In this episode, we are joined by Chastity Werner, CEO of Nationwide Prescription Connection, to discuss how to implement an effective medication assistance program.Learn how to listen to The Hospital Finance Podcast® on your mobile device.
Highlights of this episode include:
- How the COVID pandemic has exacerbated the issue of medication non-adherence with patients.
- Important first steps for providers when creating a medication assistance program.
- Common obstacles that providers can expect when implementing a medication assistance program.
- How pharmacists play an integral role in the process.
- Ways to measure the success of a medication assistance program.
- And more…
Mike Passanante: Hi, this is Mike Passanante and welcome back to the award-winning Hospital Finance Podcast®. Cost is a major barrier for many patients when it comes to getting and staying on the medications they’re prescribed. Medication assistance programs have been shown to improve access to medications, increase adherence, and can, ultimately, reduce avoidable healthcare costs. To talk to us about how to start an effective medication assistance program, I’m joined by Chastity Werner, CEO of Nationwide Prescription Connection. Chastity, welcome to the show.
Chastity: Thank you so much, Michael. I’m excited to be here.
Mike: Well, we’re happy to have you. Let me start out by asking you this. Medication non-adherence, it’s been a problem for some time, but COVID has, certainly, exacerbated this issue. Can you give us an overview of what’s going on now, and what providers can expect?
Chastity: I think like most things right now, this process is kind of on steroids. There’s a lot of factors and things that we just don’t know what we don’t know. And one of the things that we do know is the fact that many have lost their employment, which in turn means they’ve lost their insurance. But what we’re not certain of is exactly how many of them have gotten insurance through a spouse, or went out to Marketplace or other places, or qualified for Medicaid, or are just choosing to go without insurance. What we know is that whenever they choose to go without insurance, they’re losing their medication coverage as well. And medication cost is one of the largest factors in nonadherence whenever we look at those things. So what I think that we can expect is that more patients are going to be faced with that difficult decision of choosing to get their medication or pay for their utilities, mortgage, or groceries. It’s where we are today, and it’s a very unfortunate situation. And what we know is that whenever they go without their medication that they need, they in turn end up in our EDs or get readmitted, and that they end up with poor outcomes.
Mike: And we know that medication assistance programs can, certainly, be helpful in curbing nonadherence. What’s the first step an organization can take to get started with creating an assistance program?
Chastity: Absolutely. The first step is creating that strong program, getting all of your team together, and making sure that all of them understand what’s out there and available for the patients, showing them how to identify which patients are in need of these programs. So when we look at who should be involved, we should look at involving our providers, our clinicians, our care coordinators, financial assistance, patient access, anybody that can identify which patients may have a need and are impacted by the cost of their medication. It’s having those cost conversations that we need to train our team and staff on because, as you can imagine, these programs– although there’s many great, accessible programs out there that will allow these patients to get their medication even free for twelve months, shipped to their home – and these programs have been around for a long period of time – in order to be able to get those patients on those programs and approved, we have to identify, which means cost conversations, talking to the patients, and letting them know, if they’re having issues with paying for the medication, that there are programs out there and available. Once you’ve trained your team to do those things, then you really have to create a great marketing program to spread the word, and make sure patients are comfortable with saying that they cannot afford their medication.
One of the other biggest areas too is giving our teams the access resources and tools to be able identify, when they’re prescribing the medication for the patient, what that cost is going to be for the patient. Because what we have to remember is, at the point of discharge or whenever a patient is coming in for a visit, and they’re identifying that, all of a sudden, they’ve been diagnosed with a cancer or diabetes or something of that nature, we’re giving them so much information, and they’re also just overwhelmed with this abundance of information. And then we’re giving them a list of medications that they need to go and have filled. Well, what we lack a lot of times at the point of prescribing those medications is to be able to explain to the patient what it’s going to cost them. So many times the patients do not realize what that cost is going to be until they get to the pharmacy. And at that point, say it’s Eliquis or one of the most popular medications that’s out there today, they’re going up to the pharmacy, they’re handing the list of medications that they need to get filled, and then they’re finding out that they’re going to have a 500-, 600- or 1000-dollar out-of-pocket. Well, they may choose at that point to get it filled the first time, but they may also have the factor that they can’t afford it, and they just vacate and walk away. So it’s really– the first steps in creating a strong program is getting everybody involved, and explaining what’s out there and accessible, and then training them to have those cost conversations, and getting the word out.
