Transcript Meeting the Medication Needs of Iowans: the IowaCare Pilot

Meeting the Medication Needs of Iowans: the
IowaCare Pilot Pharmaceutical Program and
UIHC Medication Assistance Center
Lisa Mascardo, PharmD
Assistant Director
Ambulatory Pharmaceutical Care
The University of Iowa Hospitals and Clinics
Goals and Objectives
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To gain an understanding of medication assistance
options for Iowans
To describe the differences in medication benefits
between the State Papers Program and IowaCare
Pilot Prescription Program
To gain an understanding of methods used to
predict prescription utilization and costs
To gain a general understanding of how Patient
Medication Assistance Programs work
Societal Problem
 Patients
that cannot afford their
medications are at higher risk for
readmission and reoccurrence of their
illness.
Medication Assistance Options for
Iowans
 Medicaid
 Medicare
Part D plans
 Patient Medication Assistance Programs
(manufacturers)
 State Papers  IowaCare Pilot Prescription
Program
History of Providing Services to
Indigent Patients – UIHC’s role
 State
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Papers Program
Each county in Iowa issued a certain number of
“papers” based on population
Patients received comprehensive health care at
UIHC
UIHC received state appropriation to cover costs
Full medication benefit available
Approximately 3700 Iowans had State Papers
when the program ended in June, 2005
Medication Benefit under State Papers
Program
A
tiered formulary was created based on the
UIHC formulary
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Generic meds, necessary sole-source brand name
meds in Tier 1
Higher-cost brand name meds in upper tiers
Prior authorization by clinical faculty or
documented failure of Tier 1 med required for use
of higher tier meds
Refills mailed to patients at no cost
Transition to IowaCare Program
 In
July 2005, the State of Iowa officially ended
support for the State Papers Program and
implemented the IowaCare Program
 Had
effect of expanding health care coverage
to greater number of Iowans
Elements of IowaCare Program
 Patient
eligibility based on income (below
200% of FPL)
 Income level determined monthly premium
amount
 Patients could declare a hardship and have
monthly premiums waived
Medication Coverage under IowaCare
– FY06
 Medication
coverage limited to a 10-day
supply of medications at discharge
 Continued to provide chronic medications for
FY05 State Papers patients
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Patient profiles reviewed for chronic indications
Meds for chronic indications identified for
coverage
No newly identified conditions covered after 7/05
 Similar
to Medicaid program – charged copays
Medicare Part D
 Medication
coverage became available for
approximately 2000 patients formerly covered
under State Papers program
 Dual coverage not allowed – must use MCR
Part D if eligible
 Eligible patients received letters reminding
them to sign up with MCR Part D plan
 Grace period
Creation of IowaCare Pilot
Prescription Program
 Planning
 Goal
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started in March, 2006
to estimate costs of program
Anticipated number of patients to utilize program
Prescription utilization rate per patient
Average drug cost per prescription
Estimated drug cost per program
Personnel and mailing costs
Number of Patients participating in
Pilot Prescription Program
 Total
number of IowaCare (IC) enrollees as of
5/5/06 (at that point in time)
 Estimated number of IC patients receiving Rx
 Subtracted number of former State Papers
patients
Estimated Prescription Utilization Rate
Est average annual number of Rx per patient
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State Papers utilization data
Utilization data from large insurance company
 Estimated
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IowaCare Prescription Rates
25% like State Papers
35% like commercial insurance
40% mid-utilization
Estimated Prescription Utilization Rate
 Assumed
that 80% of Rx written would be
filled
 Est
total number of prescriptions filled
annually for IC patients = (Est ave annual
number Rx per patient) (Est number of patients
utilizing prescription pilot program)
Estimated Drug Costs of Pilot Program
 Average
drug cost per prescription (pharmacy
computer system data)
 Average annual drug cost per patient = (Ave
number of Rx per patient) (Ave drug cost per
Rx)
 Total
estimated drug cost of program = (Ave
drug cost per patient) (Est number of patients)
Additional Costs to Provide Pilot
Program
 Mailing
 Staffing
refills to patients
needs to handle increase in
prescription volume
Pilot Prescription Program Benefit
Summary
 IowaCare
patients seen at UIHC by UIHC
providers would receive:
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All generic medications on UIHC formulary
One 30-day supply of brand name medications
 30-day supplies
filled and refills mailed to
patients living outside of Johnson county
 Polk Co. residents may receive a 10-day
supply of meds at discharge only
Implementation Issues
 Patients
not previously seen at UIHC needed
to have prescriptions written by UIHC
providers
 Patients who had prescriptions written by
UIHC providers but filled at outside
pharmacies needed prescriptions transferred
 Access issues
Implementation Issues
 All
patients enrolled in IowaCare qualified for
the same pilot prescription program
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Former State Papers patients on chronic
medications were limited to generic meds
Profile reviews to determine which meds could be
switched to generics
Patients requiring brand name meds were referred
to the UIHC Medication Assistance Center
Medication Assistance Center
 Joint
effort by Department of Pharmaceutical
Care and Department of Social Services
 Staffed
by Financial Counselor Pharmacist,
pharmacy technician and three social workers
MAC Mission
The UI Hospitals and Clinics Medication
Assistance Center (MAC), in accordance with
the UIHC mission of promoting the health of
Iowans regardless of their ability to pay, helps
qualified patients gain access to medications
provided by drug manufacturers at little or no
cost to the patient.
MAC Services Provided
 Medication
profile reviews
 Initial applications
 Reapplications
 Receiving and dispensing medications
 Medication financial counseling
 Staff training regarding resources
available
Summary
 Assistance
in obtaining affordable medications
is available to qualified Iowans
 The IowaCare Pilot Prescription Program was
implemented to fill the gap created when the
State Papers program was discontinued
 Prescription utilization and cost projections
were based on an estimation of the population
size and combination of known commercial
and State Papers utilization rates
Summary
 Other
programs are available to fill in
coverage gaps:
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Manufacturer Medication Assistance Programs
Discount generic programs such as Xubex,
Walmart and Kmart
QUESTIONS??