Pharmacy Outreach to
Underserved AreasMedication Assistance
Program Development
Bruce Hancock, MS RPh
Carriann Richey-Smith, Pharm D
Background: Role of Pharmacists
• Pharmacists are sometimes considered the most accessible health
care provider; however, federal designations of medically
underserved areas do not consider the role of pharmacists.
• Previously documented research suggest that recruitment and
retention of students to medically underserved communities is
reflective on tuition reimbursement (such as in medicine),
geographic and community characteristics as well as experiential
learning.
• A 1994 study, by Scammon DL et al, suggests
that physicians practicing in rural underserved areas were primarily
motivated by personal values to make a difference and work in a
challenging, stimulating and personally rewarding position.
This sessions objectives
• Determine methods to identify key areas to
focus pharmacy involvement through outreach
programs in designated areas throughout the
State.
• Identify key strategies for involvement of
students in selected sites based on needs noted
by health care providers at the site.
• Implement medication access programs that will
benefit the site and collect data to document
interventions and outcomes.
WHY PHARMACY?
Background: Prescription Costs
• Prescription drug costs are an ever increasing
financial burden for many patients
– According to the Congressional Budget Office, in
2010 over 50 million people in the U.S. were
reported to be without health insurance
• Even more patients are without prescription
coverage causing a significant limitation to
accessing treatment
Background: Prescription
Behavior
• April 2008 survey from
the Kaiser Family
Foundation
• Among those who
reported these actions,
many said their
medical conditions
worsened as a result
Economic problems facing families. Kaiser Public Opinion
Survey Brief. Kaiser Family Foundation, 2008. Available at
http://www.kff.org/kaiserpolls/upload/7773.pdf.
Initial Experience/Research
• Past Participation in RUAH Grant
• Experience with faculty and students at
underserved sites
• Early exposure of students to patients in
need
• Limitations were providing a constant
presence
• Relationship with IRHA initiatives
Initial Research
Student Researchers supported faculty in the following
projects
• Survey of how community health centers meet the
medication needs of their patients
• Survey of pharmacy students perceptions of medically
underserved areas
• Survey of pharmacists perceptions of community health
in HPSAs
• Survey of patients as select pharmacies regarding the
role of their pharmacist
Initial Research
• Survey of Purdue and Butler Pharmacy Students
530 students completed survey
Butler: 256 (37.5% of eligible Butler students); Purdue:
274 (23.1% of eligible Purdue students)
Are you interested in serving as a resource for community
health as a future pharmacist?
• Yes: 426 (80.4%) No: 9 (1.7%) Not sure: 95 (17.9%)
Underserved collaborations
• As part of the College’s strategic plan, key
areas of the State were identified to focus
our involvement with potential
collaborators who were providing services
to the underserved.
• Utilized maps of full county HPSAs and
results from surveys of patients and
pharmacists in that area
Establishing the partnerships
• Local meetings with
– County Health Department
– Pharmacist (s)
– Other community leaders
• Review of staffing and ability of facility to support
the needs of students
• Pharmacist interested in being a preceptor and
promoting the public health role of pharmacy
• Locate fully furnished safe housing
Promoting the public health role
of pharmacy
• Pharmacists serve the whole patient not
just their medication needs
• Pharmacists help with lifestyle and
behavior health considerations especially
in areas with a shortage of other health
care providers
• Pharmacists address concerns of patients
regarding ability to pay
Role at sites
• Once sites were identified with worked with each
site to decide on what key activities we would
have Pharm.D. students assist with while doing
rotations at the sites.
• A wide variety of key activities were identified
through these discussions, with each site having
unique, but at the same time, common needs.
• A consistent need was to review medication
assistance program options and assist with the
implementation of a selected program at the site.
WHY MANUFACTURE
ASSISTANCE PROGRAMS?
Background: Assistance
Programs
• Manufacturer assistance programs
(MAPs) have evolved to provide
medications to low income patients at little
or no cost
• Many community health centers utilize
MAPs
Need for the Study
• Participation in MAPs has demonstrated
numerous benefits
– Improved access to needed medications
– Improved health outcomes
– Increased patient compliance
– Decreased out-of-pocket expenses
– Decreased ER visits and hospitalizations
Chauncey D, Mullins CD, Tran BV, et al. Medication access through patient assistance programs. Am J Health Syst Pharm 2006;63(13):1254-9.
Harmon GH, Lefante J, Roy W, et al. Outpatient medication assistance program in a rural setting. Am J Health-Syst Pharm. 2004; 61:603-7.
