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Overview
Medicine is an important component of many patients' treatment regimens. Unfortunately, some patients may try to save money by going without their medicines or reducing the amount they take. Helping patients to access low-cost medicines can support them in taking their prescriptions as directed.
Action
Assess patients' ability to pay for their medicines.
- Ask patients directly about difficulty they may be having getting their medicines. For example:
- "It's sometimes hard to afford all the things we need. Have you gone without medicine or not taken your full dose because of cost?"
- Let patients know you can help. Emphasize how important it is for them to take their medicines. Ask them to let you know if they have problems paying for medicines before they run out.
Fact:
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Review patients' insurance coverage.
- Everyone is now required to have health insurance. If patients are uninsured, help them access your State's Marketplace, where they can apply for insurance (including Medicaid and subsidized insurance). Personal help, in the form of "navigators," is available from most Marketplaces.
- For Medicare patients, make sure they have Part D. Patients can get help enrolling in Part D from the State Health Insurance Assistance Program (SHIP).
- When referring patients to navigators or the SHIP, follow up to make sure they have been able to connect. (Go to Tool 6: Follow Up with Patients.)
- Explore insurer's mail order options as a way to save money.
Resources
To find your Marketplace Web site, which will have information about local navigator programs, go to https://localhelp.healthcare.gov/.
To locate a nearby SHIP provider, go to http://www.medicare.gov/contacts/organization-search-criteria.aspx, choose SHIP and your State from the drop down menus. Call your State SHIP program to find out about local SHIP providers.
Connect patients with medicine assistance programs.
- Below are assistance programs that connect patients with low-cost medicines. Separate applications will be required for each medicine needed.
- NeedyMeds provides patient assistance programs, drug discount cards, and a list of disease-based assistance programs. Help with paperwork to apply for assistance is available in some areas.
- Partnership for Prescription Assistance offers a single point of access to more than 475 public and private programs, including nearly 200 offered by pharmaceutical companies.
- RXAssist offers a comprehensive database of patient-assistance programs, as well as practical tools, news, and articles so that health care professionals and patients can find the information they need.
- RXOutreach is a non-profit, mail order pharmacy that offers prescription medicines to people who are uninsured or have limited prescription drug coverage.
- Fee-based programs: Among other services, these sites may help patients fill out the applications needed. However, there may be a charge for services.
- RxHope.com assists patients with applying for free or low-cost medicines and also allows physicians to set up accounts and manage that process as well.
- Select Care Benefits Network is a patient advocate agency working with low-income patients to help them obtain their medicines from pharmaceutical companies.
- Local programs: State Pharmaceutical Assistance Programs exist in some States, and there may be some local agencies that will give financial assistance for medicines.
Track Your Progress
Track over time how many patients need assistance paying for their medicines, and note the services the practice provided.
Ask each patient seen during 1 week if they went without medicine or did not take their full dose because of trouble paying for it in the last month. Repeat after 2, 6, and 12 months. Note whether there has been a change in the percentage of patients who report having gone without medicine or having taken less than they should because of cost.
Choose a sample of patients whom you've referred to insurance or medicine assistance programs. Follow up after 1 month to see how many have obtained insurance or other help paying for medicine.
If you field questions from the Health Literacy Patient Survey, calculate what percentage of patients responded "Yes" to questions #30 and #31.
