Hospital Pharmacy Lecture 4 notes Flashcards
Often times you will hear from patients that they can’t afford their medications and so when a patient hears that there medication is not covered and what the cash price of their prescription may be they will often feel overwhelmed
Often times in the hospital setting we are starting new medications and the patient needs to be able to continue these medications when they are discharged from the hospital in order to prevent them from being readmitted to the hospital whether this be a new antibiotic for an infection that they have whether this be a new medication that will treat heart failure exacerbation or a COPD exacerbation. Some of these medications will need to be continued indefinitely after the hospital or for a short course to continue treating what we started to treat in the hospital and so what we need to do for the pharmacist for these patients as part of this interprofessional care team is ensure that these patients are able to continue these medications when they leave the hospital and this will help to prevent hospital readmissions so if a medication is not covered for one of our patients its our job as the pharmacist to explain why these medications are not covered so it may be that the medication requires a prior authorization and then us as a pharmacist on the team can help our medical providers in order to complete the prior authorization process kind of walk them through that or remind providers that they need to complete a prior authorization in order for the pt to continue on this medication when they leave us…
Co-pay is too high…a tier reduction might be impossible…might be alternative medication that works the same way that comes on a lower tier for that patient’s insurance…we can consider alternative medication…maybe patient has deductible and they need to know that they need to know that they need to finish paying the deductible before insurance coverage is going to kick in and that’s why this medication costs so high but future fills might not be as high so need to educate them on that and that’s just part of knowing their insurance plan works
Pt might have medicare and be in the donut hole can they be eligible for medicare savings program that’s something else to consider
Do they need a DWO form so DWO form is a detailed written order form and this is required in a retail setting in order for certain medications to be filled through Medicare B plan and so this form might need to be completed by the prescriber in order for this medication to be covered through that patients medicare part b program
Medications not on formulary…is there a formulary alternative (is this a medication we want to prescribe this patient.. the patients prescription is not on formulary in the outpatient setting therefore resulting in a high cost is there a formulary alternative that may be appropriate for this pt and then what is that formulary alternative we can work on that with the insurance company let the prescriber know and have the patient switched so that they are on a medication that they can afford prior to discharge
If pt doesn’t have insurance a lot of the hospital settings have case management and social workers who are able to work with our financial department and do financial assistance programs for these patients in order for pt to have medication that they need upon discharge
If it’s a specialty pharmacy that causing this high cost we can have prescription sent to specialty pharmacy where the cost of this medication may be lower
Is a prior authorization needed for the medication…what type of insurance does the pt have and how is that affecting the cost of this medication…what options are available if medication is covered by the patients insurance but still too expensive…does this pt have followup planned…maybe it’s a followup with infectious disease team for antibiotic to say when course is finished or maybe its for anticoagulation clinic to ensure they are appropriately taking their new anticoagulated medication so these are things we need to consider when we are trying to ensure we have the pt on whether this pt is able to continue these medications after discharge…if medication is not covered who will inform the patient…its all about designated who is going to tell the pt so pt is aware and we have to consider how long the pt will go without their medication and if this lack of medication will result in a hospitalization because this helps us prioritize which medication we need to ensure coverage for so we can make this a top priority in order that the pt not come back to the hospital
You can buy insulin with or without a prescription at Walmart
If pt has been on 2 inhalers at the hospital and needs to be discharged on these because they either need an inhaled corticosteroid plus a long acting beta agonist or one of these combination regimens we can try to combine it into one inhaler so instead of having to pay a high copay for two inhalers they only have to pay a high copay for 1 inhaler and they are able to continue the necessary therapy
Once pt reaches a certain dollar amount which changes every year depending on the program they reach the donut hole or coverage gap at this point in time they have less coverage and they have to pay a certain percentage based on the type of medication that they are trying to buy at the pharmacy so they will have to pay the majority of the medication cost at this point time while they are in coverage gap. Once they get through the coverage gap they pay up to a certain dollar amount then medicare’s catastrophic coverage begins and at this point in time the plan will pay 100% of all the covered drugs and pay majority for noncovered drugs
Dollar amount pt needs to meet changes every year
Until pt reaches deductible they are paying everything for their medications…they are paying what it costs and that’s there out of pocket costs…medicare is not paying anything…after that 545 is met then coinsurance and copayment kicks in so that’s the first part of coverage so at this point in time
Once they reach 5,030 pt will pay out of pocket cost of 8,000 before they can get through next level…they are paying everything and medicare is not paying anything…once they reach 8,000 out of pocket now they go into catastrophic coverage pt doesn’t have to pay anything on formulary medications…once pt gets to catastrophic coverage and if pt has high prescription cost they reach to catastrophic coverage is reached faster
