Prescription Assistance Programs Research Articles

54675 Organizations to Assist Patients in Accessing Prescription Assistance Programs for Dermatology Medications

54675 Organizations to Assist Patients in Accessing Prescription Assistance Programs for Dermatology Medications

Factors in Immigrant Children's Use of Physician and Dentist Visits, Hospital Care, and Prescribed Medication in the United States.

Applying the behavioral model of health services utilization to data from the United States, this study examined immigrant children's use of physician and dentist visits, hospital care, and prescribed medication. We employed data describing 9759 immigrant parents and children who participated in 2021's National Survey of Children's Health. Logistic regression results negatively linked physician visits to child health, child age, Asian children, fathers, lower parent education, lower family income, uninsured children, and parent's U.S. residence under 5 years. Dentist visits were positively associated with child age, girls, Hispanic children, parent education, family income, public/private health insurance coverage, and U.S.-born children, but such use was associated negatively with Asian children. Hospital use was positively associated with poor child health, Black children, children of "other" race/ethnicity, younger parent age, enrolled in health insurance, and parent's U.S. residence under 5 years. The use of prescribed medication was negatively associated with Asian children, younger child age, lower parent education, uninsured child, and lack of English proficiency. The paper's conclusion suggests policymakers expand Medicaid and CHIP eligibility among immigrant children and suggests community education to foster awareness of children's physical and oral health needs and of Medicaid, CHIP, and prescription assistance programs. The conclusion calls for healthcare providers and social workers to accommodate and respect immigrants' traditional health-related beliefs, showing cultural competence.

Evaluation of 340B prescription assistance program on healthcare use in chronic obstructive pulmonary disease

BackgroundThe federal 340B drug program was designed to stretch scarce federal resources to provide more comprehensive services for more eligible patients. To help satisfy community needs, 340B Prescription Assistance Programs (PAPs) allow eligible patients to access medications at significantly reduced costs. ObjectivesTo measure the impact of reduced-cost medications for chronic obstructive pulmonary disease (COPD) through a 340B PAP on all-cause hospitalizations and emergency department visits. MethodsThis multi-site, retrospective, single-sample, pre-post cohort study involved patients with COPD who used a 340B PAP to fill prescriptions for an inhaler or nebulizer between April 1, 2018, and June 30, 2019. Data from included subjects were evaluated and compared in the year before and after each individual patient's respective prescription fill in the 340B PAP. The primary outcome evaluated the impact of 340B PAP on all-cause hospitalizations and emergency department visits. Secondary outcomes evaluated the financial impact associated with program use. Wilcoxon signed-rank test was utilized to assess changes in the outcome measures. ResultsData for 115 patients were included in the study. Use of the 340B PAP resulted in a significant reduction in the composite mean number of all-cause hospitalizations and emergency department visits (2.42 vs 1.66, Z = −3.12, p = 0.002). There was an estimated $1012.82 mean cost avoidance per patient due to reduction in healthcare utilization. Annual program-wide prescription cost savings for patients totaled $178,050.21. ConclusionsThis study suggested that access to reduced-cost medications through the federal 340B Drug Pricing Program was associated with a significant reduction in hospitalizations and emergency department visits for patients with COPD, decreasing patients' utilization of healthcare resources.

Cost savings analysis of prescription assistance programs at a student-run free clinic

The Free Clinic at Lubbock Impact (TFC) is a student-run, volunteer free clinic affiliated with Texas Tech University Health Sciences Center in Lubbock, Texas, that provides free weekly health services to the local uninsured patient population. The clinic also helps patients enroll in prescription assistance programs (PAPs) from pharmaceutical companies, which supply eligible patients with certain medications at little or no cost. This study presents a cost savings analysis of TFC patients enrolled in PAPs from February 2019 through February 2020. Cost savings were calculated by matching medication doses and units with the cost per unit for each brand-name medication listed on GoodRx.com at Walgreens pharmacies located in TFC’s zip code, 79410. Sixty-one patients received 23 different medications with a total cost savings value of $222,563. Medications were sorted into diabetic, respiratory, and miscellaneous disease categories, for which cost savings totaled $114,110, $60,219, and $48,234, respectively. This study highlights the value of utilizing PAPs at a free clinic to address the barrier of medication cost for uninsured patients in Lubbock, Texas, and surrounding areas.

