Pharmacists go beyond filling patients' prescriptions

[00:00:00] 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. If they don't take their prescribed medication, many patients won't get better, and they run the risk of being hospitalized again. So some hospital pharmacies are focused on helping to make sure patients get and take their prescriptions when they go home. Here with me to talk about this is Christina Hyde, the manager of pharmacy utilization and program development at Upstate. Welcome to "The Informed Patient," Dr. Hyde.

[00:00:38] Christina Hyde, ND: Thank you so much. It's great to be here.

[00:00:41] Host Amber Smith: Now, ideally, every patient who is gonna go home from the hospital would get the medicine they need to help them get better or stay healthy, but that's not always the case. There's many barriers or reasons this might not happen for someone. So let's talk about how the Upstate Outpatient Pharmacy is able to address some of the most common barriers. Some people don't have insurance, or even if they do, it doesn't cover the cost of the prescription, so they struggle to afford the medicine. What sorts of programs do you have in place to help in this situation?

[00:01:13] Christina Hyde, ND: Medication affordability is a huge and perhaps the No. 1 barrier we see for patients in obtaining their medicines. To combat that, we have a medication assistance team, and they work with patients who have copays greater than $20 automatically. If they are participating with our pharmacy, and a copay comes across, they automatically kick in, will reach out to the patient, discuss their options with them, and work with them to get their copays as low as possible, even sometimes to $0. They are able to access grants to various foundations, manufacturer copay cards, or Upstate financial assistance programs.

Many people can't afford even that $20. And so we really encourage patients to talk to their provider, to talk to the pharmacy representatives when they get there, talk to pharmacists, the technicians and say, "you know, I can't afford this." And we will do everything we can to get that copay as low as possible. We want people to get their medicine.

[00:02:21] Host Amber Smith: Now, what is the program called Medications for Hope?

[00:02:26] Christina Hyde, ND: Medications for Hope is a wonderful program, and we really would like more people to know about it and be able to access it. It is a program where we receive direct donations from pharmaceutical companies of something like 4,000 medications. And patients who are uninsured are able to access these free of charge.

[00:02:52] Host Amber Smith: Now for patients who do have some sort of insurance, can you explain what prior authorization is and what patients need to know about that?

[00:03:01] Christina Hyde, ND: Oh, of course. So in its most basic sense, a prior authorization is information that an insurance company needs to determine whether or not they're going to cover a medication. Prior authorizations are another one of those barriers that patients often run into when they're going to fill a prescription.

At this point, about 90% of specialty medications and 50 to 60% of non-specialty medications require a prior authorization. So we have a dedicated team, again, in our pharmacy that when a patient is engaged with the outpatient pharmacy, they're in the hospital, they're in one of 46 of our ambulatory clinics, the team automatically begins working on those prior authorizations. We have access to the same EHR (electronic health records) that the providers are using, and so can begin those very, very quickly and turn them around very quickly.

[00:04:05] Host Amber Smith: That's good to know. Now, in the news lately we've seen reports of shortages of certain cancer and other medications.

Can you talk about how frequently patients have trouble just finding the medication that they've been prescribed?

[00:04:19] Christina Hyde, ND: The shortages of medications is an ongoing issue. The cancer medications did absolutely make the news. An interview on PBS just a short while ago, estimated that from 2021 to 2022 about 30% of medications experienced some type of shortage. So you know, this really is a significant and ongoing issue. And those are the chemotherapy drugs, but they're also drugs for things like attention deficit disorder, depression and some antibiotics. So a whole range of very critical medications.

We are very fortunate, and being part of a hospital system, have a significant leg up on community pharmacies, and even most specialty pharmacies. So the first thing I would mention is that we are part of a vast network, so we, ourselves, have a tremendous amount of just in-house resources to draw from. And then we start moving into, we have a procurement department that pays attention, tries to proactively look at the landscape, what shortages may be coming, trying to up our stock of medications that are of concern. We have built in a very redundant supply chain so that if we are not able to get medication from one of our suppliers, we have two or three others that we can seek them from.

We have dedicated specialty pharmacists and we have dedicated pharmacists who work with non-specialty medications, who are able to connect with providers if we do have just an absolute inability to access a medication, share with them what is available, work with them to see if there will be an acceptable substitute. So we really are fortunate in that we are almost never in a position where we're unable to provide medication that's necessary for a patient.

