Pharmaceutical Access Program: Navigating Resources to Best Assist the Client
“I take Trulicity and Toujeo and I am already in the coverage gap. I was wondering if there is any help for getting prescriptions. My cost for just these two is over $450, and I only get $600 a month. Thank you so much, if you can help.” This is just an example of a request we get every day for medication assistance when people’s expenses exceed their income and resources.
Another example: a mother brought in her son who was experiencing a change in insurance coverage. He was previously covered under Medicaid, but is now transitioning into Medicare. As his coverage was changing, they wanted to make sure that the Medicare drug plan he was auto-enrolled in would provide adequate coverage for the drugs he was currently using. As a member of our team reviewed the plan and his coverage, it was discovered that one of the key drugs he was taking was not on the formulary of the plan chosen for him. Upon this revelation, a comparison was made with other plans available through Medicare. A plan providing much better drug coverage was chosen, as well as health coverage, and he was enrolled the same day, providing no gap in his drug coverage.
“Pharmaceutical Access” is much broader than just funding the cost of prescriptions. It encompasses reviewing a person’s insurance coverage, income and resources, as well as medication needs. We then assist them with navigating insurance enrollment and coverage issues. It also includes exploring opportunities to utilize pharmaceutical company resources, such as copay saving cards and patient assistance programs. The Pharmaceutical Access Program staff look for savings and resources in all areas and help each client navigate those resources as needed. Providing assistance with funds through the hospital is the last resource utilized. Each year, the needs of those within our community continue to grow, so it is incumbent upon us to be good stewards of the resources available to us so we may serve as many as possible.
All Health Project staff work together to do the screenings necessary to provide pharmaceutical access to life-sustaining medications for persons who would otherwise struggle to obtain them. Each year, the Health Project’s Pharmaceutical Access Program serves over 3,000 clients and provides assistance for over 8,000 prescriptions.
The PAP Manager, Ron Rademacher, stated that, “The Health Project’s Pharmaceutical Access Program is important because of its efforts to assist our patients obtain the medications they require, as well as discern other needs they may have affecting their ability to stay healthy. Its mission is to protect and improve the overall health of our community one person at a time.”