MART Tool

Question 1

Why does insurance status matter?

Answer 1

how the patient is currently paying for their medications
- Government funded (Medicare or Medicaid)
- Commercial or Private (Employer)
- No insurance

Question 2

Government Funded (Medicare or Medicaid)

Answer 2

Medicaid (state funded for poor/low income)
- Short Term: refer for discounted medication options
- Long Term: 340B pharmacy or charitable pharmacy or FQHC

Medicare (federal funded for elderly)
- If med is not covered: PA
- If med is too much: refer for discounted medication options

MEDICAID/MEDICARE WILL NOT ALLOW COPAY CARDS

Question 3

Commercial or Private Insurance (Employer)

Answer 3

1. Find root cause of unaffordability
   - expensive copay
   - medication not covered at all
2. Verify what Tier the medication is on the patient’s insurance formulary or if it is not formulary
   - High Tier (insurance has preference or different agent): provide patient with name of preferred agent
   - Low Tier (patient has preferred agent): manufacturer copay card or discounted medicated options

Question 4

Tier

Answer 4

how preferred a drug is for insurance

Question 5

Tier 1

Answer 5

most preferred

Question 6

Tier 4/5

Answer 6

least preferred, higher copay

Question 7

Copay Cards

Answer 7

• supplied by manufacturers to reduce the insurance copay when used with private/commerical insurance

Tips:
- cover BRAND, not generic
- temporary solution (limit how much is covered)
- strict rules with insurance plans

Symbol: scissors with dotted box

Question 8

No insurance

Answer 8

1. Discount lists (walmart 4$ list)
2. Discount cards (GoodRx)
3. Medication Assistance Programs

Question 9

Example of Discount Lists

Answer 9

Walmart Rx Program
- 4$ for 30 day fills
- 10% for 90 day fills

Kroger Health Savings Club (annual membership)

Walgreens Prescription Savings Club (annual membership)

Question 10

Example of Discount Cards

Answer 10

GoodRx
- based on pharmacy, medication, quantity

NeedyMeds
- discount cards, same for any pharmacy

Question 11

Medication Assistance Programs

Answer 11

• a program via the drug manufacturer who supplies medications for free (low cost) for specific patients

Criteria:
- no insurance
- medicare patients with expensive copays and low income
- low income

AVAILABLE FOR MEDICARE AND MEDICAID

Symbol: two pills