New program helps the uninsured afford prescription medications

Host Amber Smith: Upstate Medical University in Syracuse, New York invites you to be "The Informed Patient," with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. Americans who don't have health insurance sometimes go without life saving prescription medications because they cannot afford them. Now Upstate offers Medications for Hope, for Central New Yorkers who are uninsured and who meet income eligibility. Here to explain the program and how it works is Eric Balotin, Upstate's director of retail specialty pharmacy services, and Meaghan Murphy, upstate's ambulatory care pharmacy coordinator. Welcome back to "The Informed Patient," Mr. Balotin and Ms. Murphy.

Eric Balotin: Thank you. Happy to be here.

Meaghan Murphy: Thank you.

Host Amber Smith: Ms. Murphy, let me start by asking you how big of an uninsured population we have in Central New York.

Meaghan Murphy: We have a huge uninsured population in Central New York. My team serves our clinic population who have primary care providers here at our Upstate primary care clinics. So we don't have a huge uninsured population. However, when our patients have gaps in insurance coverage, it's really important that we have programs in place to help our patients have access to life saving medications, particularly insulins and anticoagulants or anti thrombotics, as our pharmacy team really helps co-manage those chronic disease states. And if patients don't have access to those medications, it can really lead to rehospitalizations and the inability for patients to get better.

Eric Balotin: And with the uninsured population, things that people don't think about is the gaps in coverage, like Meaghan mentioned. Because you could be a fully employed person who has insurance, loses that job for a period of time and become uninsured, before you get your new job. So those are the type of patients that we're really trying to capture, patients that lose their insurance, don't have insurance, have gaps in coverage, and as well as we have a significant high poverty rate in this area that we want to capture those patients in need.

Host Amber Smith: So it sounds like this is something you would encounter every week, every day? I mean, it seems like it happens a lot, right?

Meaghan Murphy: It does. It happens regularly. And when it does, a lot of these medications are very expensive, upwards of hundreds of dollars per month. And as Eric said, with our high poverty rates andpatients with gaps in insurance due to job changes or financialrestrictions, it can be very difficult to find established programs that are in place here to support our specific patient population to give them access to the medications. And then not only that, but help the providers make the best choices for medication therapy decisions. It really helps providers choose the best therapy for that specific patient rather than, being cornered into less optimal therapies just based on financial affordability.

Host Amber Smith: I'm curious how Medications for Hope got its start. Mr. Balotin?

Eric Balotin: So this program's been around actually nationally since around 2007, and an organization out of Tennessee called Dispensary of Hope really was on the forefront of building this program to roll it out nationally. And what they did through some providers out there and through some national laws that were created back in the early 2000's allowed this organization to accept samples that were going to be discarded by manufacturers and then redistribute those samples out to indigent patients throughout the country. So the program's been around for quite a while. There's probably only about 100 of these dispensary locations throughout the country, so we've been fortunate to be able to get this organization kind of working with us in Central New York.

Host Amber Smith: Is this the only pharmacy that's supplied by the Dispensary of Hope outside of New York City?

Eric Balotin: Correct. For New York state, there's five of these locations within the city itself, but none outside of the city. And then the closest other state entity would be Northern Pennsylvania. Or really, this organization's a Southern organization. So if you looked at their map, most of these pharmacy dispensing locations are in the south, with a few out west and actually they just opened up the one location nationally in Africa. So it is starting to go global.

Host Amber Smith: Ms. Murphy, which medications are included in the Medications for Hope?

Meaghan Murphy: There is quite a bit. We have a lot of treatment options for patients. It includes generic medications as well as branded medications for a variety of chronic illnesses, as well as acute illnesses. So, again, having the variety of medications from antibiotics and antivirals to blood pressure medications, insulins and anticoagulants can really help provide patients with access to medications who wouldn't otherwise have the ability to afford them and treat either an acute illness or continue their chronic disease treatment plan to keep these patients healthy and out of the hospital.

Host Amber Smith: How dangerous is it if someone who has diabetes -- that requires insulin, and they have a prescription for insulin, but they can't afford it, so they don't take it -- how dangerous is that for that person?

