How Senior PHARMAssist works

In 1992, a task force of the Durham County Hospital Corporation conducted a needs assessment and feasibility study for a pharmaceutical assistance program for senior adults. They concluded that two public health issues needed to be addressed:

• Financial access to necessary medicines for seniors with limited incomes
• And polypharmacy – the use of multiple, sometimes unnecessary medications

These findings led to the creation of Senior PHARMAssist, which began serving participants in June 1994. Over the past 12 years, our medication assistance program has served some 8,000 individuals. In simplest terms, the goal of Senior PHARMAssist is to help Durham residents – 60 years and older – obtain medicines they need, avoid ones they don’t need, and tap into other community resources that can further support their health and independence. Program evaluations have demonstrated that our participants report reduced visits to the hospital and improved perceived health, among other positive outcomes.

The Problem/Challenge

Historically, senior adults living on limited or fixed incomes, particularly those with multiple health problems, have found it difficult to pay for their prescribed medicines. Until recently, Medicare did not help pay for medications, though Medicaid did. This changed in late 2003 with passage of the Medicare Prescription Drug Improvement and Modernization Act, which created a two-phase Medicare prescription program. The implementation of phase two – Medicare’s full-fledged prescription drug benefit – in January 2006, has improved medication access for many older adults but left others still struggling to obtain needed medicines. The complexity of the program with its multitude of plan options has also been a challenge for seniors and people with disabilities (who qualify for Medicare).

Beyond medication access, many older adults find it difficult to properly manage their medicines; it is not unusual for a senior to see a variety of healthcare specialists with no one having a complete picture of the medications (prescription, over-the-counter, and herbal) a patient may be taking. This can result in drug interactions and drug-induced illnesses, leading to unnecessary hospital visits, as well as premature admissions to adult care and nursing homes. Older adults are already at higher risk for adverse effects from their medications because medicines often affect seniors differently than the general population.

Senior PHARMAssist responds

Senior PHARMAssist helps older adults and some individuals younger than 60 by providing a range of services. In Fiscal Year 2007 (July 1, 2006 - June 30, 2007), our staff helped 1,079 persons - most received tailored, hands-on assistance with Medicare’s prescription drug benefit. We helped individuals sort through the 51 Medicare drug plans offered in Durham County to select the best plan for them and also screened seniors for eligibility for governmental low-income subsidies. We helped individuals apply for this financial assistance to further reduce their out-of-pocket expenses related to Medicare drug coverage. In addition, we helped 167 individuals directly pay for needed medicines - primarily by supplementing their Medicare Part D plan.

For years, our prescription card program served as a “primary payer” in helping eligible Durham seniors 65 and older pay for needed medicines. Today, Senior PHARMAssist “supplements” Medicare Part D payments for those 60 and above and provides primary payment for those 60 and older without drug coverage. To qualify for assistance individuals must be Durham County residents and have monthly incomes at or below 200% of the federal poverty level ($1,733/individual or $2,333/couple). Participants can use our prescription card at any pharmacy in Durham County and pay $3 for generics and $6 for brand-name medications covered by our geriatric formulary - medicines that we (staff and local clinicians trained in geriatrics) have determined are safer, more effective and more cost-effective for older adults.

Medication reviews are another integral component of our core program. Every six months, each participant meets with a program pharmacist for one-on-one counseling to discuss correct and safe medication use and other preventive health practices. The pharmacist encourages adherence to prescribed medication when appropriate and reviews current medications to identify potential problems. Each senior receives a medication record listing all of his/her medications. Participants are encouraged to maintain the record and share it with other healthcare providers. Our pharmacists contact prescribers and community pharmacists during or after these reviews to ensure that medication therapy is optimized.

Our clinical staff also provides participants with tailored referral to other community and governmental resources, including medical transportation, home-delivered meals, and senior centers. One of our most important referrals is to MQB or partial Medicaid, which helps seniors pay their Medicare Part B premium - potentially saving them over $1,000 per year.

Individuals who don’t qualify for our supplemental or primary drug coverage can still receive meaningful assistance, such as help better managing their medicines and tapping into other community and governmental resources. Medicare beneficiaries of all ages and income levels in Durham can obtain annual help sorting through “Part D” drug plan options and - when appropriate - applying for low-income drug subsidies, including NCRx. There’s no charge for this service. And to help younger adults who are struggling with medication access but are not eligible for Medicare we provide tailored information regarding drug company programs.

Community partners

Prescribers (doctors, nurse practitioners, PAs, dentists etc.) help their elderly patients by referring them to our program, reviewing their medication records, and selecting medications on the Senior PHARMAssist formulary when appropriate. In turn, the program supports prescribers by providing patients with regular, comprehensive medication reviews; alerting prescribers to significant changes in a patient’s drug regimen or adherence; furnishing patients with helpful tools such as medication records and pillboxes; and helping ensure that patients can obtain prescribed medicines.

Pharmacists are very supportive of Senior PHARMAssist and its participants — in part, because our participants can purchase their medications at their local community pharmacy. In addition, participating pharmacies have agreed to accept lower reimbursement when filling prescriptions for those in our program. We assist community pharmacists by sharing significant medication review findings with them; furnishing their customers with medication records that include prescription and nonprescription medicines; helping their customers apply for Medicare drug plans and financial subsidies; and by providing supplemental prescription coverage so that covered medications cost their customers $3 or $6. Finally, to help pharmacists do their job better, we link community pharmacies via computer to catch potential medication problems for seniors who use more than one pharmacy.

Social Workers and Nurses are often the first people to identify the medication needs of seniors and match those needs with Senior PHARMAssist. Through a variety of organizations in Durham, social workers are trained to interview seniors for eligibility for our range of services. In addition, Senior PHARMAssist will refer its participants to social workers to help them obtain other needed assistance.

Senior PHARMAssist’s supporters and volunteers are often the same people we serve: seniors, prescribers, social workers, nurses, pharmacists, and other concerned individuals. By helping older adults better manage and afford their medications, Senior PHARMAssist is helping Durham maintain the vital community involvement of its seniors and also helping save precious healthcare dollars.

Proven results

Program evaluation is crucial for Senior PHARMAssist. Participant data are collected on an ongoing basis to assess medication adherence, health services utilization, functional capability, and satisfaction. Our first program evaluation demonstrated that 31% fewer funded participants used emergency departments and 29% fewer participants stayed overnight in hospitals after being enrolled in Senior PHARMAssist for one year. This information was published in the March/April 2000 issue of the NC Medical Journal.

A February 2006 report on our second program evaluation was published in the American Journal of Health-System Pharmacy (Effects on health outcomes of a community-based medication therapy management program for seniors with limited incomes, Vol. 63 - Feb. 15, 2006). These findings, based on data gathered over 7 1/2 years, demonstrated that after 24 months in our program, the rate of participants reporting any hospitalizations decreased by 51%, and the rate of participants reporting any emergency department visits also declined significantly (27%). In addition, participants reported improved perceived health over the 24 months, and they maintained their ability to perform tasks measuring independence, such as bathing, dressing, and taking medications on their own.

Program evaluation doesn’t end there - we also follow up with prescribers with whom we consult to gauge how helpful our communications have been.

Further program descriptions can be found in the journal of Pharmacy Technology, The Consultant Pharmacist (the peer-reviewed journal of the American Society of Consultant Pharmacists), and Drug Topics.