Many of the programs have eligibility requirements and online applications. Each drug program has specific eligibility criteria. The medication will be sent either to the physician’s office or directly to the patient’s home, and refill requirements vary from plan to plan. Some plans automatically refill prescriptions, with the requirements of filling out a new application only once a year; other plans require a new application every 90 days; and still other plans require a new application every month with each refill.
With hundreds of programs and many needy patients, it can be time-consuming to enroll patients in PAP programs—especially if a patient needs more than one medication. In Kearney, Neb., Sentinel Healthcare of Kearney created an assistance program to help local physicians and their staff enroll patients. It began in July 2002 and currently serves 2,500 patients; last fiscal year the program assisted patients in receiving more than $3 million of medications. The program is run by a staff supervisor and four assistants; staff salaries are paid by administration fees from PHO contracts. Other programs have a small co-pay for each medication applied for, to fund a staff position to help process applications. The site www.rxassist.org contains many other examples of programs and advice on starting a program in your community.
The ACR and the Regional Advisory Council actively monitor this issue. If you have questions or comments, please contact the ACR’s coding and reimbursement specialists, Resaee Freeman, CPC, or Melesia R. Collins, CPC, at (404) 633-3777.
Dr. Blakely is a rheumatologist at Kearney Arthritis Institute in Kearney, Neb., and Melesia Collins is an ACR coding specialist.