Frontline Pharmacist
F rontline Pharmacist Experience with a student-run patient medication assistance service
M
ore than 45 million patients in the United States have no prescription drug coverage and are faced with the financial burden of medication costs.1,2 As a result of financial hardship, patients underutilize their medications, a practice that often leads to adverse health outcomes. 1 Patients may take their medications less frequently in an effort to maintain treatment before their supply is exhausted. Other patients may accept a prescription but do not fill the medication or request only a partial fill as a way to decrease medication costs. In recent years, several methods to obtain medications at low or no cost have been established, including retail pharmacy discount drug lists ($4-drug lists) and patient medication assistance programs (PMAPs) sponsored by pharmaceutical companies. Free brand-name medications are available through most drug companies when patients enroll in PMAPs. These programs have eased the burden of medication costs but are not without their barriers. Prescribers often struggle to find costfriendly medication alternatives for managing patients with financial hardships. Some prescribers, while aware of PMAPs, may not have the resources to actively identify patients’ issues, enroll patients in the programs, or manage their enrollment. As the medication expert, pharmacists can play a pivotal role on the health
care team and are well positioned to manage pharmacotherapy issues relating to medication cost and underutilization. Pharmacists can conduct comprehensive medication reviews and recommend cost-effective alternative therapies. When a less-costly alternative is not available, PMAPs become a valuable option. Establishing the medication assistance service. A service to assist underserved patients in obtaining medications via PMAPs was established in three clinics. This resource offers an important benefit to the clinics’ patient population of mostly uninsured or underinsured, unemployed, or homeless patients. Patients fill out an application form, provide income verification, and receive free medication if they meet the specific criteria developed by the pharmaceutical manufacturer. Each drug company has a unique form and set of qualifications for patients to meet to receive free medications, which may require the completion of multiple applications (one for each drug company) to supply the patient with the appropriate therapy regimen. Many of the applica-
The Frontline Pharmacist column gives staff pharmacists an opportunity to share their experiences and pertinent lessons related to day-to-day practice. Topics include workplace innovations, cooperating with peers, communicating with other professionals, dealing with management, handling technical issues related to pharmacy practice, and supervising technicians. Readers are invited to submit manuscripts, ideas, and comments to AJHP, 7272 Wisconsin Avenue, Bethesda, MD 20814 (301-664-8601 or [email protected]).
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tions are several pages in length with varying complexity. Patient barriers to the use of application forms include illiteracy, absence of a home computer or printer for accessing applications, and lack of a stable home situation for shipment of medications. Clinical pharmacy faculty were integrated into these clinics and asked to manage the existing service. Pharmacy students were incorporated into the service as they began their advanced practice pharmacy experiences (APPEs) in their fourth year of pharmacy school. The students, once trained by the clinical pharmacists, function independently, with oversight provided by the pharmacist and medical staff as needed. Clinic settings. This medication assistance service is offered at three ambulatory care clinics for the underserved in southwest Florida. The medication assistance service is provided at clinics 1 and 2 via an outpatient medical clinic specializing in the care of patients over age 50 years. To qualify for care, patients must be over age 50 years with limited or no income and residents of the county in which the clinic is located. Fees are based on a sliding scale according to patient need and ability to pay. Clinics are staffed by volunteer health care providers, many of whom are retired from private practice. Services offered at each office location vary but include general medicine, dentistry, and limited specialized medicine such as gynecology, orthopedics, and cardiology. Each site has approximately 4000 patient visits annually.3
Frontline Pharmacist
Pharmacy services at the clinics consisted of maintaining a supply of donated sample medications and assisting patients in obtaining new medications and refills for long-term medications. Once pharmacy faculty members and pharmacy students were added to these sites, other services were added, including medication review and management of chronic diseases (e.g., diabetes, dyslipidemia). Pharmacy faculty became essential to clinics 1 and 2 when grant funding that had supported a part-time employee was withdrawn. Time allotment to patient assistance was accordingly diminished, affecting patient enrollment in PMAPs. This was some patients’ only access to medications due to financial hardship. Clinical pharmacists were able to incorporate the medication assistance service into their daily duties by training APPE students to obtain and assist the patients in filing PMAP forms. The medication assistance service had previously been a fee-based service; however, through the use of pharmacy students and faculty pharmacists, the service is free of charge to clinic patients. Additional staffing through the APPE also allows for full-time services to be provided by