Transcript Enrollment Site - North Carolina Hospital Association

www.medassist.org
What is NC MedAssist?
NC MedAssist is a charitable statewide pharmacy program created to assist
uninsured and low-income North Carolinians gain access to prescription
medications. Eligible applicants have the opportunity to obtain FREE brand
name and generic prescription medications with the benefit of having their
prescriptions mailed directly to their homes or to a local clinic or pharmacy
for pick up.
www.medassist.org
MedAssist of Mecklenburg
MedAssist of Mecklenburg was incorporated in 1997, as a free pharmacy
program to serve any uninsured, low-income senior adult in Mecklenburg
County and is a member of NCAFC.
In 2005, MedAssist expanded its program guidelines to include any
Mecklenburg County resident of any age that is uninsured and low-income.
Through a grant from the Attorney General’s Office, MedAssist expanded
once again in 2009 to include eligible clients at the state level. Since
expanding our services to the statewide level, NC MedAssist now provides
life-saving medications to North Carolina citizens in 96 counties across the
state.
www.medassist.org
A unique pharmacy program
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NC MedAssist has partnered with seven major drug manufacturers to
provide patients with medications by utilizing bulk replenishment programs.
Currently contracted with Pfizer, Merck, AstraZeneca, Novartis, Eli Lilly,
Abbott and Alcon.
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NC MedAssist dispenses the donated brand name (and generic
medications) obtained by the pharmaceutical companies through
a centralized location (NC MedAssist, Charlotte office).
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The patient or their provider completes the enrollment application
and mails or faxes it to NC MedAssist. One application gives the
client access to all of the branded and generic medications on
our formulary.
www.medassist.org
One Application =
Generic Medications
www.medassist.org
Astra Zeneca
Eli Lilly
Abbott
Novartis
Alcon
Merck
Pfizer
NC MedAssist Eligibility
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Uninsured
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No other means for prescription medications such as:
o Medicaid
o Veterans Administration
o Private Health Insurance
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Patients must have a Social Security number/w-7 to obtain branded
medications.
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Low-income, under 200% of FPL
o $22,340/year – individual
o $46,100/year – family of 4
www.medassist.org
Supporting Documentation
Patients should be prepared to provide the following information to complete the
enrollment application:
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Proof of North Carolina residency: Phone Bill, Lease Agreement or Utility Bill
Written prescriptions from a medical provider, medical history and allergies
Documents supporting proof of income- the following will be accepted:
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Pay stubs from employer
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Current year social security benefit letter
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Notice of awards letter, with start date if on SS Disability
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Most recent IRS Tax form 1040, including Schedule C, if self-employed
www.medassist.org
Safety-Net Partners
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NC MedAssist has developed a network of over 60 safety-net partners throughout the
state to assist in enrolling patients into the program.
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Those agencies are comprised of Free Clinics, FQHC’s, Health Departments, DSS
facilities, Community resource centers, CCNC networks and Hospital outpatient
pharmacies.
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Point of Entry:
– The Point of Entry assists the patient in the enrollment process
– The medication is sent to the facility (must have a licensed pharmacy and be
classified as a non-profit facility)
Enrollment Site:
– The enrollment site simply assists the patient in the enrollment process
– The medication is sent directly to the patients’ home
www.medassist.org
NC MedAssist Workflow: Patient process
Step 1
Step 2
Step 3
Step 4
• Patient obtains a prescription for medication(s) that are available on the NC MedAssist
formulary
• Patient or patient advocate completes the enrollment application and faxes or mails it,
along with the supporting financial documents to NC MedAssist. The application can be
found on the NC MedAssist website or on the MARP (Medication Access and Review
Program) software system
• NC MedAssist Customer Service Representatives (CSR) review the application,
prescriptions and supporting documentation to verify patient’s eligibility
• CSR will call the patient if any additional information is needed
• Once the patient is enrolled into the program the pharmacy fills the prescriptions and
sends the medication directly to the patient or the clinic partner. Patient or clinic partner
can expect to receive the medication 3-5 days after enrollment process is complete.
www.medassist.org
NC MedAssist Workflow continued…
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Medication comes pre-packaged, labeled and ready to dispense directly to the
patient.
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Branded medications are provided in a 30 day initial supply and 90 day refills.
Generic medications are provided in 90 day supply (with the exception of mental
health medications, which are provided in a 30 day supply).
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Refills do not require additional paperwork and can simply be placed by using the
automated phone system (the patient or patient advocate can call in the refill).
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Enrollment is active for one year, and there is no limit to the number of prescriptions a
client can receive.
www.medassist.org
Who helps the patient enroll?
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In the hospital setting, the following employees can assist the patient in the
enrollment process:
• Case Managers
• Financial counselors
• Discharge planners
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The medication can be sent to the hospital outpatient pharmacy or directly
to the patients’ home.
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Educating the prescribing staff on the NC MedAssist formulary is a critical
component of successfully implementing the program in the hospital setting.
www.medassist.org
A collaboration with NC MedAssist provides
the following benefits:
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Decreases the likelihood of readmissions to the hospital
Increases the overall efficiency of pharmaceutical care for the uninsured
Increases likelihood of compliance by delivering right to their home
Reduces staff time keeping track of individual patient assistant
applications.
• Reduces pharmacists time in checking and labeling
• Increases the agency’s capacity to serve more people
www.medassist.org
Chatham Cares Community Pharmacy
Siler City, NC
Chatham Cares Community Pharmacy is a private, volunteer-based,
non profit organization that provides prescription drug assistance to
residents of Chatham County.
Jack Brooks, Rph
Patricia Dowdy
[email protected]
919-663-0177
www.medassist.org
New Hanover Regional Medical Center
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“NC MedAssist has supplied many of our patients with generic medication
assistance that would have otherwise been unavailable. This program has
kept our patients from having to decide between spending $10 on a
medication or putting food on their table.”
Nicole Jenson, Support Associate at NHRMC
www.medassist.org
NC MedAssist
Cost Avoidance for access to and compliance with medication
www.medassist.org
Growth FY 2007 – 2012
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The Affordable Care Act and its Future Effect
on Patient Assistance Plans
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Medicaid Eligibility (2014)
– The June 2012 Supreme Court decision made expanding Medicaid
optional.
– North Carolina will not be expanding Medicaid
– 50% of current clients at or below 138% of Federal Poverty Level
• $15,414.60 annually for an individual or $31,809.00 for a family of four
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ACA allows for people to opt-out
–
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If premiums are greater than 8% of a person’s gross income; people are not held to the
mandate
For people with income 139% - 200% - health insurance premiums would need to be less
than $149/mo.
www.medassist.org
The Affordable Care Act and its Future Effect
on Patient Assistance Plans Con’t….
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Because there will still be uninsured people, our pharmaceutical partners
understand there will still be a need.
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Based on what we are hearing from national advocates they are looking to
amend program guidelines to include underinsured patients in the
programs.
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There continues to be a need for Prescription assistance for the low-income
uninsured residents of North Carolina.
www.medassist.org
“I sat down and cried when I found out I could get
my medicines from MedAssist. It was such a
weight off my shoulders that I wasn’t going to have
to choose anymore between heat or food or
medicine. Now I can sleep at night. I feel so much
better, physically and mentally”
- Mike
picking up $1,800/mo
in medication
www.medassist.org
Questions?
Jennifer Teague, Clinic Relations Manager
(866)331-1348 x1732
[email protected]
www.medassist.org