developing a medication access program - ushp - home
TRANSCRIPT
![Page 1: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/1.jpg)
Developing a Medication Access Program
![Page 2: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/2.jpg)
No Financial COI to Disclose
•While we mention situations involving off-label usage, we will not discuss the off-label usage of specific medications.
![Page 3: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/3.jpg)
Pharmacist Objectives1)
2)
3)
4)
5)
![Page 4: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/4.jpg)
Who are we?
•
••
•
•
•
•
![Page 5: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/5.jpg)
HCH Infusion Center
![Page 6: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/6.jpg)
Factors that Generated the Need for a MAP
1.
2.
3.
4.
5.
![Page 7: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/7.jpg)
What is Not Considered a Factor for a Medication Access Program?
a)
b)
c)
d)
![Page 8: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/8.jpg)
Why Focus on Prior Authorizations?
•
•
•
•
•
![Page 9: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/9.jpg)
What was done before?
••
•
•
•
![Page 10: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/10.jpg)
What Changed?
••
•
•
•
Patient Convenience!
![Page 11: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/11.jpg)
Key components of a MAP program
•
•
•
•
•
![Page 12: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/12.jpg)
Medication Access Process
Continuous Improvements:
Standardized process
Dedicated PA Staff
Expanding multidisciplinary coverage
Ongoing Challenges:
New insurance hurdles
More expensive medications
More non-standard processes
ACA - ?
![Page 13: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/13.jpg)
Bridging the Gap
CPhT
Disease state & Tx
PharmD
![Page 14: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/14.jpg)
Pharmacist Role in PA Process
•
•
•
•
•
•
Pharmacist
Prior Authorizations
Nurse
ProviderMAC Tech
Patient
![Page 15: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/15.jpg)
What is Not a Pharmacist Task?
a)
b)
c)
d)
![Page 16: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/16.jpg)
Sarcoma Clinic Flow Chart (Old Process)
![Page 17: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/17.jpg)
Sarcoma Clinic (New process)
![Page 18: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/18.jpg)
Pharmacist Time in Clinic
•
•
Misc, 10%
Technical, 27%
Professional, 29%
Clinical, 34%
AMBULATORY PHARM D MARCH 2015
Misc, 9%
Technical, 5%
Professional, 42%
Clinical, 44%
AMBULATORY PHARM D NOVEMBER 2016
![Page 19: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/19.jpg)
Benefits of a MAP•
••
•
••
•
•
![Page 20: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/20.jpg)
Technician Objectives•
•
•
•
•
![Page 21: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/21.jpg)
Innovative Role for CPhT
•
•
•
•
•
MAC CPhT
![Page 22: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/22.jpg)
A Day in the Life of a MAC Tech. . .
• Miscellaneous Activities
• Training & Meetings
• Lunch & Breaks
• Other Technical Activities• Documentations
• Workqueues
• Patient Interaction
• PAP Activities• PAP Enrollment
• Ordering & Inventory
• PA Activities• Benefit
Investigation
• Prior Authorizations
• Appeals
24.3%
24.3%
12.5%
38.8%
![Page 23: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/23.jpg)
Which of the Following is an Innovative Role for a Technician?
a)
b)
c)
d)
![Page 24: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/24.jpg)
What is Medication Access?
•
![Page 25: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/25.jpg)
Barriers to Access
•
•••
••••
•
•
![Page 26: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/26.jpg)
Categories of Assistance
Insurance
Copay Assistance
Access Programs
• Copay Cards
• Foundations
• Free Drug
• Replacement Drug
![Page 27: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/27.jpg)
Definitions - Insurance Terminology
• Amount patient must pay before plan will share costs.
Deductible (Ded.)
• Flat fee for service
Copay
• Percentage-based fee for service
Co-insurance (Co-ins.)
• Once patient has paid this amount the insurance plan will pay 100% of costs for the remainder of the contract.
Out-of-Pocket Max (OOP)
![Page 28: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/28.jpg)
Expen$afil
•
•Expen$afil
•
•
•
•
![Page 29: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/29.jpg)
Comparison of patient costs with & without copay assistance.
$10,000
$50,000
Cost Sharing
Patient Insurance
$175
$50,000
$9,825
Cost Sharing
Patient Insurance Copay Assistance
Patient pays $10,000 total Patient pays $175 total
![Page 30: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/30.jpg)
Getting Started: What do you need?
••
•
•
••
•
•
![Page 31: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/31.jpg)
Getting Started: Who do you need?
•
•
•
•
•
![Page 32: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/32.jpg)
Which of the Following is Not aFunction of a MAC Tech?
a)
b)
c)
d)
![Page 33: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/33.jpg)
How is Success Measured by the. . .
•
•
•
•
•
•
•
•
•
•
![Page 34: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/34.jpg)
The Real Measure of Success.
“It has made all the difference!”
“I am awed by and grateful for your staff, in particular (Technician) whose help in finding ways to pay for and finance medications for this disease are swift, timely and compassionate.”
![Page 35: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/35.jpg)
Measuring Success
•
•
•
•
•
![Page 36: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/36.jpg)
What Metrics Should Not Be Used to Measure Success?
a)
b)
c)
d)
![Page 37: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/37.jpg)
Number of Prior Authorizations (IV/PO)
0
200
400
600
800
1,000
1,200
1,400
1,600
1,800
# O
F M
ED
ICA
TIO
NS
AU
TH
OR
IZE
D
# of Prior Authorizations by Month
![Page 38: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/38.jpg)
Patient Assistance - Quantity & AWP
0
20
40
60
80
100
120
$0
$500,000
$1,000,000
$1,500,000
$2,000,000
$2,500,000
# O
F O
RD
ER
S
$ V
AL
UE
(A
WP
)
2016 - PAP Tracking by Month
![Page 39: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/39.jpg)
Write-offs
-100,000.00
-50,000.00
0.00
50,000.00
100,000.00
150,000.00
200,000.00
250,000.00
300,000.00
350,000.00
400,000.00
2016/02 2016/03 2016/04 2016/05 2016/06 2016/07 2016/08 2016/09 2016/10 2016/11 2016/12 2017/01 2017/02
![Page 40: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/40.jpg)
Conclusion•
•
•
•
•
•
![Page 41: Developing a medication access program - USHP - Home](https://reader031.vdocument.in/reader031/viewer/2022012423/617755e816079e10be32ad9a/html5/thumbnails/41.jpg)
Questions