Critical Path Network: Hospital's medication program helps uninsured
Critical Path Network
Hospital's medication program helps uninsured
Prescriptions must be related to hospital stay
When its population of uninsured patients increased as more people lost their jobs, Ingham Regional Medical Center in Lansing, MI, developed a program to provide medication for people who can't otherwise afford it.
The program, which is administered by the case management department, covers prescriptions that are related to the hospital stay.
"Like other hospitals, we are concerned about patients who come back to the hospital for the same diagnosis because they cannot afford to fill their prescriptions or can't afford the copay. With this program, we help uninsured patients get the medications they need to keep their conditions under control and avoid readmissions," says Marsha Bailey, RN, case manager at the 243-bed hospital.
The program was started about 10 years ago with funds donated by local businesses and members of the community but has increased in recent years as unemployment has risen in the Lansing area. The hospital administration has made an ongoing commitment to meet this need and allocates the cost of the program as charity care, Bailey says.
Economic impact
"In this down economy, people are faced with many more challenges. We see more people who have lost their jobs and are unable to afford the COBRA payments because their only income is unemployment. They have an illness and find themselves without any insurance or without prescription coverage. It's a challenge to case managers when we coordinate discharge planning and need to find a way to get patients the medication they need so they can be safely discharged and stay out of the hospital," Bailey says.
When the admissions nurse fills out the paperwork to admit patients to the hospital, she verifies the patients' insurance coverage, finds out if they have a medication plan, and asks them if they have had trouble paying for their medication.
Case managers receive the insurance information along with the patient's demographic information on a face sheet each morning when they receive their daily patient census.
"The only exception is if a patient is transferred from another facility or is admitted in an emergency situation. Then we find out the information as soon as we can," Bailey says.
At Ingham, case managers are responsible for discharge planning and utilization review as well as making sure that patients meet severity of illness and level-of-service criteria.
They assess patients for eligibility for the prescription program early in the stay and are the only people who can authorize access to the indigent prescription program.
"The case manager has to assess the patient and approve the situation even if the physician writes the prescription," Bailey says.
The case managers authorize use of the indigent prescription fund, and the director of pharmacy handles the detailed accounting process.
Patients who are eligible for the prescription assistance program must use the hospital's outpatient pharmacy to fill their prescriptions.
In the majority of cases, the indigent prescription assistance medications have to be related to the hospitalization or surgical procedure.
"For instance, if a patient comes in for cardiovascular surgery and is also on an antidepressant, we can't cover the antidepressant. We also don't cover medications for patients with chronic pain," Bailey says.
The case managers evaluate the patients and their needs on a case-by-case basis. For instance, if a patient is hospitalized with cardiac problems and is diagnosed with diabetes, the case manager may give him or her a two-week supply of insulin since the diabetes may exacerbate the cardiac problems.
However, if a patient has diabetes but is hospitalized for something unrelated to diabetes, such as an appendectomy or an injury, his or her insulin would not be covered.
Case managers take the patients' insurance status in mind when they do discharge planning and ensure that they will have the medication they need after discharge, Bailey says.
If patients do have insurance, the case managers make sure they have prescription coverage and that they can afford their copays.
"Typically, if patients have any type of prescription coverage, we don't authorize paying for their prescriptions but, in some cases, we will help with the copay," Bailey says.
For instance, when patients who are covered by a Medicaid product can't afford the copay for their prescriptions, the hospital may bargain with the patient to pay part of the copay while the hospital pays the rest, or, in some cases, the hospital will provide a two-week supply of medication and give the patients information on resources, such as pharmaceutical companies that offer prescription assistance.
"We show them the web sites on the computer and give them the paperwork to fill up, but we also educate them that they need to follow up. We do our best to give them every shred of information we can to help them get their medications, but there is some work involved on their part," Bailey says.
Pharmaceutical companies hold frequent inservices for the case management staff and provide cards the case managers can use to give need patients a two-week supply of medication.
When patients are prescribed expensive drugs, the case managers use the cards to supplement the two-week supply the hospital provides, giving the patients a 30-day supply, while they apply for pharmacy assistance.
The indigent prescription plan covers patients' medication up to $200. After that, the patient's situation is evaluated on an individual basis.
When its population of uninsured patients increased as more people lost their jobs, Ingham Regional Medical Center in Lansing, MI, developed a program to provide medication for people who can't otherwise afford it.Subscribe Now for Access
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