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Background

Why Is WVRx Needed?

  • Most uninsured patients represent charity care for hospitals. In 2006, the cost of charity care in WV hospitals was $231 million, up from $178 million in 2004, a 75% increase! This program will save millions in charity care costs for WV hospitals and the doctors who care for these patients.
  • Estimates of the uninsured in West Virginia range from 265,000 to around 300,000. Many, perhaps most, citizens in this group are the working men and women who struggle to make ends meet. They cannot afford to get sick and when they get sick they cannot afford the medicines they need. The drug makers say they want these patients to have their products for free or reduced cost. This program will remove the barriers and allow the manufacturers to be more successful in keeping this commitment.
  • This program is not needed in a few clinics around the state that already have central fill pharmacies and while we may compliment what they do, we will not replace them.
  • A heavily advertised PhRMA program is a one patient at a time approach. It connects the patient to the individual manufacturer’s paper work. While helping hundreds of patients in West Virginia, it has done so at great cost to doctors and clinics who try to make it work. A study in the Journal of Managed Care Pharmacy reveals that every 10 patients with an average of 4 prescriptions via PPARx imposes an overhead cost of one thousand dollars each year on the doctor or clinic.
  • The WVDHHR, DIVISION OF PRIMARY CARE has recently tallied a $365,000 cost related to this one patient at a time approach, involving 34 primary care clinics. That is over $10,000 for each clinic on an annual basis.
  • When this cost is combined with the fact that the prescription assistance programs are difficult to access and a hassle to use, it is no wonder that practicing physicians find them frustrating and are unable to afford the time or funds to make them available to their full potential.
  • An NIH study has shown that if uninsured patients stay connected to needed medicines, they go to the ER 40% less often and have 60% fewer hospitalizations.
  • In West Virginia, approximately a half million West Virginians or nearly 30% of the state’s residents lack prescription drug coverage.

What Are We Doing?

  • Simplifying and streamlining the dispensing of brand name medicines donated by manufacturers.
  • Providing a user friendly service for patients, doctors and clinics.
  • Collaborating with drug makers in a way that creates a sense of partnership with them and the prescribing community.
  • Making this service available throughout the state of West Virginia.
  • Providing a primary point of entry function that will screen and refer patients to other available programs that provide affordable access to needed medications and programs.
  • Organizing as a public-private partnership via West Virginia Health Right, a non-profit agency to reduce the costs of uncompensated care and to keep patients connected to their medications.

How Are We Doing This?

  • We are developing and maintaining a network of patient advocates, doctor’s offices and clinics throughout the state and working through them for patient referrals.
  • The referral goes through our primary point of entry and the patient’s eligibility is determined. Screening for other help the patient needs will also be realized. For example, all families will be screened for SCHIP and if their children aren’t enrolled, WVRx will assist through its network.
  • Armed with the knowledge that the patient is eligible and what medicines can be accessed, the prescriber registers the patient, and eligibility information is sent via fax or mail to WVRx.
  • The pharmacist will fill the prescription and send it to the patient within 24-48 hours of receiving eligibility documents.

Why Is WVRx Needed?

  • Most uninsured patients represent charity care for hospitals. In 2006, the cost of charity care in WV hospitals was $231 million, up from $178 million in 2004, a 75% increase! This program will save millions in charity care costs for WV hospitals and the doctors who care for these patients.
  • Estimates of the uninsured in West Virginia range from 265,000 to around 300,000. Many, perhaps most, citizens in this group are the working men and women who struggle to make ends meet. They cannot afford to get sick and when they get sick they cannot afford the medicines they need. The drug makers say they want these patients to have their products for free or reduced cost. This program will remove the barriers and allow the manufacturers to be more successful in keeping this commitment.
  • This program is not needed in a few clinics around the state that already have central fill pharmacies and while we may compliment what they do, we will not replace them.
  • A heavily advertised PhRMA program is a one patient at a time approach. It connects the patient to the individual manufacturer’s paper work. While helping hundreds of patients in West Virginia, it has done so at great cost to doctors and clinics who try to make it work. A study in the Journal of Managed Care Pharmacy reveals that every 10 patients with an average of 4 prescriptions via PPARx imposes an overhead cost of one thousand dollars each year on the doctor or clinic.
  • The WVDHHR, DIVISION OF PRIMARY CARE has recently tallied a $365,000 cost related to this one patient at a time approach, involving 34 primary care clinics. That is over $10,000 for each clinic on an annual basis.
  • When this cost is combined with the fact that the prescription assistance programs are difficult to access and a hassle to use, it is no wonder that practicing physicians find them frustrating and are unable to afford the time or funds to make them available to their full potential.
  • An NIH study has shown that if uninsured patients stay connected to needed medicines, they go to the ER 40% less often and have 60% fewer hospitalizations.
  • In West Virginia, approximately a half million West Virginians or nearly 30% of the state’s residents lack prescription drug coverage.

What Are We Doing?

  • Simplifying and streamlining the dispensing of brand name medicines donated by manufacturers.
  • Providing a user friendly service for patients, doctors and clinics.
  • Collaborating with drug makers in a way that creates a sense of partnership with them and the prescribing community.
  • Making this service available throughout the state of West Virginia.
  • Providing a primary point of entry function that will screen and refer patients to other available programs that provide affordable access to needed medications and programs.
  • Organizing as a public-private partnership via West Virginia Health Right, a non-profit agency to reduce the costs of uncompensated care and to keep patients connected to their medications.

How Are We Doing This?

  • We are developing and maintaining a network of patient advocates, doctor’s offices and clinics throughout the state and working through them for patient referrals.
  • The referral goes through our primary point of entry and the patient’s eligibility is determined. Screening for other help the patient needs will also be realized. For example, all families will be screened for SCHIP and if their children aren’t enrolled, WVRx will assist through its network.
  • Armed with the knowledge that the patient is eligible and what medicines can be accessed, the prescriber registers the patient, and eligibility information is sent via fax or mail to WVRx.
  • The pharmacist will fill the prescription and send it to the patient within 24-48 hours of receiving eligibility documents.