Mike: And what are some of the obstacles providers can expect to face as they implement a program?
Chastity: The biggest obstacle is identifying the patients. There’s a lot of great flexibility with these programs to where it ranges for the full assistance program, where a patient can actually get approved and get their medication from a pharmaceutical program, shipped directly to their home for free for 12 months. They have great flexibility in the fact that they can be anywhere up to like 500% of the federal poverty level. So when you’re looking at a family of four, you’re looking at, give or take, an average income of $100,000 for the household. So whenever we’re talking about this base of patients, it’s patients that aren’t used to being able to qualify for assistance. They’ve probably worked very hard their whole lives and not used to having things out there for free and accessible to them. So one of the biggest obstacles is identifying those patients. And it really goes back to having those touchpoints and talking to the patients. Then the next, probably, largest obstacle, I would say, is getting the team together, and investing in the human capital on our side to ensure that we’ve set this program up right. We’ve trained a team to identify all of the available programs, know what those programs require from an application standpoint and process standpoint, and we’ve invested our team into helping those patients get through the process in its entirety.
It’s kind of similar to when we’re looking at a revenue cycle claim. Imagine if our billing departments required our patients to file that claim with their insurance, and our revenue was dependent upon that. We wouldn’t do that because there’s so many different steps and pieces with it, the patients would get overwhelmed, and we would lack revenue. What’s similar to that with this: there’s a lot of steps that are required in completing an application with a diagnosis code and the dosage and the quantity of medications. You, a lot of times, have to submit financial documents and proof, and then submit that into these programs, and then follow up with the programs to ensure they’ve successfully processed that patient’s application. When we put that in the hands of our patients, they get overwhelmed, and many times are unable to complete that process because they just don’t know how to make the next step. But if we can help them through that process, invest our team into working with those patients on an individual standpoint, and ensuring that they are approved for these programs, then those patients could end up saving thousands of dollars a month. They can get their medication, their insulins, their Eliquis, their Entresto, and all of those shipped directly to their home.
When you think about it, with medication adherence/nonadherence, there’s really two factors to it. There’s “behavioral,” which is where the patient doesn’t have a cost factor to it. They’re just choosing to not take it the way it’s prescribed. And then there’s “cost-related.” “Cost-related” is for our indigent patients, but it also is for our individuals that have a great income, but they have a high-deductible health plan, and they’re looking at having to spend $1000 a month. They don’t realize that there’s a co-pay savings program, or something of that nature, out there, and they just don’t know what next steps to do. So when it comes to the largest obstacles, it’s really identifying the patients, investing on our side to ensure the process is successfully completed, and helping the patients through that process.
Mike: Chastity, let’s switch gears and talk about pharmacists for a minute. What role do they play in the process?
Chastity: In my opinion, the pharmacist should really be that safety net, the last step in this. When we’re looking at this, by the point that the patient has made it to the pharmacy, they should have already known and heard that there are medication assistance programs out there and available. Because the problem is, if we wait until the patient gets to the pharmacy, many times patients just vacate that prescription and end up not getting it filled. So especially, if the patients are going to various pharmacies that are, say, outside of our facilities, like a Walgreens or a CVS or something of that nature, there’s not financial gain for those organizations to complete applications, and help the patients get free medication. So when we look at, as healthcare providers and the pharmacy role, it should really be to the point that the patient gets to that pharmacy, we have built strong relationships with the pharmacy to where the pharmacist and the pharmacy teams know that, if the patient cannot afford the medication, they refer them back to us so that we can help them get onto a medication assistance program. One of the things that I have learned which is interesting is, similar to our hospitals getting penalized from readmissions, pharmacies get penalized with the Medicare programs from the aspect that, if the patient is not adherent to their medication, they will get penalized for that as well. So as healthcare facilities, we should build strong relationships with the pharmacy to ensure success on both sides. It’s kind of amazing because many times in the pharmacists that I’ve spoke to, they do feel helpless in the fact that they’re the ones that are telling the patient what their medication cost is going to be. And when the patient cannot afford it, they’ve experienced the patients even crying or having tears, and they see the look on their face whenever they’re realizing the financial impact of taking this medication that they know that they need. So I think that in building those relationships, you have a great opportunity to not only improve the patient’s life and outcomes, but have a great marketing aspect with it.
