Medical Assistance Program Research Articles

Diabetes Care in Community Health Centers: A Focus on Health Resources and Services Administration-Funded Clinical Pharmacy Demonstration Projects

Millions of Americans have limited access to health care and are ethnically diverse and medically underserved. Many of these patients are seen in community health centers (CHCs). These centers are federally supported clinics that provide primary care services for > 11 million underserved patients.1 CHCs were established in 1965 under the Public Health Services Act, through a federal grant program. CHCs serve patients who are uninsured, underinsured, or have a very low income. Many of these patients are at great risk for safety because of cultural or language barriers. Starting in 2000, the Health Resources and Services Administration (HRSA) of the Department of Health and Human Services awarded clinical pharmacy demonstration grants to 18 CHC networks. The purpose of these grants was to demonstrate that access to medications and comprehensive pharmacy services results in an improvement in the health status of patients by either starting pharmacies to provide affordable medications through 340B Drug Pricing Programs2 or expanding medication assistance programs (MAPs) by pharmaceutical manufacturers. Another goal was to determine the impact of pharmacists on diabetes and its comorbidities in these settings. In many cases, CHC patients were provided access to pharmacist care for the first time. These networks were composed of HRSA-funded health centers, a college of pharmacy, and sometimes other organizations. Mathematica Policy Research, provided the overall evaluation of these grants and prepared a report to the HRSA.3 Mathematica highlighted five of the clinical pharmacy demonstration projects (CPDPs) in their report. Each CHC project was unique, but all provided certain components of disease management, expanded patient access to medications, medication formulary activities, and training of pharmacy students or residents. The highlighted projects had at least three characteristics in common: positive diabetes disease management clinical data, a large number of patients given pharmacist-provided care, and good retention …

Kidney Function and Use of Recommended Medications after Myocardial Infarction in Elderly Patients

Several studies have found reduced use of recommended medications after myocardial infarction (MI) in patients with impaired kidney function. However, the reasons for such undertreatment are not well understood. A total of 1380 Medicare patients who survived at least 90 d after MI and had prescription drug coverage through Pennsylvania's medication assistance program for the elderly were studied. Filled prescriptions were used to assess use of angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), beta blockers, and statins within 90 d of MI. Patients' demographics, comorbidities, and health care utilization before MI also were ascertained. We used logistic regression to test the association between kidney function and postdischarge use of each medication. Overall, 619 (45%) patients filled a prescription for a beta blocker, 675 (49%) received an ACEI or ARB, and 406 (29%) received a statin after discharge but within 90 d after their admission for MI. Reduced kidney function was associated with both lower beta blocker and statin use (P = 0.01 and P = 0.002, respectively), but after multivariate adjustment, these associations disappeared (P = 0.23 and P = 0.62, respectively). Use of ACEI or ARB was nearly half in patients with estimated GFR <30 ml/min compared with patients with better kidney function in univariate and multivariate analyses (P < 0.001). Analyses using serum creatinine measurements rather than estimations of GFR yielded similar results. Differences in other characteristics such as age, rather than kidney function, may be responsible for much or all the reported reduction in use of preventive medications after MI seen in patients with chronic kidney disease.

Constrained least squares estimation of payment lag distributions in the United States' Medical Assistance Program

Constrained least squares estimation of payment lag distributions in the United States' Medical Assistance Program

Program to Support Safe Administration of Oral Chemotherapy

Program to Support Safe Administration of Oral Chemotherapy

Program to Support Safe Administration of Oral Chemotherapy

Program to Support Safe Administration of Oral Chemotherapy

Policy context of the poor progress of the pro-poor policy: A case study on the Medical-Aid policy during Kim Dae-jung's Government (1998–2002) in the Republic of Korea

