Discharge Planning Advisor: Redirect indigent funds for prescription drugs

Hospital spends $1 to provide $16 in medication

W.A. Foote Memorial Hospital in Jackson, MI, has dramatically increased the bang for its prescription drug buck by forming a medication assistance program (MAP) in conjunction with several community agencies, says Beth A. Smith, RN, MSN, MBA, director of case management.

Rechanneling funds it originally contributed to a United Way-sponsored operation run by Catholic Social Services (CSS), the hospital developed an in-house program that is providing some $16 in free medications to the needy for every dollar spent, adds Smith, who serves as liaison between the new program and the community.

Old program had limited funds

Previously, she explains, the hospital had contributed $60,000 annually to the CSS program, which also received $50,000 a year from United Way. "They could service about 100 patients a month and would normally run out of money by the middle of the month."

Under that system, the agency gave vouchers to patients after a cursory financial screening, and the patients went to a pharmacy to purchase their medications, Smith notes. "They paid retail price, so [the program] couldn’t service that many people."

Another problem was that there was no case management of the program, which was run by a clerical employee, she says. "One person needed treatment for a toe fungus, and the physician prescribed medicine that costs $200. There are other, less-expensive treatments," Smith explains.

Because the CSS program focused on serving as many people as possible, patients received funding for their medications intermittently, maybe once or twice a year, Smith notes. That meant there was no provision for those who were on, for example, long-term heart medication, she adds.

Meanwhile, officials at the hospital, which is part of Foote Health System, had been batting around the idea of starting its own indigent prescription drug program, she says. "The issue was funding."

An organization called the Emergency Needs Coalition, which looks at shelter, heating and health care needs in the community, asked a group of agencies to get together and address the prescription drug issue, Smith adds. After some discussion and initial resistance from those administering the CSS program, the coalition agreed to let Foote take the $60,000 it was contributing to the United Way and use it to fund its own program, she says. "The community felt we could serve more people."

With its own pharmacists overseeing the program as part of their jobs, the hospital uses the funds to pay an annual $4,500 licensing fee for the computer software program Indicare and to hire two pharmacy technicians [1.4 full-time equivalents (FTEs)], who do the processing that the IndiCare computer program requires, she notes.

Approximately $12,000 a year goes to pay for medications that cannot be obtained from pharmaceutical indigent programs or from samples contributed by the drug companies and by physician offices, she says. Those medications are dispensed at cost in the case of brand-name products, or for a $5 copay for generics, Smith adds.

Prescriptions given are 10 times greater

While CSS was able to provide 100 patients a month with about 222 prescriptions, the Foote program provides about 450 patients with a total of 2,300 prescriptions, she adds.

Other results are not as easily measured but are very real, Smith notes. "All of the community agencies have noticed a decrease in the requests for medications, a lessening of the burden." In addition, she says, the hospital has been able to discharge patients earlier because of the availability of home intravenous infusions provided through the program.

"We have received numerous letters from the patients and their families in appreciation of this program," Smith wrote in an application proposing MAP for a national award. "In many cases, it helped relieve what had become a desperate financial situation."

There are plans for expansion, she notes. "We are looking at adding one or two FTEs. The bang for the buck is so incredible. Our pharmacists do this along with their normal job, so we’re hoping to add [funding for some] pharmacist hours."

In addition, Smith says, the Emergency Needs Coalition is asking for funds from United Way to replicate parts of the program at the Center for Family Health, a federally qualified health center that serves Medicaid patients and the uninsured.

[For more information, contact:

Beth Smith, RN, MSN, MBA, Director of Case Management, W.A. Foote Memorial Hospital, Jackson, MI. Telephone: (517) 789-5926. E-mail: beth.smith@wafoote.org.]