Posted by Ted (205.188.197.52) on August 06, 2000 at 15:22:17:
From
American Journal of Health-System Pharmacy
Medication Assistance Reports Medication Assistance Programs For Uninsured and Indigent Patients
Marie A. Chisholm, Bess O. Reinhardt, Leslie J. Vollenweider, Bridgett D. Kendrick, and Joseph T. Dipiro
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Abstract
Pharmaceutical company-sponsored medication assistance programs and the pharmacist's role in obtaining medications for indigent patients are discussed.
Information about enrolling in medication assistance programs can be obtained through a variety of sources, including the Internet. Although some eligibility criteria may be common to many programs, each company operates independently, and the eligibility criteria vary. Individuals involved in the administration of medication assistance programs should strive to ensure that correct information is reported. Pharmacists can play an important role in acquiring medications for patients by reviewing patient information, recommending patients for enrollment, and serving as a liaison between the patient or health care provider and the program administrator.
Many pharmaceutical companies have programs that provide prescription medications to indigent or uninsured patients. Pharmacists can serve as a liaison between these programs and the patient or the health care provider.[Am J Health-Syst Pharm 57(12):1131-1136, 2000. © 2000 ASHP, Inc.]
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Introduction
With the growing number of uninsured individuals in the United States -- approximately 43 million at present -- many patients are unable to purchase their prescription medications.[1-3] Medication assistance programs sponsored by pharmaceutical manufacturers are an avenue for indigent and uninsured patients to acquire prescription medications free or at reduced prices.
Through these programs, eligible patients receive needed prescription medications that may improve their treatment compliance, health, and quality of life. Medication assistance programs are promoted by pharmaceutical manufacturers as one of their philanthropic efforts.[4] The pharmaceutical industry has traditionally provided prescription medications at no charge to patients in need, and many companies have said that no patient in need of their medicines will do without them. In 1999 the Pharmaceutical Research and Manufacturers of America (PhRMA) reported that more than 2.7 million prescriptions costing over $500 million were filled through medication assistance programs for some 1.5 million patients.[4]
Pharmaceutical manufacturers offer three types of assistance programs to help indigent patients obtain medications or insurance coverage for medications.[5] Most programs provide free prescription medications to patients who meet specific financial criteria, such as not qualifying for third-party-payer assistance or having insufficient income or assets to afford medications, which are established by each company. Some programs help determine the scope of a patient's insurance coverage for medications, help identify billing problems, and attempt to resolve claim denials. A few programs offer payment limitation programs for expensive and long-term medications. In these cases, the pharmaceutical company has established an annual medication cost limit to the third-party payer or the individual, and all costs exceeding this predetermined limit are paid by the pharmaceutical company.
Medication assistance programs provide valuable options to both patients and health care providers. This report identifies resources available for use in enrolling patients in pharmaceutical companies' medication assistance programs, provides an overview of the enrollment process, and describes the pharmacist's role in obtaining medications for patients from these programs.Information Sources
Information about pharmaceutical company-sponsored medication assistance programs can be obtained directly from the companies and from Web sites, pharmacists, social workers, and other health care providers. Internet sites that have information about medication assistance programs include www.needymeds.com, www.themedicineprogram.com, www.familyvillage.wisc.edu, and www.phrma.org/patients. The www.needymeds.com site provides detailed information about each company's assistance program, including the company's name, the program's address, the telephone and fax numbers, guidelines and notes, the health care provider's role, the patient's role, information needed to initiate enrollment, information regarding the amount of medication and how it is dispensed, refill information, the estimated response time, and limitations of the program.[6] For a $5 processing fee for each medication requested, the www.themedicineprogram.com site will assist the patient in the enrollment process.[7] Patients without access to the Internet can contact a health care provider or a pharmaceutical company to receive information about medication assistance programs.
