Drug Cost Assistance- CIPA WNY IPA, Inc.

CIPA Pharmacy Program Information

How to Help Your Patients Afford Their Medications:

And Resources to Do So

T or F? Only very low income patients can get extra help to obtain their medications?

T or F? Medicare D is all the extra help seniors can get?

Both are false. An increasing base of patients is having difficulty affording their medication for numerous reasons. Ranging from inability to afford premiums altogether (uninsured), ever increasing co-pays, misunderstanding insurance coverage, chronic or serious conditions requiring multiple medicines and/or very expensive medications and dare I say, “gas prices”. The obvious predicament is, “If a patient cannot afford the treatment prescribed, ALL the effort, labs, and time spent with the patient is essentially pointless”. Thankfully, there is an accumulating base of programs designed to assist patients having trouble obtaining their medications, helping to fill some gaps in care.

Goals of This Document:

· Introduce approach to designing a system in your practice that gets this information to patients in need

· Introduce the various drug cost assistance programs available

· Provide resources to enable you and your staff to provide patient drug cost assistance

· Set the stage for incorporation of resources and “How-to’s” into Pharmacy Section of CIPA’s web page

Range of Programs Available:

Abbott Diabetes Careà Xubex Discount Pharmacy Servicesà‘$4-generic’ type programsà

Co-pay assistance programsà Sleep apnea supplies for uninsured

· There is wide variation in how each program functions compared to the others. However, building an office based drug cost assistance program IS possible and would certainly benefit your patients.

· Perhaps consider the program like you would a specialist. In other words, just as you’d refer a patient with HIV to see a specialist, a patient who can’t afford their medications is in special need of extra care, or your referral to a ‘specialist’. Either way time and paperwork is involved.

PLEASE NOTE: In seeking cost savings for patient, attempt to obtain all necessary medications from a single location, or as few as possible, to ensure the pharmacist filling the prescription has ALL relevant medical records (to prevent drug interactions, etc.). Alternatively, ensure or enable the patient to carry an UPDATED and COMPLETE list of their medications and relevant medical conditions and provides this information to the pharmacist.

To get started, a few things to consider in your practice:

· For visit check-in utilize a visit checklist (if not already doing so) and add a check off question that will help indicate if patient is having trouble affording their medications (or broaden it by wording as having any difficulty obtaining their medications – cost, insurance, pharmacy issues)

o This process would also afford a quick measure of compliance at the same time

· Recruiting a Volunteer Patient Advocate (VPA) (other practices around the country have successfully done so)

o ~8hrs a week of dedicated time at your office

o This volunteer would work with Care Coordinators and Pharm.D. to assist MD and patient in identifying drug cost assistance programs, applying and finally obtaining medications

· If choosing to start a Drug Cost Assistance program within your practice, start small

o Develop a Drug Cost Assistance Program Formulary

§ i.e., identify meds you use most that are brand only (Byetta, Actos, etc)

§ Allow staff to become familiar with specific drugs chosen and their program process, then build onto formulary over time as appropriate

· Identify meds that you’re having the most trouble obtaining via insurances, contact drug company representatives and have them do in-service or dinner teaching your staff how to go about obtaining prior auth, etc.

o If given a list of drugs, Pharm.D. could arrange in-service with drug companies and staff

· Adopt, or develop a ‘Patient Assistance Contract’ (example attached)

· Use drug samples as a last resort; avoid having to rely on these for patients month-to-month

· Last but certainly not least, monitor your prescribing habits.

o Look to Pharmacy Drug Class Reviews (monthly) or other preferred source to evaluate differences among members of the same class of medicine, etc.

o Participate in CIPA programs

Common Things You Will Need From/For Each Patient (Pharm.D. will develop form that can be utilized, to be posted on CIPA website, pharmacy section)
Patient Demographics	Rx Specifics	Prescriber Specifics	Signed Patient Assistance Contract
· Name, Address, Phone · SSN · DOB · Diagnosis · Citizenship/Residency · Proof of Income · Application’s consent forms · Medicaid or Insurance Denial letters · Signature	· Drug Name · Drug Strength · Drug Directions · Drug Qty/month	· License # · Degree · Phone, Address · Signature	· Use form from AAFP · Or develop your own

General Program Descriptions

Assistance Program Databases

These databases should be the basis of your program. Typically they allow a comprehensive, searchable database that allows you to search by company, brand name, generic name or therapeutic drug class.