Why did not the Medical-Aid 1 1 Medical-Aid is a public medical assistance program for the poor, similar to Medicaid in the United States. policy for the poor progress as expected during Kim Dae-jung's government in the Republic of Korea, despite his pro-egalitarian position and his campaign pledge to expand welfare benefits? To answer this question, Korea's history was briefly reviewed and summarized in this paper to describe “a triple burden”. The study presents three major characteristics of the policy context that acted as barriers to progress of the Medical-Aid policy: the overflowing ideologies against the pro-poor policy, the governance crisis, and the immaturity of the civil society. The paper argues that any discussion about the health policy processes and consequences must stem from a clear understanding of the policy context. The future of pro-poor policies in Korea, such as Medical-Aid, will greatly depend on how Korean society overcomes these contextual barriers. The observed characteristics of the context surrounding the Medical-Aid policy can also help us understand, in part, the dynamics of other recently introduced health policies in South Korea. Moreover, other countries that share a similar historical background and policy context with South Korea can learn valuable lessons from Korea's experience.

Social Security Meets Race

P resident Bush has appealed to African-American voters by arguing that they would benefit from the replacement of part of the traditional Social Security retirement income system with private retirement accounts. The argument goes like this: The average 50-year-old African American has a life expectancy of 27.3 years, as compared to an average of 30.5 years for Caucasians. This means that African Americans receive retirement benefits for fewer years and are more likely to die before receiving any benefits at all. In a system of private retirement accounts, African Americans could bequeath their accounts to their heirs, thereby closing some of the “black-white” wealth gap and ensuring that blacks no longer get a bad deal from Social Security. There are good reasons for introducing private retirement accounts, such as increasing national savings and improving labor supply incentives. But achieving racial parity in Social Security benefits is not one of them. Blacks benefit disproportionately from other features of Social Security. Because they have below-average lifetime earnings, they are helped by the Social Security benefit formula that replaces a larger fraction of pre-retirement earnings for low earners than for high earners. For the retirement portion of Social Security, these two effects almost exactly cancel, meaning that blacks receive rates of return on their Social Security payroll tax payments at least equal to those for whites. When benefits for disability and young survivors are included, blacks clearly receive an above-average return from the current Social Security system. Because Social Security benefits are protected from inflation and last as long as you live, they are especially valuable to low-income groups that count on them for a large portion of retirement income. Thus, changing Social Security may in fact harm, rather than help, blacks. ![Figure][1] CREDIT: J. SCOTT APPLEWHITE/AP It is hard to judge how different racial and ethnic groups would fare under an approach that has not yet been fully defined, but there are reasons for worry. First, the president proposes to divert payroll tax revenue away from the current system. That raises the chance that disability and survivor benefits will be cut, disproportionately affecting blacks. Second, there might not be any redistribution from high earners to low earners in the privatized portion of the reformed system, meaning that gains to blacks from the bequeathability of accounts will be at least partially offset. Third, any sensible privatization plan will require retirees to convert their account balance into annuities upon retirement; because members of long-lived groups will receive annuity payments for more years, there will continue to be redistribution from groups with low life expectancy to groups with high life expectancy. Fourth, the introduction of market risk into Social Security will be more of a burden for low-income groups such as blacks. One could design a system with privatized accounts in which blacks do fine: by maintaining disability benefit levels, enhancing redistribution from high earners to low earners, and requiring that annuities provide payments to the retired worker or his or her heirs for a minimum of 10 years. Blacks could indeed be winners from such a reform. But these features are unrelated to privatization; all could be accomplished within the traditional Social Security system. If the real objective is to help demographic groups with short life expectancy, tinkering with Social Security rules may not be the best approach. Instead, investing in the health of low-income populations with early mortality could produce greater benefits in the short run and help to close the longevity gap in the long run. Under the present system, if black and white longevities were equal, blacks would receive about $4 billion of additional Social Security benefits per year. That's less than 2% of spending on Medicaid, the nation's medical assistance program for low-income individuals. Even if that sum were sensibly invested in expanding access to health care, improving community health centers, increasing research expenditures on racial differences in disease, and so on, it is doubtful whether longevity differences could be eliminated. That's because the differences are large, and the things that are likely to have the biggest impact—changing diet and exercise habits—are hard to alter with government policy. Thus, investing in the health of low-income populations may well be the best way to spend money on behalf of groups with short life spans. But we should not kid ourselves into believing that investments of this size will erase racial differences in health outcomes. And the president should not kid African Americans that Social Security privatization will make them richer. [1]: pending:yes

