Challenges and Opportunities

  • Free Drug”concept and other Safety Net Program patients
    • Other local programs began sending patients to our program without notification
      • Solution: Meet with local clinics & safety net programs to anticipate potential added volume.
    • Consider options to address revenue not secured in dispensing purchased medication.
      • Solution: Institute aSafety Net Drug programat $3.00 (?) per prescription. Apply for grant funding for purchased meds/supplies (diabetic supplies, etc.)
  • Physicians Not Aware of Available Inventory
    • Prescribers unaware of charitable pharmacy and formulary were not prescribing meds that were available.
    • Increase in patient wait time results in the pharmacist needing more time to resolve therapeutic changes.
      • Solution: Partner with medical leaders across the systems to educate physicians, hospitalists and other key providers
      • Educate prescribers that stock is for short term use until eligible patients receive medication from PAP
      • Distribute current formulary to prescribers who frequently send patients
      • Establish Collaborative Practice Agreement with prescribers to make changes then notify prescriber
  • Staffing and Stress of Staff (paid staff)
    • Patient and prescription volume grow quicker than anticipated and not initially able to hire additional staff due to budget constraints.
      • Solution: Seek short term (1 year) grant to add additional full time or part time staff (social worker, technician. Introduce an automated robot or counting machine to help manage workflow better.
  • Staffing (volunteer staff)
    • Not enough volunteers to help break down incoming samples, process the inventory, complete paperwork, and maintain patient’s files.
      • Solution:Volunteering for charitable pharmacy was placed on the hospital pharmacy employee evaluation as a way to exceed expectations related to the mission of the hospital.
      • Partner with local university for healthcare and foreign language students for Experiential Service Learning to interact with patients and help maintain pharmacy tasks.
  • Language and Literacy Barriers
    • Patients whose language is not English without an interpreter
    • Difficulties explaining the program or requirements (proof of income)
    • Forms only in English or patient unable to read English or their primary language
  • Validating Proof of Income
    • Patients with no income
    • Undocumented workers (paid in cash, no social security number, can’t have a bank account)
    • The number of people in the in household (who should be responsible?)
      • Solution:Require a formalized letter of support from family members, friends, and organizations that help support the patient’s bills
      • Require a letter from the patient’s employer that includes the amount that the patient is paid per week (month or year) and a phone number to call and verify the amount paid for patients who are paid in cash
      • Letter of support does not require a notary as the process was burdensome for the patients
      • Verification of food stamp benefits by using the state benefit website instead of requiring patients to bring in paper copy as proof of income
      • Example of processes inPatient Eligibility/ Enrollment
      • Example forms inAppendices/Eligibility/HDGB Enrollment Forms
  • Undocumented Workers (proof of income/PAP programs)
    • Patients not eligible for Manufacturer PAP programs but have long term need
    • Documenting proof of income
      • Solution:Some PAPs use soft credit tool to determine income which may work for some patients
      • Use therapeutic interchanges to provide medication from manufacturer with best fit for eligibility
      • If patient meets residency requirements, some programs will accept letter from employer
      • Direct donations do not require supplemental income documentation
      • Some coupons provide discounted med for up to one year if patient can afford low copay
  • Coordinating physician donations of samples and Pick ups
    • Need a sustainable supply of medications
    • Supply and demand- donations do not always match what is needed the most
      • Solution:Specify to physician donors what is needed and only accept those donations
      • Complete Track and Trace documentation for all donations. (See:Tracking the Medication Supply Chain)
      • Use therapeutic interchange when possible to dispense from present inventory
  • Maintaining a retail pharmacy environment
    • The program is integrated into a working retail pharmacy
    • Employees and other customer wait times increased to get prescriptions filled/check out
      • Solution: Designate a specific window or area for patient enrollment that stocks enrollment paperwork and clipboards for patients who can read and write to begin enrollment process independently
      • Use various colored bins to designate newly enrolling patients, who expect a longer wait time, versus other patients.