In other words, if you have a patient who can’t afford Januvia®, and you feel an alternative is not sufficient, simply type in the drug name in the search field and numerous programs for assistance in obtaining Januvia® will load. All contact information and general program specifics is provided as well. From there it’s a matter of paperwork (remember – Volunteer Patient Advocate) and whether or not the patient qualifies. These sites also contain some general forms, example letters, example appeal letters, etc.

· RxAssist (www.rxassist.org)

· NeedyMeds (www.needymeds.com)

· Partnership for Prescription Assistance – PPA (www.pparx.org)

· Pharmaceutical Research and Manufacturers of America (www.PhRMA.org)

· RxHope (www.RxHope.com)

· Volunteers in Health Care (www.volunteersinhealthcare.org)

Patient Assistance Programs (PAPs)

Persons in Family Unit	100% FPL	200% FPL
1	$10,400	$20,800
2	$14,000	$28,000
3	$17,600	$35,200
4	$21,200	$42,400
5	$24,800	$49,600
6	$28,400	$56,800
7	$32,000	$64,000
8	$35,600	$71,200
Each Addtnl	$3,600	$7,200

Most companies have one or more PAP(s). Although eligibility requirements vary by company, most require that patients: be US citizens or legal residents, have a household income under 200% of the Federal Poverty Level (FPL) and have prescription coverage.

Patient assistance programs (PAPs) are programs set up by drug companies that offer free or low cost drugs to individuals who are unable to pay for their medication. These programs may also be called indigent drug programs, charitable drug programs or medication assistance programs. Most of the best known and most prescribed drugs can be found in these programs. All of the major drug companies have patient assistance programs, although every company has different eligibility and application requirements.

The Drug companies offer these programs voluntarily; the government does not require them to provide free medicine.

For PAPs be sure to:

· Fill out every part of application

· Include all required documents with the application

· Sign wherever required

· Copy the entire application

· Follow up w/phone call in 2-3wksàwhere application is in the process (again, remember VPA!)

· Submit an appeal letter if needed if you think patient has compelling case

· Detail the individuals financial and medical situation in the letter and address it to program supervisor

(Generic Drug) Patient Assistance Programs

Rx Outreach and Xubex have patient assistance programs comprising of generic medications. These programs differ from all other patient assistance programs in that they are not offered by the pharmaceutical manufacturer of the drug. Programs include several different generic drugs (~250 to ~360) which are purchased by the company and then made available for a fee to low income individuals.

The income levels are more lenient than most PAPs with Rx Outreach at up to 300% of Federal Poverty Level and Xubex at up to 240% of FPL. These programs also do NOT restrict for age or use of another cost saving program or insurance. Cost of medication ranges from $20 to $40 per 90day supply, (for Rx Outreach - regardless of number of pills required).

NOTE: Many of the Retail Pharmacies now offer certain generic medications for around $10 to $15 per 90day supply, regardless of income level but with restrictions on number of pills required.

· Rx Outreach (www.rxoutreach.com)

· Xubex (www.xubex.com)

Discount Pharmacy or Pharmacy Services (i.e. $4 generic type)

Many retail pharmacies are now offering discounted prices on select lists of generic drugs. Some offer discounts on brand name medications as well. Most do not require an enrollment fee, restrict age or income. However, typically do require Rx to be filled in the retail store (i.e., not by mail order). Comparison chart below:

Company & Link to site

Mail order or In store?

