[968] Influence of a Pharmacy-Based Transplant Patient Medication Assistance Program on Length of Stay (LOS), Re-Admissions, and Costs.

Anne Jarrett, Lori Svejkovsky, William Doares, Elizabeth Ashcraft, Alan Farney, Erica Hartman, Jeff Rogers, Patricia Adams, Robert Stratta Wake Forest Univ. Baptist Med. Center, Winston-Salem, NC

Patient Assistance Programs (PAPs), sponsored by pharmaceutical manufacturers, provide medically necessary medications for free or at reduced cost to patients with limited means. The implementation of Medicare Part D offered all Medicare beneficiaries prescription drug coverage. However, immunosuppressive medication costs which are covered by Medicare Part B are not eligible for coverage under Medicare Part D. As a result, the annual minimum out-of-pocket medication costs for transplant patients on CNI- and MMF-based regimens who have only Medicare Part B and Part D insurance in 2006 was $ 8,500. In 2007, changes to the Medicare Part D program will translate into larger out-of-pocket expenses for transplant patients. In the example of a patient insured with Medicare Part B and Part D only, the annual minimum out-of-pocket expenses for CNI- and MMF-based regimens will be $ 8,750. Further, PAPs have been severely restructured by manufacturers since the inception of Medicare Part D to avoid sanctions. At our center, a pilot pharmacy-based PAP was begun in February 2005. We reviewed transplant patient admissions from 8/1/04 through 8/31/06 to determine if any impact towards length of stay (LOS), readmissions, and medication cost was made by this pilot program.
Results: To date, 101 patients have received assistance. Inpatient days prior to patients receiving assistance through this program accounted for 56% of total inpatient days that occurred during the observation period. Inpatient days after patients began receiving assistance decreased to 6% of total inpatient days. Readmission days prior to patients receiving assistance through the program accounted for 55% of total inpatient days. Readmission days dropped to 9.6% of total inpatient days after patients received help from the program. Medication cost prior to assistance through the pilot program accounted for 86% of total readmission medication costs during the observation period. Medication cost since the inception of the program account for 14% of total readmission medication costs during the observation period.
Conclusions: We have shown that a pilot pharmacy-based PAP can contribute to decreased LOS, decreased readmissions, and decreased medication cost. Further study is warranted in light of the ever changing insurance and PAP landscape.
Keywords: Length of stay; Immunosuppression; Medicare; Pharmacoeconomics

Session Information
Session Title: Poster Session: Non-Organ Specific: Economics, Public Policy, Allocation, Ethics (12:45 PM-2:00 PM)
Date: Sunday, May 6, 2007 - 12:45 PM
Room: Exhibit Hall, Lobby Level, Moscone West Convention Center