Impact of Pharmaceutical Prescription Assistance Programs on the Care of Patients with Chronic Myeloid Leukemia in a Safety Net Hospital

Introduction: The ever-rising cost of the oncology prescription drugs not only impacts the global cost of cancer care, but also affects the individual patient's financial toxicity, compliance, and outcomes. In safety-net setting, where the quality and quantity of care can be limited by the institution's budget, Prescription Assistance Programs (PAPs) are critical to patient care. Navigating the application process for these programs can be challenging for patients, especially for minorities and those with low health literacy. We looked at a pharmacy-run service for PAP enrollment at our safety-net hospital for patients diagnosed with chronic myeloid leukemia (CML). Methods: A total of 113 patients with CML who were receiving care at Parkland Health and Hospital System in Dallas, Texas, between January 2018 and December of 2019 were identified. Our pharmacy-run PAP service utilizes medication access technicians to complete PAP application packets for oncology patients. Patient records were reviewed to identify the payor mix, the choice of tyrosine kinase inhibitor (TKI), and number of prescriptions filled during the study period. Cost estimates are based on best advertised price for the individual drugs. For imatinib, cost estimate was based on the generic form. Results: Of the 113 CML patients, 78 did not have insurance. The majority of patients were Hispanic (61%); 19% were Black. In 62 patients (55%), English was not the primary language. TKIs used in first-line (insured vs uninsured) were: imatinib (49% vs 46%), dasatinib (31% vs 49%) and nilotinib (11% vs 5%). All uninsured patients were enrolled in Prescription Assistance Programs (PAP). The average time from diagnosis to application approval by the pharmaceutical companies was 23 days. Patients on average received the drug shipment 7 days after application approval. Uninsured patients received a total of 623 months' supply of their TKIs during the study period. Of these, only 7 were covered by the institution, most commonly to allow timely initiation of treatment while the PAP application was being processed. The estimated medication cost for the uninsured patients over the study period was $5.4m, of which $93k (2%) was covered by the institution. Conclusion: Our pharmacy-run PAP service allowed for rapid enrollment of all uninsured patients in pharmaceutical free drug programs and significantly reduced the cost of CML care for the institution. An expansion of this service to allow better utilization of copay assistance programs for insured patients can impact the financial toxicity associated with TKIs and is currently being planned. Disclosures No relevant conflicts of interest to declare.

Use of Prescription Assistance Programs After the Affordable Health Care Act.

Insurance coverage in the United States seems to be in a state of unrest. The 2010 passage of the Patient Protection and Affordable Health Care Act (ACA) extended health insurance coverage to roughly 32 million people. An increase in the number of people with health insurance benefits raised the question of whether prescription assistance programs (PAPs) would still be used after ACA implementation. To evaluate the use of PAPs following the implementation of the ACA insurance mandate. Health insurance was not required by the ACA until January 2014, so we retrospectively examined the use of drug company-sponsored PAPs before and after the ACA implementation. Since each PAP had its own qualifying criteria, any person who used a PAP through the assistance of NeedyMeds and its PAPTracker between the years of 2011 and 2016 were included for analysis. Data were pulled by NeedyMeds from the PAPTracker software, which produces completed PAP applications from drug manufacturer forms for PAPs. The number of PAP orders, number of unique patient orders, and annual patient prescription savings were assessed. Between 2011 and 2013, there was an average of 4.2 annual PAP orders per patient; however, annual PAP orders decreased to 3.1 per patient between 2014 and 2016 (P < 0.001). PAP orders declined by an average of 3.0% per month between 2014 and 2016 (P < 0.001), and average prescription savings per order increased from $870.40 before the ACA to $1,086.40 after ACA implementation (P = 0.0024). Patients saved an average of over $3,000 on prescriptions annually with the use of PAPs after the ACA mandate. Although health care reform is inevitable, our study showed that PAPs remain important to help cover prescription drug costs for eligible patients, even with invariable changes to health insurance, including a health insurance requirement. While the ACA may have been an important step forward in extending health insurance coverage to millions, PAPs are still used to help U.S. patients obtain their medications at no cost or very low cost. These programs will most likely remain relevant until other approaches are taken to help alleviate the effects of increasing drug prices in the United States. No outside funding supported this research. The authors have no relevant financial or nonfinancial relationships to disclose. Study concept and design were contributed by Khan, Lerchenfeldt, and Karabon. Khan collected the data, and all authors participated in data analysis. The manuscript was primarily written by Lerchenfeldt, along with Khan and Karabon, and revised by Lerchenfeldt, along with Karabon and Khan.