students on rotation. Clinic 3 provides primary care medical services to uninsured patients age 18–64 years, as patients outside the age range are eligible for Medicaid or Medicare coverage. The target population of this clinic is homeless patients who cannot afford services at other institutions that might provide care on a sliding-scale rate. Many of these patients cannot afford $4 copayments for prescriptions through drug discount programs. This clinic is an interdisciplinary effort between a pharmacist and a physician. Both clinicians are faculty at a local school of pharmacy and osteopathic medicine. Once a patient receives a diagnosis, the pharmacist, along with APPE students, works with the physician’s team to determine the proper drug therapy for the patient. Along with working to choose proper drug therapy, pharmacy services include management of chronic diseases (i.e., diabetes, hypertension,
dyslipidemia, asthma, chronic obstructive pulmonary disorder [COPD], and anticoagulation) and tobacco cessation, as well as patient medication assistance. The goal of the clinic is that every patient in need receives patient assistance for medications. Historically, many patients at the clinic have been noncompliant with their drug regimens due to the high cost of medications. By providing most medications free of charge, it is hoped that compliance will increase in this population The students, working under the supervision of the pharmacist, are responsible for each patient enrolled in the medication assistance service. Student responsibilities. The studentrun medication assistance service consists of fourth-year APPE students who help to identify medications for which patient assistance could be obtained, select the appropriate forms for completion, assist patients with completing the forms, and provide proper income documentation. At the start of their four-week rotation, the students are trained by the pharmacist in methods for determining the need for patient assistance, choosing the correct therapy, and enrolling patients in the PMAPs. Students use online databases and manufacturer websites as resources whenever necessary.4,5 The student-run medication assistance service involves patient referrals to the pharmacy for evaluation. After patients receive a diagnosis, students create a drug therapy regimen that takes into account patient compliance and availability of the drugs through a PMAP. The new regimen is then presented to the clinic’s physician team for discussion. Once approved, the pharmacy students complete all forms with the patient and mail them to the companies. If the patient has a permanent residence, the medications are mailed there; otherwise, they are mailed to the clinic. Once received, the patient is instructed to make an appointment with the pharmacy clinic to review how to properly take the medications, determine if any possible replacement medications are needed, and discuss the possible adverse effects of treatment. Students also verify patients’ medication lists
to capture any dose or therapy changes and conduct medication reviews to determine if any other issues need to be addressed with the patient or prescriber. In some cases, referrals to pharmacist-run disease management clinics are generated as a result of medication reviews. If PMAPs are not available for a prescribed medication and cost remains an issue for the patient, students identify alternative cost-effective therapies. Additional student responsibilities and educational opportunities include participating in patient visits with the clinical pharmacist or prescriber, attending journal club, writing newsletter articles, and preparing presentations to clinic staff, faculty, and other students. Clinic sites also offered interaction with nursing, medical, and physician assistant students, allowing pharmacy students to begin developing interdisciplinary practice skills with peers. Experience with the medication assistance service. Two fourth-year pharmacy students completed the ambulatory care APPE each month at clinics 1 and 2 from January 1 to June 30, 2011. Each student saw patients half a day each week with the clinical pharmacist. Students were at the clinic site four days each week; the fifth day is spent on campus for journal club, presentations, and other educational activities. Clinic 3 had two fourth-year pharmacy students complete the ambulatory care APPE each month, seeing 506 patients from January 1 to June 30, 2011, with pharmacist interventions occurring for nearly every patient seen. The students were responsible for attending to all patients scheduled for pharmacy consultations each day. They also worked with the physician team to address any immediate prescription needs. Students saw patients five days each week during the clinic’s hours of operation. They also completed projects that involved journal clubs, a new drug and clinical controversy newsletter, a case-based disease presentation, and numerous topic discussions. Data were collected monthly from the start of each medication assistance
Am J Health-Syst Pharm—Vol 70 Dec 15, 2013
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Frontline Pharmacist
