1. Meeting the Medication Needs of Iowans: the IowaCare Pilot Pharmaceutical Program and UIHC Medication Assistance Center Lisa Mascardo, PharmD Assistant Director Ambulatory Pharmaceutical Care The University of Iowa Hospitals and Clinics

2. Goals and Objectives 1. To gain an understanding of medication assistance options for Iowans 2. To describe the differences in medication benefits between the State Papers Program and IowaCare Pilot Prescription Program 3. To gain an understanding of methods used to predict prescription utilization and costs 4. To gain a general understanding of how Patient Medication Assistance Programs work

3. Societal Problem  Patients that cannot afford their medications are at higher risk for readmission and reoccurrence of their illness.

4. Medication Assistance Options for Iowans  Medicaid  Medicare Part D plans  Patient Medication Assistance Programs (manufacturers)  State Papers  IowaCare Pilot Prescription Program

5. History of Providing Services to Indigent Patients – UIHC’s role  State Papers Program Each county in Iowa issued a certain number of “papers” based on population Each county in Iowa issued a certain number of “papers” based on population Patients received comprehensive health care at UIHC Patients received comprehensive health care at UIHC UIHC received state appropriation to cover costs UIHC received state appropriation to cover costs Full medication benefit available Full medication benefit available Approximately 3700 Iowans had State Papers when the program ended in June, 2005 Approximately 3700 Iowans had State Papers when the program ended in June, 2005

6. Medication Benefit under State Papers Program  A tiered formulary was created based on the UIHC formulary Generic meds, necessary sole-source brand name meds in Tier 1 Generic meds, necessary sole-source brand name meds in Tier 1 Higher-cost brand name meds in upper tiers Higher-cost brand name meds in upper tiers Prior authorization by clinical faculty or documented failure of Tier 1 med required for use of higher tier meds Prior authorization by clinical faculty or documented failure of Tier 1 med required for use of higher tier meds Refills mailed to patients at no cost Refills mailed to patients at no cost

7. Transition to IowaCare Program  In July 2005, the State of Iowa officially ended support for the State Papers Program and implemented the IowaCare Program  Had effect of expanding health care coverage to greater number of Iowans

8. Elements of IowaCare Program  Patient eligibility based on income (below 200% of FPL)  Income level determined monthly premium amount  Patients could declare a hardship and have monthly premiums waived

9. Medication Coverage under IowaCare – FY06  Medication coverage limited to a 10-day supply of medications at discharge  Continued to provide chronic medications for FY05 State Papers patients Patient profiles reviewed for chronic indications Patient profiles reviewed for chronic indications Meds for chronic indications identified for coverage Meds for chronic indications identified for coverage No newly identified conditions covered after 7/05 No newly identified conditions covered after 7/05  Similar to Medicaid program – charged copays

10. Medicare Part D  Medication coverage became available for approximately 2000 patients formerly covered under State Papers program  Dual coverage not allowed – must use MCR Part D if eligible  Eligible patients received letters reminding them to sign up with MCR Part D plan  Grace period

11. Creation of IowaCare Pilot Prescription Program  Planning started in March, 2006  Goal to estimate costs of program Anticipated number of patients to utilize program Anticipated number of patients to utilize program Prescription utilization rate per patient Prescription utilization rate per patient Average drug cost per prescription Average drug cost per prescription Estimated drug cost per program Estimated drug cost per program Personnel and mailing costs Personnel and mailing costs

12. Number of Patients participating in Pilot Prescription Program  Total number of IowaCare (IC) enrollees as of 5/5/06 (at that point in time)  Estimated number of IC patients receiving Rx  Subtracted number of former State Papers patients

13. Estimated Prescription Utilization Rate Est average annual number of Rx per patient State Papers utilization data State Papers utilization data Utilization data from large insurance company Utilization data from large insurance company  Estimated IowaCare Prescription Rates 25% like State Papers 25% like State Papers 35% like commercial insurance 35% like commercial insurance 40% mid-utilization 40% mid-utilization

14. Estimated Prescription Utilization Rate  Assumed that 80% of Rx written would be filled  Est total number of prescriptions filled annually for IC patients = (Est ave annual number Rx per patient) (Est number of patients utilizing prescription pilot program)

15. Estimated Drug Costs of Pilot Program  Average drug cost per prescription (pharmacy computer system data)  Average annual drug cost per patient = (Ave number of Rx per patient) (Ave drug cost per Rx)  Total estimated drug cost of program = (Ave drug cost per patient) (Est number of patients)

16. Additional Costs to Provide Pilot Program  Mailing refills to patients  Staffing needs to handle increase in prescription volume

17. Pilot Prescription Program Benefit Summary  IowaCare patients seen at UIHC by UIHC providers would receive: All generic medications on UIHC formulary All generic medications on UIHC formulary One 30-day supply of brand name medications One 30-day supply of brand name medications  30-day supplies filled and refills mailed to patients living outside of Johnson county  Polk Co. residents may receive a 10-day supply of meds at discharge only

18. Implementation Issues  Patients not previously seen at UIHC needed to have prescriptions written by UIHC providers  Patients who had prescriptions written by UIHC providers but filled at outside pharmacies needed prescriptions transferred  Access issues

19. Implementation Issues  All patients enrolled in IowaCare qualified for the same pilot prescription program Former State Papers patients on chronic medications were limited to generic meds Former State Papers patients on chronic medications were limited to generic meds Profile reviews to determine which meds could be switched to generics Profile reviews to determine which meds could be switched to generics Patients requiring brand name meds were referred to the UIHC Medication Assistance Center Patients requiring brand name meds were referred to the UIHC Medication Assistance Center

20. Medication Assistance Center  Joint effort by Department of Pharmaceutical Care and Department of Social Services  Staffed by Financial Counselor Pharmacist, pharmacy technician and three social workers

21. MAC Mission The UI Hospitals and Clinics Medication Assistance Center (MAC), in accordance with the UIHC mission of promoting the health of Iowans regardless of their ability to pay, helps qualified patients gain access to medications provided by drug manufacturers at little or no cost to the patient.

22. MAC Services Provided  Medication profile reviews  Initial applications  Reapplications  Receiving and dispensing medications  Medication financial counseling  Staff training regarding resources available

23. Summary  Assistance in obtaining affordable medications is available to qualified Iowans  The IowaCare Pilot Prescription Program was implemented to fill the gap created when the State Papers program was discontinued  Prescription utilization and cost projections were based on an estimation of the population size and combination of known commercial and State Papers utilization rates

24. Summary  Other programs are available to fill in coverage gaps: Manufacturer Medication Assistance Programs Manufacturer Medication Assistance Programs Discount generic programs such as Xubex, Walmart and Kmart Discount generic programs such as Xubex, Walmart and Kmart

25. QUESTIONS??