Abstract A36: [Advocate Abstract:] What patients need, but cannot afford: Uptake and value of supplies and services provided by Cancer Services, Inc, a community-based, non-profit cancer support agency in NC

Abstract Background: Cancer Services, Inc. is a non-profit, 501c3 providing a comprehensive range of services addressing financial, physical and emotional needs of cancer patients primarily in the Triad region of NC. One of the major challenges facing cancer patients is the costs associated with cancer care. This study evaluates the uptake, cost, and value of supplies and services provided to individuals seeking support from a community-based, non-profit cancer support agency over the past five years. Methods: Retrospective de-identified data were obtained from a database maintained by Cancer Services, Inc. between 2011 and 2015. We estimate the most common support provided, whether these supplies and services were provided directly by the agency (either donated or paid), and whether the agency facilitated the receipt of supplies and services from another source. Each supply/service was assigned a monetary value based on the cost the agency paid or estimated value of the procured support. Data are reported in the aggregate and time trends were also assessed. Results: There were 10,448 unduplicated clients served during the five years, including 70% female, 21% African American and 4% Hispanic, with 22% below the 200% federal poverty level. The majority of clients were diagnosed with breast cancer (40), followed by gastrointestinal (11%), hematologic (10%) and thoracic (10%) malignancies. There were 187,485 services/supplies provided during this period. Agency personnel secured more than $44M in medications from external sources by providing technical support, such as determining eligibility for the medication and completing necessary paperwork on behalf of their clients. The agency provided an additional $1.38M in donated supplies/services to their clients, including equipment and home health supplies (59%), wigs (16%), mastectomy supplies (13%), ostomy supplies (3%), and nutritional supplements (3%). The organization incurred $911K in expenses to provide direct support to their clients, with most of these funds going towards medication (60%) and emergency financial assistance (31%). This does not include the cost of staff time required to secure the assistance. The value of the medications accessed through outside agencies has markedly increased from $4.2M in 2011 to $14.5M in 2015, while the amount paid for medications directly from the agency has declined from $132K in 2011 to $81K in 2015. A similar pattern emerged for emergency financial assistance, with a more than doubling in value of medications accessed from outside sources in the past 5 years ($23K to $51K) to a decrease in funds provided directly by the agency to their clients ($75K to $31K). Conclusions: Patients and their families face considerable expenses associated with cancer care that are often not covered by insurance. While programs exist to help support low-resource patients (e.g., Prescription Assistance Programs), they often do not know how or have limited capacity to access these resources. Moreover, some services/supplies (e.g., wigs, nutritional supplements, hospital equipment) must be purchased or rented by the patient, incurring additional expenses often not covered by traditional health insurance. Cancer Services Inc. plays an important role in facilitating the procurement of much-needed cancer care supplies and services that are not paid for by insurance-predominately medication. Such support alleviates the financial toxicity of cancer care, which according to a recent study reported in Cancer, affects 29% of cancer survivors the majority of whom (86%) have health insurance. The financial burden of cancer is a health equity issue, affecting all patients, but especially those with the least resources. Citation Format: Carla Strom, Julie Lanford, Kristie Foley. [Advocate Abstract:] What patients need, but cannot afford: Uptake and value of supplies and services provided by Cancer Services, Inc, a community-based, non-profit cancer support agency in NC. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A36.

Utilization of Pharmaceutical Patient and Prescription Assistance Programs via a Pharmacy Department Patient Assistance Program for Indigent Cancer Patients