program for four to eight months. Data collected include the number of patients assisted, number of individual drugs ordered, types of drugs ordered, approximate retail cost of medications if the patient had self-paid, the number of APPE students each month, and the number of hours spent by faculty and APPE students working at each site each month. Drug costs were approximated based on dose and number of units ordered. Pricing was obtained from Redbook Online.6 When drug cost data were unavailable, the information was left out of the overall estimated monthly cost, resulting in a lower-than-actual cost approximation. A total of 297 medications were obtained via the medication assistance service at clinic site 1 over the eight-month reporting period. Clinic site 2 obtained 63 medications over a four-month reporting period. Over a six-month period, clinic site 3 obtained 78 medications. The most frequently requested medications at all sites were for the treatment of diabetes, hypertension, COPD, asthma, hyperlipidemia, and atrial fibrillation. The approximate total retail cost per month of medications processed via the medication assistance service ranged from $6,300 the first month to a high of nearly $43,000.6 Clinic site 1 provided a total of $130,000 of brand-name medications over the entire reporting period, with clinic site 2 reporting just under $23,000, and clinic site 3 providing $43,600 of brand-name medications. Clinic site 2 generated 16 referrals for additional pharmacy services using medication reviews. Referrals were generated for the management of patients with diabetes, asthma, COPD, and dyslipidemia. Discussion. One barrier to successful medication management for many patients is medication cost. Discounteddrug lists have helped to improve this burden, but these lists are not all-inclusive. Often, medications on discounted-drug lists are adequate for initial therapy but fail to meet the needs of patients who require more aggressive treatment. Other issues arise when patients cannot tolerate or
2178
are allergic to certain medications and no therapeutic alternatives are available on the discounted-drug lists. For low-income patients and patients without prescription insurance, these barriers become even more troublesome. PMAPs are helpful tools to provide patients with a financial hardship with brand-name medications when cheaper therapeutic alternatives are not available or appropriate. Benefits of PMAPs extend beyond improved health for patients. These programs offer an opportunity for pharmacy involvement. Pharmacists and pharmacy students are excellent candidates to facilitate patient enrollment into PMAPs, as these programs provide the opportunity for comprehensive medication reviews, patient consultation, and therapeutic interventions. The medication assistance services at all three clinics are student run under the direction of the clinical pharmacist. This setup provides a positive learning environment for the students, while maintaining continuity of care from month to month. While establishing a new practice site, pharmacy services used the PMAP as a patient recruitment tool for disease management clinics. An extensive chart review was conducted for each patient in the medication assistance service. Emphasis was placed on review of pertinent laboratory values and medications and overall management of diabetes, dyslipidemia, asthma, and COPD. If patients had any of these diseases and their conditions were uncontrolled based on current guidelines, a pharmacy referral request was made for physician approval. Using the medication assistance service as a recruitment tool was successful in the beginning stages of establishing a new practice site. During the first three months of service at the new clinic, 16 referrals were made, and three pharmacist-run disease management clinics were established. While PMAPs offer multiple benefits to patients, students, and pharmacy service development, these programs are not without challenges. One major complication associated with PMAPs is the time lapse from application submission to receipt of the medication. While
Am J Health-Syst Pharm—Vol 70 Dec 15, 2013
each program is slightly different, most require an application to be submitted along with proof of income and a prescription via mail or facsimile. Once approved, the PMAP mails the requested medication to the provider. This process can take anywhere from one week to one month or more if any documentation is missing or incorrect. This time lapse can be problematic if the medication is needed immediately. Another common challenge associated with PMAPs is accessibility and communication with the prescribing physician, as any new application or change to medication therapy will require physician approval. Finally, record keeping can be a daunting task as the number of patients enrolled in PMAPs increases. Several computer software programs are available to assist with keeping track of medication orders, filling out applications, and sending reminders when refills are necessary, but most of these programs have a subscription fee. The medication assistance service at these three clinics provides access to medications for patients who might not otherwise obtain their medications due to financial hardship. The students involved in this service learn to effectively communicate with patients and health care providers, hone medication review skills, and gain knowledge of low-cost alternatives for financially challenged patients. These skills can be applied in nearly any pharmacy practice setting. In addition, prescribers’ collaboration with pharmacy services for PMAPs helps to boost referrals for pharmacist-managed clinics for diabetes and smoking cessation. 1. Heisler M, Wagner TH, Piette JD. Patient strategies to cope with high prescription medication costs: who is cutting back on necessities, increasing debt, or underusing medications? J Behav Med. 2005; 28:43-51. 2. Dvorcek JJ, Cook KM, Klepser DG. Student-run low-income family medicine clinic: controlling costs while providing comprehensive medication management. J Am Pharm Assoc. 2010; 50:384-8. 3. Senior Friendship Centers. Centers for Healthy Aging medical and dental clinics. www.friendshipcenters.org/Services/ t a b i d / 6 8 / a r t i c l e Ty p e / Ar t i c l e Vi e w / articleId/16/Centers-for-Healthy-Aging. aspx (accessed 2011 Jul 15).
