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Forming a Patient Advocate Organization is just the beginning step of the important work of assisting patients in getting free and low cost medication via Patient Assistance Programs sponsored by pharmaceutical companies. Patient Advocate Organizations are run just like any business – there are set tasks that need to be completed for each patient and necessary tools that need to be in place to run smoothly. From how to enroll patients into your organization to pre-qualification for specific drug programs, to securing proper documentation – we cover it all.
Managing PAPs – How to Manage PAP’s in your Patient Assistance Program
Congratulations to you! You have created your Patient Advocate Organization, and you are ready to start accepting patients. Before you embarked upon this important inaugural step, it’s important to be sure that you are understand the full cycle of enrolling a patient, getting them qualified with drug companies, getting the proper forms, etc. This piece will take you through the entire process so that you can methodically set processes and systems for your organization.
Patient Enrollment
The first thing you will do when working with new patients is to enroll them into your specific advocate organization. This means that they meet the standards and guidelines of your organization and understand exactly what it will be like to work with you and what they can realistically expect. Do not promise the moon to your patients. The process to obtain free prescription medications is sometimes difficult and sometimes there are unforeseen setbacks when a company is backlogged or some other circumstance that is out of the advocate’s control. In all cases, it’s best to under promise and over deliver to keep your patients satisfied.
When enrolling a patient into your program, it is best to collect all the information that will be required by all the patient assistance programs and to store it into your software or database. (Again, do not rely on a paper filing system or simple spreadsheet as this will be nothing but a tic\]’king time bomb of confusion that will hurt your organization and your patients.) Have them sign an authorization for you to act as their patient advocate. It will be very useful to you in the future when dealing on their behalf.
Setting Patient Expectations
Setting the right set of expectations in your patient’s mind up front will be invaluable to you in satisfying your patient and in saving you a lot of time dealing with let-down patients who didn’t have proper expectations from the start . Explain to them the realities of dealing with patient assistance programs. The main points are to let them know that there will be a processing time from the prescription assistance program and they will not receive their medications until that processing time has been satisfied. Also, as some patient assistance programs ship the medications to the physician’s office and some directly to the patient, it is a good idea to let them know what to expect in this regard as well. Finally, you must let them know that this is not the last step of the process. Let them know that you will be following up with them when it is time to process their renewal and re-applications for their free prescription medications.
Once you have your patients enrolled in your program and have given them proper expectations, it’s time to start the process of getting them their medications. These processes can be broken down into three steps: Initial Enrollment, Renewal Applications/Orders and Reapplications.
Initial Enrollment
The initial enrollment of your patient into a patient assistance program that will help them receive free prescription medications consists of 3 steps. These steps are pre-qualification, securing supporting documentation from your client, and completing the initial applications.
Pre-Qualification
The most important step in finding assistance for your patient is to pre-qualify them for the patient assistance program that can provide them free prescription medications before you spend the time and energy applying for what you may not receive. You can use the RxHelp360 pre-qualification calculator or the tools in your PAP management software (if it has one) in order to save a lot of time and money.
*Note: If your patient is taking a costly generic drug, you can often find the brand name equivalent on a patient assistance program for free. Most generic Patient Assistance Programs involve a small “co-pay” so finding a free program is always to their benefit if possible.
Remember, the goal of patient advocacy is to find the very best situation for your patient. There will be times when a patient does not qualify for a medication they need from the patient assistance program that provides it because of their qualification criteria. However, there may be alternative medications in the same drug class that your patient can qualify to receive because the patient assistance program that provides it has a different criteria. If this is so, your patient can discuss with their physician if this is a good alternative for them. If their physician agrees that it can benefit them then you can assist them with getting it.
*Note: NEVER EVER recommend a client substitute one drug for another unless you are a qualified physician and licensed to practice and prescribe medicine. All you can do is simply give an analysis of which patient assistance programs your patient will qualify to receive prescription assistance from so that they may discuss the situation with their physician.
Securing Proper Documentation from your Patient
Most free medication programs will require proof of income and others will require additional information such as copies of the patient’s driver’s license and social security card. Also, depending on the situation of the patient, additional documentation may be requested by the Patient Assistance Program. There is no one set group of supporting documentation required by patient assistance programs - each company is different. Furthermore, what patient assistant programs consider as acceptable proof of income may vary from company to company and from situation to situation. Always follow the patient assistance program’s instructions exactly. If you’re not sure what is required, you can check the patient assistance program pages on rxhelp360 or feel free to call the patient assistance program directly.
Completing Initial Applications
Most applications for patient assistance programs are self-explanatory. The main thing is to make sure that you fill them out 100% accurately, do not leave anything blank and provide the proper documentation. Be sure that all areas of the application are signed by the physician and the patient and the proper prescription is attached.
Receiving Medications (if applicable)
If you will be receiving medications on behalf of your patient (ONLY you are a licensed clinic or healthcare provider) it is imperative to have procedures in place to dispense these medications to your patient and track that they have been dispensed. Most of the time the dates when the patient will be eligible for renewal and re-applications will be provided by the prescription assistance program in the packing slip with the medications provided. Be sure to update your software or management system at that time with the correct dates to avoid applying to early and being denied. Your PAP management software should have a renewal reminder function in it.
Renewals and Re-Applications
Renewing your patients medication supplies through Patient Assistance Programs will consist of two types of actions: Renewals and Re-Applications.
Renewal applications are necessary after your patient has been approved for the program for a period of time (normally 1 year) but needs a new supply of medication and their approval period has not run out. Normally these are required once every three months. In cases where a different supply of medications is sent (i.e. 60 day supply) then it will be required in that time frame. Some patient assistance programs will allow the renewal application to be called in by the physician’s office or patient advocate (see detailed information on program pages) while others will require a new form altogether. For call in renewals, it is best if you call in as soon as possible after the date in which you are allowed to reapply to give your patient the best chance of receiving their renewal order before they run out of their medications from the last shipment. For renewals requiring a new form, it is best to do the legwork beforehand so that you will be able to get the renewal application in at the earliest date possible. Be careful not to send the application in too quickly as some patient assistance programs will deny the application even if it arrives only one day early. This can cause terrible delays.
Re-applications are required once the patient’s eligibility for the program has run out. Normally this happens once per year. When this happens you must make sure that your patient fills out a new application and gives all the supporting documentation, such as proof of income, as requested. Be sure to have the legwork done as soon as possible and, like renewals that require a form, apply as early as possible but never too early.
Note about Special Medications
There are some medications that will have a lot more stringent guidelines or unusual controls on them. Most of the time, these are narcotic medications or medications with certain DEA restrictions. Be sure that you are aware of the special circumstances for each of these medications and create procedures within your organization to handle all aspects of the application processes for the medications. If you train your staff in advance to know how to identify these situations, you will save you and your patients a lot of time and hassle in the long run.
The work of assisting with receiving free prescription medication is incredibly important. You should find that once you are up and running, the system that works best for your organization and your clients will become clear. While the process is confusing and often difficult, it’s possible to effectively run a patient advocate organization that provides a much needed service to your patients.
Resources for Patient Advocates
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