With the advances in cancer treatments, mortality rates in the United States have been consistently falling but they are accompanied by substantial increases in the cost of cancer care. Patient and prescription assistance programs (PPAPs) are offered by pharmaceutical manufacturers to provide free medications to medically indigent patients. To assist the Cancer Care Center (CCC) at Nassau University Medical Center (NUMC) with drug costs for chemotherapies, the pharmacy department uses a patient assistance program (PAP) to obtain medications from the drug companies at no cost. This study evaluates the impact of the PAP at a public hospital from which indigent cancer patients obtain assistance for chemotherapy. We followed all patients requiring assistance with chemotherapy who enrolled in the PAP from January 1, 2011 through December 31, 2012. Medications included both oral and parenteral chemotherapy drugs and antiemetics used in the outpatient clinic setting. The program served 347 patients in 2011 and 579 patients in 2012. The total number of visits in the clinic over 24 months was 9,405. The total cost savings of the medications was $1,066,000 in 2011 and $1,715,538 in 2012. A pharmacy-based PAP to procure free medications from PPAPs for cancer patients has helped to defray the expense of providing care at NUMC, increased patients' compliance with chemo protocols, and allowed many patients to receive the treatment they otherwise would not be able to afford. The combination of PPAPs and PAP provides a safety net to ensure that indigent cancer patients receive needed prescription medications in the outpatient clinic setting.

APhA recognizes 2016’s Immunization Champions

Clinic, a walk-in clinic for patients aged 15 years and older, at a large Indian Health Service medical center in Phoenix. But providing only 10% of the vaccines given on campus, the clinic’s reach isn’t great enough for Van Lew. “We want vaccines addressed at every visit,” Van Lew said. Primary care alone, she noted, can’t cover all adult vaccines. Patients may have many specialty visits between less frequent primary care visits at the time immunizations are due. Van Lew aimed to standardize the approach to immunizations across the medical center campus. Through education campaigns, she has motivated nurses to embrace CDC recommendations to address immunizations at every visit. She successfully advocated for a protocol that would allow all nurses to offer routine vaccines anywhere on campus. In 2015, she provided 20 education sessions to more than 250 providers across specialties and professions to increase vaccine awareness, integrate vaccination into workflows, and devise better ways to use electronic health records and screening tools in this endeavor. Nationally, Van Lew has collaborated on research with CDC and the National Center for Immunization and Respiratory Diseases to better understand and improve adult vaccination rates. “I get involved in so many different arenas because there’s so many different ways we can impact vaccination rates—not just in the clinic.” In 2015, on Van Lew’s watch, more than 44,000 vaccines were administered to children and adults in her health system, substantially increasing immunization rates for zoster, human papillomavirus, tetanus, diphtheria, and pertussis.

Connecting Patients to Prescription Assistance Programs: Effects on Emergency Department and Hospital Utilization.

Manufacturer prescription assistance programs (PAPs) have been developed to provide medications at little or no cost to eligible patients. There are over 200 PAPs available from pharmaceutical companies, and each may have different eligibility requirements and assistance guidelines. A formalized community-based patient prescription coordinator can help patients navigate these programs by reviewing an applicant's financial information and medication requirements to identify which PAPs are most appropriate. Little is known, however, about whether providing such guidance is associated with a reduction in acute care utilization. To evaluate changes in emergency department and hospital utilization among patients who received care coordination and financial assistance with prescribed medications. This single-cohort interrupted time-series study included participants in eastern Washington state who enrolled in the Spokane Prescription Assistance Network (SPAN) program between March 1, 2009, and August 31, 2012. Referrals to the SPAN patient prescription coordinator were made by a social service agency or medical provider for patients who may have difficulty paying for prescribed medications. Initial patient contact occurred while the patient was still being treated in a clinic or hospital or through a direct visit to the coordinator's community-based office. Participants were contacted 6 months after the initial appointment and then annually thereafter to review current medications and health status. A review of electronic health records provided information on hospitalizations and emergency department visits in the 12 months before and after program entry. Among SPAN participants (n = 310), emergency department and hospital encounters declined from 0.38 per participant in the year before enrollment to 0.20 encounters in the year following program entry. A repeated-measures mixed-effects model indicated SPAN participation was associated with a 51% decline in the rate of emergency department and hospital utilization (incidence rate ratio [IRR] = 0.49; 95% CI = 0.31-0.77; P = 0.002). Observed effects differed by prescription class. Factor interactions revealed significant reductions in utilization for participants with prescribed pulmonary medications (IRR = 0.58; 95% CI = 0.37-0.92; P = 0.019). Assistance with mental health (psychotropic) medications was associated with increased incidence of utilization (IRR = 2.07; 95% CI = 1.32-3.24; P = 0.001). At the time of SPAN enrollment, 60% of participants had prescriptions for psychotropic medications. A formalized patient prescription coordinator can help patients access prescribed medications at low cost and remain compliant with treatment plans. In a study of a coordination pilot program, reductions in hospital admissions and emergency department visits were observed following program participation. This study was not supported by any outside funding. The authors declare no conflicts of interest. Study design was created by Burley, McPherson, and Daratha. Burley Daratha, Selinger, and Armstrong collected the data, with interpretation performed by Burley, Daratha, and Tuttle, assisted by McPherson. The manuscript was written by Burley, Daratha, and Selinger, with assistance from White, and revised by Burley, White, and Selinger, with assistance from Daratha and Tuttle.