Frontline Pharmacist
4. RxAssist Patient Assistance Program Center. Homepage. www.rxassist.org (accessed 2013 Feb 28). 5. NeedyMeds. Homepage. www.needymeds.org (accessed 2013 Feb 28). 6. Redbook Online. Greenwood Village, CO: Thomson Reuters Healthcare. Updated periodically.
Melissa Murfin, Pharm.D., PA-C, Assistant Professor Physician Assistant Program Elon University Campus Box 2087 Elon, NC 27244 [email protected] Ryan Wargo, Pharm.D., BCACP, Assistant Professor of Pharmacy Practice Alejandro Vazquez, Pharm.D., Assistant Professor of Pharmacy Practice Lake Erie College of Osteopathic Medicine School of Pharmacy Bradenton, FL
The authors have declared no potential conflicts of interest. DOI 10.2146/ajhp120753
Am J Health-Syst Pharm—Vol 70 Dec 15, 2013
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Copyright of American Journal of Health-System Pharmacy is the property of American Society of Health System Pharmacists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
F rontline Pharmacist Experience with a student-run patient medication assistance service
M
ore than 45 million patients in the United States have no prescription drug coverage and are faced with the financial burden of medication costs.1,2 As a result of financial hardship, patients underutilize their medications, a practice that often leads to adverse health outcomes. 1 Patients may take their medications less frequently in an effort to maintain treatment before their supply is exhausted. Other patients may accept a prescription but do not fill the medication or request only a partial fill as a way to decrease medication costs. In recent years, several methods to obtain medications at low or no cost have been established, including retail pharmacy discount drug lists ($4-drug lists) and patient medication assistance programs (PMAPs) sponsored by pharmaceutical companies. Free brand-name medications are available through most drug companies when patients enroll in PMAPs. These programs have eased the burden of medication costs but are not without their barriers. Prescribers often struggle to find costfriendly medication alternatives for managing patients with financial hardships. Some prescribers, while aware of PMAPs, may not have the resources to actively identify patients’ issues, enroll patients in the programs, or manage their enrollment. As the medication expert, pharmacists can play a pivotal role on the health
care team and are well positioned to manage pharmacotherapy issues relating to medication cost and underutilization. Pharmacists can conduct comprehensive medication reviews and recommend cost-effective alternative therapies. When a less-costly alternative is not available, PMAPs become a valuable option. Establishing the medication assistance service. A service to assist underserved patients in obtaining medications via PMAPs was established in three clinics. This resource offers an important benefit to the clinics’ patient population of mostly uninsured or underinsured, unemployed, or homeless patients. Patients fill out an application form, provide income verification, and receive free medication if they meet the specific criteria developed by the pharmaceutical manufacturer. Each drug company has a unique form and set of qualifications for patients to meet to receive free medications, which may require the completion of multiple applications (one for each drug company) to supply the patient with the appropriate therapy regimen. Many of the applica-
The Frontline Pharmacist column gives staff pharmacists an opportunity to share their experiences and pertinent lessons related to day-to-day practice. Topics include workplace innovations, cooperating with peers, communicating with other professionals, dealing with management, handling technical issues related to pharmacy practice, and supervising technicians. Readers are invited to submit manuscripts, ideas, and comments to AJHP, 7272 Wisconsin Avenue, Bethesda, MD 20814 (301-664-8601 or [email protected]).
