medical Record protocol for PtAP Program When a provider orders a medication, (Example A) the EMR System will: 1. The EMR system will first look at the patient s financial rating and only if the patient is rated as indigent, then, 2. The system will check the drug against our PtAP database to see if a PtAP form is listed for the specific drug. If yes, 3. The system will notify the provider that a PtAP form is available D). (Example C) and provide the Web link to the PtAP forms (Example 4. The provider can either continue with the original order or go to the Patient Assistance Program list and print the form.

4 Attachment A MetroHealth Medical Center Indigent Medication Distribution System Patient given financial rating by Financial Business Office Provider prescribes meds Is Patient Rated 2-6? Provider prescribes meds Is Med in APPLE Program? Is there an APPLE Substitute? Provider changes order to APPLE meds? Is Med included in PtAP Program? Provider/Pt submits PtAP form to Supplier? Social Work provides Voucher for prescription Is patient eligible for Med Voucher? Pt receives meds from MH Pharm pays APPLE charge Pt receives meds from Pharmaceutical Company Pt receives meds from MH Pharm free of charge Patient pays for meds based on rating (25%,50%,75%,100%) plus a service charge

5 Example A - PAXIL and ACTOS are ordered. Example B - An alternate for PAXIL is suggested. If an APPLE alternative medication is available for the patient the Alternative Selection window will display a list of alternative medications. The provider will have the choice to select one of the alternatives or continue with the original order.

6 Example C - The electronic medical record indicates that a Medication Assistance form is available for ACTOS and to Click Web Link at right to obtain form.

7 Example D - PtAP Reference Page comes up and ACTOS form is pulled up by clicking on Takeda.