Connecting Patients to Prescription Assistance Programs: Effects on Emergency Department and Hospital Utilization

Connecting Patients to Prescription Assistance Programs: Effects on Emergency Department and Hospital Utilization

Helping patients find and use prescription assistance programs

Patients without health care coverage or with limited coverage often cannot afford their medications. The result is medication nonadherence— skipping or taking lower doses of prescribed medications or forgoing meds altogether. Nonadherence can lead to serious health complications, more visits to the emergency department, and hospitalizations, especially among patients with chronic medical conditions. Prescription assistance programs are one solution to this problem.

Reducing the burden of medication costs to improve medication adherence

The high cost of medications is one reason that patients do not adhere to treatment plans. Providers can take actions to relieve the economic burden such as prescribing generic medications and offering patients information on various resources, including discount generic drug lists, discount cards, mail-order pharmacies, and prescription assistance programs.

Use of a Prescription-Assistance Program for Medically Uninsured Patients With Cancer: Case Study of a Public Hospital Experience in New York State.

With the advances in early detection, prevention, and treatment of some cancers, mortality rates in the United States have been consistently falling. However, with these successes have come substantial increases in the cost of cancer care. Antineoplastics are the leading class in hospital drug expenditures. Cancer treatments are causing a serious financial burden for patients, families, hospitals, and society at large, especially for those who are uninsured. Prescription assistance programs (PAPs) are offered by pharmaceutical manufacturers to provide medications at no out-of-pocket cost to medically indigent patients. To assist the Cancer Care Center at Nassau University Medical Center (NUMC) with drug costs for chemotherapies, a clinical pharmacist-managed PAP was implemented to procure chemotherapy medications from pharmaceutical manufacturers. NUMC is a safety-net teaching hospital in suburban New York. It serves mostly an indigent population, and its Level I trauma center has more than 77,000 emergency department visits per year. We observed all patients requiring assistance with chemotherapy who enrolled in PAPs from January 1, 2011, through December 31, 2012. The total number of visits in the clinic over 24 months was 9,405. Individuals potentially eligible for the PAP were identified by oncologists. Patients received a referral to the PAP when they mentioned to office personnel that they had difficulty obtaining medications or expressed financial concerns related to management. The clinical pharmacist spent the majority of his time assisting uninsured individuals, working with charity pools from the drug manufacturers, and obtaining medications through the PAP. The program served 341 patients in 2011 and 579 patients in 2012. Medications obtained for these patients included both oral and parenteral chemotherapy drugs and antiemetics. The total cost savings of the medications was $908,944.11 in 2011 and $1,715,538.37 in 2012. In 2012, a total of 783 prescriptions were processed, and 775 were approved by the manufacturers (98.9%). PAPs provide a valuable safety net to ensure that uninsured patients with cancer receive needed prescription medications. The rising cost of health care and the high proportion of indigent patients have financially burdened the hospital. For the pharmacy department, this has resulted in a lack of compensation for pharmaceuticals dispensed to indigent patients. A pharmacy-based program to procure free medications for uninsured patients with cancer has helped to defray the expenses of the Cancer Care Center in providing care at NUMC, increased patient compliance with chemotherapy protocols, and allowed many patients to receive the treatments they otherwise would not have been able to afford.

