Patient Assistance Programs: From Practicalities to Pearls
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1 Health Disparities and Cultural Competence (HDCC) Special Interest Group (SIG) Patient Assistance Programs: From Practicalities to Pearls Kelly Murray, PharmD, BCACP Michelle Lamb, PharmD, CDE, BCACP University of Oklahoma College of Pharmacy February 25, 2013
2 Objectives 1. List the application steps for a patient assistance program (PAP). 2. Describe timeline for PAP initial application and renewal process. 3. Identify potential safety issues associated with dispensing PAP medications. 4. Given a patient case, select the appropriate PAP application based upon clinical background and financial circumstances.
3 POLL: Tell us about your practice site! 1. Pharmacotherapy Clinic 2. Community Pharmacy 3. Inpatient setting/hospital 4. Other
4 POLL: How familiar are you with patient assistance programs? 1. Very familiar 2. Somewhat familiar 3. Heard of these programs 4. Not at all familiar
5 Case Study MK comes to your pharmacotherapy clinic. MK has recently lost her job and therefore is not receiving a paycheck. She also has no insurance and does not qualify for state assistance. She is concerned about how to pay for her medications, as she has recently been diagnosed with DM, HTN, and dyslipidemia.
6 Case Study Current meds include: Levemir Apidra Cozaar samples Crestor
7 Case Study How do we ensure continuity of care for this patient?
8 Case Study How do we ensure continuity of care for this patient? Options include: PAP Therapeutic interchange Brand to generic switch
9 PAPs: Definition Provided by pharmaceutical companies To provide brand-name medications For low-income individuals who lack prescription drug coverage PAP = MAP, PMAP Vs. coupon, sample, 340B, drug card, bulk replacement programs, and Medicare Part D Advocate PAPs are a long term solution to a current medication access problem Am J Health-Syst Pharm. 2006; 63: Sagall RJ. Pharmaceutical companies helping patients get their medications. Accessed at on 2/21/13.
10 NeedyMeds Programs Available Partnership for Prescription Assistance RxAssist TogetherRx Access National Council on Patient Information and Education Manufacturers websites
11 Finding an application Medications covered Type (brand, generic) Insurance status Private insurance Medicare Part D (coverage gap) No insurance
12 Case Study Novo Nordisk Basal insulin: Levemir Bolus option: Novolog Sanofi Aventis Basal option: Lantus Bolus insulin: Apidra Program facts: At or below 200% FPL App is faxable Allow 7-10 days for processing Program facts: At or below 250% FPL App is faxable Allow 2-4 days for processing
13 Case Study Novo Nordisk Basal insulin: Levemir Bolus option: Novolog Sanofi Aventis Basal option: Lantus Bolus insulin: Apidra Program facts: At or below 200% FPL App is faxable Allow 7-10 days for processing Program facts: At or below 250% FPL App is faxable Allow 2-4 days for processing
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16 Process of Application Determine patient s eligibility for program
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18 Process of Application Determine patient s eligibility for program Help patient download, fill out, and sign paperwork Fax (or take) paperwork and correct prescription to physician for signatures Fax (or mail) application, rx, and proof of income to drug-manufacturing company
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20 Process of Application Determine patient s eligibility for program Help patient download, fill out, and sign paperwork Fax (or take) paperwork and correct prescription to physician for signatures Fax (or mail) application, Rx, and proof of income to drug-manufacturing company Wait approximately 4 weeks Pick up medications at clinic or physician s office!
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22 Filling Out an Application
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27 Federal Poverty Line Calculator on needymeds.org
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29 Federal Poverty Line Persons in family/household Poverty guideline For families/households with more than 8 persons, add $4,020 for each additional person. 1 $11, , , , , , , , % of FPL for 1 person = $28,725 DHHS 2013 Federal Poverty Lines. Accessed at on 2/20/13.
