Primary Intended Outcome(s)
- Create an advanced role for a certified pharmacy technician to expand the scope of pharmacy services and leverage and extend available resources for patients
- Enhance the accuracy of documented patient applications and efficiently manage medication procurement for medication assistance through the provision of a dedicated pharmacy technician to these processes
- Increase the capability of the pharmacist to focus on direct patient care and patient counseling while optimizing patient care and satisfaction
Site Description
UC Health – University of Cincinnati Medical Center (UCMC) is part of an integrated delivery network that manages large numbers of acute care and ambulatory patients and has nearly 50 physician offices. UCMC is the flagship academic medical center and serves as a leader in trauma, solid organ transplant, and ambulatory care.
UCMC pharmacy services extend across the health system, including services offered in the inpatient, outpatient, ambulatory, and corporate settings. The outpatient pharmacy distributes medications, provides clinical services and houses and supports the Medication Access Service. Medication Access Services are provided to patients transitioning from the acute care setting to ambulatory settings in coordination with the Discharge Concierge Medication Delivery Service and Transitions of Care Services, those receiving care in a UC Health infusion suite and patients seen in UCMC ambulatory care clinics. The Medication Access Team consists of one coordinator and six full-time Patient Advocates that work diligently to assist patients. The responsibilities of the Medication Access Team include investigation of insurance benefits to determine coverage, coordination of response to payer requests for prior authorization, managing patient prescription refill needs, and the ability to support patient enrollment in pharmaceutical manufacturer and foundation assistance programs.
Advanced Role Description
Pharmacy technicians serve as patient advocates by assisting patients in obtaining their medications as part of the Medication Access Service. Pharmacy technicians are vital in this position as they have the background knowledge and understanding of several key aspects necessary to advocate on behalf of patients in the requirements to complete the tasks essential to meet the needs of underinsured and uninsured patients. Patient advocates collaborate with physicians, clinic staff, case managers and pharmacy staff to identify potential patients for enrollment. Medication assistance is offered to and available for any of the patients that have prescriptions filled at UCMC Hoxworth Outpatient Pharmacy. Patient interviews are conducted to determine their potential qualification for Medication Assistance Programs and Foundations by reviewing health/prescription insurance, financial status and documentation. Advocates work to obtain clinical information from patient charts specific to program requirements. They also communicate with assistance program representatives, patients, physicians, pharmacists and other parties as necessary for maintenance of patients in existing medication assistance programs and new programs. This leads to increased access to medications for patients and an increase in patient satisfaction due to improved health outcomes.
How to Start
Ensure adequate resources and technology are available including access to resources for assistance and the electronic medical record. The Medication Assistance Team and the Epic analyst at UCMC partnered to build a flagging system within Epic Willow Ambulatory in order to integrate the pharmacy and medication assistance workflow. The flagging system generates a list within the work queue in Epic in order to identify patients that would be eligible to benefit from the program. This is key for new patients who are not referred from a provider but are still in need of assistance. This efficient process supports optimal workflow.
Regulatory and/or Legal Requirements
The role of the patient advocate pharmacy technician, under the supervision of UCMC pharmacists, is in compliance with the rules and statutes of the State of Ohio.
Revenue & Expense Parameters (abbreviated financials as applicable)
Direct costs include salary and benefits for the pharmacy technician. Additionally, the technician’s workstation is outfitted with a computer, phone, printer, access to the electronic medical record (EMR), office supplies, etc. A monthly report of drug expense avoidance and revenue received for each program is monitored; the program averages about approximately $130,000 per month in revenue in prescriptions processed through the out-patient pharmacy and $211,000 in costs avoided through stewardship of county funding and manufacturer replacement programs for infusions.
Training and/or education requirements
Required
- Associate or Bachelor Degree
- Excellent communication and interview skills
- Experience in managing financial and /or clinical information
- Experience working with financial eligibility or third party programs
- Experience working with data base computer software programs
Preferred
- Two years of experience working directly with customers
Advocates are certified through the Pharmacy Technician Certification Board (PTCB). Additional training is provided using direct observation and exposure to educational resources provided and supported by the department, institution and organization.
Outcome Measures
- Number of patients interviewed
- Number of applications submitted
- Number of applications accepted
- Number of refills processed
- Cost avoidance
- Revenue generated
Lessons Learned
- Importance of pharmacy technician involvement to apply knowledge of pharmacy information and workflows to a business setting
- Integration with out-patient pharmacy workflows through technologies to facilitate and enhance communication.
- Provide support for ongoing professional development e.g., education and professional skills