Prescription drug program helps communitySpecial to The Mountaineer
Like so many programs that have made a positive impact on individuals in the community, the Meridian Behavioral Health Services Patient Assistance Program (PAP) grew out of one staff person just wanting to assist someone in need. About four years ago Kyler Robbins, a counselor with Meridian, was assisting a woman in the Recovery Education Center in Haywood County.
She was prescribed a costly antidepressant medication that she was unable to afford on her fixed income. Robbins knew that this particular medication was crucial to her recovery and assisted her with the volume of paperwork necessary to obtain the needed medication through the pharmaceutical company. The PAP, once provided by a different agency, fell victim to the ever-changing reforms that are impacting mental health, substance abuse and intellectual and developmental disability services in North Carolina.
Companies that can no longer make a profit discontinue the needed service creating a gap in the delivery of services and care. Meridian like many nonprofit agencies saw the need and explored alternate ways of meeting that need. Providing medication that individuals in their program needed was one of those needs they felt compelled to meet.
Having to choose between buying food and buying needed medication isn’t a choice anyone should have to make but for Donna Dupree, the individual meeting with Robbins, it was a reality.
Dupree, now 68, began experiencing some severe physical symptoms in 1994. She was having slurred speech, couldn’t connect words, was losing her balance and was dizzy even when sitting down. After much testing she was diagnosed with a serotonin imbalance. Six years later, this combined with diabetes, created additional symptoms. She no longer enjoyed things such as hobbies, watching TV and eventually lost interest in just about everything. She did not even want to get out of bed. At this time she was diagnosed with clinical depression. The cost of this new anti-depressant combined with insulin and other medications was far more than she could afford.
“Like a lot of other senior citizens I have had to make the choice, do I eat or do I take my medication,” said Dupree. “For me, it was definitely the medication. Without it I didn’t even want to eat or even get out of bed. In the past I had gone off of my medication for this reason and the side effects were horrible. I don’t want to feel like that again.”
Dupree, a widow and single parent at age 28, did not have a career that offered a pension or retirement benefits. At this point in her life with only her small amount of social security benefits, she was again faced with this choice. Access to the Patient Assistance Program and Recovery Education Center has allowed Dupree to take charge of her recovery. At first she was seeing a counselor monthly, then quarterly and now sees someone only twice a year. This continued involvement with a physician and a counselor is important in order to monitor her for medication side effects.
“I don’t know what I would do without this program. Medication keeps me from having to experience all of those symptoms and to have a normal life,” said Dupree.
Dupree does indeed have a full and normal life. She is a hostess in a retreat center at Lake Junaluska, participates in a prayer shawl knitting ministry at the First United Methodist Church and is a member of the Junaluska Jewels Red Hat Society. To see Dupree today, it is hard to imagine her as anything except the self-assured, charming lady that has taken control of her own recovery.
The patient assistance program is a critical element in the Meridian Recovery Education Center’s services. Recovery education, for individuals with mental illness and substance abuse, is a program that encourages each person through education and support services to determine what will best enable them to take control of their own recovery. For many this recovery process includes medications to treat their mental illness. Although there are a variety of medications on the market, many of the new options are not yet in a generic form. Without this program, when these high cost but effective medications were prescribed the individuals, like Dupree, who could not afford them did not get their prescriptions filled.
Pharmaceutical companies make their prescription drug programs available to the community at large for individuals that meet their economic guidelines, however, the paperwork and requirements are often more than an individual can handle. Having the program administered by an agency such as Meridian ensures that each individual will be able to get the medications they need on a regular basis.
“By [Meridian] providing the patient assistance program the physicians are able to prescribe the most effective medications for a particular individual rather than being limited to choosing prescriptions on a generic pharmacy list,” said Reid Smithdeal, recovery service manager for Meridian. “The PAP frees the doctor up to prescribe the best medication for each person, which is the best practice in treating mental illness,”
As more individuals were enrolled in the program, the administrative burden soon became more than Meridian was able to absorb with existing staff. Through a grant from the Evergreen Foundation they were able to purchase RxAssistPlus, an online program to facilitate the completion of the PAP forms, submit the necessary documentation electronically, and also track and monitor the service. The Evergreen Foundation provides funding for projects that support and enhance the lives of individuals challenged by mental illness, substance abuse and intellectual and developmental disabilities in Western N.C.
Not only does the patient assistance program meet the medication needs of the individuals it also provides a cost savings to the entire community. Individuals participating in the recovery education program and taking their medications as prescribed are more productive members of the community and have fewer relapses during their recovery. In the 2011-12 year there were 327 participants and presently there are 599 individuals enrolled. Having this program for psychotropic medications allows funds that were previously used to provide prescription assistance through other community programs to be allocated to other needs such as heating and food. These high cost medications, now being provided through the PAP, are ones that would have quickly depleted these local funds. Through the online program, Meridian is able to track the cost savings for the region. The calculated costs for these prescriptions in the 2010-11 program year was $316,828; in 2011-12 it was $1,085,711 and in this year the cost savings for the first seven months is $1,124,714. Meridian estimates that it will exceed $2,000,000 in savings to the community this year.
As with most human service programs, the primary cost to Meridian is in the amount of staff time required to provide the initial enrollment, updates and tracking of medications. This type of assistance does not fall into the services that are reimbursable and covered by state and federal funding. In addition to the purchase of the RxAssistPlus, Meridian has been able to secure additional funding from the Foundation to hire certified medical assistants (CMA) needed to staff the program. Hiring certified staff is necessary since the CMA is responsible for triaging medication related phone calls, calling in prescriptions, documenting in the medical record, assessing medication side effects as well as filling out the paperwork and tracking all of the prescriptions. The cost savings for the prescriptions are not the only benefit to the communities, other benefits that are not as easily quantified are the benefits to the quality of life for the participants and the reduction in hospitalizations and crisis intervention services that would otherwise be needed.
“Unfortunately, 65 percent of the individuals that participate in our Recovery Education Centers do not have any kind of insurance (Medicaid, Medicare or Commercial) and therefore often can’t afford to purchase the medications that are prescribed,” said Joe Ferrara, Meridian executive director. “Thanks to the financial support of the Evergreen Foundation, Meridian is able to offer this much-needed service to those in our communities who are most in need. The powerful combination of skills training, clinical and peer support and effective medications promotes healing and sustains individuals on their recovery journeys.”
Meridian began providing the program in Haywood County in 2009 and now has been expanded to Jackson and Macon Counties. For information on Recovery Education and the Patient Assistance Program contact Meridian Behavioral Health at 631-3973 or visit www.meridianbhs.org.
For additional information on the Evergreen Foundation and grant requirements, contact Tom McDevitt, executive director at 456-8005.