Another resource is the 1999-2000 Directory of Prescription Drug Patient Assistance Programs published by PhRMA. This directory, which is aimed at making the growing number of assistance programs easier to identify, lists 49 manufacturers' programs that provide medications to physicians whose patients could not otherwise afford them.[4] The only programs listed in the directory are those sponsored by pharmaceutical manufacturers that are members of PhRMA. The directory can be located on the Internet at www.phrma.org/patients or obtained by writing to PhRMA at 1100 15th Street, N.W., Washington, DC 20005.
Other sources include various medical references, such as Drug Facts and Comparisons and Physicians' Desk Reference, which contain telephone numbers of pharmaceutical manufacturers.[8,9] Medical professionals may call the pharmaceutical companies and inquire about assistance programs for a particular medication. Health care providers may also contact the local representative of a particular pharmaceutical company for information about assistance programs offered by that company.
Information Sources
Information about pharmaceutical company-sponsored medication assistance programs can be obtained directly from the companies and from Web sites, pharmacists, social workers, and other health care providers. Internet sites that have information about medication assistance programs include www.needymeds.com, www.themedicineprogram.com, www.familyvillage.wisc.edu, and www.phrma.org/patients. The www.needymeds.com site provides detailed information about each company's assistance program, including the company's name, the program's address, the telephone and fax numbers, guidelines and notes, the health care provider's role, the patient's role, information needed to initiate enrollment, information regarding the amount of medication and how it is dispensed, refill information, the estimated response time, and limitations of the program.[6] For a $5 processing fee for each medication requested, the www.themedicineprogram.com site will assist the patient in the enrollment process.[7] Patients without access to the Internet can contact a health care provider or a pharmaceutical company to receive information about medication assistance programs.
Another resource is the 1999-2000 Directory of Prescription Drug Patient Assistance Programs published by PhRMA. This directory, which is aimed at making the growing number of assistance programs easier to identify, lists 49 manufacturers' programs that provide medications to physicians whose patients could not otherwise afford them.[4] The only programs listed in the directory are those sponsored by pharmaceutical manufacturers that are members of PhRMA. The directory can be located on the Internet at www.phrma.org/patients or obtained by writing to PhRMA at 1100 15th Street, N.W., Washington, DC 20005.
Other sources include various medical references, such as Drug Facts and Comparisons and Physicians' Desk Reference, which contain telephone numbers of pharmaceutical manufacturers.[8,9] Medical professionals may call the pharmaceutical companies and inquire about assistance programs for a particular medication. Health care providers may also contact the local representative of a particular pharmaceutical company for information about assistance programs offered by that company.
Information Sources
Information about pharmaceutical company-sponsored medication assistance programs can be obtained directly from the companies and from Web sites, pharmacists, social workers, and other health care providers. Internet sites that have information about medication assistance programs include www.needymeds.com, www.themedicineprogram.com, www.familyvillage.wisc.edu, and www.phrma.org/patients. The www.needymeds.com site provides detailed information about each company's assistance program, including the company's name, the program's address, the telephone and fax numbers, guidelines and notes, the health care provider's role, the patient's role, information needed to initiate enrollment, information regarding the amount of medication and how it is dispensed, refill information, the estimated response time, and limitations of the program.[6] For a $5 processing fee for each medication requested, the www.themedicineprogram.com site will assist the patient in the enrollment process.[7] Patients without access to the Internet can contact a health care provider or a pharmaceutical company to receive information about medication assistance programs.
Another resource is the 1999-2000 Directory of Prescription Drug Patient Assistance Programs published by PhRMA. This directory, which is aimed at making the growing number of assistance programs easier to identify, lists 49 manufacturers' programs that provide medications to physicians whose patients could not otherwise afford them.[4] The only programs listed in the directory are those sponsored by pharmaceutical manufacturers that are members of PhRMA. The directory can be located on the Internet at www.phrma.org/patients or obtained by writing to PhRMA at 1100 15th Street, N.W., Washington, DC 20005.
Other sources include various medical references, such as Drug Facts and Comparisons and Physicians' Desk Reference, which contain telephone numbers of pharmaceutical manufacturers.[8,9] Medical professionals may call the pharmaceutical companies and inquire about assistance programs for a particular medication. Health care providers may also contact the local representative of a particular pharmaceutical company for information about assistance programs offered by that company.