Trompeter JM, Havrda DE. Impact of Obtaining Medictions from Pharmaceutical Company Assistance Programs on Therapeutic Goals. Ann
Pharmacother. 2009; 43:469-77.
Schoen MD, DiDomenico RJ, Connor S, et al. Impact of the cost of prescription drugs on clinical outcomes in indigent patients with heart disease.
Pharmacotherapy. 2001; 21(12):1455–1463.
Need for the Study
• Lack of published literature demonstrating
the tools and processes needed to
implement a MAP enrollment service
Study Objectives
• The primary objective is development of a
service for enrolling and maintaining eligible
patients in MAPs at an underserved clinic
• A secondary objective is to quantify cost
savings as it relates to the implemented
MAPs
Methods – Data Source
• Patients’ medical charts
• RxAssist Plus© software program
• Feedback collected from clinic staff,
pharmacy staff
– Monthly feedback was elicited through
meetings or e-mail communication
– Evaluation of MAP procedure steps
– Positive/Negative experiences
– Additions/Deletions to the MAP Guide
Methods – Inclusion Criteria
• Patients with one of the following
diagnosis requiring treatment with a brand
name medication
– Type 2 Diabetes Mellitus, Asthma, Chronic
Obstructive Pulmonary Disease, Mental
Health diagnosis
• Patients prescribed up to four brand name
medications
• Patients who can not afford brand name
medications without MAPs
Methods – Exclusion Criteria
• Patients with active prescription drug
insurance
• Unable to meet financial requirements of a
MAP
• Five or more medications requiring MAPs
(alternative process available for these
patients)
Intervention
RxAssist Plus©
• Software program was purchased to help
manage MAP applications at the clinic
– Create patient records
– Retrieve information on hundreds of
manufacturer programs
– Print out completed MAP applications
– Track participation, refills, and cost savings
Tools/Processes Developed
Patient Assistance Questionnaire
MAP Guide
Process to manage arrival, documentation,
and dispensing of MAP medications
Tools
Patient Assistance Questionnaire
• Patient demographics
-Age, gender, race
• Employment status
• Household income
• Medical/prescription insurance
Tools
MAP Guide
• Developed for the most commonly prescribed
medications on the clinics’ formulary
• Manufacturer contact information
• Medications available for assistance
• Patient eligibility information
– Financial requirements
• Physician licenses and signatures required
• Quantity of medication dispensed
• Refill and renewal information
Results
Stepwise approach to identify patients
1. Does the patient meet inclusion
criteria/not meet exclusion criteria
2. Prescriber indicated brand name
medication was therapeutically necessary
3. Pharmacy staff would determine if there
were available MAPs utilizing RxAssist
Plus© or the MAP Guide
Results
• Samples provided to patients if available
while they wait on medications to arrive
• Drug inventory, record keeping and
distribution was also managed by
pharmacy staff
• Appropriate package labels, medication
guides via Micromedex®, and counseling
was also provided to patients
Results
• After six months of feedback, an RxAssist
User Manual was created
• The manual was used to orientate new
pharmacists, pharmacy students, and
clinic staff to MAPs
• Listed detailed steps on how to enroll and
maintain eligible patients in MAPs
Results
• Contents of RxAssist User Manual:
– Selecting and enrolling patients in the MAP
service
– Clinic’s procedure for submitting and tracking
MAP applications
– Record-keeping and inventory requirements
– How to utilize and run RxAssist Plus© reports
Results
Need to update with results across all
states.
Limitations
• Consistency of staff to dedicate their time to the
MAP process
• Inability to require volunteers to attend
education/training on the new process
• Different prescribing practices
• Software limitations especially with regard to
refills
• Ability to maintain long-term pharmacy
connection
Conclusion
• Prescription drug costs are an ever increasing financial
burden for many patients.
• Patient assistance programs can offset these rising drug
costs by providing prescription medications to uninsured
and underinsured patients.
• Enrolling and maintaining eligible patients in MAP can be
a complex and overwhelming.
Future actions and areas of
research
• Creation of further educational training
sessions/materials for providers of clinic
on manufacture assistance programs
• Effect of MAP enrollment on increased
compliance of patients to medication
therapy
• Effect of MAP enrollment status on
improved therapeutic outcomes
Acknowledgements
The following students assisted in variety of
research projects leading up to these
initiatives
Kelli Salmon
Betsy Ummel
Erin McCann
Megan Schwegal
Tiffany Hall
Nikki Javit
Courtney Seal
Jessica Lamb
Josh Lorenz
Janna Fett
Questions