Meeting the Medication Needs of Iowans: the Meeting the Medication Needs of Iowans: the IowaCare Pilot Pharmaceutical Program and IowaCare Pilot Pharmaceutical Program and

UIHC Medication Assistance CenterUIHC Medication Assistance Center

Lisa Mascardo, PharmDLisa Mascardo, PharmDAssistant DirectorAssistant Director

Ambulatory Pharmaceutical CareAmbulatory Pharmaceutical CareThe University of Iowa Hospitals and ClinicsThe University of Iowa Hospitals and Clinics

Goals and ObjectivesGoals and Objectives

1.1. To gain an understanding of medication assistance To gain an understanding of medication assistance options for Iowansoptions for Iowans

2.2. To describe the differences in medication benefits To describe the differences in medication benefits between the State Papers Program and IowaCare between the State Papers Program and IowaCare Pilot Prescription ProgramPilot Prescription Program

3.3. To gain an understanding of methods used to To gain an understanding of methods used to predict prescription utilization and costspredict prescription utilization and costs

4.4. To gain a general understanding of how Patient To gain a general understanding of how Patient Medication Assistance Programs workMedication Assistance Programs work

Societal ProblemSocietal Problem

Patients that cannot afford their Patients that cannot afford their medications are at higher risk for medications are at higher risk for readmission and reoccurrence of their readmission and reoccurrence of their illness.illness.

Medication Assistance Options for Medication Assistance Options for IowansIowans

MedicaidMedicaid Medicare Part D plansMedicare Part D plans Patient Medication Assistance Programs Patient Medication Assistance Programs

(manufacturers)(manufacturers) State Papers State Papers IowaCare Pilot Prescription IowaCare Pilot Prescription

ProgramProgram

History of Providing Services to History of Providing Services to Indigent Patients – UIHC’s roleIndigent Patients – UIHC’s role

State Papers Program State Papers Program Each county in Iowa issued a certain number of Each county in Iowa issued a certain number of

“papers” based on population“papers” based on population Patients received comprehensive health care at Patients received comprehensive health care at

UIHCUIHC UIHC received state appropriation to cover costsUIHC received state appropriation to cover costs Full medication benefit availableFull medication benefit available Approximately 3700 Iowans had State Papers Approximately 3700 Iowans had State Papers

when the program ended in June, 2005when the program ended in June, 2005

Medication Benefit under State Papers Medication Benefit under State Papers ProgramProgram

A tiered formulary was created based on the A tiered formulary was created based on the UIHC formularyUIHC formulary Generic meds, necessary sole-source brand name Generic meds, necessary sole-source brand name

meds in Tier 1meds in Tier 1 Higher-cost brand name meds in upper tiersHigher-cost brand name meds in upper tiers Prior authorization by clinical faculty or Prior authorization by clinical faculty or

documented failure of Tier 1 med required for use documented failure of Tier 1 med required for use of higher tier medsof higher tier meds

Refills mailed to patients at no costRefills mailed to patients at no cost

Transition to IowaCare ProgramTransition to IowaCare Program

In July 2005, the State of Iowa officially ended In July 2005, the State of Iowa officially ended support for the State Papers Program and support for the State Papers Program and implemented the IowaCare Programimplemented the IowaCare Program

Had effect of expanding health care coverage Had effect of expanding health care coverage to greater number of Iowansto greater number of Iowans

Elements of IowaCare ProgramElements of IowaCare Program

Patient eligibility based on income (below Patient eligibility based on income (below 200% of FPL)200% of FPL)

Income level determined monthly premium Income level determined monthly premium amountamount

Patients could declare a hardship and have Patients could declare a hardship and have monthly premiums waivedmonthly premiums waived

Medication Coverage under IowaCare Medication Coverage under IowaCare – FY06– FY06

Medication coverage limited to a 10-day Medication coverage limited to a 10-day supply of medications at dischargesupply of medications at discharge

Continued to provide chronic medications for Continued to provide chronic medications for FY05 State Papers patientsFY05 State Papers patients Patient profiles reviewed for chronic indicationsPatient profiles reviewed for chronic indications Meds for chronic indications identified for Meds for chronic indications identified for

coveragecoverage No newly identified conditions covered after 7/05No newly identified conditions covered after 7/05

Similar to Medicaid program – charged copaysSimilar to Medicaid program – charged copays

Medicare Part DMedicare Part D

Medication coverage became available for Medication coverage became available for approximately 2000 patients formerly covered approximately 2000 patients formerly covered under State Papers programunder State Papers program

Dual coverage not allowed – must use MCR Dual coverage not allowed – must use MCR Part D if eligiblePart D if eligible

Eligible patients received letters reminding Eligible patients received letters reminding them to sign up with MCR Part D planthem to sign up with MCR Part D plan

Grace periodGrace period

Creation of IowaCare Pilot Creation of IowaCare Pilot Prescription ProgramPrescription Program

Planning started in March, 2006Planning started in March, 2006

Goal to estimate costs of programGoal to estimate costs of program Anticipated number of patients to utilize programAnticipated number of patients to utilize program Prescription utilization rate per patient Prescription utilization rate per patient Average drug cost per prescriptionAverage drug cost per prescription Estimated drug cost per programEstimated drug cost per program Personnel and mailing costsPersonnel and mailing costs

Number of Patients participating in Number of Patients participating in Pilot Prescription ProgramPilot Prescription Program

Total number of IowaCare (IC) enrollees as of Total number of IowaCare (IC) enrollees as of 5/5/06 (at that point in time)5/5/06 (at that point in time)