[00:06:27] Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with Dr. Christina Hyde, the manager of pharmacy utilization and program development at Upstate. Can you explain what the "Meds to Beds" program is?

[00:06:42] Christina Hyde, ND: Of course. I would love to. I have been very involved with this program, since I started with the pharmacy, and I'm just proud of everything we do here. But the Meds to Beds program, in particular, really started to address what we were seeing as barriers for patients accessing their medications. So we talked about affordability. We talked about prior authorization. We talked about supply at community pharmacies.

And so what the Meds to Beds program does is, it seeks to address those proactively and get medications to a patient's bedside before they're discharged from the hospital. So this allows patients to leave the hospital with all of their discharge medications, go home and focus on recovering.We see, month over month, improved outcomes and reduced readmission rates for patients who are participating in the Meds to Beds program versus the overall hospital system readmission rate. So we know that it is effective, and we're taking better care of patients.

[00:07:53] Host Amber Smith: Now, is this something patients have to sign up for, or is this automatic if you're hospitalized?

[00:08:00] Christina Hyde, ND: So both. At the Community campus, Upstate Community Hospital, we went live with a full hospital auto-enroll on January 9th of this year. That means that anybody who is admitted to the hospital is automatically enrolled in the Meds to Beds program. They have the option to opt out and do not have to participate if they do not wish to, but they are automatically enrolled. The downtown campus, they have the option to enroll in the program during the admissions process.

[00:08:35] Host Amber Smith: And so this is just for people who get admitted. I guess I'm wondering if you go to the emergency department, and you're not admitted, but you're treated there, are you part of this also?

[00:08:46] Christina Hyde, ND: That's a great question. Right now it is only for patients who are admitted to the hospital. We can certainly fill prescriptions through the outpatient pharmacy for patients who are seen in the emergency department. The time that they're in the emergency department is typically not long enough for us to do the work on the back end that we would in the Meds to Beds program, but certainly we can still fill the prescriptions and offer the same sort of services for that patient once they become engaged with our pharmacy.

[00:09:24] Host Amber Smith: Now once a patient is back home, they may need refills of the medication or they may be taking a medicine constantly or chronically, what barriers do you commonly see and what do you do to solve them?

[00:09:37] Christina Hyde, ND: The barriers we see, just the common ones that I continue to mention: affordability, the prior authorization, ability to obtain the medication at their local pharmacy, but also transportation.

We see a lot of patients that experience challenges in the domains of social determinants of health. And so transportation and the ability to actually get to the pharmacy to pick up their medications is a challenge. And so the way that we have answered that is we are able to mail prescriptions to patients. We're able to provide courier service to patients. And now, in a radius around the Community campus, we're able to deliver via drone. So we're continually seeking ways to help patients access their medications and remove that as a barrier.

[00:10:33] Host Amber Smith: I heard about that drone pilot program. How is that going?

[00:10:37] Christina Hyde, ND: It's going really well. I have had the opportunity to observe the drone in action, and it's just, it's exciting. Right now we have done a number of deliveries to that radius around the Community campus, and that's gone well. We drone medications from the pharmacy over to Community hospital now and are just really excited to start expanding that program.

[00:11:06] Host Amber Smith: Well, let me ask you, for people who take several medications, I know it can get confusing and challenging to manage. You have something called a Medication Adherence Program. What does that do?

[00:11:18] Christina Hyde, ND: Many of our patients, as you said exactly, are on many medications, and they take them at various times in the day. And that gets very difficult to manage.

Sometimes they have prescriptions that they pick up every third Wednesday. They have prescriptions they pick up the first of the month. They have prescriptions they pick up at various times. That's also very, very confusing. So what our Medication Adherence Program does is, it assists patients who are struggling to manage their medications and struggling to maintain adherence to their medication regimens because of that maintain compliance.

So what it does is we have a Medication Adherence Team, a MAP team for short, comprised of pharmacists and pharmacy technicians. Once a patient is enrolled in the MAP program, they receive an initial call from a pharmacist who runs through their disease state, the medications that they're on, tells them about the program, talks to them about the various packaging options that are available to them. And then if the patient decides to enroll in the program, we move forward with full medication reconciliation. We sync up their medications so everything is picked up at the same time, and they're not trying to navigate all of that confusing piece of it.

