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Assistance program helps patients access high-cost medications

Sep. 25, 2019, 3:39 PM


Pharmaceutical Services’ Pharmacy Patient Assistance Program helps patients who face financial barriers to access their medications.
Pharmaceutical Services’ Pharmacy Patient Assistance Program helps patients who face financial barriers to accessing their medications. (photo by Anne Rayner)

by Kelsey Herbers

Patients who face financial barriers to accessing their medications are provided financial support thanks to a medication assistance program offered through Vanderbilt University Medical Center’s Department of Pharmaceutical Services.

The Pharmacy Patient Assistance Program capitalizes on financial assistance offered by drug manufacturers for high-cost medications that patients may otherwise not be able to afford.

Many manufacturers will provide medications free of charge or offer to cover copays for patients who demonstrate financial need.

Patients are typically uninsured or underinsured, though guidelines for assistance vary across manufacturers. Programs may also assist Medicare Part D patients when they reach the doughnut hole in their coverage — the point where the patient has surpassed their initial coverage limit but has not yet reached the catastrophic coverage level.

The Pharmacy Patient Assistance Program, which consists of a dedicated team of pharmacy staff, finds opportunities for which patients may be eligible and applies for assistance on their behalf, completing all necessary paperwork.

Since the program’s launch in 2010, the team has saved patients millions of dollars, with cost savings for the last year alone estimated at greater than $5.6 million.

“We determined the need for this type of program several years ago when we calculated that on average, 89 times per day, patients at our retail pharmacies were telling us, ‘I can’t afford this medication,’” said Andrea Bryant, PharmD, executive director of Business Operations for VUMC’s pharmacy department. “Our pharmacy technicians didn’t know what to do or how to help, so they’d try to track down a social worker. At the same time, they’d have a line of patients waiting to be helped. There was no structure in place for getting patients the assistance they needed.”

Prior to the program’s launch, patients would return to the clinic for a follow-up visit without having filled the prescription from their previous appointment, often delaying their treatment by several weeks. By linking patients with assistance, the program reduces physician and nurse workload while speeding the time it takes for patients to receive their medications and begin treatment.

“Most clinics don’t have time to go back and forth with manufacturers to find out what options a patient may have. Also, physicians may not be aware they can contact the insurance to request a drug be moved to a different coverage class in order to make it more affordable for the patient,” said Phillip McCreary, PharmD, director of VUMC’s medication access programs.

“Pharmacy technicians know the ins and outs of benefits and have access to tools that can help them determine whether a patient will be eligible for support based on their insurance provider or specific need. They may also be aware of savings opportunities that aren’t advertised.”

Once a patient qualifies for assistance, VUMC’s pharmacy services will mail the prescription and any refills to the patient, reducing other barriers — such as transportation to a pharmacy — that may restrict access. Assistance can last up to one year, depending on the program, and is re-evaluated to ensure continued need. Since Jan. 1, 757 new patients have been enrolled.

Treatments commonly covered by the program include HIV drugs, diabetic insulin, asthma inhalers and certain high-cost cancer medications. Patients who can’t afford these medications often cut the dosage in half, take the medication sporadically or avoid taking it altogether, all of which may drastically impact health outcomes.

The pharmacy also provides assistance to VUMC’s Homeless Health Services program, which offers acute treatments for patients on the street. Fourth-year pharmacy students sometimes join the program’s weekly outreach to learn about barriers patients face when accessing medications.

“We try to show our pharmacy students that pharmacy isn’t just standing behind a counter in a drug store, and that not everyone has an insurance card to pay for their medications,” said McCreary.

“Patients may face unique challenges. They may be prescribed insulin but have no way to properly store it. It’s good for students to see the various needs in the community so they can better understand how to address them.”

The Pharmacy Patient Assistance Program is part of a larger effort across the region through the Safety Net Consortium of Middle Tennessee, which regularly discusses pharmacy needs for the uninsured. Vanderbilt receives no financial benefit from the assistance program.

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