 February 2003 • Volume 9 • Number 2 |
BY SHERI PORTER
Seems there's a downside to every good idea -- and physicians know that's true of patient assistance programs, set up by pharmaceutical companies to get medicine to indigent patients who might otherwise go without. There's no question that the PAPs are working. According to the Pharmaceutical Research and Manufacturers of America, 3.5 million patients received medications valued at $1.5 billion (wholesale) for free through PAPs in 2001.
The problem is that physicians have been assigned as gatekeepers, and that role takes time. To help cover their administrative costs, some FPs are assessing a small fee.
One unidentified FP recently fired off this comment to an AAFP e-mail discussion group: "We charge a $3 fee per (PAP) prescription. I know it doesn't cover all the costs, but at least we're setting a precedent that there is a limit to the cr-p we are willing to do for free."
Strong words ... but an indication of much pent-up frustration.
Tactics to try
There are many PAPs, and each program has its own rules. "Some programs only ask us to hand patients the literature," said FP Meetul Shah, M.D., of Battle Ground, Wash., "while others require us to complete part of the application."
Shah said his office assigns a medical assistant to the PAP paperwork detail each day. "Our assistants are getting stressed out, and as a result, there's been discussion by our administrators of possibly discontinuing our participation in the programs," he said.
Shah doubted most of his patients -- farmers and blue-collar workers in a semirural community -- could afford to pay even $5 to $10.
Patients will pay, said Debbie Heck, M.D., an FP from Muncie, Ind., who uses the programs extensively. Initially, she did the paperwork for free. Now Heck charges $10 each time her nurse enrolls a patient in a program.
"Patients realize the paperwork takes considerable time, and they're willing to personally pay the fee," she said.
But maybe they don't have to.
Kent Moore, AAFP manager of health care financing and delivery systems, said physicians may be able to bill for such services and pointed out CPT code 99080, which reads: "Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form."
Moore suggested physicians bill this service in conjunction with another service, such as an office visit. "Whether or not the insurance company will pay is a different question," he cautioned.
Tackling the paper pile
This paperwork burden has not gone unnoticed by AAFP's Commission on Health Care Services. A draft policy, "Physician Rights Relative to Imposed Administrative Costs," was on the table at the commission's Jan. 16 18 meeting in Tucson, Ariz. According to James Bare, AAFP policy analyst, the wording in the draft would include the administrative work generated by PAPs. At press time, FP Report did not know the outcome of that meeting.
"For years we've struggled with the whole issue of paperwork and compensation," said Leonard Fromer, M.D., of Santa Monica, Calif., immediate past chair of the commission. "While the concept that someone should be reimbursing the physician in this situation is reasonable, who is going to pay the bill? The patient? These are the very people who are most likely already on assistance for their health care.
"Perhaps reimbursement should be looked at in terms of the PAP that is requesting the paperwork."
Tweaking PAP procedures
Jan Weiner, executive director of public affairs for Merck & Co. Inc., said Merck considers the physician's role vital "because physicians are in the best position to understand the circumstances surrounding a patient's need for free medication." Weiner said Merck is sensitive to the time issues involved in completing paperwork and last year enhanced Merck's PAP to "maximize convenience for physicians and be more responsive to patients."
Changes in the Merck program included providing direct patient access to forms, so paperwork can be completed before the visit; enabling physicians to write prescriptions for a full year --an initial 90-day supply with up to three refills; allowing delivery of prescriptions to the patient's home, thus avoiding an office visit; and giving patients a toll-free number to order refills.
"These changes have been well received by physicians and their office staffs," said Weiner.
Other companies are also trying to simplify their programs. "We don't want to overburden physicians," said GlaxoSmithKline spokesperson Mary Anne Rhyne, of GSK's program. "But we're committed to providing low-income patients access to medicines, and physicians are key players in that process."
Scott Morris, M.D., a family physician from Memphis, Tenn., who provides health care for the working uninsured, said PAPs are "an invaluable source for us to care for our patients -- but that doesn't mean they don't require a lot of work."
"While there is great room for improvement in the PAPs, much good has been done because of them," he said.
To reach writer Sheri Porter, e-mail sporter@aafp.org.
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To learn more about patient assistance programs, discount drug cards, and state and local patient aid programs, read "How to Help Your Low-Income Patients Get Prescription Drugs" in the November/December Family Practice Management, available online at http://www.aafp.org/fpm/20021100/51howt.html. A list of physician resources appears with the article. |
FP Report is
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Copyright © 2003 by American Academy of Family Physicians.