Application Process and Screening Patient Navigation March 30

Application Process and Screening: Patient Navigation March 30, 2017 Ashley Bennett, Pharm D Jennifer Belue, Social Worker

STH Dispensary of Hope Plaza Pharmacy- Dispensary of Hope- West 4230 Harding Rd, Suite A 214 Nashville, TN 37205 615 -222 -6216 615 -222 -5801 (social worker) Mon-Fri 8 am-5 pm Saint Vincent Pharmacy- Dispensary of Hope- Midtown 2000 Church Street Nashville, TN 37236 615 -284 -6170 M, T, W, F 9 am-5 pm (closed for lunch 1 -2 daily) Thur 10 am-5 pm Saint Louise Pharmacy- Dispensary of Hope- Rutherford 1020 North Highland Ave (inside the Saint Louise Clinic) Murfreesboro, TN 37130 615 -396 -6167 M-TH 8: 30 -5: 30 (closed for lunch daily 1 -2 pm) Fri 8: 30 -1: 00 pm Dispensary of Hope- Hickman County Centerville, TN Planned Opening July 2017 2 November 27, 2020

Application Development • Reviewed several drug manufacturers’ Patient Assistance Program applications to see what criteria they deemed essential to provide assistance • Fleshed out their application questions to allow for assessment of other needs or other resource options • Once complete, application was translated to have form for our Spanish speaking population • Other forms like Letter of Support, Patient Responsibility form, and Patient Information sheet were also translated • Applicants reapply for program with updated proof of income every 6 months 3 November 27, 2020

Initial Visit to Dispensary of Hope • Patient or family member completes one page application • Meets with intake person to review and clarify any unanswered questions. • If person appears to meet criteria, based on their application and verbal statement of income, medications are filled but subsequent fills require necessary documentation. • Person is provided a list of patient responsibilities so they know what to expect from the program. Intake person explains how the program works 4 November 27, 2020

Strategic Questions Certain questions are asked to prompt discussion of needs and other possible resources. Are you a US citizen or a legal US resident? Are you a Veteran? Lets us know if a patient will be eligible for Patient Assistance Programs or if disabled then if they may qualify for SSI, SSDI, Medicare, Tenncare (Medicaid) Do you have Social Security or Disability Benefits? Prompts us to ask about Tenncare or Medicare status (people frequently confuse Medicare and Medicaid)- if it starts soon, we may need to help them sign up for the Part D subsidy or give them options for Part D plans 5 November 27, 2020

Strategic Questions How many people are in the household? Earnings? • Household size and income info is requested to see if person meets Do. H financial criteria. • We would ask who the people are in the home since a household is determined by relationships i. e. a romantic partner living with the patient would be considered part of the applicant’s household but a friend who is allowing them to stay on their couch would not be part of the household. • Based on their answers, we may also ask ages of people in home since we would consider their children under age 18 as part of their household, but an adult child would not be included. 6 November 27, 2020

Verification of Eligibility • Identification- Social Security card, Driver’s License or State ID, Passport, Debit card with photo, photo ID from originating country • Insurance status- Utilize Mc. Kesson Pharma. Serv to check Medicare Part D and commercial insurance. Use One. Source/Passport to check Tenncare/Medicare eligibility • Proof of Income- current paystubs, tax return, Food Stamp letter, letter from shelter, statement of earnings from employer, and letter of support 7 November 27, 2020

Verification of Eligibility Dispensary of Hope Distribution Center offers a self attestation form as a minimal tool for income verification for pharmacy access sites that are not located within a clinic or FQHC. 8 November 27, 2020

Review Prescriptions 1. Are free Branded samples or donated generic medications available? Each STH site sources Novo Nordisk insulin samples (Levemir, Novolog 70/30, Tresiba) through prescribers like Saint Thomas hospitalists to supplement a gap in patient care 2. If not, do we have another option in same class to call prescriber to request change (i. e. no samples of metoprolol succinate, but could get metoprolol tartrate samples)? 3. Do we have a manufacturer coupon or voucher for the medication (1 st fill free- Symbicort, Breo Ellipta, Dulera, Effient, Brilinta, Xarelto, etc. )? 4. If donated free drugs are limited, are Patient Assistance Programs available and is the patient eligible (ex. Undocumented patient needs Brilinta- one time free coupon, no samples for future fills, so called prescriber and changed to Plavix for future fills) Needy Meds is a great resource for PAP forms and eligibility criteria http: //www. needymeds. org/ 5. If the medication is not available here, is there another option like Walmart $4 list, discount cards, Rx Outreach, coverage for med at Health Department or other community programs 9 November 27, 2020

Patient Resources/Pearls Patient Assistance Programs • Income guidelines- several have higher criteria so may help people that we cannot • Undocumented individuals- some programs assist if living in US and being treated by US provider • Medicare- required to have Part D plan, out of pocket spending, or in coverage gap (donut hole) Medicare beneficiaries • Assist with one time coupons or PAP if they meet criteria • Help sign up for Part D subsidy- if they get approved, they don’t have to wait for open enrollment to sign up for Part D plan • Aid patients in finding Part D plans that cover their medications • Provide QMB/SLMB information and where to apply- this can help with their Medicare premium and other co-pays 10 November 27, 2020