30 Incorporating applications into workflow Management Software Purpose Examples MedData PAP Rx Tracker (PAP Tracker) M&D Cares RxAssist Plus Indicare
31 Incorporating applications into workflow USA Drug pharmacy model
32 Incorporating applications into workflow Clinic models Who is the best person to run this program? Average cost per application: $25.18 Co-pay vs. enrollment fee For profit (or mixed) models Example: Buhler s Pharmacy #3 Clay P, et al. Costs to physician offices of providing medications to medically indigent patients via pharmaceutical manufacturing prescription assistance programs. J Manage Care Pharm. 2007; 13: Mounts VL, et. al. Implementation of a Patient Medication Assistance Program in a Community Pharmacy Setting. J AM Pharm Assoc. 2005; 45:
33 Safety issues Integrate into EMR Bridge to initial supply Lapses in supply Storage Refrigerated items Sample closet
34 Safety issues Labeling Counseling Drug-seeking behavior Pseudo-Controlled Manufacturer recall
35 Timeline considerations: Revisit case Day 5: Pt. brings financial docs to clinic Day 14: Application denied! Day 25: Application approved, meds sent Day 1: Pt. presents to PAP Clinic Day 7: Prescriber completes application section and app is mailed Day 20: Patient brings missing docs, app resent Day 30: Meds arrive and are picked up by patient
36 Timeline considerations: Revisit case Day 5: Pt. brings financial docs to clinic Day 14: Application denied! Day 25: Application approved, meds sent Day 1: Pt. presents to PAP Clinic Day 7: Prescriber completes application section and app is mailed * Day 20: Patient brings missing docs, app resent Day 30: Meds arrive and are picked up by patient *Note: 30 days before patient can begin regimen!
37 Timeline considerations: Revisit case Day 90: Renewal process should begin Day 125: Renewal form sent to mfr. Day 130: Refill meds arrive and are picked up Day 30: Pt. begins medication regimen Day 120 (ish): Patient out of meds, uh oh! Day 130: Refill meds arrive (90 days)
38 Timeline considerations: Revisit case Day 90: Renewal process should begin Day 125: Renewal form sent to mfr. Day 130: Refill meds arrive and are picked up Day 30: Pt. begins medication regimen Day 120 (ish): Patient out of meds, uh oh! * Day 130: Refill meds arrive (90 days) *Note: 10 days without medication!
39 Insulin Pearls Order basal/bolus from same company Faxed vs. mailed Zero income Example may be found at Print on clinic letterhead
40 Clinic LOGO XXXXX Health Center Anystreet Anycity, USA February 25, 2013 RE: patient name SS# To Whom It May Concern: The above-named patient is currently under my care. In accordance with your eligibility criteria and to the best of my knowledge, this patient currently has zero income and is unable to afford to pay for this drug due to financial hardship. The patient also has no insurance coverage to help pay for the cost of this drug. If you have any further questions, please call We greatly appreciate the free medications your company makes available to the patients we serve. Thank you for your assistance. Physician Signature Date Physician name Patient Signature Date Patient name
41 Power of attorney Pearls Watch days supply (90 vs. 120, anticipate titration up) with counseling Discharge sheet Dedicated phone number Pt. receive mail at home
42 Pearls Pharmacy student involvement Application Advocates Tracking outcomes AWP Number of apps Number of patients Indication Mean daily meds Clinical outcomes Impact on adherence Medication possession ratio Picked up Flagging patients Nykamp D, et al. Impact of an indigent care program on use of resources: experiences at one hospital. Pharmacotherapy. 2000; 20:
43 Case Study Money saved Improved care Improved access improved control Patient/Advocate satisfaction Am J Health-Syst Pharm 2005; 62: Circulation 1997; 96: I-617
44 Questions?
45 Health Disparities and Cultural Competence (HDCC) Special Interest Group (SIG) Patient Assistance Programs: From Practicalities to Pearls Kelly Murray, PharmD, BCACP Michelle Lamb, PharmD, CDE, BCACP University of Oklahoma College of Pharmacy February 25, 2013
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