Nonprofit Health Facilities Streamline Patients’ Access to Rx Assistance

SANTA BARBARA, Calif., March 1, 2019 /PRNewswire/ -- Last month, more than 6,000 patients in 20 states received life-sustaining medication they otherwise couldn't afford. The free medicines were made available through a program launched a decade ago by Direct Relief to help nonprofit safety-net healthcare providers more efficiently care for their patients. 

Despite an expansion in health insurance coverage nationally over the past decade, the percentage of people in the U.S. without health insurance has risen from 12.7 percent two years ago to 15.5 percent, or more than one in six persons, according to the Commonwealth Fund. 

For people lacking insurance and living with a chronic illness like diabetes, forgoing medication can be life-threatening. That means patients with little or no income require other means of accessing treatment. 

Programs do exist to ease the financial barriers to healthcare for people who meet specific criteria. According to the Partnership for Prescription Assistance, more than 400 assistance programs offer medicines at no cost or discounted rates to qualified individuals, and biopharmaceutical companies offer nearly 200 of these programs. 

Removing Barriers for Those Most in Need of Assistance

While such patient assistance programs (PAPs) are a critical component of the nation's healthcare safety net, their sheer number and the typical arrangement – under which each must be separately applied for, adjudicated, and administered – can present navigational challenges for patients, particularly for those who rely on multiple medications to manage a chronic condition. PAPs can also place a strain on the healthcare providers responsible for enrolling patients, one medication at a time, one company at a time. 

"When patients have to fill prescriptions at different pharmacies and through individual patient assistance programs, the benefits of using a single pharmacy are lost," said Debbie Kinder, Chief Executive Officer of the medication assistance program at Welvista, a nonprofit pharmacy in Columbia, South Carolina serving uninsured patients throughout the state. 

To help streamline the process, remove redundancies, and ease the administrative burden for patients and healthcare providers alike, Direct Relief launched an initiative 10 years ago with several companies and nonprofit safety-net healthcare providers as an alternative to the traditional patient assistance model.  

"A treatment is only as good as the system that delivers it," said Joseph Visaggio, Executive Director, U.S. Group Patient Assistance Programs at Novartis Corporation. "Novartis, therefore, seeks opportunities to strengthen healthcare systems and lower local barriers to healthcare delivery, working in collaboration with partners such as Direct Relief." 

Rather than requiring each patient – and the patient's healthcare provider – to apply to a separate program for each manufacturer's prescriptions, Direct Relief began enrolling safety-net health centers, clinics, and charitable pharmacies at the facility level after ensuring that the nonprofit facilities had strong controls and procedures in place to identify patients who meet all companies' eligibility requirements. 

"We believe the Direct Relief model, which supports nonprofit healthcare facilities, can help provide quality patient care in areas where we can collectively have the greatest impact," said Visaggio. 

Better Care, Improved Service, Lower Cost, Stronger Controls 

By working with healthcare manufacturers directly, Direct Relief equips providers with medications from multiple companies for their patients through a single source and replenishes those medications, bottle for bottle, based on the prior month's usage.  This approach allows healthcare providers to dispense medications during appointments when patients receive a diagnosis and a prescription. 

Beyond the important patient-care benefit of receiving a medication when needed are other advantages stemming from the focus on strengthening the nonprofit facilities' controls and procedures to determine all patients' insurance status, including based their income status upon which eligibility for public insurance such as Medicaid is.  The approach ensures that persons eligible for Medicaid or other public health insurance may be properly enrolled while also identifying others who are eligible for multiple companies' patient assistance programs, thus eliminating the need for filling out multiple individual patient applications. 

"The ability to have prescriptions filled at no cost is a tremendous benefit for our patients and we are grateful to Direct Relief for their assistance," said Trudy Pacheco, Director of Grant and Project Development at Miami Beach Community Health Center. The facility serves a population that is predominately low-income with high rates of chronic disease. 

Since the initial pilot launched 10 years ago, several companies have signed on, and the program has expanded to include 55 facilities and 70 delivery sites across 22 states. 

"Eli Lilly and Company's long-standing support of Direct Relief's initiative to provide donated Lilly medicines to safety-net clinics reflects our belief in the incredible impact of this organization," said Steve Stapleton, Director, Lilly Patient Assistance Programs. "It also reflects our company's commitment to improve access to quality healthcare for those with limited resources." 

Over that period, the program delivered over 300,000 prescriptions for more than 63,000 patients, helping treat a variety of medical conditions including hypertension, cardiovascular disease, HIV/AIDS, diabetes, hormone replacement, mental health, and ocular health. 

"It's a privilege for Direct Relief to work so closely with both our nonprofit colleagues at health centers, clinics, and pharmacies who provide care every day for people with very limited means who need help and with leading companies that lean in to provide it," said Damon Taugher, Director of U.S. Programs for Direct Relief. "The needs that exist and the clear potential shown by this collaborative effort provides daily inspiration to look for different ways to accomplish the important goals we all share to help our neighbors in the most efficient, productive way possible."  

Reducing Administrative Burden, Costs of Assisting Patients in Need

In the absence of Direct Relief's program, the 63,000 patients who received needed medications at no charge would each have to complete, together with the prescribing healthcare professional, separate applications for each company's assistance program.  Most patients receive a medication from more than one of the participating companies, so the number of applications and related adjudications otherwise required would have exceeded 100,000 under the most conservative estimate model.  The enrollment of 55 facilities with appropriate internal controls versus the alternative of 100,000 individual applications and related adjudications from patients at those very same facilities reflects the enormous reduction in administrative barriers and costs that have been achieved.                     

"Our patient and medication demand have increased tremendously and our partnership with Direct Relief ensures we are able to meet the increasing demand as well as streamline our replenishment process," said Welvista's Kinder. "Direct Relief helps us fulfill our mission every day. We are so grateful for our partnership." 

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SOURCE Direct Relief