Meaghan Murphy: It's quite dangerous, actually, and can not only lead to hospitalization, but more troublesome side effects like diabetic ketoacidosis and even death. And so patients who require insulin and are unable to afford it and don't have access to fill those at the pharmacy can really be harmed if they are unable to obtain their medications. And so to have this program available for our patients is a really big perk. And it's great for not only the patients, but it feels great to have this program as a provider, honestly.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with two pharmacists about the new Medications for Hope. Eric Balotin is Upstate's director of retail specialty pharmacy services, and Meaghan Murphy is Upstate's ambulatory care pharmacy coordinator. Now, Mr. Balotin, can you walk us through how a patient would access Medications for Hope?

Eric Balotin: It's a pretty simple process. And even the registration process, as I talked about, you'll find that is fairly simple as well. Soeven if you don't think you qualify, if you think you qualify or don't think you qualify, I would ask your providers to send your prescriptions to the SUNY Upstate Outpatient Pharmacy, which is located at 5000 West Seneca Turnpike in Syracuse. Once the prescription arrives at the pharmacy, we have systems in place that looks for to see if a patient has insurance. So without even the patient calling us, once we receive the prescription, we evaluate that prescription. If you don't have insurance, we immediately have a team of medication assistance coordinators, which will directly reach out to patients and try to qualify them for this program, because we recognize that you're self-pay. There's no insurance on our screens that we can find for you. And then we try to qualify you based upon your financial ability to pay.

And what's nice about the qualifying criteria... A family of one, the income level's $40,770. A family of four, an income level of $83,250. When some people think of "indigent," they think of no money. We're talking about patients who still can have an income. Don't be afraid to kind of reach out to us. And then really it's the not having that insurance piece is really the qualifying criteria to move forward. So once we have that prescription, we reach out to you. There's a very simple attestation form that you sign, that a patient would sign that says, "Yes, I meet the income threshold. And yes, I don't have insurance." We don't ask for any kind of verification on the income. It's really a trusted type of form. You just have to sign it and say that I agree that I don't meet those levels.

Host Amber Smith: Now do patients have to have an Upstate provider in order to use the Upstate Outpatient Pharmacy, for this program?

Eric Balotin: They do not. What's nice about our pharmacies is we accept patients from Upstate providers or not Upstate providers. So we encourage it. We know this program is going to be large and vast. It's going to actually cover in all the 19 counties that Upstate services. So, you know, some of those patients in different counties may not be a direct Upstate patient, but we want to help them. Part of being a state institution, part of being who we are at Upstate is really trying to make that extra effort to get out there and help our community. At the end of the day, if we don't do something, they're going to end up back in our emergency room, or they're going to end up back in the hospital. So this is our chance to try to do something, to prevent them from having any adverse effects from not taking their medications.

Host Amber Smith: So are there any residency requirements for Medications for Hope?

Eric Balotin: Because the program first rolled out, we did kind of try to limit this to Onondaga County to see how this program would be received within our community. And then, we have been very fortunate now that we have rolled this program out to all 19 counties that are serviced by the Upstate University Hospital system.

Host Amber Smith: Now tell me again, where is the pharmacy located and what are its hours?

Eric Balotin: So the pharmacy that services this program -- Upstate's got two outpatient pharmacies -- but the one for this program is the SUNY Upstate Outpatient Pharmacy at Community campus. It's at 5000 West Seneca Turnpike, Syracuse, New York. It is open Monday through Friday, 8 a.m. to 6 p.m. Now that may seem weird to somebody in Lewis County or Cayuga County that we're in Syracuse, Onondaga County, but we have the ability to ship to the patients directly. So they will receive the meds within 24 hours by UPS. It's next day shipping. A Friday would arrive on a Monday. But normally, monday through Thursday, it's next day shipping.

Host Amber Smith: That's good to know.

Ms. Murphy, can you tell us about other ways Upstate works to make prescriptions more affordable for people who maybe have insurance, but don't have enough money to pay for the prescriptions?

Meaghan Murphy: That's a great question, because we encounter that situation quite often, as well. Luckily we have Eric Balotin and his team to collaborate with. We serve a very diverse population here at Upstate in our primary care clinics, including our Center for International Health Services. We have a large refugee population, and so due to the diversity, we really have to have systems in place to help all types of patients.

