CMSA Today - Issue 6, 2016 - 19

Medication Access P atients undergoing bone marrow transplants encounter many challenges that can include physiological, psychological as well as financial. The out-ofpocket cost of transplant medications is substantial. Patients may have high copays or no coverage at all. The pharmaceutical arena is a million-dollar industry, and as medication costs continue to rise, patients will most likely experience higher copays and deductibles. One conundrum that institutions face when requesting authorization for transplant admission is that pharmaceutical benefits are considered a different entity from their medical counterparts; therefore, payers do not include post-transplant medications as part of the admission package. Medications such as immunosuppressants, antifungals and antivirals are crucial in the success of bone marrow transplant, and, more importantly, overall patient outcomes. Lack of medication coverage, prior authorization process and high copays are factors that increase hospital length of stay. At Memorial Sloan Kettering Cancer Center, we simplified the process by having a case manager follow the patient throughout the continuum in both the outpatient and inpatient settings. The goal of this initiative was to identify potential barriers prior to admission and to intervene early to prevent delays in discharge. Some of the challenges prior to this program were: * Patients with no identified caregivers. * Limited medications benefit coverage. * High co-pay for medications or no coverage at all. * Home care services needed. * Unexpected prior authorization required for discharge medications. These issues required immediate intervention and directed our attention to putting a plan in place: The case manager (CM) provided patients with a list of potential discharge medications prior to admission, which included contact information for drugs assistance programs in order for the patient to initiate application if needed. We found that approximately 20 percent of patients didn't follow through. In the inpatient setting, the CM verified coverage for discharge medications by sending "One conundrum that institutions face when requesting authorization for transplant admission is that pharmaceutical benefits are considered a different entity from their medical counterparts; therefore, payers do not include posttransplant medications as part of the admission package." prescriptions to the outpatient pharmacy three days prior to discharge. The outpatient pharmacist communicated to the CM high copays medications, lack of coverage or prior authorization (PA) needed. The CM related information to the team, and the nurse practitioner started the PA process. For patients with high copay or no coverage, the CM met with the patient, provided resources and initiated applications for medications assistance programs, which caused delays in discharge. One of the caveats to completing that application was that proof of income was needed to complete it. Most of the patients didn't have the financial information necessary to complete the forms required. One of the main problems in helping patients to qualify for assistance is to meet the income criteria. Most of the major pharmaceutical companies have patient assistance programs, but each company has different eligibility and application requirements. Some of these programs follow the NPL (National Poverty Level) income criteria instead of evaluating the patient's overall financial picture based on ongoing medical treatment and market geography. The issue of medications coverage delaying discharge was still a challenge to overcome. In 2005, Dr. Sergio Giralt, chief of Adult Bone Marrow Service, included pharmacists as part of the BMT multidisciplinary team. Pharm Ds rotate within the inpatient and outpatient setting. The outpatient Pharm D initiates medications teaching and verifies insurance coverage of potential discharge medications prior to admission. The case manager works closely with the pharmacists in ensuring medication access and coverage. Once the pharmacist confirms benefits and identifies patients with high copays or no coverage, the case manager is notified. The case manager then reaches out to the patient prior to admission and educates her about resources available regarding drug assistance programs, as well as initiates the application process. The collaboration of both disciplines has reduced LOS by 70 percent when it is related to medications coverage issues. Another approach is that the CM is reaching out to pharmaceutical companies and increasing awareness of medication access issues. Pharmaceutical companies are changing their perspectives and have made changes to create better programs. Pharmaceutical companies can prevent a cascade of issues by working together with case managers, Pharm Ds and insurance companies to facilitate medication access and assistance. As new drugs are being approved, case managers need to increase the awareness to this industry to create better resources and affordability. Discharge planning for the BMT population starts prior to admission-in the outpatient setting. A holistic and multidisciplinary approach is crucial in helping with medication assistance and access as well as other potential discharge issues. By implementing these measures, patient access increases, medication adherence improves, length of stay decreases-and most importantly, patients experience an improved QOL (Quality of Life) and decreased financial burden. ■ Carmen Castillo, RN, BSN, CCM, is currently a Case Manager for the Bone Marrow Transplant Service at Memorial Sloan Kettering Cancer Center (MSKCC) in New York. Mary McDonough MSN, RN, CCM, is Clinical Manager/Case Management at Memorial Sloan Kettering Cancer Center. Issue 6 * 2016 CMSA TODAY 19

Table of Contents for the Digital Edition of CMSA Today - Issue 6, 2016

Patient-Centered Care
Association News
CMSA Corpo rate Partners
On Living Well: The Life-Transforming Power of Palliative Care
Improving Medications Access for Bone Marrow Transplant Patients
Breaking Down Silos & Strengthening Hospital Care Coordination
Cultivating the Art and Science of Compassionate Care
Index of Advertisers
CMSA Today - Issue 6, 2016 - cover1
CMSA Today - Issue 6, 2016 - cover2
CMSA Today - Issue 6, 2016 - 3
CMSA Today - Issue 6, 2016 - 4
CMSA Today - Issue 6, 2016 - 5
CMSA Today - Issue 6, 2016 - Patient-Centered Care
CMSA Today - Issue 6, 2016 - 7
CMSA Today - Issue 6, 2016 - Association News
CMSA Today - Issue 6, 2016 - 9
CMSA Today - Issue 6, 2016 - 10
CMSA Today - Issue 6, 2016 - CMSA Corpo rate Partners
CMSA Today - Issue 6, 2016 - On Living Well: The Life-Transforming Power of Palliative Care
CMSA Today - Issue 6, 2016 - 13
CMSA Today - Issue 6, 2016 - 14
CMSA Today - Issue 6, 2016 - 15
CMSA Today - Issue 6, 2016 - 16
CMSA Today - Issue 6, 2016 - 17
CMSA Today - Issue 6, 2016 - Improving Medications Access for Bone Marrow Transplant Patients
CMSA Today - Issue 6, 2016 - 19
CMSA Today - Issue 6, 2016 - 20
CMSA Today - Issue 6, 2016 - Breaking Down Silos & Strengthening Hospital Care Coordination
CMSA Today - Issue 6, 2016 - 22
CMSA Today - Issue 6, 2016 - 23
CMSA Today - Issue 6, 2016 - Cultivating the Art and Science of Compassionate Care
CMSA Today - Issue 6, 2016 - 25
CMSA Today - Issue 6, 2016 - Index of Advertisers
CMSA Today - Issue 6, 2016 - cover3
CMSA Today - Issue 6, 2016 - cover4
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