Discharge Planning Advisor: Solutions needed for prescription drug problem

Making sure patients without an insurance plan for prescription drugs get the medications they need is an increasing challenge, case managers and discharge planners tell Discharge Planning Advisor.

Faced with a high-cost list of prescribed medications, "patients decide to take only some of the drugs or maybe some of the doses or none at all," says Tina Davis, RN, MS, CMAC, senior director for continuum of care at Arnot Ogden Medical Center in Elmira, NY.

"This can lead to readmission to the hospital," Davis points out.

Contributing to the problem is some physicians’ tendency to prescribe "the latest and the greatest," which can cost much more than "the tried and true," she adds.

Case managers who are aware of the issue may try to put patients in touch with pharmaceutical companies that provide no-cost drugs to needy individuals, Davis notes, but sometimes it takes six weeks to obtain the medications.

Lisa Zerull, RN, MS, the program director for the Community Nurse Case Management Program at Valley Health System in Winchester, VA, points out that the philanthropic programs sponsored by drug companies all require different processes and forms, and may include restrictions that can make it difficult to obtain the help.

For instance, Zerull adds, some require that for a patient to qualify, the drug company’s local sales representative must call on that patient’s physician.

"The prescription drug problem is a very hot issue," agrees Jackie Birmingham, RN, MS, CMAC, a longtime case manager who now is managing director for Curaspan Inc., in Needham, MA. "It’s especially a problem for those who are on pain medications and have traveled a far distance to a center for surgery," she notes.

"Patient satisfaction is a huge issue when you are unable to [obtain] the medications to get them started until they can go to their own pharmacy to get the prescriptions filled. The patient needs to go home, and the family needs to leave them to go get the medications," Birmingham adds.

(Discharge Planning Advisor will look at possible solutions to the various problems associated with obtaining prescription drugs for patients in future issues. Please send any feedback on the issue to Lila Moore at lilamoore@mindspring.com.)