Information Sources
Information about pharmaceutical company-sponsored medication assistance programs can be obtained directly from the companies and from Web sites, pharmacists, social workers, and other health care providers. Internet sites that have information about medication assistance programs include www.needymeds.com, www.themedicineprogram.com, www.familyvillage.wisc.edu, and www.phrma.org/patients. The www.needymeds.com site provides detailed information about each company's assistance program, including the company's name, the program's address, the telephone and fax numbers, guidelines and notes, the health care provider's role, the patient's role, information needed to initiate enrollment, information regarding the amount of medication and how it is dispensed, refill information, the estimated response time, and limitations of the program.[6] For a $5 processing fee for each medication requested, the www.themedicineprogram.com site will assist the patient in the enrollment process.[7] Patients without access to the Internet can contact a health care provider or a pharmaceutical company to receive information about medication assistance programs.
Another resource is the 1999-2000 Directory of Prescription Drug Patient Assistance Programs published by PhRMA. This directory, which is aimed at making the growing number of assistance programs easier to identify, lists 49 manufacturers' programs that provide medications to physicians whose patients could not otherwise afford them.[4] The only programs listed in the directory are those sponsored by pharmaceutical manufacturers that are members of PhRMA. The directory can be located on the Internet at www.phrma.org/patients or obtained by writing to PhRMA at 1100 15th Street, N.W., Washington, DC 20005.
Other sources include various medical references, such as Drug Facts and Comparisons and Physicians' Desk Reference, which contain telephone numbers of pharmaceutical manufacturers.[8,9] Medical professionals may call the pharmaceutical companies and inquire about assistance programs for a particular medication. Health care providers may also contact the local representative of a particular pharmaceutical company for information about assistance programs offered by that company.Enrollment in Programs
Medication assistance programs have varying eligibility criteria and requirements for enrollment. Some eligibility criteria are common to many programs and may include income limitations, limited or no prescription insurance coverage, and limited or no public assistance for medications (e.g., Medicaid, Department of Veterans Affairs assistance). Some programs require patients to pay a nominal fee or shipment charge once the patient has been accepted into the program. The fees are either predetermined or based on patient income information. However, a shipment charge, if required, is an established fee for all program participants, regardless of their income.
Physicians, patient advocates (e.g., pharmacists, social workers, and nurses), and patients all play an active role in the enrollment process for manufacturer-sponsored medication assistance programs. Patients and physicians are responsible for providing all requested information, which may differ among the various programs. Table 1 lists information commonly requested from both the health care provider and the patient for completing an application; however, other program-specific information may be required.
The application process is either provider initiated or patient initiated. Provider-initiated programs require a physician or patient advocate to contact the manufacturer assistance program office to request an application for patient enrollment or perform pre-enrollment procedures via telephone. Likewise, patient-initiated programs allow patients to pre-enroll via telephone or to request an enrollment application. Because applications may be medication specific, the patient or patient advocate may need to provide medication information to receive the appropriate application or program information. In lieu of an application, several assistance programs require the physician to submit a letter of need on office letter-head.
After a request for an application is made, the program mails or faxes an application to the physician's office for completion. Depending on the program, the application can be a booklet of applications, a single blank application, or a partially completed application containing patient-specific information obtained via telephone before enrollment. Some application forms may not be photocopied, depending on program specifications, and the use of a photocopy could result in a delay in patient enrollment. However, some programs permit application forms to be photocopied, thus preventing the provider from having to contact the program each time a patient requests enrollment.
Once the application is received, the physician and patient complete, sign, and mail the application back to the program office, which may have an address different from that of the pharmaceutical company's headquarters.
In addition to the application, some assistance programs require the physician to attach an original prescription. The completed application is reviewed, and eligibility is determined by the assistance program. If the patient is eligible for program participation, a supply of medication is delivered to the physician's office or the patient's home. The time required for medication delivery depends on the company involved, and other means of providing the medication to the patient may be necessary until delivery. Similarly, the amount of medication provided at one time varies among the assistance programs.