Estimated number of IC patients receiving RxEstimated number of IC patients receiving Rx Subtracted number of former State Papers Subtracted number of former State Papers

patientspatients

Estimated Prescription Utilization RateEstimated Prescription Utilization Rate

Est average annual number of Rx per patientEst average annual number of Rx per patient State Papers utilization dataState Papers utilization data Utilization data from large insurance companyUtilization data from large insurance company

Estimated IowaCare Prescription RatesEstimated IowaCare Prescription Rates 25% like State Papers25% like State Papers 35% like commercial insurance35% like commercial insurance 40% mid-utilization40% mid-utilization

Estimated Prescription Utilization RateEstimated Prescription Utilization Rate

Assumed that 80% of Rx written would be Assumed that 80% of Rx written would be filledfilled

Est total number of prescriptions filled Est total number of prescriptions filled annually for IC patients = (Est ave annual annually for IC patients = (Est ave annual number Rx per patient) (Est number of number Rx per patient) (Est number of patients utilizing prescription pilot program)patients utilizing prescription pilot program)

Estimated Drug Costs of Pilot ProgramEstimated Drug Costs of Pilot Program

Average drug cost per prescription (pharmacy Average drug cost per prescription (pharmacy computer system data)computer system data)

Average annual drug cost per patient = (Ave Average annual drug cost per patient = (Ave number of Rx per patient) (Ave drug cost per number of Rx per patient) (Ave drug cost per Rx)Rx)

Total estimated drug cost of program = (Ave Total estimated drug cost of program = (Ave drug cost per patient) (Est number of patients)drug cost per patient) (Est number of patients)

Additional Costs to Provide Pilot Additional Costs to Provide Pilot ProgramProgram

Mailing refills to patientsMailing refills to patients

Staffing needs to handle increase in Staffing needs to handle increase in prescription volumeprescription volume

Pilot Prescription Program Benefit Pilot Prescription Program Benefit SummarySummary

IowaCare patients seen at UIHC by UIHC IowaCare patients seen at UIHC by UIHC providers would receive:providers would receive: All generic medications on UIHC formularyAll generic medications on UIHC formulary One 30-day supply of brand name medicationsOne 30-day supply of brand name medications

30-day supplies filled and refills mailed to 30-day supplies filled and refills mailed to patients living outside of Johnson countypatients living outside of Johnson county

Polk Co. residents may receive a 10-day Polk Co. residents may receive a 10-day supply of meds at discharge onlysupply of meds at discharge only

Implementation IssuesImplementation Issues

Patients not previously seen at UIHC needed Patients not previously seen at UIHC needed to have prescriptions written by UIHC to have prescriptions written by UIHC providersproviders

Patients who had prescriptions written by Patients who had prescriptions written by UIHC providers but filled at outside UIHC providers but filled at outside pharmacies needed prescriptions transferredpharmacies needed prescriptions transferred

Access issuesAccess issues

Implementation IssuesImplementation Issues

All patients enrolled in IowaCare qualified for All patients enrolled in IowaCare qualified for the same pilot prescription programthe same pilot prescription program Former State Papers patients on chronic Former State Papers patients on chronic

medications were limited to generic medsmedications were limited to generic meds Profile reviews to determine which meds could be Profile reviews to determine which meds could be

switched to genericsswitched to generics Patients requiring brand name meds were referred Patients requiring brand name meds were referred

to the UIHC Medication Assistance Centerto the UIHC Medication Assistance Center

Medication Assistance CenterMedication Assistance Center

Joint effort by Department of Pharmaceutical Joint effort by Department of Pharmaceutical Care and Department of Social ServicesCare and Department of Social Services

Staffed by Financial Counselor Pharmacist, Staffed by Financial Counselor Pharmacist, pharmacy technician and three social workerspharmacy technician and three social workers

MAC MissionMAC Mission

The UI Hospitals and Clinics Medication The UI Hospitals and Clinics Medication Assistance Center (MAC), in accordance with Assistance Center (MAC), in accordance with the UIHC mission of promoting the health of the UIHC mission of promoting the health of Iowans regardless of their ability to pay, helps Iowans regardless of their ability to pay, helps qualified patients gain access to medications qualified patients gain access to medications provided by drug manufacturers at little or no provided by drug manufacturers at little or no cost to the patient.cost to the patient.

MAC Services ProvidedMAC Services Provided

Medication profile reviewsMedication profile reviews Initial applicationsInitial applications ReapplicationsReapplications Receiving and dispensing medicationsReceiving and dispensing medications Medication financial counselingMedication financial counseling Staff training regarding resources Staff training regarding resources

availableavailable

SummarySummary

Assistance in obtaining affordable medications Assistance in obtaining affordable medications is available to qualified Iowansis available to qualified Iowans

The IowaCare Pilot Prescription Program was The IowaCare Pilot Prescription Program was implemented to fill the gap created when the implemented to fill the gap created when the State Papers program was discontinuedState Papers program was discontinued

Prescription utilization and cost projections Prescription utilization and cost projections were based on an estimation of the population were based on an estimation of the population size and combination of known commercial size and combination of known commercial and State Papers utilization ratesand State Papers utilization rates

SummarySummary

Other programs are available to fill in Other programs are available to fill in coverage gaps:coverage gaps: Manufacturer Medication Assistance Programs Manufacturer Medication Assistance Programs Discount generic programs such as Xubex, Discount generic programs such as Xubex,

Walmart and KmartWalmart and Kmart

QUESTIONS??QUESTIONS??