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Am J Health-Syst Pharm—Vol 70 Dec 15, 2013
tions are several pages in length with varying complexity. Patient barriers to the use of application forms include illiteracy, absence of a home computer or printer for accessing applications, and lack of a stable home situation for shipment of medications. Clinical pharmacy faculty were integrated into these clinics and asked to manage the existing service. Pharmacy students were incorporated into the service as they began their advanced practice pharmacy experiences (APPEs) in their fourth year of pharmacy school. The students, once trained by the clinical pharmacists, function independently, with oversight provided by the pharmacist and medical staff as needed. Clinic settings. This medication assistance service is offered at three ambulatory care clinics for the underserved in southwest Florida. The medication assistance service is provided at clinics 1 and 2 via an outpatient medical clinic specializing in the care of patients over age 50 years. To qualify for care, patients must be over age 50 years with limited or no income and residents of the county in which the clinic is located. Fees are based on a sliding scale according to patient need and ability to pay. Clinics are staffed by volunteer health care providers, many of whom are retired from private practice. Services offered at each office location vary but include general medicine, dentistry, and limited specialized medicine such as gynecology, orthopedics, and cardiology. Each site has approximately 4000 patient visits annually.3
Frontline Pharmacist
Pharmacy services at the clinics consisted of maintaining a supply of donated sample medications and assisting patients in obtaining new medications and refills for long-term medications. Once pharmacy faculty members and pharmacy students were added to these sites, other services were added, including medication review and management of chronic diseases (e.g., diabetes, dyslipidemia). Pharmacy faculty became essential to clinics 1 and 2 when grant funding that had supported a part-time employee was withdrawn. Time allotment to patient assistance was accordingly diminished, affecting patient enrollment in PMAPs. This was some patients’ only access to medications due to financial hardship. Clinical pharmacists were able to incorporate the medication assistance service into their daily duties by training APPE students to obtain and assist the patients in filing PMAP forms. The medication assistance service had previously been a fee-based service; however, through the use of pharmacy students and faculty pharmacists, the service is free of charge to clinic patients. Additional staffing through the APPE also allows for full-time services to be provided by students on rotation. Clinic 3 provides primary care medical services to uninsured patients age 18–64 years, as patients outside the age range are eligible for Medicaid or Medicare coverage. The target population of this clinic is homeless patients who cannot afford services at other institutions that might provide care on a sliding-scale rate. Many of these patients cannot afford $4 copayments for prescriptions through drug discount programs. This clinic is an interdisciplinary effort between a pharmacist and a physician. Both clinicians are faculty at a local school of pharmacy and osteopathic medicine. Once a patient receives a diagnosis, the pharmacist, along with APPE students, works with the physician’s team to determine the proper drug therapy for the patient. Along with working to choose proper drug therapy, pharmacy services include management of chronic diseases (i.e., diabetes, hypertension,
dyslipidemia, asthma, chronic obstructive pulmonary disorder [COPD], and anticoagulation) and tobacco cessation, as well as patient medication assistance. The goal of the clinic is that every patient in need receives patient assistance for medications. Historically, many patients at the clinic have been noncompliant with their drug regimens due to the high cost of medications. By providing most medications free of charge, it is hoped that compliance will increase in this population The students, working under the supervision of the pharmacist, are responsible for each patient enrolled in the medication assistance service. Student responsibilities. The studentrun medication assistance service consists of fourth-year APPE students who help to identify medications for which patient assistance could be obtained, select the appropriate forms for completion, assist patients with completing the forms, and provide proper income documentation. At the start of their four-week rotation, the students are trained by the pharmacist in methods for determining the need for patient assistance, choosing the correct therapy, and enrolling patients in the PMAPs. Students use online databases and manufacturer websites as resources whenever necessary.4,5 The student-run medication assistance service involves patient referrals to the pharmacy for evaluation. After patients receive a diagnosis, students create a drug therapy regimen that takes into account patient compliance and availability of the drugs through a PMAP. The new regimen is then presented to the clinic’s physician team for discussion. Once approved, the pharmacy students complete all forms with the patient and mail them to the companies. If the patient has a permanent residence, the medications are mailed there; otherwise, they are mailed to the clinic. Once received, the patient is instructed to make an appointment with the pharmacy clinic to review how to properly take the medications, determine if any possible replacement medications are needed, and discuss the possible adverse effects of treatment. Students also verify patients’ medication lists
