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Financial Barriers to Adherence

When patients have financial barriers to medication adherence, the financial hardship can be due to a number of medication reasons: being uninsured, being underinsured, being prescribed non-preferred or brand name agents, or due to polypharmacy, etc. When you have identified that money or cost may be preventing adherence for patients, there are several questions you can ask the patient to better address the specific problem.

 

First, follow the diagram above to find the problem and to find suggested solutions. Then, ask the pertinent questions below to better identify the needs of your specific patient.

  1. What copay can the patient afford?
  2. Has the patient used medication assistance programs in the past? Why did they stop using this program?
  3. Can the patient’s medication therapy be simplified or combined? Example: consolidating a calcium channel blocker and an ACE inhibitor to a higher dose of the ACE inhibitor.
  4. Is this a temporary financial hardship or long term?
  5. Does the patient qualify for the resources on page 2?
  6. Can the patient meet with a social worker from his/her hospital or clinic in order to establish insurance/medical assistance coverage?

Helpful Website Resources

All Patients:                                                                                                   

http://www.rxassist.org/

  • A database to find current application forms and information on patient assistance programs. 

http://www.needymeds.org/index.htm

  • This website contains databases such as Patient Assistance Programs, Disease-Based Assistance, Free and Low-cost Clinics, government programs and other types of assistance programs, including manufacturer coupons.

https://www.pparx.org/

  • A database for patient assistance resources. 

https://www.dhs.wisconsin.gov/guide/cancer-drugrepo.htm

  • Wisconsin Drug Repository at participating clinics, hospitals, and pharmacies can provide a 30 day supply of medication for free. This can provide additional time while assistance program applications are being processed or while other financial barriers are addressed. 

http://www.goodrx.com/

  • Find the lowest estimated cash price for a medication in your area. This is also helpful to estimate the cost burden of medications for patients.

 

ForwardHealth patients (Wisconsin Medicaid patients):

https://www.forwardhealth.wi.gov/WIPortal/Tab/42/icscontent/provider/medicaid/pharmacy/resources.htm.spage#

  • Pharmacy resources page with many helpful links: Preferred Drug List Quick Reference, diabetic supply list quick reference, and covered OTC medications.                                
Copyright © 2017 Pharmacy Society of Wisconsin. All rights reserved.
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