Cost-Effectiveness of Reducing Heart Failure Hospitalizations through Use of a Medication Assistance Program and Intensive Patient Education in Rural Eastern North Carolina

Cost-Effectiveness of Reducing Heart Failure Hospitalizations through Use of a Medication Assistance Program and Intensive Patient Education in Rural Eastern North Carolina

Effects of a medication assistance program on health outcomes in patients with type 2 diabetes mellitus

The effects of a clinic-based medication assistance program (MAP) on the health outcomes and medication use of patients with type 2 diabetes mellitus were studied. In this retrospective analysis, data from the University of Arkansas for Medical Sciences pharmacy-managed MAP and outpatient pharmacy databases were collected for adult patients with type 2 diabetes mellitus who were monitored in the university's internal medicine clinic one year before and after enrollment in the MAP. Data on patient demographics, medication use, and disease indicators (glycosylated hemoglobin [HbA(1c)], high-density-lipoprotein [HDL] cholesterol, low-density-lipoprotein [LDL] cholesterol, total cholesterol, triglyceride, and blood pressure levels) were collected for the year before enrollment and for one year after enrollment. Statistical analyses were conducted using descriptive analyses, paired t tests, and the Wilcoxon signed rank test. Of the 401 patients enrolled in the internal medicine clinic who were enrolled in the MAP, sufficient data were available for 52 patients, of whom 73% were women, 50% were African American, and 48% were white. Their mean age was 59 years. All were self-paying customers, with 67.3% receiving Medicare benefits. Patients received more prescription medications (p < 0.001) and antihyperglycemic medications (p = 0.001) after enrollment in the program. Mean HbA(1c) and LDL cholesterol levels decreased significantly after enrollment (p < 0.001 for both). Mean HDL cholesterol levels and systolic and diastolic blood pressure measurements did not change significantly. A clinic-based MAP managing the use of pharmaceutical manufacturers' drug assistance programs increased indigent patients' access to antihyperglycemic medications and improved patients' clinical outcomes.

Intervention for Decreasing Excessive Acetaminophen use in Pennsylvania Medicaid Recipients

ILENE H. ZUCKERMAN, PHARM.D., is Associate Professor and MIKHAIL MENIS, PHARM.D., M.S., is Graduate Research Assistant, Pharmaceutical Health Services Research Department, School of Pharmacy, University of Maryland (UM), Baltimore. DIANE L. MCNALLY, B.S.PHARM., M.S., is DUR Coordinator, School of Pharmacy, UM. BARBARA A. LAYNE, R.N., is Director, Center for Professional Drug Education, Pennsylvania Medical Society, Harrisburg. C. DANIEL MULLINS, PH.D., is Professor and Chair, Pharmaceutical Health Services Research Department, School of Pharmacy, UM. The support of the Office of Medical Assistance Programs, Pennsylvania Department of Public Welfare, and the assistance of Pharmaceutical Research Computing, University of Maryland, Baltimore, are acknowledged. Address correspondence to Dr. Zuckerman at the School of Pharmacy, University of Maryland, 515 West Lombard Street, Suite 273, Baltimore, MD 21201.

Pharmacist-facilitated enrollment in medication assistance programs in a private ambulatory care clinic.

