Medication Access Flashcards
Please list some medication insecurity stats
- 58 million adults in the US cannot afford their prescriptions
- 16.4% of americans ration their medications
- 19% of Americans did not fill their medications because of the cost
- 8% of americans reported their condition worsening as a result of not taking medications
How do social drivers of health impact medication access?
Tie it all together
* Education -> health literacy
* Healthcare -> health care access
* Economic stability -> insurance coverage/ bargaining
* Housing stability -> safe storage of medications
* Social and community context -> resources
There is an established correlation between food insecurity, housing instability and medication insecurity
What are the effects of medication insecurity?
- Healthcare avoidance
- Medication nonadherance
- Delayed evidence-based treatment
- Increased complications/mortaility
- Bargaining between food/shelter and medications
- Increased stress, decline in mood and confidenced
What are the main drivers of medication cost?
- 75% cost of brand-drugs
- 10% of prescription brand drugs
What is willingness to pay?
The cost patients are willing to pay out of pocket for medications
What are types of government funded insurance?
Medicare, Medicaid, Tricare
What are examples of non-government funded insurance?
Private/commercial insurance
Examples: Aetna, Cigna, Anthem, Blue cross
What is the difference between medicaid and medicare?
Medicaid
* Standardized formulary
* Preferred versus non-preferred drug classes (organized by drug class
Medicare
* Formulary varies based on specific plan
* Medications listed in a tiered system/formulary versus non-formulary
* Not all patients enrolled in Medicare have prescription coverage
How to brand name companies make medications more affordable?
Makers of brand-name medicines use the coupons to help increase access to and demand for their products. Patients with commercial insurance like the coupons because they can help make expensive brand-name drugs more affordable. But the coupons may also discourage patients from considering appropriate lower-cost alternatives, including generics
What questions do you need to ask yourself to see if changes need to be made?
- Is the medication preferred? Refer to provider
- Are they filling for the appropriate quantity?
- Do they need a prior authorization?
What is tier 1 vs tier 4/5?
Tier 1: Most preferred
Tier 4/5: Less preferred, higher co-pay
What is a charitable pharmacy?
- A nonprofit 501(c)3/or equivalent pharmacy that serves as a safety net to reduce health disparities and increase medication access
- Typically serve people with household income 300 to 400% of the federal poverty level
What is a federally qualified health center?
Federally funded nonprofit healthcare center or clinic
- Qualify for funding under Section 330 of the Public Health Service
- Provide comprehensive services
- Serve underserved population
- Healthcare safety net
What is a copay card?
a card supplied by** drug manufacturers** to usually run with commercial insurance to help reduce the insurance copay
Most of the time, these cards don’t work for people without insurance
Created by PBM (pharmacy benefit managers)
What are the pros and cons of a copay card?
Pros
- Decrease high out of pocket costs for drugs
- Easy to use and widely accepted
- Quick to access
Cons
- Does not improve access for generic drugs
- Incentivize the use use of expennsive brand name drugs
- Strict rules with insurance. plans
- Temporary assistance
