Improving care for low-income, uninsured patients: A pilot to increase access to medicines through a replenishment program

In 2007, approximately 36.1 million adults in the U.S went without necessary prescription drugs because they could not afford them. People who are not in compliance with their prescribed medications have poorer health outcomes, and the most vulnerable – those with low incomes and without health insurance – face the greatest unmet need for prescription drugs.

Patient Assistance Programs (PAPs) provide prescription medicines to low-income, uninsured patients and are an essential element of the healthcare safety net. To access these PAPs on behalf of their patients, clinics must invest significant time and administrative functionality that is burdensome to staff. Separate PAP requirements create unintended barriers to access and delays in care.

Direct Relief established a pilot program as an alternative to traditional PAPs to increase access to healthcare and medicine for low-income, uninsured people receiving care at safety net clinics. Direct Relief's Replenishment Program:

• Increases access to medicines for low-income patients without health insurance; • Improves the way patients receive medications at clinics and health centers; • Streamlines the clinics' administrative processes spent on PAP enrollment and dispensing; • Maximizes efficiencies in providing donated medicines to patients; and • Provides a scalable platform for a national program accessible to additional pharmaceutical companies and recipient clinics.

The program works as follows: 1. The pharmaceutical manufacturers send donated medications to Direct Relief, in order to reach qualifying patients with their medications through eligible and vetted clinics. Direct Relief serves as a single entry point for the manufacturers wanting to provide access to medicine for low-income and uninsured patients 2. Direct Relief certifies clinics to participate in the program based on set eligibility criteria, and provide bottle-for-bottle replenishment of PAP medications based on utilization on behalf of the manufacturer. 3. In this centralized model of distribution, participating clinics receive bulk replenishment of multiple donated medications based on drug utilization reports. Direct Relief serves as the distributor and repository of drug utilization data.

Since inception, the Replenishment Program has achieved the following outcomes: provided no-cost medicine to over 8,000 people; dispensed over 45,000 prescriptions; expanded to 10 clinic partners; and partnered with 3 healthcare companies. In addition, time studies have demonstrated a time-savings in put-away time between Replenishment Program drug shipments (8 seconds/prescription) versus traditional PAP drug shipments (1 minute 43 seconds/prescription.