$5/30day, $10 or $15/90day

$20/individual, $35/family

Does not have a similar plan, however will price match any pharmacy within 4 miles

BJs Wholesale Club Pharmacy, Rite-Aid, and CVS do not offer $4 generic type, other discounts available.

*(not accounting for multiple strengths);

**despite Qty limits most of these pharmacies pro-rate price based on discount when qty exceeded.

Drug Discount Cards and Manufacturer Discount Cards

These are discount cards offered by for profit or nonprofit entities or pharmaceutical manufacturers which have made arrangements with pharmacies to discount certain drugs. Cards other than those offered by the pharmaceutical manufacturer may have an annual (between $30 and $60 for families) or monthly fee (from $4.75 to $7.95 per month).

Together RxAccess (www.togetherrxaccess.com)

· This card is sponsored by 12 pharmaceutical manufacturers. It is free and offers a 25%-40% discount on 300+ brand-name and generic prescription drugs as well as other prescription products, such as glucose test strips.

· To apply the patient:

o Cannot be eligible for Medicare

o Cannot have prescription drug coverage (public or private)

o Must have a household income equal to or less than $30,000 for one person, $40,000 for a family of two, $50,000 for a family of three, $60,000 for a family of four or $70,000 for a family of five and

o Must be a legal US resident

Merck's Prescription Discount Program (Merck Assistance Website)
This card offers 15% to 40% discount on selected Merck medicines to individuals without prescription coverage. Enrollment is free, but you must be a legal U.S. resident to be eligible.

· This program does NOT have age or income limitations

Pfizer Helpful Answers™ (www.pfizerhelpfulanswers.com)

Pfizer Helpful Answers is a family of programs that helps people without prescription coverage save on many Pfizer medicines, no matter their age or income. People with limited incomes might even qualify to get their Pfizer medicines for free.

NOTE:Lower income individuals who have insurance coverage for prescription medicines – such as Medicare, Medicaid or other private insurance – may still be eligible for assistance for their Pfizer medicines if they are experiencing significant financial or medical hardship.

GlaxoSmithKline (Savings Programs Website)

This site covers Medicare D aspects, Partnership for Prescription Assistance, Together RxAccess, GSK Access, Bridges to Access, Commitment to Access, and GSK coupons and other offers.

If an individual has a specific disease or chronic condition, it is always a good idea to check out the local chapter of the national non-profit organization representing that condition. Local chapters may have specific programs or funds available to assist with treatment, supplies, etc. The following national organizations either provide financial assistance to patients or have local chapters that may do so.

T or F? Those with private insurance are unlikely to have problems affording their medications?

In a striking finding, (a) survey said although those without insurance were more likely to report going without care, those WITH INSURANCE had a greater percentage increase in unmet medical needs.

Details on Program

Caring Voice Coalition

Current programs include: Insurance Reimbursement and Advocacy, Vital Relief (need based financial assistance limited to certain disorders or medical conditions), Compassionate Care (counseling and counseling referrals) and Public Advocacy.

The Chronic Disease Fund

Its focus is to provide assistance to those under-insured patients who are diagnosed with chronic or life altering diseases that require the use of expensive, specialty therapeutics.

The HealthWell Foundation

A non-profit organization established to address the needs of individuals who cannot afford their insurance copayments, premiums, coinsurance, or other out-of-pocket health care costs.

The National Marrow Patient Assistance Program and Financial Assistance Fund

The Marrow Foundation is the fund-raising partner of the National Marrow Donor Program (NMDP). Funds from this program help patients pay for searching the National Marrow Donor Program (NMDP) Registry and/or some post-transplant costs.

The Patient Access Network Foundation

A non-profit organization dedicated to supporting the needs of patients that cannot access the treatments they need due to out-of-pocket health care costs.