Some programs have a benefit card attached to the application that can be given to the patient to present at a pharmacy of his or her choice. A pharmacist enters the card number into the computer just like an insurance card number and dispenses the medication prescribed. The benefit card number is electronically transmitted to the pharmacy benefit management company, and the pharmacist immediately receives an acceptance or denial concerning the claim. If the claim is accepted, the pharmacy usually receives a reimbursement check in four to six weeks from the pharmacy benefit manager administering that company's program. If the patient becomes ineligible for participation at any time, the benefit card becomes invalid, resulting in a denial to the pharmacy transmitting a claim.
Patient enrollment approval is not indefinite. Although the financial status of some patients may remain the same, most programs require reapplication on a recurring basis (e.g., every three months or yearly).
The Pharmacist's Role
Because pharmacists are trained in pharmacotherapy and disease management, they can play a major role in initiating enrollment and obtaining medications for patients from medication assistance programs. Pharmacists can review patients' medications and make recommendations for therapeutic interchanges that are more accessible and effective. Pharmacists can also review payer information and the medical records of uninsured or indigent patients to assess whether they are eligible for participation. In addition, many programs require information from multiple health care personnel, and the pharmacist can serve as a liaison between the patient, the patient's physician, the social worker, or the reimbursement specialist and the program.
Pharmacists are often asked to contribute to budget reduction strategies and can identify medications having the greatest impact on the pharmacy budget and attempt to enroll eligible patients in medication assistance programs. Table 2 lists assistance programs available for selected medications that may have a substantial effect on a pharmacy budget. The medications listed in Table 2 cost $50 or more (based on 1999 average wholesale prices 10 ) for an average 30- day supply. Enrolling patients in programs for these and other high-cost drugs can result in institutional cost savings. In fact, effective use of medication assistance programs can substantially reduce an institution's pharmacy budget. Decane and Chapman [11] at the City of Hope National Medical Center estimated a net cost avoidance of $150,000 for more than 200 patients the first year; over 92% of the applications for medication assistance were approved by the pharmaceutical companies. The calculated acquisition cost of the medications received by the medical center was $448,851 in fiscal year 1992 and $504,211 in fiscal year 1993. [11] The savings of an indigent care program to the pharmacy of a psychiatric facility averaged $7146 per month during the first eight months of 1997 and exceeded the pharmacy's program personnel costs sixfold.[12] Therefore, these savings can justify the pharmacy personnel costs.
Program liabilities and risks
Pharmaceutical manufacturers are confronted with several risks when they decide to offer medication assistance programs. One substantial risk is the potential for diversion of medications. Health care professionals and patients may be tempted to sell medications acquired from assistance programs for profit or to distribute them to patients who would otherwise purchase their medications. These activities are prohibited.
Another big risk is the reporting of false information by patients. Most pharmaceutical manufacturers rigorously screen potential enrollees. Before the patient's application is approved, most programs screen patients' assets, including bank accounts, stock and real estate holdings, and retirement funds, to confirm that the patient has exhausted all other financial resources. However, some programs rely solely on the information reported on the application and do not further investigate the patient's financial status. It is essential for the health care provider to encourage patients to provide accurate and complete financial information to avoid enrollment delays and to ensure that only needy patients receive the benefits.
Drug diversion and the reporting of false information may lead pharmaceutical manufacturers to end medication assistance programs or create more stringent eligibility criteria and program guidelines. Therefore, health care providers involved in the administration of medication assistance programs should strive to ensure that patients report correct medical, medication, and other information requested by assistance programs. Only by monitoring reported patient information will health care workers be able to protect the reputation of the involved institution or medical practice and ensure that patients in need receive the appropriate assistance.
Conclusion
Many pharmaceutical companies have assistance programs that provide prescription medications to indigent or uninsured patients. Pharmacists can serve as a liaison between these programs and the patient or the health care provider.
References for:
Medication Assistance Reports Medication Assistance Programs For Uninsured and Indigent Patients
[Am J Health-Syst Pharm 57(12):1131-1136, 2000. © 2000 ASHP, Inc.]
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