This project aimed at understanding why people in Rutland County, Vermont struggle with buying medications for their health. The project implemented and proposed several methods to help the population of Rutland area better adapt to the growing cost of prescriptions via $4 medication lists, rebates, samples, etc.https://scholarworks.uvm.edu/fmclerk/1337/thumbnail.jp

Patel, Niketu P

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University of VermontScholarWorks @ UVMFamily Medicine Clerkship Student Projects Larner College of Medicine2017Barriers to Affordable Prescriptions in RuralVermontNiketu P. PatelUVM Larner College of MedicineFollow this and additional works at: https://scholarworks.uvm.edu/fmclerkPart of the Community Health and Preventive Medicine Commons, Medical EducationCommons, and the Primary Care CommonsThis Book is brought to you for free and open access by the Larner College of Medicine at ScholarWorks @ UVM. It has been accepted for inclusion inFamily Medicine Clerkship Student Projects by an authorized administrator of ScholarWorks @ UVM. For more information, please contactdonna.omalley@uvm.edu.Recommended CitationPatel, Niketu P., "Barriers to Affordable Prescriptions in Rural Vermont" (2017). Family Medicine Clerkship Student Projects. 331.https://scholarworks.uvm.edu/fmclerk/331Barriers to Affordable Prescriptions in Rural VermontNiketu PatelJuly-August 2017, Rotation 3George Fjeld, MD & Susan WhiteProblems with Medications in Rural VT• Cost of  medications and medical care are rising across the nation• Many are not insured or have minimal insurance in rural Vermont• In Rutland county, many patients, nurses and care providers are unaware the cost of  medications they prescribe or where to find cheap medications• Large chain and federal pharmacies do a poor job publicizing reduced medications list to the public and to medical offices• Local pharmacies in Brandon, VT do not post their individual medication costs2aNeeds in Rural Vermont• There is no central database to list individual medication costs or rebates from manufacturers• Many medical providers do not split prescriptions to different pharmacies• Patients in rural Vermont need an easy way to find the cheapest medications where they live2bRising cost of  health costs and health insurance coverage• Rutland County has the second largest number of  Medicare enrollees.• Per capita income of  Rutland county in Vermont is $26K, and median Health Care expenditures per capita are $8K • As of  2015, 3.8% (24,000) of  Vermont’s population did not have insurance• As of  March 2016, more than 130K people have Medicare in Vermont (21% of  the population). • As of  March 2017, more than 170K people have Medicaid in Vermont (27% of  the population)3Community Perspective- Community Health Centers of  Rutland Region• “It doesn’t make sense…Inhalers can cost $300, $600, $900, and it should never cost that much for anything”• “I am a nurse, and I never knew the cost of  medications until now. I didn’t know about reduced price list for medications until I took a new position as a patient care coordinator”• Our founders chose to make our practice a Federally Qualified Health Center to help meet the need of  our rural community, but there are so many stipulations and proper procedures we have to constantly watch to get our funding from the state. 4Intervention and Methodology• First Stage• Publicizing to patients different local pharmacies that have certain medications on discount as handouts and passing out their specific pharmacy’s list (ex: $4 medication list from Wal-Mart, Rite-Aid $3 meds list, etc.) • Encourage patients to find rebates for their current medications online and look for free samples. • Instruct patient to go to local pharmacy and receive a price list of  medications• Most importantly, the patient should enter their medications into a website like www.GoodRx.com (where it will show the total cost of  a list of  medications at each nearby (large chain) pharmacy).5a• Stage 2: Involve a patient care coordinator/nurse/volunteers to work with patient to see if  certain medications can be adjusted to meet the discounted medications and get approval with physician. Examples:• 1. Switch current medication to different drug in the same class to match the discounted drug and dosage list—switching Sertraline to Paroxetine, Citalopram, or Fluoxetine.• 2. Increasing or decreasing the dose to match the discounted medication—1mg of  finasteride (30 day supply $14) is prescribed but 30 day supply of  5mg finasteride is $8 on the list. Increase dose and teach patient how to use a pill cutter. Results in a 4 month supply of  1.25mg Finasteride for $8, or $2 a month or a savings of  $12/month!• 3. Many large chain pharmacies will give medications or supplies for free. Ex. Rite-Aid- diabetic supplies and many antibiotics. • Stage 3: Split your prescriptions list. • If  medications are cheaper in two different locations, request physician to send certain medications to one location and others to another• Choose one official pharmacy and get physician to print the rest on paper for you to fill yourself5bResponses & Results• Of  the ten patients we sampled, only two tried to find which pharmacy around Brandon sold the cheapest prescription.• None of  the ten looked for rebates or free samples.• No one knew about the $4 and $3 medications list.• We saved one person $360 by switching LABA inhalers and giving him a 2 month sample. • “Thank you for giving me this list, I’ll take some time and see which medications I can switch or change the dose….I’ll buy a pill cutter if  I have to” – young person on disability who cannot work6Effectiveness and Limitations• Patients were very receptive to this approach and were excited to find ways to save money on medications, especially those on disability• Due to the short duration, only parts of  stage 1 were implemented• “I would look for cheaper medications, but I don’t have a computer”-patient’s comments• Other limitations are that the patient population taking many medications, majority are elderly, do not know how to use the internet to find these websites, enter their medications and print off  rebates. 7Recommendations for Future Projects• I would highly suggest implementing stage two and three of  this plan and report the effectiveness of  the intervention.• Because almost 50% of  the Vermont is on Medicare or Medicaid, collaborate a way with the state to create a database like GoodRx.com, where local Vermont pharmacies, federal pharmacies, mail-in pharmacies and large chains can submit their medications prices for the cheapest cost to the patient.• Work with EMR companies to integrate the reduced medications lists into the EMR, so that physicians can tell patients how much it will cost with their insurance status before prescribing.• Get high school volunteers to go through medication lists with patients and find rebates for them8References (links in individual slide notes)• The Henry J. Kaiser Foundation, non-profit specializing in global health policy• US Census Bureau –• “SELECTED ECONOMIC CHARACTERISTICS 2009-2013 American Community Survey 5-Year Estimates“ • "ACS DEMOGRAPHIC AND HOUSING ESTIMATES 2009-2013 American Community Survey 5-Year Estimates". U.S. Census Bureau. Retrieved 2015-01-12.• "HOUSEHOLDS AND FAMILIES 2009-2013 American Community Survey 5-Year Estimates". • Healthinsurance.org , website geared to providing health insurance information assistance • The Dartmouth Institute of  Healthcare and Policy9

Barriers to Affordable Prescriptions in Rural Vermont

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Barriers to Affordable Prescriptions in Rural Vermont

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