The Patient Advocate Foundation

A national non-profit organization that seeks to safeguard patients through effective mediation assuring access to care, maintenance of employment and preservation of their financial stability. The Patient Advocate Foundation's Co-Pay Relief (CPR) Program provides direct co-payment assistance for pharmaceutical products to insuredAmericans who financially and medically qualify. The Program offers personal service to all patients through the use of CPR call counselors.

Patient Services Incorporated

A non-profit organization primarily dedicated to subsidizing the high cost of health insurance premiums and pharmacy co-payments for persons with specific chronic illnesses and rare disorders. PSI is committed to assisting persons with chronic medical illnesses in accessing health insurance and pharmacy co-payment assistance. Families requiring assistance in maintaining the high cost of their health insurance premiums or co-payments are offered assistance based upon the severity of medical and financial need. PSI offers a "safety net" for persons who have expensive chronic illnesses and for those persons who "fall through the financial assistance cracks.

Low Cost Diabetic and Other Medical Supplies

Assistance is available for diabetic supplies, as well as other supplies and medical equipment such as braces, prosthetic devices, assistive technology, colostomy supplies, eyeglasses, hearing aids, oxygen, and sleep apnea.

Abbott Diabetes Care Patient Assistance Program (Abbott Diabetes Care Application)

This program is designed to assist financially disadvantaged individuals who meet certain income criteria.

IPump.org, Inc. (www.ipump.org)

This organization offers limited reimbursement for diabetes medications, supplies, and insulin to persons who qualify under their "ERMA" (Emergency Request for Medical Assistance) program. They also offer limited monthly financial assistance to qualifying persons to help cover the cost of insulin, diabetes medications and supplies.

Islets of Hope (Islets of Hope Website)

This organization lists comprehensive assistance programs by state, as well as international resources for other countries. It includes private, corporate, and government programs.

Braces and prosthetic devices

· Limbs for Life at www.limbsforlife.org or 1-888-235-5462

· The Barr Foundation Amputee Assistance Fundat http://www.oandp.com/resources/organizations/barr/index2.htmor 561-394-6514

· Local Independent Living Resource Centers; find at www.virtualcil.net/cils/

· Other local service based charities, such as United Way, Catholic Charities, Jewish Family and Children’s Services, Lutheran Social Services, etc.

Colostomy Supplies

These organizations may be able to put you in touch with local suppliers who might be willing to donate supplies.

· Convatec at 1-800-422-8811 or Hollister Company at 1-800-323-4060. These companies may help on a case by case basis.

· United Ostomy Association of America at www.uoaa.org

· American Cancer Society at www.cancer.org

Eyeglasses (for uninsured)

· New Eyes for the Needy at www.neweyesfortheneedy.org/us/us.html

· For uninsured children, contact Sight for Students at http://www.sightforstudents.org/

Hearing Aids (for uninsured)

· Local Independent Living Resource Centers; find at www.virtualcil.net/cils/

· Local Lions clubs; find at www.lionsclubs.org/EN/index.shtml#

Oxygen Supplies (for uninsured)

· American Lung Associationat www.lungusa.org or 1-800-LUNGUSA

· Local suppliers of durable medical equipment who might be willing to provide donated or reduced cost oxygen.

Sleep Apnea Supplies (for uninsured)

· American Sleep Apnea Association at www.sleepapnea.org or 202-293-3650

· Local support groups may have programs that can offer assistance.

· Local sleep clinics, pulmonology practices, pharmacies that sell medical equipment or medical equipment suppliers. These entities might donate new or used equipment (e.g., from a patient who has upgraded.) (Cpap Express, etc)

Medicare Part D Resources

Local Independent Health Medicare Information Centers (IHA website)

Medicare Information Center in Cheektowaga, located in the Valu Plaza at Dick Rd. and George Urban Blvd.

Seating is limited for all programs. For dates and times or to make a reservation, please call (716) 635-4900 or 1-800-958-4405. TDD users may call (716) 635-4840.

Drug Cost Assistance

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