Helping low-income seniors and others use a medication assistance program
Abstract
People on fixed incomes, such as seniors or others in need, often have trouble paying for expensive medications and their options are limited. In a program generated by the Senior Life Cycle of the Grant County Health Council of Grant County, New Mexico, RSVP volunteers help seniors and others obtain medications through a prescription assistance program offered nationally by the Pharmaceutical Research and Manufacturers of America (PhRMA). In this program initiated by health care professionals, member companies of PhRMA provide drugs to physicians for low-income qualifying patients, but the process can be complicated and time-consuming for patients. RSVP volunteers provide invaluable support by helping patients complete the necessary paperwork.Issue
The Original Medicare Plan does not cover prescription drugs except in a few cases, like certain cancer drugs. Many Medicare + Choice plans cover prescription drugs, up to certain dollar limits (sometimes for an extra cost), and some Medigap policies and states also cover prescription drugs, but not all seniors can afford these additional plans. Programs that offer discounts or free medication to individuals in need include state prescription drug assistance programs, programs sponsored by pharmaceutical companies, and disease-specific programs. Member companies of the Pharmaceutical Research and Manufacturers of America (PhRMA) provide drugs to physicians for patients who could not otherwise afford them, through a process that must be initiated by the health care professsional. Because the process is complicated and time-consuming, patients often need assistance applying for medications through PhRMA. Nurses in doctors' offices often fill this need, while volunteers offer assistance in other communities. Providing services to seniors is a pressing problem in New Mexico, where many seniors are living below the federal poverty level.Action
The Medication Assistance Program (MAP) which operates in Grant County, New Mexico, was generated by the Senior Life Cycle of the Grant County Health Council. Volunteers provide assistance to seniors and others in Grant County wishing to obtain medications through the Pharmaceutical Research and Manufacturers of America (PhRMA) process. After a referral, the patient must apply for medications directly to pharmaceutical companies and the volunteers help patients cope with the paperwork.
Senior Life Cycle has 10-12 volunteers working several mornings a week at two doctor's offices. Medications are requested jointly by the patient and physician but must be delivered to the doctor, which is why the program operates at the medical practice. Volunteers, who are generally over 55, are also members of RSVP. Most of the patients being served are over 65, with chronic health conditions, and most are receiving only Social Security benefits.
Effective practices from this project include:
- Locating the volunteers in or adjacent to the doctor's office.
- Keeping confidential files locked in the doctor's office.
- Helping patients complete necessary forms.
- Helping patients find necessary information on income, family details, benefits received.
- Developing an internal referral form.
- Tracking applications.
- Making sure all information in patient and doctor sections is complete.
- Helping patients reapply as needed every three months.
- Finding volunteers who have abilities to pay close attention to detail, work in close quarters, and handle high demand.
- Having at least one Spanish-speaking volunteer on each shift.
- Total number of volunteers is 10–12.
- Hours of service are generally 9 a.m. – 12 p.m., for two to three days a week at two centers, for a total of about 15 hours of direct service per week. After hours paperwork is another 2 hours per week.
- Center 1: Monday, Wednesday and Friday from 9 a.m. – 12 p.m. with 1-3 volunteers each day.
- Center 2: Monday from 9 a.m. – 12 p.m. with three volunteers and Wednesday from 9 a.m. – 12 p.m. with 4 volunteers. After hours paperwork is done one day from 12 noon – 2 p.m. by two volunteers.
Context
Grant County is located in the southwest corner of New Mexico, on the Arizona border. New Mexico is a large state in area, but it is thinly populated and many seniors live in small towns or rural areas, where access to services can be limited. Grant County has a population of 31,002 people, or about 8 people per square mile (U.S. Census, 2000). Grant County is served by the Gila Regional Medical Center, with 45 staff physicians. New Mexico ranks highest in poverty of the 50 states, according to the U.S. Census Bureau, and 16.5 percent of New Mexicans aged 65 and over live below the Federal Poverty Limit.
One important issue raised in the 1999 Grant County Health Plan by the Senior Life Cycle was the need for medication services to seniors on limited incomes who were having to choose between buying food and buying medicine. A recommendation to the Health Council was that primary care providers should be encouraged to make full use of the free medication programs offered by drug companies. A member of the Senior Life Cycle who had been trained by the Health Insurance Benefits and Assistance Corps (HIBAC) and who therefore had some knowledge of the Prescription Assistance Program, volunteered once a week at a local medical practice, helping patients complete the necessary paperwork and sending the forms to the physicians for signature. With the encouragement and support of the Senior Life Cycle, more volunteers were recruited and trained.
The Senior Life Cycle is one of six different life cycle groups under the Grant County Health Council, helping develop goals and objectives for health care for all ages in Grant County. The life cycle groups are composed of agencies that serve the age group targeted, and consumers in that age group. HIBAC is a project of the New Mexico State Agency of Aging.
Most volunteers working on the Medication Assistance Program are also RSVP volunteers. The Grant County RSVP recently signed a memorandum of understanding with Senior Life Cycle. Plans are being made to implement this program statewide.
Outcome
From January–September 2001, one center counted 900 patient contacts. Each person might need five to eight medicines, each refilled every three months, so the Medication Assistance Program volunteers estimate that this one center helped 350 people obtain prescriptions each quarter. Statistics are being compiled for the second center.Posted On
November 1, 2001For More Information
Related Practices
Related sites
Medicare Prescription Drug Assistance Programs Database
New Mexico State Agency on Aging
PhRMA Directory of Prescription Drug Patient Assistance Programs