Healthy Skepticism Library item: 7742

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Journal Article

Rosier RA, Phillips RE, Elam JW.
Medication assistance outpatient program; providing access to free or low cost pharmaceuticals.
ASHP Midyear Clinical Meeting 2002;

Abstract:

Outpatient medication costs hinder patients’ ability to be compliant with their drug regimen. Our program provides indigent patients with no-cost or low-cost name brand maintenance medications to facilitate drug compliance. Our healthcare system obtained grants to fund personnel and supply costs to develop the 356-MEDS program. The 356-MEDS personnel perform an assessment of financial need for indigent patients. Patients whose eligibility and income guidelines meet the manufacturer’s patient assistance requirements may apply to the program. Our program will seek to obtain a maximum of 5 non-controlled brand name medications per patient. If patients are eligible for Medicaid programs, referrals are made. Based on financial and household information obtained in the assessment, 356-MEDS researches reimbursement possibilities, requests forms, assists the patient and physician in completion of the forms, and mails the forms to drug manufacturers. Once approved, the pharmaceutical company sends a free three-month supply of medication either directly to the patient or to the physician’s office for patient pickup. In 2001, 235 patients received $100,504 of free medication. Seventy four applicants were referred to the Medicaid program for enrollment, which saved the healthcare organization an estimated $454,138, assuming the prior “self-pay” status would have yielded no reimbursement to the healthcare system. Estimates are based on $6,137/patient, the yearly average paid by Medicaid to healthcare organizations as determined by CMS. A no-cost program to our healthcare organization has yielded significant community health benefits as well as shifted self-pay patients to the Medicaid program to improve revenue for our organization. Learning Objectives: 1. An outpatient medication assistance program improves community health and hospital reimbursement. 2. Marketing approaches to inform the public, providers, and the community at large regarding an outpatient medication assistance program. 3. Understanding the process of obtaining outpatient medication assistance. Self-assessment questions: T/F 1. Medicare provides outpatient medications for its recipients. 2. Anyone can qualify for free medications provided by the drug manufacturer. 3. Nearly 90% of our referrals/applicants on Medicare qualify for free medications through the patient assistance programs provided by the 356-MEDS program. Answers 1. False. Medicare part A and B only pays for medications administered on an inpatient basis. A real and impending need exists to provide medications to the Medicare outpatient population. 2. False. Only patients who can show financial need based on the manufacturer’s income guidelines can qualify for the various patient assistance programs. 3. True. Medicare A/B is not a form of outpatient prescription coverage. Most patients would then qualify for free manufacturer’s medications.