Pharmacy-Managed Medication Assistance Program
Pharmacy-Managed Medication Assistance Program
According to the U.S. Census Bureau, an estimated 14% of the U.S. population lacked health care coverage for the entire year of 2000. A recent survey of 85 large metropolitan areas found that 13.5% of Hartford, Connecticut, residents are uninsured. An internal estimate made at Hartford Hospital showed that 22% of the patient population lacks health care coverage. 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. Other institutions throughout the country, as a means of reducing costs and aiding patients who otherwise could not afford to purchase their medications, have implemented pharmacy-managed medication assistance programs. These programs coordinate the supply of free drugs from pharmaceutical manufacturers to indigent patients and result in as much as $500,000 a year in free medication. In addition, favorable effects on patients' ability to reach medication-related treatment goals were achieved in an uncontrolled study.
Criteria for eligibility and application processes to receive free medication from manufacturer-sponsored charitable aid programs vary greatly among manufacturers. Eligibility criteria commonly include low income and lack of insurance or prescription coverage. A majority of the available programs are detailed in the Pharmaceutical Research and Manufacturers Association's (PhRMA) Directory of Prescription Drug Assistance Programs 2001-2002. Due to the wide variability of manufacturers' requirements, the identification, screening, and application processes to obtain these drugs are often time consuming and could require significant time from pharmacy department personnel.
In a community-based academic health center, the need to wisely distribute scarce resources is paramount. Pharmacoeconomic analysis can assist decision-makers in selecting between competing alternatives or assessing the value of a certain program. There are a number of methods to conduct pharmacoeconomic analyses including cost-minimization, cost-effectiveness, cost-utility, and cost-benefit analysis. Cost-minimization evaluations are used to compare the cost of alternative programs that have demonstrated equivalent outcomes. Cost-effectiveness and cost-utility evaluations compare alternative programs that measure cost in monetary terms and consequences in units of effectiveness (e.g., mm Hg decrease in blood pressure) or quality of life. Cost-benefit analysis compares the value of all resources consumed (costs) from implementing a program to what is gained (benefits). Cost-benefit analysis differs from other methods of pharmacoeconomic analysis because it values all outcomes in monetary units, allowing decision-makers to evaluate competing alternatives. Cost-benefit analysis can also help illustrate the level of output needed to achieve the optimal benefit.
Because of the high proportion of uninsured patients at Hartford Hospital, the pharmacy department decided to initiate a pilot medication assistance program. Literature review yielded overwhelming evidence that a successful medication assistance program required a dedicated individual to manage the program. After receiving funding for the pilot phase, the pharmacy department would design and implement the program and justify its benefit to the institution to merit further funding after the initial funding expired. Specific goals of the pilot program included characterizing the financial benefit to the institution and resources required to administer the program and identifying areas of the hospital on which to focus further program efforts.
According to the U.S. Census Bureau, an estimated 14% of the U.S. population lacked health care coverage for the entire year of 2000. A recent survey of 85 large metropolitan areas found that 13.5% of Hartford, Connecticut, residents are uninsured. An internal estimate made at Hartford Hospital showed that 22% of the patient population lacks health care coverage. 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. Other institutions throughout the country, as a means of reducing costs and aiding patients who otherwise could not afford to purchase their medications, have implemented pharmacy-managed medication assistance programs. These programs coordinate the supply of free drugs from pharmaceutical manufacturers to indigent patients and result in as much as $500,000 a year in free medication. In addition, favorable effects on patients' ability to reach medication-related treatment goals were achieved in an uncontrolled study.
Criteria for eligibility and application processes to receive free medication from manufacturer-sponsored charitable aid programs vary greatly among manufacturers. Eligibility criteria commonly include low income and lack of insurance or prescription coverage. A majority of the available programs are detailed in the Pharmaceutical Research and Manufacturers Association's (PhRMA) Directory of Prescription Drug Assistance Programs 2001-2002. Due to the wide variability of manufacturers' requirements, the identification, screening, and application processes to obtain these drugs are often time consuming and could require significant time from pharmacy department personnel.
In a community-based academic health center, the need to wisely distribute scarce resources is paramount. Pharmacoeconomic analysis can assist decision-makers in selecting between competing alternatives or assessing the value of a certain program. There are a number of methods to conduct pharmacoeconomic analyses including cost-minimization, cost-effectiveness, cost-utility, and cost-benefit analysis. Cost-minimization evaluations are used to compare the cost of alternative programs that have demonstrated equivalent outcomes. Cost-effectiveness and cost-utility evaluations compare alternative programs that measure cost in monetary terms and consequences in units of effectiveness (e.g., mm Hg decrease in blood pressure) or quality of life. Cost-benefit analysis compares the value of all resources consumed (costs) from implementing a program to what is gained (benefits). Cost-benefit analysis differs from other methods of pharmacoeconomic analysis because it values all outcomes in monetary units, allowing decision-makers to evaluate competing alternatives. Cost-benefit analysis can also help illustrate the level of output needed to achieve the optimal benefit.
Because of the high proportion of uninsured patients at Hartford Hospital, the pharmacy department decided to initiate a pilot medication assistance program. Literature review yielded overwhelming evidence that a successful medication assistance program required a dedicated individual to manage the program. After receiving funding for the pilot phase, the pharmacy department would design and implement the program and justify its benefit to the institution to merit further funding after the initial funding expired. Specific goals of the pilot program included characterizing the financial benefit to the institution and resources required to administer the program and identifying areas of the hospital on which to focus further program efforts.
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