Utilization of prescription-assistance program for medically uninsured cancer patients: A case study of a public hospital experience in New York state.

e17537 Background: With the advances in early detection, prevention, and treatment of some cancers, mortality rates in the United States have been consistently falling. However, with these successes have come substantial increases in the cost of cancer care. Antineoplastics are the leading therapeutic classes in hospital drug expenditures. Lack of insurance is associated with lower rates of cancer screening, later stage at diagnosis, and increased cancer mortality. Prescription assistance programs (PAPs) are offered by pharmaceutical manufacturers to provide medications at no out-of-pocket cost to medically indigent patients. To assist the Cancer Care Center at NUMC with drug costs for chemotherapies and maintain the quality care for patients, the Pharmacy department instituted a Patient Assistance Program (PAP) to obtain medication from the drug companies at no cost. NUMC is a “safety net” teaching hospital in suburban New York. It serves mostly an indigent population and is a Level 1 Trauma Center with over 77,000 emergency department visits per year. Methods: We followed all patients requiring assistance with chemotherapy who enrolled in our PAPs from January 1, 2011 to December 31, 2012. Individuals potentially eligible for PAPs were identified by Oncologists and by the pharmacy department. Medications included both oral and parenteral chemotherapy drugs and antiemetics. Results: The program served 341 patients in 2011 and 579 patients in 2012. The total number of visits in the clinic over 24 months was 9,405. The total cost savings of the medications was $908,944.11 in 2011 and $1,715,538.37 in 2012. Conclusions: PAPs provide a valuable safety net to ensure that cancer patients without insurance receive needed prescription medications. The rising cost of health care and the high proportion of indigent patients have financially burdened the hospital. A pharmacy-based program to procure free medications for uninsured cancer outpatients has helped to defray the Cancer Care Center’s expense of providing care at NUMC, increased patients’ compliance with chemo-protocols and allowed many patients to receive the treatment they otherwise would not be able to afford.

Health decision-making among rural women: physician access and prescription adherence

Introduction: Rural residents and women have been identified as forming US population groups who experience health disparities, including access barriers to health care. Rural women are at significantly higher risk for poor health outcomes than their urban counterparts, and they are the 'gatekeepers' of their families’ health, thus influencing the health of the broader community. Not seeking or adhering to care recommendations may extend the course of disease, thereby protracting patients’ problems and increasing the burden of disease on the community. In this research, factors were examined related to physician access and prescription adherence among rural, low-income women. Methods: Data from Rural Families Speak (n = 266), a US multi-state study, were analyzed using multivariate logistic regression. Results: Women with depressive symptoms and more chronic health conditions were less likely to access a physician, while those who had health insurance and perceived greater physician availability were more likely to access a physician. Health insured women were less likely to delay or forgo filling prescriptions. Conclusions: Interventions in rural areas should increase knowledge about available primary care services and prescription assistance programs.

Monetary Value of a Prescription Assistance Program Service in a Rural Family Medicine Clinic

To quantify the monetary value of medications provided to rural Alabamians through provision of pharmaceutical manufacturer-sponsored prescription assistance programs (PAPs) provided by a clinical pharmacist in a private Black Belt family medicine clinic during 2007 and 2008. Patients struggling to afford prescription medications were referred to a clinical pharmacist by the physician or nurse practitioner for medication assistance evaluation. Once patients were deemed eligible, the pharmacist assisted in the PAPs completion process, maintained detailed records, and aided in recovery of refills. Patients paid $5 per application to cover office supply costs. An annual retrospective review was performed each December to evaluate the monetary value of free medications provided to patients during this 24-month period. One hundred forty-two applications were completed, enrolling 31 patients in 22 PAPs. Patients received $138,400 worth of medications; the clinic collected $710 in fees. Antihypertensive, antidepressant, lipid-lowering, antiplatelet, and proton pump inhibitor medications were most frequently prescribed and represented 74% of the total monetary value of free medications provided to patients. Clopidogrel (Plavix) and esomeprazole (Nexium) were the most commonly requested medications, representing 16% of the monetary value. PAPs offer an avenue to obtain medications when cost may lead to non-adherence. PAP services helped rurally isolated Alabamians receive needed therapies they otherwise likely would not have purchased. Similar programs offering assistance services for merely cardiovascular products would provide a substantial public health impact. Providers interested in initiating similar services should identify a program coordinator, designate a private location for patient interviews, and develop systems to ensure patients receive their PAP medications.

Costs to physician offices of providing medications to medically indigent patients via pharmaceutical manufacturer prescription assistance programs.