We then provide monthly calls to check in on the patient about a week prior to their refills being due. We ask, how much of this do you have left? Through that we've been able to identify, "gosh, you are using your rescue inhaler all the time, but you have all of your control inhaler left. Can you tell me what is going on there? Do you have questions for your provider? We can let the provider know."

Then our pharmacist does a monthly medication reconciliation. So we are trying to catch, has this person into the emergency department and received another medication? So we are really, really working to maintain tight understanding, tight control, making sure the patient can be successful in adhering to their treatment.

Another piece that we're able to offer that I touched on briefly is different packaging forms. So we have something that is called a compliance pouch, and that puts patient medications from morning, afternoon, and evening in individual pouches. So they just need to tear it off and take their morning medication, take their afternoon medication, and their evening medication. It simplifies things tremendously.

For patients who have potentially low health literacy and for whom that may be still a bit confusing, we have what's called dispill packaging. It's a blister card, and it's color coded, so one color would be for the morning, one for the afternoon, one for evening. And that has proven particularly useful in patients for whom English is a second language, for example. We utilize it primarily with our refugee population right now, and it's been a tremendous benefit.

And then some patients do well with vials. They just need that extra support that our team is able to provide.

[00:14:56] Host Amber Smith: Now, does the patient pay for the Medication Adherence Program?

[00:15:00] Christina Hyde, ND: They do not. That is a free service that is offered by our pharmacy.

[00:15:05] Host Amber Smith: And so they can sign up just by contacting the Upstate Outpatient Pharmacy?

[00:15:10] Christina Hyde, ND: They can. There are a number of ways that they can enroll in the program. They can talk to their provider if they wish to be enrolled. Their provider might refer them. They may identify that this person is struggling with adherence and could benefit from this additional support. If they are part of a particular disease state program, which includes heart failure, stroke, COPD, asthma, they're identified upon admission to the hospital as being potentially high risk for readmission, and they're automatically referred for review by our team in conversation with the provider and enrolled that way. So there are multiple points of entry to the program.

[00:15:56] Host Amber Smith: Now prescriptions, I know, come with instructions, but do you ever get calls from patients who have questions about a particular medicine? Are they able to call and talk to a pharmacist?

[00:16:07] Christina Hyde, ND: Yes, absolutely. It's very interesting, and we actually monitor the Call Connect data monthly to see how many people are calling, how many people are calling about medications. And one thing that we've noticed and are very proud of is that the number of patient calls regarding medications who are engaged with the outpatient pharmacy, who receive our services, we receive less calls from them than patients who do not receive their services from the outpatient pharmacy. But certainly we do receive calls. We have pharmacists here during regular business hours to answer calls. A patient's always able to speak with a pharmacist. And then after hours we always have an on-call pharmacist. So should something come up in the evening or on the weekends, there is a pharmacist on call that they're able to speak to.

[00:17:04] Host Amber Smith: Now you said Call Connect. Is that the same thing as Upstate Connect where people can call for questions about a variety of health issues?

[00:17:12] Christina Hyde, ND: Yes, it is the same thing.

[00:17:13] Host Amber Smith: Let me let listeners know the Upstate Connect phone number is available 24 hours a day at 3 1 5 - 4 6 4 - 8 6 6 8. Now if someone listening is interested in transferring their prescriptions to the Upstate Outpatient Pharmacy, how would they go about doing that?

[00:17:33] Christina Hyde, ND: So they can do that in several ways. One would be to call their provider's office and say, "I would like to change my pharmacy to the Upstate Outpatient Pharmacy." Another way would be during their next office visit with their provider. It's always a question that is asked: what is your pharmacy? What is your preferred pharmacy? They can share at that time that they would like to transition to the SUNY Outpatient Pharmacy.

And then they're always able to call our pharmacy directly, and we can make that change for them.

[00:18:08] Host Amber Smith: That's good to know. Well, I appreciate you making time for this interview, Dr. Hyde.

[00:18:13] Christina Hyde, ND: Of course. So nice to be here. Thank you.

[00:18:16] Host Amber Smith: My guest has been Dr. Christina Hyde, the manager of pharmacy utilization and program development at Upstate. "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. If you enjoyed this episode, please tell a friend to listen too. And you can rate and review "The Informed Patient" podcast on Spotify, Apple Podcasts, YouTube, or wherever you tune in. This is your host, Amber Smith, thanking you for listening.