Managed Health Care Through Prescription Service

MANAGED HEALTH CARE THROUGH PRESCRIPTION SERVICE

A CASE STUDY

A low-income family of three (mother, father, and adult daughter) had a difficult time affording prescription medications necessary for a variety of serious medical conditions, including mental illness, diabetes and hypertension. Their income consists solely of SSI and all have Medicaid for their health insurance. Their Medicaid only covers the cost for five prescriptions per month for each family member.

The mother has 11 prescription medications that she needs to take on a regular basis. Because of the family’s financial situation, she would get five prescriptions filled one month, another five the next month, and so on. Her health conditions were worsening over time because she was not taking her medicines correctly.

APS Pharmacy is a pharmacy provider that specializes in behavioral health. APS utilizes an “on site” employee called a Care Coordinator, to assist patients who have challenges to access for their medication. The APS Care Coordinator found that none of her medications are available free of charge through prescription assistance programs offered by pharmaceutical manufacturers. However, she found an online program available for low-income families where she can buy medications not covered under Medicaid in three to six month supplies at a low, supplemented price. Despite the fact that the “average” price per month was very low for each medication, the patient still could not afford the out-of-pocket expenses for her prescriptions.

APS Pharmacy worked hard to find a solution to her healthcare problems. Working in partnership with the patient and her healthcare providers, APS Pharmacy was able to work out a system in which the mother could receive, and, most importantly, afford, all of her medications.

Working with her healthcare providers,we got new prescriptions for three-month supplies on all of her medications. APS Pharmacy staff identified which of the maintenance medications would be covered under Medicaid in three-month supplies and which ones were the most expensive. The five most expensive medications were covered under Medicaid and the others were filled in three-month supplies at the lowest price possible.

In the end, APS Pharmacy was able to match or beat the prices from the online program and worked out a monthly payment plan that was affordable to the family.