Mike: Chastity, how do you measure the success of a medication assistance program?
Chastity: Absolutely. So there’s many different ways that you can measure your success. I think one of the greatest ways to measure the success of a successful medication assistance program is by looking at the data in regards to your patient outcomes. Are they improving? Look at the high utilizers of your ED and your high readmits, and looking at their medication adherence. Are you tracking whether your patients are actually going and getting the refills on a timely basis? And looking at your uncompensated and your charity care costs. We have a great opportunity, especially when you look at your patients that are in financial assistance. Majority of them, if they qualify for financial assistance, they’re going to qualify for a medication assistance program. When you look at your self-pay population and your self-pay, when most of them will also qualify as well, and if you’re able to get them on a medication assistance program and save on their medication costs, then that will allow them to have more funds to actually pay their medical bills, and pay towards those self-pay accounts. We also want to look at patient testimonies. Organizations have an amazing opportunity to tell a powerful story – I kid you not – whenever your teams get in there, and they really start to work with patients, and they hear how much this has become a relief to your patients, and how much it has impacted their lives – it’s allowing them now to get groceries or pay the rent or become adherent on their medication process – whenever that’s all they really want to do, but they didn’t know how to do it. And we also look at the total number of savings that we do by patient, the total number that we’ve gotten approved. We look at our ED volume, and pulling it and reconciling it to the medications that those individuals are on, and seeing how many we’ve successfully been able to get through those programs. We also want to look at our unresponsive rate, unfortunately, too. One of the biggest things that we’ve run into with the patients is, unfortunately, you can have as many programs available as possible, but you can only do so much to try to get the patient on the programs and approved for it.
Mike: A minute ago, you mentioned Medicare. So is it safe to assume that Medicare patients qualify for these types of programs?
Chastity: One of the biggest areas of confusion, I think, that we run into is that organizations believe that Medicare and Medicaid patients cannot qualify for these programs. And there is some truth in certain areas, but with Medicare and Medicaid– let me kind of take those in two separate areas. Medicare patients, the patients that hit the donut hole– there are a couple of additional steps – and it’s program-dependent – that you do have to do, like you have to submit an expense report from the pharmacy to reflect that the patient has spent 2% or 4% of the household income, and some of those different pieces. But they can still qualify. We’ve had great success rates with Medicare patients. And with Medicaid patients, if the Medicaid program does not cover the medication, then they can also get approved for full assistance as well in some cases. Obviously, there’s no guarantee. Every program varies in their criteria and all of those different things, as we know. But you can submit the denials and different pieces, and get that patient on that medication because, even though there’s a lot of great generic opportunities out there, we all know, as healthcare providers, certain medications only seem to have a certain success rate with patients, especially in our mental health, bipolar, and those areas. That’s with the full assistance programs. Now, co-payment savings programs, that is strictly with your commercial patients, and Medicare and Medicaid patients do not qualify for those. But as I said, Medicare and Medicaid patients can qualify for full prescription assistance programs if you do the right steps.
Mike: All right. Thanks for clearing that up for us. Chastity, if someone wanted to find out more about Nationwide Prescription Connection and what you do there, where can they go?
Chastity: They can go to our website, which is www.npc-meds.com, or they can also contact me directly at email@example.com. During the COVID times, we are offering trials out to certain members and so forth, so we would love the opportunity to share services or help in any manner that we can.
Mike: Chastity Werner, thanks for coming by the podcast today, and helping us understand more about medication assistance programs.
Chastity: Thank you so much for having me. It’s been a pleasure.