Thursday, January 12, 2012



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(Abst. 3.088 ), 2011

Patient Assistance Program for Medication: Is it Cost Effective?

Authors: J. C. Dean, C. D. Allen, K. S. Gery
Instit: Epilepsy Institute of North Carolina, Epilepsy Institute of NC
Content:
RATIONALE:
Optimum patient care requires attention to many details, including non-billable services. The pharmaceutical industry has patient assistance programs(PAP) to provide medications at no cost to patients whom they deem eligible, but it is difficult for many patients to cope with specific PAP requirements and application variability. Most physicians do not have an in-house PAP program to assist their patients to apply for and receive these medications because of time constraints and costs associated with in-house assistance. Over time, patient instructions, phone calls, drug dispensing and government regualtion have increased to create a complex problem for physicians and their patients. The Epilepsy Institute of NC (EINC) is a not-for-profit comprehensive epilepsy service. We established an in-house PAP program (1999)to provide and evaluate a formal PAP mechanism to determine its feasibility. It is staffed by an RN coordinator to assure privacy for patients and individualized PAP management and record keeping.
METHODS:
We include all willing patients who have no insurance, meet various PAP income guidelines, are students,or are in the Medicare donut hole. We hired a single coordinator four 8-hour days per week.The job description requires the performance of 20 activities. We identify and track all communications over twelve months. We categorize functions of our in-house PAP program to determine cost according to function and establish a data base to record demographics, phone calls, personal interactions with patients and supply and store medications. We also record patient medication pickup,correspondence with companies, involvement of in-house staff, and patients leaving the program to obtain generics or insurance coverage. The PAP program began in 1999 and we tabulated results on 250 patients registered in 2010.
RESULTS:
Study Demographics:N=250; age 26; (17-65) years; gender: female(58%) male(42%).Number of medications: 1=85%,2=15%. Seizure type: 57% partial seizures,43% primary generalized; 25% of these were intractable. The number of communications over 12 months was tabulated: telephone calls averaged 6 per patient and the average call duration was 17 minutes, for advice, drug information and intervention. The coordinator spent 70% of time on patient registration, screening, advising and requesting medication with the company, returning cslls, providing forms, letters, prescriptions and recording in medical records. Patient intiated 40% of the calls, 15% of the calls required assistance from a physician or physician's assistant. The annual cost of the in-house PAP service was found to be $200 per patient.
CONCLUSIONS:
The drug assistance program requires a full-time knowledgeable staff member. Phone time, especially return phone calls, pill counts and identification, variation of forms all presented a challenging process for our comprehensive program. Although helpful to our patients, the in-house PAP program is not cost effective in our comprehensive epilepsy program. Alternative commercial patient assistant programs are a viable option, are patient generated and drugs are mailed to home.
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