Help your needy patients get free medication

September 20, 1999

Enroll them in assistance programs offered by pharmaceutical manufacturersand watch the quality of their lives improve.

Help your needy patients get free medication

Enroll them in assistance programs offered by pharmaceuticalmanufacturers—and watch the quality of their lives improve.

By Cheryl L. Branche, MD

The author, a general practitioner in Jackson, MS, for several years,recently moved to New Zealand.

For most physicians, managing a chronic illness without medication isinconceivable. Yet for many patients, paying for the prescriptions is justas impossible. As the cost of drugs skyrockets, many poor patients haveto decide which pills they can get and how often they can afford to takethem.

While practicing at a clinic for the homeless in Mississippi, I founda way to get free medications for many of my patients through patient assistanceprograms offered by about 50 major pharmaceutical companies.

These programs provide free products to eligible patients. My patientshave received a wide variety of medications, from nicotine patches to AZT,covering the needs of most chronic illnesses, including heart disease, hypertension,arthritis, diabetes, and mental illness. (The programs don't help in acutecare situations, however, because it can take weeks to receive the drugs.)

With a little extra time and organization, any physician can use theseprograms to help needy patients.

Agnes W. is an insulin-dependent diabetic. An obese woman in her 60s,she also has angina, osteoarthritis, and hypertension. Although she worksas a cab driver, she's homeless.

One day, Ms. W. came to me complaining that she wasn't feeling well.Her blood sugar was so high that I sent her to the ER. Later, she told meshe had stopped taking her insulin. She was on eight or nine different medications,but she couldn't afford them all.

As Ms. W. sat in my office, I contacted Lilly Cares, the patient assistanceprogram at Eli Lilly, the manufacturer of Humulin. She qualified for theprogram. When I told her that she would receive a free and refillable supplyof the drug, she was grateful and relieved.

Many of my patients, especially the elderly, have multiple medical problemsand receive more prescriptions than they can afford to fill. It's commonfor patients to take a medication every two or three days—instead ofdaily, as prescribed—if reducing the dosage doesn't make them feeltoo bad. This allows them to stretch a one-month supply to two or threemonths.

Virtually every physician has at least one patient down on his luck.With help, that patient doesn't have to miss any medications.

Using the patient assistance programs helps make medical care a realityfor poor patients by enabling them to get the drugs they need and take themedication as prescribed.

Here are the basics of dealing with these programs:

Verifying eligibility. Although the exact rules vary by company, mostprograms require that the patient be a US citizen.

Most of the programs are available only to patients who have no privatehealth insurance and are ineligible for Medicare or Medicaid. Some companies,however, will help patients who have private insurance but lack coveragefor outpatient prescription drugs. Assistance is also sometimes availableto Medicaid patients who exceed allowable expenses. For example, Mississippi'sMedicaid limits the number of medications for most adults. A patient whoexceeds the allowed amount may qualify for assistance with the additionalprescriptions.

The programs generally are open only to patients whose income falls belowa certain level, usually the federal poverty line. Although most applicationforms don't request specific income information, the programs do requirethat the physician certify that the patient meets the requirement.

Many programs will take medical expenses into consideration when determiningincome eligibility. Even lower-middle-income patients can qualify, if heavymedical expenses drop their net income below the poverty level. This happensoften for AIDS patients, whose medical expenses are extremely high.

Applying for assistance. List all the medications your patient takesfor chronic conditions, including the manufacturers' names, addresses, andphone numbers.

Call each drug company and ask for the patient assistance program. Requesta list of covered medications and enrollment applications. The company usuallycan fax this information to you. The list of covered products changes frequently,so call to update your information regularly. You can also find a list ofpatient assistance programs along with contact and other information atthe Web site of the Pharmaceutical Research and Manufacturers of America(www.phrma.org/patients).

Most of the information you'll need for the application can be foundon the patient's chart. Other information, such as income and expenses toverify eligibility, must come from the patient.

Mail completed forms immediately. Some programs will even accept applicationsover the phone.

I like to work with the patient on the application. Going through theprocess creates a bond between us, raises the patient's self-esteem, andreduces her feelings of helplessness. We call the company, figure out thedetails, and complete the paperwork together. Patients seem to appreciatethe attention, and they learn that they are able to help themselves.

Don't underestimate the need for sensitivity. Disclosing informationabout income or assets is just as invasive for poor patients as it is forwealthy individuals.

Dispensing the medicine. Most programs mail the products to the physician'soffice. Patients typically receive a one- to three-month supply for eachprescription. The drugs must be stored in a cool place that's easily accessibleto all staff members. At our clinic, the supplies are kept in the samplecloset.

It's important to record the shipment's arrival and place a copy of thepacking sheet in the patient's medical file. Promptly call the patient topick up the medications.

Some drug companies mail out coupons that can be redeemed at a pharmacy.Just give the coupon to the patient.

Many patient assistance programs allow for refills of the free products.At follow-up visits, check to see whether the patient needs a new supplyof medicine.

Maintaining accurate records. Be prepared for lots of paperwork and phonecalls when you start dealing with the programs. But once you're familiarwith the process, things should run smoothly. I'm able to manage assistanceprograms for more than 50 patients with the help of a nurse and a good filingsystem.

Make no mistake, using patient assistance programs can be time-consuming.It takes an average of 30 minutes to enroll a patient in each program; somepeople are eligible for several programs for different medications. WhileI choose to do much of the work myself, a nurse or office assistant couldhandle many of the management tasks.

Whoever runs the program needs to gather the information required foreach application, keep track of all correspondence and shipments, notifypatients when the drugs come in, and maintain the files.

To avoid getting overwhelmed by paperwork and shipments, it is vitalto maintain a well-organized filing system. Information about the patientassistance programs should be easily accessible by not only you, but alsoby other physicians in your practice, your nurse, and office staff.

I place all documents relating to the patient assistance programs ineach patient's medical file, including copies of the enrollment forms andoriginal prescriptions, and supporting documents such as letters and packingslips. I also instruct my staff to treat any mail about the programs asif it were a lab report: pull the patient's file and place it on my deskwith the letter.

To keep track of the many different programs, what they cover, and whatthey require, I also have a separate file for each drug company involved.In each folder I place information about the company's program, enrollmentapplications, products offered, and a copy of the enrollment packet foreach of my patients in the program.

Detecting which patients are financially unable to take medication asprescribed isn't always easy. Patients rarely volunteer that money is aproblem or that they're not taking their medications. You have to be alertto evidence of noncompliance, and use some gentle prodding to discover whichpatients are having financial problems. If a hypertensive patient's bloodpressure is not going down, it's possible he just can't afford the prescription.And that's where these programs can help.

Patient assistance programs aren't perfect. To get free medications,your patients will have to give up some privacy, and you and your staffwill have to give up some time.

There's also the danger of choosing a medication because it's coveredby a patient assistance program, not because it's the best choice for thepatient. For each patient, you'll have to balance medical needs carefullywith social and financial issues.

The benefits of these programs outweigh any problems in using them. Patientsappreciate the attention and effort, and they become more willing to followyour advice. They'll finally be able to take the medications they need,not just the ones they can afford.



Cheyrl Branche. Help your needy patients get free medication.

Medical Economics

1999;18:57.