to capture any dose or therapy changes and conduct medication reviews to determine if any other issues need to be addressed with the patient or prescriber. In some cases, referrals to pharmacist-run disease management clinics are generated as a result of medication reviews. If PMAPs are not available for a prescribed medication and cost remains an issue for the patient, students identify alternative cost-effective therapies. Additional student responsibilities and educational opportunities include participating in patient visits with the clinical pharmacist or prescriber, attending journal club, writing newsletter articles, and preparing presentations to clinic staff, faculty, and other students. Clinic sites also offered interaction with nursing, medical, and physician assistant students, allowing pharmacy students to begin developing interdisciplinary practice skills with peers. Experience with the medication assistance service. Two fourth-year pharmacy students completed the ambulatory care APPE each month at clinics 1 and 2 from January 1 to June 30, 2011. Each student saw patients half a day each week with the clinical pharmacist. Students were at the clinic site four days each week; the fifth day is spent on campus for journal club, presentations, and other educational activities. Clinic 3 had two fourth-year pharmacy students complete the ambulatory care APPE each month, seeing 506 patients from January 1 to June 30, 2011, with pharmacist interventions occurring for nearly every patient seen. The students were responsible for attending to all patients scheduled for pharmacy consultations each day. They also worked with the physician team to address any immediate prescription needs. Students saw patients five days each week during the clinic’s hours of operation. They also completed projects that involved journal clubs, a new drug and clinical controversy newsletter, a case-based disease presentation, and numerous topic discussions. Data were collected monthly from the start of each medication assistance
Am J Health-Syst Pharm—Vol 70 Dec 15, 2013
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Frontline Pharmacist
program for four to eight months. Data collected include the number of patients assisted, number of individual drugs ordered, types of drugs ordered, approximate retail cost of medications if the patient had self-paid, the number of APPE students each month, and the number of hours spent by faculty and APPE students working at each site each month. Drug costs were approximated based on dose and number of units ordered. Pricing was obtained from Redbook Online.6 When drug cost data were unavailable, the information was left out of the overall estimated monthly cost, resulting in a lower-than-actual cost approximation. A total of 297 medications were obtained via the medication assistance service at clinic site 1 over the eight-month reporting period. Clinic site 2 obtained 63 medications over a four-month reporting period. Over a six-month period, clinic site 3 obtained 78 medications. The most frequently requested medications at all sites were for the treatment of diabetes, hypertension, COPD, asthma, hyperlipidemia, and atrial fibrillation. The approximate total retail cost per month of medications processed via the medication assistance service ranged from $6,300 the first month to a high of nearly $43,000.6 Clinic site 1 provided a total of $130,000 of brand-name medications over the entire reporting period, with clinic site 2 reporting just under $23,000, and clinic site 3 providing $43,600 of brand-name medications. Clinic site 2 generated 16 referrals for additional pharmacy services using medication reviews. Referrals were generated for the management of patients with diabetes, asthma, COPD, and dyslipidemia. Discussion. One barrier to successful medication management for many patients is medication cost. Discounteddrug lists have helped to improve this burden, but these lists are not all-inclusive. Often, medications on discounted-drug lists are adequate for initial therapy but fail to meet the needs of patients who require more aggressive treatment. Other issues arise when patients cannot tolerate or
2178