Efforts to reduce patients' out-of-pocket expenses for prescription drugs by incorporating pharmaceutical manufacturer assistance programs (PMAPs) into a private ambulatory care facility's pharmaceutical services are described. From March 2001 through March 2002, the clinic's pharmacist prospectively evaluated patients for PMAP enrollment. The pharmacist completed the pharmaceutical manufacturer's application forms for patients identified as candidates for PMAP assistance and helped them obtain documentation. Some companies sent medications directly to patients, and others sent them to the clinic, where they were stored until the patients picked them up. The patients informed the pharmacist when refills were needed, which allowed the pharmacist to review patient records, verify compliance, and ensure proper follow-up. Forty-four patients were enrolled in 22 PMAPs during the year. The mean +/- S.D. annual household income for all patients was 15,631 dollars +/- 7,845 dollars. A total of 115 medication orders were processed for the patients. The mean +/- S.D. number of medications per patient obtained through PMAPs was 2.5 +/- 1.8, and the mean +/- S.D. number of refills was 1.8 +/- 1.0. The total cost of the medications was 48,143 dollars. The pharmacist needed an average of 15-20 minutes to perform the initial patient interview, 10-15 minutes to complete each initial application, and 5-15 minutes to complete a renewal application. Total pharmacist time needed to process each medication order was estimated at about one hour per year. A pharmacist in a private ambulatory care facility helped patients enroll in PMAPs and reduced the patients' expenses for prescription drugs.

Community Boundedness, Personal Relevance, and the Knowledge Gap

Research on the knowledge gap has explored individual and social factors that may influence the creation, maintenance, and demise of socioeconomically based differences in information gained as the result of communication campaigns. Recent work by Viswanath and colleagues suggests that the extent to which an issue affects members of a community—termed “community boundedness”—may have an independent influence on knowledge acquisition for members of the affected community. This study finds that community boundedness had a positive impact on awareness of a medical insurance program targeted to lower income children, whereas personal relevance did not. Specifically, African Americans and Latinos were more likely to be aware of a medical assistance program during the course of a campaign than were non-Hispanic Whites, controlling for income and personal relevance. The study also documents an inverse knowledge gap in which persons of lower socioeconomic status had greater awareness than did persons of higher socioeconomic status.

Outpatient medication assistance program in a rural setting.

Efforts to provide medication assistance to the rural poor in central Louisiana are described. The Central Louisiana Medication Access Program (CMAP) began functioning in 2001 with the objective of providing medication assistance and medication education to the rural poor in the community. The program serves individuals who use the outpatient clinic at the state-run public hospital in central Louisiana. Patients receive prescription drugs for a variety of chronic conditions, paying only a processing fee of dollar 3 per prescription, with a maximum outlay of dollar 15 per visit. A pharmacist counsels the patients about their medications. The medications are funded both through the program and through assistance programs run by pharmaceutical companies. A total of 5307 patients were enrolled in the CMAP between May 2001 and March 2003, and they received over 140,000 prescriptions at a cost saving to them in excess of dollar 2.5 million. The CMAP has been able to provide prescription medications and medication counseling to needy patients in a rural environment at little cost to them.

Increasing medication access to transplant recipients.

Transplant recipients require numerous medications to maintain graft survival and health. Post-transplant medication therapy costs greater than 12000 dollars annually, and the cost of therapy is expected to increase. Although medication costs continue to rise, a substantial portion of Americans lack adequate health insurance or do not have any insurance coverage. To facilitate health, it is imperative that health care providers are familiar with programs that are available to increase prescribed medication access to transplant recipients. The purpose of this manuscript is to provide an overview of common programs available to increase transplant recipients' access to medications. In addition to discussing the consequences of medication non-compliance, this manuscript reviews Medicare, Medigap, Medicaid, Qualified Medicare Beneficiaries, and pharmaceutical manufacturers' medication assistance programs and its use to increase medication access to solid-organ transplant recipients.

Cost-benefit analysis of a pharmacy-managed medication assistance program for hospitalized indigent patients.

Cost-benefit analysis of a pharmacy-managed medication assistance program for hospitalized indigent patients.

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Medication Assistance Program: University of Missouri Health Care Department of Social Services.

Journal Article Medication Assistance Program: University of Missouri Health Care Department of Social Services Get access Debra Parker-Oliver, Debra Parker-Oliver Search for other works by this author on: Oxford Academic PubMed Google Scholar Lisa Crandall Lisa Crandall Search for other works by this author on: Oxford Academic PubMed Google Scholar Health & Social Work, Volume 27, Issue 4, November 2002, Pages 303–306, https://doi.org/10.1093/hsw/27.4.303 Published: 01 November 2002 Article history Accepted: 01 August 2001 Published: 01 November 2002

Pharmaceutical manufacturer assistance programs.

