While the national health care debate heats up, Maine hospitals have been
quietly offering the uninsured and the underinsured help to get the medications
they need for free or at low cost.
In central Maine, prescription-drug assistance programs are offered through
MaineGeneral Health's CarePartners program; Franklin Community Health Network's
Franklin Health Access Rx, based in Farmington; Redington-Fairview Hospital in
Skowhegan; and Inland Hospital in Waterville.
"People are losing their jobs and their insurance. They are having their
hours cut. They are having to decide whether to get a policy with a high
deductible. People are making choices about their health care based on the
economy and that includes cutting their medications," said Jan Murton, director
of CarePartners in Kennebec County.
CarePartners and Franklin Health Access each have advocates who work
one-on-one with clients. The goal: helping them obtain their medications, but
also to encourage them to improve their overall health and well-being.
"We sit down with people and look at every possible program they may qualify
for," Murton said.
Patients are connected to free or low-cost programs that cover the cost of
preventative care such as annual check-ups, eye exams, smoking-cessation
programs, office visits to physicians when ill, hospital services or referrals
to social-service agencies, as needed. Such programs are intended for people who
earn too much to qualify for MaineCare, the health-insurance program for those
with low income or who are disabled, but who cannot afford adequate coverage for
themselves and their families.
The programs "deal with the whole package of health care," Murton said.
"People may have chronic illnesses, but they don't go to the doctor because they
don't have insurance. Then they end up in the emergency room because they're not
taking their medications properly."
If people can have access to a physician without worrying about paying a
bill, they are more likely to come in for care, she said. "That means they are
healthier and it saves the whole system money. These programs are for people who
fall through the cracks."
In the month of June, MaineGeneral's CarePartners program served 500 people
and processed $310,000 worth of free medications from pharmaceutical companies,
she said.
At Franklin Health Access Rx, 252 clients received prescription assistance in
fiscal year 2009 as the program accessed $383,288 worth of free or low-cost
medications from drug companies, said Gerald Cayer, vice president of Franklin
Community Health Network.
"If a physician in our system is aware that a patient has some financial need
and cannot afford a medication, they refer them to our prescription program," he
said.
The systems are similar. When patients call, an advocate is assigned to them
to determine if they are eligible for the hospital program or whether they
qualify for MaineCare. The staff person then helps fill out the drug-company
paperwork, which can be complicated.
All the major drug companies have patient-assistance programs, but each has
different criteria for eligibility -- and that criteria can change, frequently.
After the forms are filled out and submitted, the drug company will decide
whether the patient is eligible to receive the medication at no cost. If the
patient is eligible, the medication might be sent to the patient's home, the
physician's office or a local pharmacy, depending on the program.
The drug companies also require prescriptions to be renewed every three
months. Advocates track that schedule to make sure the forms are submitted in a
timely way -- so no one runs out of their medications, Murton said.
It can take between two and six weeks to process an application. Hospitals
can advise the client in the interim.
For example, if the medication is on the $4 generic-drug program list offered
through Wal-Mart and other commercial pharmacies, the advocate might advise the
client to try that avenue until the free medications arrive.
At MaineGeneral, the cost of interim medication might also be picked up by
the hospital, said Murton. Cayer said that, in some cases, Franklin Access can
immediately print a drug-company voucher that a client can redeem at a pharmacy
on the day of application.
Cayer said a third avenue might be General Assistance, which is an
emergency-aid program funded by the state and available through all
municipalities. It traditionally is tapped for fuel or food assistance, but has
been used for medications.
The Maine Health Access Foundation, which is the state's largest independent
health-care foundation, in 2006 awarded three-year grants totaling $2.1 million
to 10 hospitals and health centers to help Mainers get affordable medications
and better manage their prescriptions. The foundation also funded a study of
state programs by the University of Southern Maine's Muskie School of Public
Service. It found that more than 5,000 people received help getting access to
more than $4 million in low-cost medications through those pharmaceutical
patient-assistance programs.
The study also found that affordable medication improved patient health and
decreased the need for outpatient and emergency-room visits.
For information on Franklin Health Access services, call 779-2772 or (888)
952-2772.
For information on CarePartners, call (877) 883-1797 or 626-1684 in Augusta
or 872-4697 in Waterville. CarePartners is administered by Maine Medical Center
in Portland, MaineGeneral Medical Center in Augusta and Waterville, Miles
Memorial Hospital in Damariscotta and St. Andrews Hospital in Boothbay.
Inland Hospital in Waterville does not have a specific patient-assistance
program, said spokeswoman Sara Dyer. But it refers its patients who need help
paying for prescriptions to MaineCare, other service programs, or physician
practices that can connect them to drug company programs for medications at a
reduced cost.
To learn more about Inland Hospital and its programs, call (800) 491-8600 or
861-3000. To reach Redington-Fairview Hospital about its programs, call
474-5121.
Betty Jespersen -- 778-6991
bjespersen@centralmaine.com