are allergic to certain medications and no therapeutic alternatives are available on the discounted-drug lists. For low-income patients and patients without prescription insurance, these barriers become even more troublesome. PMAPs are helpful tools to provide patients with a financial hardship with brand-name medications when cheaper therapeutic alternatives are not available or appropriate. Benefits of PMAPs extend beyond improved health for patients. These programs offer an opportunity for pharmacy involvement. Pharmacists and pharmacy students are excellent candidates to facilitate patient enrollment into PMAPs, as these programs provide the opportunity for comprehensive medication reviews, patient consultation, and therapeutic interventions. The medication assistance services at all three clinics are student run under the direction of the clinical pharmacist. This setup provides a positive learning environment for the students, while maintaining continuity of care from month to month. While establishing a new practice site, pharmacy services used the PMAP as a patient recruitment tool for disease management clinics. An extensive chart review was conducted for each patient in the medication assistance service. Emphasis was placed on review of pertinent laboratory values and medications and overall management of diabetes, dyslipidemia, asthma, and COPD. If patients had any of these diseases and their conditions were uncontrolled based on current guidelines, a pharmacy referral request was made for physician approval. Using the medication assistance service as a recruitment tool was successful in the beginning stages of establishing a new practice site. During the first three months of service at the new clinic, 16 referrals were made, and three pharmacist-run disease management clinics were established. While PMAPs offer multiple benefits to patients, students, and pharmacy service development, these programs are not without challenges. One major complication associated with PMAPs is the time lapse from application submission to receipt of the medication. While
Am J Health-Syst Pharm—Vol 70 Dec 15, 2013
each program is slightly different, most require an application to be submitted along with proof of income and a prescription via mail or facsimile. Once approved, the PMAP mails the requested medication to the provider. This process can take anywhere from one week to one month or more if any documentation is missing or incorrect. This time lapse can be problematic if the medication is needed immediately. Another common challenge associated with PMAPs is accessibility and communication with the prescribing physician, as any new application or change to medication therapy will require physician approval. Finally, record keeping can be a daunting task as the number of patients enrolled in PMAPs increases. Several computer software programs are available to assist with keeping track of medication orders, filling out applications, and sending reminders when refills are necessary, but most of these programs have a subscription fee. The medication assistance service at these three clinics provides access to medications for patients who might not otherwise obtain their medications due to financial hardship. The students involved in this service learn to effectively communicate with patients and health care providers, hone medication review skills, and gain knowledge of low-cost alternatives for financially challenged patients. These skills can be applied in nearly any pharmacy practice setting. In addition, prescribers’ collaboration with pharmacy services for PMAPs helps to boost referrals for pharmacist-managed clinics for diabetes and smoking cessation. 1. Heisler M, Wagner TH, Piette JD. Patient strategies to cope with high prescription medication costs: who is cutting back on necessities, increasing debt, or underusing medications? J Behav Med. 2005; 28:43-51. 2. Dvorcek JJ, Cook KM, Klepser DG. Student-run low-income family medicine clinic: controlling costs while providing comprehensive medication management. J Am Pharm Assoc. 2010; 50:384-8. 3. Senior Friendship Centers. Centers for Healthy Aging medical and dental clinics. www.friendshipcenters.org/Services/ t a b i d / 6 8 / a r t i c l e Ty p e / Ar t i c l e Vi e w / articleId/16/Centers-for-Healthy-Aging. aspx (accessed 2011 Jul 15).
Frontline Pharmacist
4. RxAssist Patient Assistance Program Center. Homepage. www.rxassist.org (accessed 2013 Feb 28). 5. NeedyMeds. Homepage. www.needymeds.org (accessed 2013 Feb 28). 6. Redbook Online. Greenwood Village, CO: Thomson Reuters Healthcare. Updated periodically.
Melissa Murfin, Pharm.D., PA-C, Assistant Professor Physician Assistant Program Elon University Campus Box 2087 Elon, NC 27244 [email protected] Ryan Wargo, Pharm.D., BCACP, Assistant Professor of Pharmacy Practice Alejandro Vazquez, Pharm.D., Assistant Professor of Pharmacy Practice Lake Erie College of Osteopathic Medicine School of Pharmacy Bradenton, FL
The authors have declared no potential conflicts of interest. DOI 10.2146/ajhp120753
Am J Health-Syst Pharm—Vol 70 Dec 15, 2013
2179
Copyright of American Journal of Health-System Pharmacy is the property of American Society of Health System Pharmacists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