Eric has set up a team of pharmacy technicians which comprise our medication assistance team, who serve all of our inpatient and outpatient clinics, really. And they have a plethora of programs under their belt and available because they do this every day, so they can help patients sign up for New York State EPIC, (Elderly Pharmaceutical Insurance Coverage.) We have some of our own homegrown financial assistance programs here. Patients provide financial information, and showing the need for that, as well as coupons and manufacturer assistance that they could help patients sign up for and facilitate those forms and applications. We consider ourselves, as pharmacists here in the clinic working directly with patients and chronic disease management, so lucky to have these resources under Eric's umbrella so we can collaboratively as a team to care for the patients. There are a lot of resources here at Upstate that are very patient-centered and really help the patient have access to everything they need. And then to piggyback on what Eric said before, his pharmacy provides mail services for free, courier services. And so our patients with transportation barriers and some other barriers that prevent them from access to medications, we can help set up those courier and delivery services so patients can get their medications sometimes same day when we're talking about insulins and anticoagulants. So, it's fantastic.

Eric Balotin: What we also have done is we built some different thresholds built within our pharmacy system that automatically trigger our medication assistance coordinators to go to action. So if a patient's copay is going to be $20, whether they ask for it or not, our systems are designed that flags our medication assistance coordinators to look for manufacturer coupon cards and kind of talk to the patients about their ability to pay, because our goal is to get patients to take their medications. And also as a state agency, and we're very fortunate to have the Upstate Foundation. They've been very good to our pharmacy with advocacy funds and some grants and foundations to Upstate that allow us to tap into those organizations, to meet patients' out-of-pocket costs and deductible costs when they are not able to meet those large deductibles.

Host Amber Smith: I'm going to shift a little bit off topic, slightly, but there's some new federal legislation that may allow Medicare to negotiate drug prices with pharmaceutical manufacturers. What impact do you think that might have on seniors at the pharmacy?

Eric Balotin: So, I think that will really be a nice thing. I think when the government gets involved, it allows us to try to drive down costs. I think currently a lot of the high associated costs are not necessarily coming from the manufacturers. It's being fed through some of the large insurance companies, PBMs, pharmacy benefit management companies. So I think with the government, having the opportunity to negotiate their top 10 drugs to start, I think that'll give us an opportunity then to drive down those drugs costs. Because if a drug costs $1,000, and a patient's got a 20% deductible, they're paying $200. If that drug is now $500, that patient's now paying $100. So patients will experience a reduction in price because they'll be paying less of a percentage of the total cost. So it will be a good thing, but that will not go into effect until 2026.

Host Amber Smith: So that's a little ways off. I also know, a lot of times in healthcare, what Medicare does, other insurers end up doing afterward. They kind of follow in Medicare's footsteps. So would that happen here, too, do you think?

Eric Balotin: That that's what I can imagine. I think they always kind of follow Medicare, to see how it goes. You know, I think the long term everybody's trying to drive down costs. I think drug pricing in general has been pretty stable over the last five to seven years, in relation to everything else as far as cost. But, it's a very low percentage of the total health care cost nationally, but it is what the patients experience the most, right? If you go to the hospital, you don't see the large cost that goes to your insurance company, for the most part. Patients truly experience the cost related to the prescription. So I think anything we can do as Upstate to drive down the cost, and anything the government can do to drive down the cost would be in that best interest of our patients.

Host Amber Smith: Well, before we wrap up, let's remind listeners how to reach the Upstate Outpatient Pharmacy. Can you let us know the phone number?

Eric Balotin: The phone number at the Upstate Outpatient Pharmacy, near the Community campus, we have two numbers that they can write down, if they want. 3 1 5 - 4 9 2 - 5 3 1 1, which is the direct line. And then we have a very unique number within pharmacy. It's the 4 6 4 number, which is the same first three digits for every Upstate extension, and then we're "drug," D R U G, drug. So that's 3 1 5 - 4 6 4 - 3 7 8 4. And the Community campus is option 3.

Host Amber Smith: Good to know. Well, thank you both for informing us about this program.

Eric Balotin: Thank you for having us.

Meaghan Murphy: Yes. Thank you so much.

Host Amber Smith: My guests have been Eric Balotin, Upstate's director of retail, specialty pharmacy services, and Meaghan Murphy, Upstate's ambulatory care pharmacy coordinator. "The Informed Patient" is a podcast covering health, science and medicine brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe. Find our archive of previous episodes at Upstate.edu/Informed. This is your host, Amber Smith, thanking you for listening.