Upstate’s Medication Assistance Team helps patients pay less for meds, savings nearly $1 million in 18 months
In a little more than 18 months, Upstate University Hospital’s newly created medication assistance coordinators have saved patients nearly $1 million on their medications.
Heidi King, CPht, and Ryan Dieffenderfer work with insurance companies, state programs, drug manufacturers and nonprofit foundations to help Upstate patients afford their medications. King’s team has helped hundreds of patients be able to afford critical medications with patient costs plummeting from hundreds or thousands of dollars a month to zero.
“They constantly tell us how thankful they are that we helped them,” King said. “We had one woman ask the pharmacist if she could give him a hug and a kiss.”
Upstate’s Outpatient Pharmacy, which opened in June 2018, is filling hundreds of prescriptions a day from inpatients downtown or at Community Hospital, or who see a doctor at Upstate. The pharmacy is also open to the public.
When a prescription rings up as costing the patient more than a $25 co-pay, King’s team is alerted. That’s when she and Dieffenderfer, both medication assistance coordinators, begin navigating and negotiating a vast network to save Upstate patients money. A first step is determining the patient’s insurance: government-funded, commercial, Medicare, Medicaid, etc. King and Dieffenderfer also help patients complete a financial form asking income and family size to calculate how Upstate can help.
King and Dieffenderfer have become very familiar with the variety of ways they can bring medication prices down— from co-pays to insurance cards to manufacturer coupons. A frequent tool is to enroll patients into the Elderly Pharmaceutical Insurance Company (EPIC) program through the New York State Department of Health, which is for people age 65 and older with Medicare Part D coverage.
King and Dieffenderfer also work with drug manufacturers that can often provide discounted or free medications. Another helpful avenue has been nonprofit foundations. Usually these organizations have money set aside to help patients pay for medications. Some like the PAN Foundation can help with all kinds of medications, while others like the Leukemia & Lymphoma Society or Cancer Cares focus on specific diseases.
“Many of these organizations allow a certain amount of funding per patient and a list of medications that they cover,” King said, noting that available funds change frequently so she and Dieffenderfer check many websites daily.
“It is a time-consuming process,” she said, noting that she makes 10 to 15 phone calls a day. “Sometimes you get it in one phone call. Other times you can spend the entire day on one patient.”
King and Dieffenderfer can also submit a patient’s financial status to the Upstate Foundation, which can provide funds to help cover medications.
“You want to get it to zero if you can,” King said. “A good example of that was someone whose insurance didn’t kick in for another month and his meds were well over $500. We were able to get the co-pay down to $150. I was kind of disappointed that I couldn’t get it lower but when I called him he was so excited.”
King and Dieffenderfer have plans to work on-site at the hospital more often this year and said working face-to-face with patients is very rewarding. They are in regular contact with Upstate pharmacists throughout the hospital and its clinics as well as the Outpatient Pharmacy’s team of seven pre-authorization specialists.
One person they work with regularly is Discharge Pharmacist Christina Phelan, PharmD, BCPS, whose job it is to make sure patients are taking the right medications when they leave the hospital.
“Unfortunately, cost can be a barrier for patients to be on the medications they need, which can lead to a patient’s return to the hospital,” Phelan said. “With these coordinators’ assistance, we are able to work with the patients in order to make their medications more affordable, which in turn, will ensure that these patients do not need to come back to the hospital. They are a wonderful asset to the institution.”
The medication assistance team is available 8 a.m. to 4:30 p.m. Monday through Friday and may be reached at 315-464-9862 or through Vocera: “Outpatient Pharmacy Medication Assistance.” Upstate’s Outpatient Pharmacy is open 8 a.m. to 6 p.m. Monday through Friday and 9 a.m. to 2 p.m. Saturdays and Sundays.
Caption: Upstate Medication Assistance Coordinators Heidi King and Ryan Dieffenderfer work with the Outpatient Pharmacy whenever a patient’s medication will cost them more than a $25 co-pay. Working out of their Upstate office at 250 Harrison St., the medication assistance team has saved Upstate patients nearly $1 million since it was created 18 months ago.