April 12, 2017

How SSM Health's 'pharmacy concierge' program helps patients afford medications

Daily Briefing

Read Advisory Board's take on this story.

SSM Health is helping make critical medications more affordable to patients with chronic conditions through a "pharmacy concierge" program.

SSM Health DePaul Hospital launched the program about two years ago and it has since expanded to other hospitals and physician offices throughout the SSM system.

A need for help

The program aims to help patients with chronic conditions overcome financial barriers to effective medication, KSDK reports.

Subash Maddipoti, head of DePaul's pharmacy concierge program, explained that "in some specialties, like endocrinology for diabetics and pulmonology for COPD, all [the] medications are branded medications, no generics." He noted that medication costs for such patients can be "hundreds of dollars per month," and that their, " patients were really struggling, they were having to choose between basic life needs and medications."

How the program works

The concierge program works by having pharmacists "embedded" in physician offices, allowing doctors and pharmacists to work together to find "cost-cutting measures most patients couldn't find on their own," KSDK reports.

For instance, pharmacists work with physicians to complete "formulary investigations," during which the team determines which drugs are covered or not under a patient's insurance plan. The team tries to find cost-saving options.

The team also works directly with patients, helping to connect those who are uninsured or have Medicare with drugmakers' patient assistance programs. To help commercially insured patients, the team looks for copayment cards and savings incentives.

KSDK highlights one case involving a patient, Bob Fortner, who was paying "thousands of dollars" for diabetes medication. The concierge program helped Fortner meet his deductible without paying out-of-pocket costs and helped Fortner find an alternative medication for one drug that would soon be removed from his coverage. The team saved Fortner several thousand dollars last year, KSDK reports.
Overall, the program saves insured patients about $60 to $70 per month and has provided about $6 million in no-cost medication to uninsured patients, Maddipoti said (Meckles, KSDK, 4/3; Bean, Becker's Hospital Review, 4/3).

Advisory Board's take

Lindsay Conway, Pharmacy Executive Forum

Medication affordability is a significant and growing problem, with serious implications for patient outcomes and health systems' financial sustainability. It's not just that drug prices are rising—patients are also shouldering a larger portion of their drug costs due to increased cost shifting by prescription drug plans. Multiple studies have found that as medication costs increase, patients are less likely to adhere to their drug regimen.

SSM Health is one of a growing number of health systems that are investing in specialized resources to ensure patients are able to tap into all available forms of financial assistance. Other strategies we've seen health systems pursue include working with their foundations to create funds to support patients in need of medication assistance.

For more on the latest pharmacy trends and their implications for health systems, check out our slides on five key issues in health system pharmacy—including how the transition to risk is changing the ROI on clinical pharmacist roles.

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