With co-pays and deductibles always increasing, pharmacies have an opportunity to work with patients and providers to help reduce medication costs.
Given that various certifications are currently advocated as a means to expand pharmacists’ professional expertise, I’d like to suggest a new type of title: the prescription savings specialist.
This title doesn’t come with a fancy diploma or approval from a national certification board. However, it does offer the satisfaction of knowing that many patients will appreciate your efforts and adhere to medications they might not otherwise be able to afford.
With co-pays and deductibles always increasing, pharmacies have an opportunity to work with patients and providers to help reduce medication costs. Therefore, a prescription savings specialist is an expert on using all available programs and tools to help make medications more affordable.
Who can become a prescription savings specialist?
While a pharmacist is the ideal choice to drive this initiative, it can also be managed effectively by an experienced and interested pharmacy technician. At the very least, it needs to be someone who’s comfortable with how retail pharmacy works.
Very few individuals working outside the pharmacy understand how the pharmacy processing and co-pay system works. Besides, pharmacy claims and co-pays can be confusing.
Here’s what becoming a prescription savings specialist requires:
1. Heightened awareness of patient co-pays.
As a front-line dispensing pharmacist, I know how easy it is to completely ignore co-pays. It’s hard enough to make sure the right patient is getting the right medication with the right directions, and that it doesn’t interact with anything else the patient might be taking. I’m checking dates of birth, age, and dosages while doing a drug utilization review and managing a host of errors that creep into the written prescription.
Being prescription savings specialist requires focusing on co-pays, too. You’ll need to consider whether the co-pay appears unusually high, based on what the patient typically pays, and decide whether the patient should be called about it.
2. Knowing how plan co-pays and tier structures work.
When confronted with a $100 co-pay, the prescription savings specialist would have to immediately begin asking questions like, “Are there other clinically similar products available?” I’d like to think a prescriber would naturally prescribe a relatively inexpensive generic, but sometimes, patients may have pushed for the more expensive drug, not realizing they were going to face a high co-pay in doing so.
At that point, the prescription savings specialist would need to determine the appropriateness of other options and their costs by either calling the health plan or running some test claims. Of course, this would also involve some conversations with the patient and the provider, but the results could be rewarding.
3. Familiarity with co-pay reduction and free trial coupons from manufacturers.
The prescription savings specialist would have to learn which drugs have such programs available and how to process the cards when appropriate. Some require activation by the patient, but others don’t. Some only work for commercially insured patients, while others allow even federally insured patients to get their first fill for free.
Of note, certain states may have some restrictions on these cards. Additionally, the prescription savings specialist would need a plan to organize these cards (like a hanging file system) for quick access.
4. Awareness of manufacturer assistance programs that provide financial help to low-income patients.
These sometimes require a different type of enrollment, which may even need an acknowledgment by the patient’s prescriber. However, many pharmaceutical companies offer select patients access to their medications through these types of programs, as well.
5. Familiarity with charitable non-profit foundations that provide co-pay assistance to patients who meet minimal income requirements.
Organizations such as the Patient Advocate Foundation or Patient Assistance Network receive financial donations to help patients with specific disease states such as cancer or hepatitis C. These often require enrollment by the pharmacy and an application process for the patient, but they can frequently be used to cover very expensive co-pays or deductibles that would make the medication otherwise inaccessible to the patient.
6. Awareness of local resources and programs that may provide free medications.
All things being equal, I’d like patients to get their monthly medications from the pharmacy. But, if a free medication program will help my patients take their prescriptions and still be able to afford food for the month, then I’m going to do the right thing and give them this information. I may lose a sale, but I’ve gained an otherwise loyal customer for life.
Gaining a reputation as a prescription savings specialist in your area doesn’t take long. As soon as patients and providers learn that you’re willing to take a few extra steps to help reduce co-pays whenever possible, word of mouth will pay big rewards for your overall business.
The title of prescription savings specialist isn’t as prestigious as some of the other certifications available, but the letters following your name aren’t nearly as important as the care that flows from your heart. As the saying goes, no one cares how much you know until they know how much you care.