How to Set Up a Free Medication Program
1. Overview
Use of Patient Assistance Programs must be part of your overall Pharmacy Plan.
This plan should take into account how you will provide or help provide medications for all your patients-you have to think about their acute medication needs, their chronic medication needs, education about their meds, continuity, adherence, follow up, and tracking.
2. Acute vs. Chronic Meds
Patient Assistance Programs work best for chronic meds, since it takes four-eight weeks once all the paperwork is completed, for the medications to arrive. Thus, for acute infections, e.g. antibiotics, other methods, either Government 340 B pricing, a purchased general formulary that your clinic dispenses, or an arrangement with the low-cost generic programs, such as offered by the retail pharmacies can be options.
3. Pharmaceutical Patient Assistance Program Volunteer Team
This team of volunteers is in charge of ordering medications for clinic patients from pharmaceutical patient assistance programs offered by various companies. Each program has different forms, and different rules. Follow the rules carefully, and make sure that all forms are filled out completely. All of these volunteers must have completed HIPAA training as well as full training in the different aspects of the program.
4. New Patients
When a new patient requiring medications offered through the PAP program joins the clinic, the following information must be gathered: patient's full name, date of birth, social security number (if any), phone number, address, residency status, citizenship status, gender, insurance info (if any), household size, number of dependents in household, household income, tax information (if any), employment status, and financial documentation (if any). If one or more of the requirements are not met, a supplemental letter may be substituted in its place. This will be discussed in more detail later. Many pharmaceutical companies require financial documentation beyond the “low-income letter” (discussed later), so ask the patient to bring copies of pay stubs, bank statements, or an employer letter stating amount paid in cash if applicable. This information must be kept confidential. The material listed above is necessary to order medications from the pharmaceutical companies and must be explained to the patient in this way, that you are not trying to intrude, but that in order to apply for these medications, you need this information. You can also ask the doctor, pharmacist, and/or health promoter who already knows the patient to help with explaining why you are asking these questions and to be a “trust bridge” to the patient. The process is described below.
5. Patient Assistance Program Steps at the Free Clinic Project
The healthcare team “checks in” with the PAP team and requests a specific medication. At this time the PAP representative will check whether that medication or similar medications will be ordered based on which medications are available based on patient eligibility and available equivalent medications. It is possible that clinic patients will not qualify for patient assistance at all or may not receive all their medications from patient assistance programs. Drugs that cannot be obtained from patient assistance, such as generic drugs, vitamins and supplements, can oftentimes be ordered through the clinic pharmacy that supplies many generic drugs (but entails a cost to the clinic). Other possibilities include the low-cost generic drug programs from retail pharmacies where medications.
If a healthcare team member submits a medication order request, the PAP representative must fill out a patient application and include the drug order, prescriber's DEA number and signature, clinic address, patient signature, and any additional information.
Due to the pandemic, not all patients were coming onsite and therefore applications were being mailed directly to the patients with stamped return envelopes.
6. Where to Find Application Forms Online
The application forms can be found online through the pharmaceutical companies' websites and then navigating to their patient assistance page. Instructions specific to each company may be found on their webpage (e.g. Is the social security number required or is a clinic letter acceptable; does a prescription need to be included; what financial documentation is acceptable?). If information is not found on the webpage, you may need to contact them directly.
7. Specific Company Examples and Links
- GSK: From GSK, many medications such as Advair, Flovent, and Imitrex may be available for your patients among others in their inventory.
- MERCK: Examples of medications we receive from Merck are Janumet and Pneumovax
- Merck also has a program for ordering adult vaccines in which vaccines must be purchased in advance and then Merck will reimburse the vaccine cost for qualifying patients.
- PFIZER: Examples of medications we receive from Pfizer are Depo-Provera, Premarin, and Prevnar-13
To find other companies, simply Google the name of the pharmaceutical company and the words "Patient Assistance" or a full list can be found on RxAssist.org.
8. Additional Information Needed/Explanatory Letters
To reiterate, each program has different forms and different rules. Follow the rules carefully, and make sure that all forms are filled out completely. If there is no or limited information for a particular answer, you can add an explanatory letter, as described above, or fill in true responses (as suggested below) but don't leave blank spaces.
As stated above, in addition to filling out the application and the drug order form, other information is oftentimes required by the pharmaceutical company, such as proof of income, social security number, etc. low-income and/or no-social-security-number letters can sometimes be used in lieu of such documents. The clinic's PAP personnel draft these letters and state”the patient's information has been verified and they qualify for the company's program.” They might also include a sentence such as “However, the patient cannot provide “proof of income because they are paid in cash or due to an unusual circumstance.” It is essential to include as much of the required information as possible to prevent the application from being rejected and mailed back.
9. Prescriber Signature
Once the application is filled out it is given to the prescriber to sign and authorize.
10. Administrative Office Volunteer Procedures
Once the prescriber has signed the application and if necessary, has included a signed prescription, the completed forms are mailed out. A record is kept of all applications and a copy of the application is kept at the office. Follow up of these applications is important. After a designated period of time, approximately four weeks, if no response has been received from the company, a PAP team member will follow up with the company to make sure that the application has been received and is being processed and take necessary steps if further action is needed.
11. Pharmaceutical Company Replies
If an application is reviewed and approved by the company, the company mails an acceptance letter with the patient's identification number and medication. While a patient is enrolled in the company, refills can be oftentimes ordered online or by phone. The enrollment period lasts between six months and one year at which time the patient will need to be reenrolled. However, if an application is rejected, due to missing information or signatures, it will be sent back to the clinic and the drug order will not be processed by the pharmaceutical company. If the pharmaceutical company calls back, or sends a letter that there is missing information, the PAP team follows up and completes the additional information required and resubmits the information.
The process described above is the general procedure for enrolling patients in pharmaceutical company patient assistance programs and ordering medications. However, there are sometimes special or unusual cases that prevent the application from being filled normally. Such cases are when a patient is homeless, paid in cash, does not work regularly (cash gigs), or really needs a medication offered by a company but does not qualify for their program. These applications must have an original letter addressing the situation and any alternative information that the company may be able to accept in lieu of the required documents.
12. Dispensing Medications
We choose to have the PAP medications delivered to the admin office and distributed to the clinics where they are dispensed to the patients. This allows us to follow up with the patients, and that the patient comes for med refill visits when we can check blood pressure, diabetes symptoms, LDL, liver enzymes etc. Having to come to us for their medications, we believe, has helped with our ability to help patients achieve better clinical outcomes. Dispensing the meds at the clinic allows for thorough patient education including teach back re their meds, to do our best to ensure patient safety and reduce patient error.
Due to the pandemic, we have been able to schedule virtual visits and therefore a delivery program was setup so patients continue to get their medications and/or other supplies without having to come directly to the clinic.
13. Conclusion
Every patient is important and it is the duty of the PAP representatives to do everything possible to provide for the patient medication requirements. Qualifications include courtesy, respect, thoroughness, attention to detail, and language skills, and commitment to follow up.
When we first began using the Patient Assistance Programs, it was very challenging. It took a long time to learn the ins and outs of each company and many forms would be returned, and follow up would not always occur. Now we have a cadre of volunteers at each site and at our admin office, committed to this program and willing to follow all the steps. Now, we receive more than 2 million dollars a year in Patient Assistance Meds. We wish you luck and are happy to help you make this work.