While there have been many public discussions concerning Medicare covering outpatient prescription medications, currently, Medicare does not pay for most outpatient prescriptions. Meanwhile, costs associated with prescription medications as well as the number of underinsured patients are rapidly increasing. Many pharmaceutical companies offer assistance programs for patients who require medications but have inadequate financial resources to obtain them. Because patient access to required prescriptions is critical and clinician involvement is necessary for patient enrollment, the purpose of this article is to facilitate awareness of pharmaceutical companies' assistance programs, the availability of such programs, and their enrollment process. English-language articles from MEDLINE (1963-2000) and Internet Web pages describing medication assistance programs were reviewed. Data obtained from pharmaceutical companies' medication assistance programs were also included. In addition to general information concerning medication assistance programs, all studies found in the literature search describing the clinical and financial impact of using these programs and data obtained from contacting several medication assistance programs were selected. To determine if an assistance program was available for a medication listed as one of the top 200 medications prescribed in the United States, we contacted the pharmaceutical company that manufactures each medication. Approximately 53% of the top 200 prescribed medications in 1999 were offered through assistance programs to indigent patients. Physician office personnel can obtain medications for eligible patients by completing the enrollment process. Pharmaceutical companies' medication assistance programs can be used to reduce individual patient drug expenditures and improve patient outcomes by increasing medication access to those in need.

Cost-benefit analysis of a clinical pharmacist-managed medication assistance program in a renal transplant clinic.

Medicare pays for 80% of the cost of immunosuppressant agents needed within the first 3 years of solid organ transplantation; however, many patients cannot afford the remaining 20%. Furthermore, many patients who are beyond 3 years post-transplantation and have prescription coverage cannot afford the co-payment for these medications. Other patients may not be able to afford their medications due to limited or no insurance coverage. The Medical College of Georgia (MCG) has been giving immunosuppressant medications to renal transplant patients if they cannot afford to pay for them. To assist MCG with drug cost for medications and maintain quality care for renal transplant patients, a clinical pharmacist-managed medication assistance program was implemented to procure immunosuppressants from pharmaceutical manufacturers. All patients enrolled in medication assistance programs from 1 January 1998 through 31 December 1998 were included in this analysis. Medication acquisition costs with and without Medicare reimbursement and the cost of implementing the clinical pharmacist-managed medication assistance program were used to determine the value of implementing this service. Sixty-one patients were enrolled in manufacturers' assistance programs and a net cost avoidance of $124,793 was realized for the year of the program (benefit-to-cost ratio of 7.5:1). Assuming that the hospital collected the maximum amount allowed for patients receiving Medicare benefits, a cost avoidance of $69,233 was calculated (benefit-to-cost ratio of 4.16:1). A clinical pharmacist-managed medication assistance program in a renal transplant clinic produced substantial cost savings over this 1-year study period. For each dollar spent in pharmacist's time, a minimum of $4 was returned to the institution.

Assistance programs available for medications commonly used in transplant patients.

Pharmaceutical manufacturers have programs available to supply medications to indigent patients at little or no cost. Enrolling needy patients into these programs should increase patient compliance to medications, minimize patient and institution financial burdens, and decrease adverse events associated with medication noncompliance. However, access to assistance programs by patients in need is limited if physicians and other health care providers are unaware of the existence of such programs or not informed of each program's enrollment process. The literature is void of a manuscript describing assistance programs available for commonly prescribed medications used in transplant patients. This article offers a concise summary of medication assistance programs available through the pharmaceutical industry to assist in the procurement of medications that are commonly prescribed for the transplant population, including immunosuppressants, antibacterials, gastrointestinal, cardiovascular, and hypoglycemic agents. This article should be used by health care professionals as a guide to the availability and requirements of medication assistance programs.