Creating a Viable Prescription Assistance Program to Improve Patient Satisfaction & Reduce Uncompensated and Charity Care Costs Prescription assistance Presenter Chastity Werner, CEO|President cwerner@npc-meds.com
• Our current state • The why? Learning • Identifying patients in need? Objectives • Creating a medication assistance program • Identifying results
Where do patients go when they cannot afford their medications? ED & Readmissions Uncompensated & Charity Care Costs
Patients are faced with daily difficult choices, such as paying for their electricity, food or their healthcare. or their healthcare.
Behavioral vs. cost-related nonadherence (CRN) How is your organization tracking medication adherence?
The cost to stay alive • 1 in 3 chronically ill adults report that they are unable to afford food, medication or both, and CRN is more common among those with food insecurity. • It was found that half of adults with diabetes perceived financial stress, and one-fifth reported financial insecurity with healthcare and food insecurity. • Fewer than half of patients with diabetes report discussing the cost of medications with their physicians, although over 75% express that such communications were important. Source: Social determinants of health, cost-related non-adherence, and cost-reducing behaviors among adults with diabetes: findings from the National Health Interview Survey (HHS Public Access)
Did you know? • 60% of Americans live with a chronic condition • 40% have two or more • 70% of Americans are on at least 1 prescription • More than ½ are on two • 20% are on 5 or more
The why Uninsured & Organizations 2.1 Billion Rx 68% 72% Post- Underinsured lack resources are NEVER Readmissions Discharge & access to FILLED - avoidable adverse High out-of- solutions adverse events are pocket events related related to expenses to medication medication non- adherence adherence
Lack of Resources & & Access to Solutions
Case Study • 70% reported difficulty paying for medicine • 45% reported at least one form of cost-related nonadherence • 40% engaged in more than one cost-related nonadherence practice • 37.5% Skipped doses • 12.5% Took less medication than prescribed • 42.5% Delayed medication refills due to cost • “Sometimes I cannot pick up from the pharmacy on time because I don’t have money” • Only 25% of these patients had a conversation with their providers Source: Identifying and Understanding Barriers and Facilitators to Medication Adherence Among Marshallese Adults in Arkansas. (Journal of Pharmacy Technology 2018)
Case Study • Over half the patients who experienced CRN had not asked healthcare providers for help in reducing their costs. • Patients may be embarrassed to tell their physicians when they cannot afford their medications or believe that it is not the doctor’s job to deal with cost issues. • Physicians tend to lack knowledge about drug costs and may not be adequately trained to inquire about a patient’s financial situation. Source: A Pilot Study on Cost-Related Medication Nonadherence in Ontario
The cost to stay alive • Cost Related Medication Underuse (CRMU) (also referred to a Cost Related Nonadherence-CRN) • Circumstance that arise when a patient takes less medication than prescribed or does not take it at all due to cost. • This includes behaviors such as: • Reducing dosage • Skipping dosage • Delaying dosage • Sharing medications • Reducing the cost barrier would lead to better chronic disease management, reduced incidence of hospitalization, and reduced healthcare costs in the long term. 3 Source: Cost-related medication underuse: Strategies to improve medication adherence at care transition (Am J Health Syst Phar 2019)
The why • It is estimated that $100 to $300 billion of annual avoidable health care costs are attributed to medication nonadherence in the US. • Accounting for three to 13 percent of overall healthcare spending. • The costs of prescription drugs in the US are among the highest in the world and continue to rise – there is no regulatory body that controls pharmaceutical rate hikes.
How does your organization identify if your patients can afford the medications that have been prescribed?
The why • Lack of insurance and high out-of-pocket costs • Organizations have lack of resources and access to solutions • Per Kaiser Family Foundation when the uninsured are diagnosed with an illness, they are more likely to forego healthcare services including medications. • Not take the medication as prescribed • Skip doses • Share prescriptions • Cut medications in half • 30 million uninsured (Before Pandemic)
Impacts of COVID19 • Loss of employment = loss of insurance • Cobra Insurance • Hospitality workers, Self Employed, & Others = $0 Income • Average American household has $1,000 savings • Elderly instructed to stay home – many are technically challenged. • Before the outbreak it was estimated that 1-in-3 were impacted by Cost-Related Medication Nonadherence (CRMN) • 30 Over million uninsured
Uninsured as of May 2020 <10% 10-12% 13-14% 15-19% 20%+
Approximate increase in uninsured adults above 2018 levels Michigan - 46% In May, the Census Bureau Iowa - 29% estimated that 26 million families Minnesota - 28% did not have enough food to eat, Illinois - 23% and 38 million adults had little or Wisconsin - 22% no confidence in their ability to Ohio - 21% pay the next month’s mortgage or Kansas - 20% rent. Missouri - 19%
COVID-19 CRN preparedness We are focused on treating and preventing COVID-19 cases, but are we thinking about what we should be doing now to prevent negative quality and financial tertiary impacts of COVID-19? • Medication adherence struggles will only be exasperated by the COVID-19 pandemic (primarily driven by ability to afford meds). • The Annals of Internal Medicine estimates that a lack of adherence causes nearly 125,000 deaths and is associated with 10% of hospitalizations. 4 • 3 months from now, will your patients prioritize paying for: • A medication necessary to manage their chronic disease? • Living expenses and debts (credit cards) incurred during their furlough? • A hospital bill?
What is your ROI? $600 x 12 months = $7,200 $100 copayment assistance card = $100 they could pay your organization 1 less ED visit or Readmission saves your organization?
Case study • $650,000 per 1,000 patients ($250,000 cost) • 3:1 ROI • Inpatient utilization decreased by 50% • ED utilization decreased by 35% • Cost per case decreased by 40% • Cost per case decreased by 15% Reduction in year-over- year “high utilizers” 66-80% decrease in number of high utilizers after Year 1 Additional 50-75% decrease between Year 1 & 2 https://www.dispensaryofhope.org/
Does your organization do meds to beds? opportunities • Increasingly, health systems are providing discharge medications at low or no cost to decrease 30-day readmission rates. Due to potential limitations, medication adherence requires a reliable, chronic supply of medications. • Available programs: • 340B • Traditional PAPs (Patient Assistance Programs) • Co-Pay Assistance Cards • Investigate generic options • Educate the patient on shopping for the best price
Creating a medication assistance program Identify if the process will be outsourced or facilitated internally • Identify stakeholders • Create a process • Pharmacy • Facilitate internal meetings to • Case Management explain the why • Care Coordinators • Ask their experiences • Nursing staff • How often do we have patients that • Providers express they are having difficulty • Clinical teams paying for their medications? • Financial Assitance • Do we see patients skipping doses • Medicaid Eligibility or not getting their scripts consistently filled? • Create a committee to build the infrastructure • Market internally • Who is going to be responsible? • Share results with your team – • Software or spreadsheets? make them proud! • Market externally • Identify and create processes for each • Press releases program • Commercials
Obstacles • Identifying patients • Lack of cost knowledge at the time or prescribing • Lack of internal communication and tracking • Obtaining patient financial records • Patient Unresponsiveness
Pharmacists & medication assistance programs Pharmacists are often the first ears to hear "My medication is too expensive" or "I can't afford that". Besides Care Management/Care Coordination, Pharmacists are also often the first individuals to help patients navigate to lower-cost options such as medication assistance programs, prescription alternatives, community resources, and financial counseling. • Do you know what the Pharmacists who work with your patients rely on to provide lower cost options? • Do Pharmacists you partner with offer Medication Assistance solutions to your patients?
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