Steps for Processing PAPs

  1. Initial Medication Supply

As PAPs require shipment, the first step is providing medication until the shipment arrives. Manufacturer or discount coupons, product samples, or a therapeutic interchange may fill the gap. Some manufacturers offer coupons which provide medication for up to one year for eligible patients. This option eliminates shipping and provides immediate dispensing – a win-win for patient and pharmacy. Providers who carry samples (e.g. cardiologists, pulmonologists, etc.) may be willing to donate directly to a charitable pharmacy even if the patient is not part of their practice. (See Direct Donations)

2. Eligibility

As PAPs require shipment, the first step is providing medication until the shipment arrives. Manufacturer or discount coupons, product samples, or a therapeutic interchange may fill the gap. Some manufacturers offer coupons which provide medication for up to one year for eligible patients. This option eliminates shipping and provides immediate dispensing – a win-win for patient and pharmacy. Providers who carry samples (e.g. cardiologists, pulmonologists, etc.) may be willing to donate directly to a charitable pharmacy even if the patient is not part of their practice. (SeeDirect Donations)

3. Enrollment

Each manufacturer has individual qualifications. Variables include:

  • Residency requirements and documentation,
  • Social Security or Tax ID number
  • Income requirements, documentation, and processes (some companies do a soft credit check for initial enrollment),
  • Insurance eligibility status,
  • Age or diagnosis restrictions.

Therapeutic Interchange may allow patients to be eligible for a similar product when not qualified for the product prescribed. 

See Eligibilityfor general details and documentation.

TIP: HOPE Dispensary adapted a patient specific section to record clinical interventions and associated potential dollar values. Metrics are then shared with stakeholders and funders, documenting services provided beyond med access. Enrollment

As with eligibility, applications and documentation vary with manufacturers. Attention to detail is paramount in reviewing each application to ensure all signatures and documentation is complete and provided prior to submission. Application variables include:

  • Patient signature (some allow caregiver, spouse, parent or guardian),
  • Provider signature – ensure matches provider used on application; hospital residents may lack credentials (state license, DEA number),
  • Signatures to be original versus faxed,
  • Acceptable photo identification, residency and income documentation,
  • Original prescription versus application becomes prescription.

When providing this service at the charity pharmacy, create guidelines and deadlines for patients and providers to provide documents and signatures. A reasonable guideline is two follow-up phone calls or requests within a four to six- week period. Document follow-up. Software is helpful for documentation and scheduling.

Once all application signatures and documents are procured, submit to manufacturer. Some require original documents/signatures necessitating mailing applications. Others accept faxes or allow scanning to a website. If a reply is not received, follow-up with manufacturer probably ten days after submission to confirm receipt of application, proper documentation, and verify patient eligibility

4. Shipping and Providing to Patient

Shipping from the manufacturer directly to the patient is convenient for the
patient but may not be best practice. Although the medication has already 
been dispensed from the manufacturer to the patient it may not be labeled in 
compliance with state laws. As clinical pharmacists, we know that a state-
approved label should be attached to container(s). Some manufacturers do
this; others send just a packing slip and medication information sheet. When servicing a patient with PAP medication, ensure the product is properly labeled with accurate directions (not “as directed”), patient is counselled and any questions are answered. Dispensing from the pharmacy provides opportunity for both proper labeling of prescription vials and patient counseling.

PatientPharmacy
Prescriptions mailed to PatientSaves patient trip to pick-up prescription Frequent changes in patient address and contact information may delay delivery Patient must call pharmacy for counselling or questionsRequires follow-up with patient to confirm delivery and questions or counselling Proper prescription label may be missing Metrics and trackability not always available
Prescriptions mailed toPharmacyPatient required to pick-up and sign for prescription Patient receives properly labeled Rx and has opportunity for counselling and questionsEnsure delivery of medication and patient receipt Follow-up for delayed delivery Ensure patient pick-up Verify proper labeling, patient education Obtain metrics Follow-up for meds not picked up Delivery challenges from manufacturer if pharmacy has limited hours, especially for refrigerated items

For PAP meds picked-up at the pharmacy, guidelines are helpful.

  • Call patient for medication pick-up
    • Document call: spoke with patient or name of other person, left voicemail, phone number not accurate, no voicemail 
    • Limit number of documented phone calls or attempts (e.g. 2 attempts/30 days or less)
  • At pick-up, remind patient to call for refill between 21 and 30 days prior to needed to allow time for contacting manufacturer, shipping, and obtaining a new prescription if this is the last refill.
  • If patient no longer needs, would they be willing to donate to the charity pharmacy for use by another patient? Document on packing slip and in other records with reason not given to patient.
  • If patient does not pick-up within set guidelines, document as above.R

5. Refills

When a patient calls the pharmacy or is contacted for a refill, check for possible changes in eligibility, contact information, provider, and directions. Contact the provider to verify any changes in directions. Contact the manufacturer and relay any changes (may require new prescription for direction changes.)

Follow-up phone calls may be made to verify patient’s need for refill, usually 30 days prior to next fill. As well as being proactive, this is an opportunity to check adherence.

Document all communications with patients, providers and manufacturers.

6. PAP Medication Destruction

Product dispensed as PAP from a manufacturer cannot be returned to another 
vendor or wholesaler for destruction. Destroy beyond use meds as per 
pharmacy policy. See: Medication Destruction and Standard Operating 
Procedures

7. PAP Metrics

Measures used to evaluate a PAP program can include:

  • Number and dollar value of PAPs processed (this quantifies time spent processing whether patient is not eligible, not all documentation is returned, or med is not picked-up
  • Number and dollar value of PAPs dispensed (this includes new and refilled PAPs)
  • Manufacturer and/or product or therapeutic class of PAPs