Prescription assistance programs (PAPs) are offered by pharmaceutical manufacturers to provide medications at no out-of-pocket cost to various categories of medically indigent patients. some PAPs require only 1 application whereas others require as many as 4 applications per year per drug per patient, depending on the manufacturer's requirements. to measure the costs incurred by a medical clinic that provides chronic prescription medications via PAPs. this project was conducted in a free-standing, inner-city, Midwestern health clinic on the PAP application process for 1 representative drug for 32 pharmaceutical manufacturers that offered PAPs for drugs taken on a long-term basis for chronic conditions. time and motion studies were conducted using a medical assistant with the greatest amount of PAP experience. Assessment of time-to-access and time-to-complete forms was performed outside of normal clinic business hours to avoid interruptions. Personnel time costs also included receipt and delivery of drug to the patient (drug distribution time), which were assessed during normal business hours for actual medications received for 10 patients and included the time required to notify the patient of the arrival of the drug and to dispense the medication to the patient. supply costs for this PAP service included printing and copying costs. submission costs associated with mailing or faxing the documents were determined and calculated using the price of materials only. total application cost was calculated by adding the personnel time cost, supply cost, and submission cost. Annual PAP time was the time spent completing PAPs for 1 medication for 1 patient for 1 year. the time and resources required and the associated costs were aggregated separately for the pharmaceutical manufacturers that required 1, 2, or 4 applications per drug per patient per year. The total average application cost for all 32 companies was $25.18 [SD, $17.23]. Personnel time costs accounted for half or more of the total application cost, regardless of submission mode. the time to complete the form for any PAP was 0:06:20 [SD, 0:05:03] minutes with a range from 0:03:01 to 0:34:22 minutes. Printing costs were $0.20 [SD, $0.10] and copying costs were $1.96 [SD, $0.21]. Average supply costs were $2.16 [SD, $0.23]. Faxing versus mailing PAPs saved $17.90 per application. total annual clinic cost to assist patients in obtaining drugs through a PAP ranged from $10.42 per patient for a drug that requires 1 application per year (15 manufacturers, 47%) to $46.30 per patient for a drug in a PAP that requires 4 (re)applications per year (12 manufacturers, 38%). PAPs transmitted by mail required 0:49:18 [SD, 0:32:18] minutes, approximately 0:25:00 [SD, 0:21:00] minutes more than by fax (0:24:13 [SD, 0:11:32] minutes) or by Internet submissions (0:28:20 minutes), respectively. The number of PAP applications required per patient per medication annually has the greatest impact on clinic time and financial resources. Application submission method also influences the overall costs of providing this service in the clinical setting. Medical clinics should base their decision to provide a PAP application service to patients on the time and costs associated over the course of 1 year and not on the 1-time application cost.

Clinical and Economic Impact of Pharmacy Services in a Low-Income Family Practice Clinic within a Community Hospital Setting

Providing medical care to the underprivileged is a mission of the Sisters of St. Joseph at St. Joseph Hospital in Orange, California. An outpatient family medical clinic was established to serve this population, a majority of whom do not have health insurance or access to government-sponsored prescription assistance programs. To provide medications to patients and to help reduce medication costs, the pharmacy department opened a medication room in the clinic and staffed it with a pharmacist and a pharmacy technician. This effort involved maximizing the use of pharmaceutical companies’ patient assistance programs, which provide free medications to qualified indigent patients. The project also incorporated pharmacist-regulated involvement; the development of and compliance with a formulary; strict inventory controls on the purchase of medications; and identification of patients who qualify for government health service programs. A computer database program that simplified the tracking, reporting, and organizing of patient information and provided financial reports was implemented. Within three years of operation, medication costs decreased from $328,000 to $32,800. The presence of a pharmacist in this setting was advantageous in both the financial and clinical arenas. The pharmacist was intimately involved in medication provision by evaluating appropriate medication use in a cost-effective manner and providing education to health care providers and patients.

Suffering it Out: Meeting the Needs of Health Care Delivery in a Rural Area

The health status of the people in the coal-producing counties of southwest Virginia is poor despite an apparent high provider to population threshold. This study used a qualitative approach to obtain information about accessibility to health care services and about perceptions of personal health status. Interview and focus group data revealed that the delivery of health care services is compromised by poverty and the large number of medically underinsured and uninsured individuals. Emergent themes included “suffering it out, a strong sense of community, quality time with provider and needed fixes. Another significant finding revealed the need for specialty providers. Community health nurses can provide a valuable service by making people aware of free and low cost prevention and prescription assistance programs, assist with understanding government health forms, and locating other low-cost health services for clients in their districts.