North Carolina’s Medication Assistance Program allowed uninsured patients access close to $100 million in prescription drugs last year by helping them apply to pharmaceutical companies for assistance. A $1.7 million state allocation for the program is not included in the Senate budget passed last week.
By Rose Hoban
Over the years, a host of Nancy Sullivan’s relatives have struggled with diabetes, so when her 26-year-old son son was diagnosed with the insulin-dependent form of the disease, Sullivan knew he couldn’t skip taking insulin. But Sullivan’s son didn’t have health insurance. No one in her family does.
“I cried because we couldn’t get his insulin,” said Sullivan. She said she’s gone for months, even a year at a time, without her blood pressure and thyroid medicines because of the cost.
“Then I met Angela,” Sullivan said. “Angela and them’s been a real godsend. There’s no way we could afford insulin. They help him get the insulin, they help him get the needles.”
Angela Herring has become the Sullivans’ friend, and the connection to free and low cost medications for the entire family. Herring is the prescription assistance coordinator at the Franklin County Volunteers in Medicine Clinic in Louisburg. Her job is to help Sullivan, and hundreds of others from in and around Franklin County, apply for free drugs from pharmaceutical companies through the state’s Medication Assistance Program.
The $1.7 million in state money that supports the program was included in the Governor’s and the House budget, but was eliminated from the budget passed by the state Senate last week.
The Medication Assistance Program (MAP) pays the salaries of dozens of coordinators, like Herring, working through free and community health clinics across the state. Those coordinators help some of North Carolina’s more than 1.6 million uninsured get access to medications they otherwise could not afford.
Funding change puts program in jeopardy
For years, the MAP was paid for by grants from the Health and Wellness Trust Fund, a quasi-governmental organization that received about a quarter of the state’s annual payment from the master tobacco settlement. Last year, the master settlement paid North Carolina more than $144 million; programs funded by the Health and Wellness Trust Fund received about $31 million, of which the MAP received $1.7 million.
But the General Assembly dissolved the Trust Fund last year, and channeled all of the state’s annual master settlement money into the general fund. Programs that had been funded by the Trust Fund are, for the first time, having their fates decided by politicians, not by the Fund’s trustees. And some of those programs, such as the MAP and the state’s tobacco cessation programs, are facing elimination.
Last year, the MAP’s $1.7 million budget allowed for thousands of uninsured North Carolinians to get access to close to $100 million in free medications, said Jason Baisden, director of the N.C. Association of Free Clinics.
“That’s a huge return on investment,” Baisden said. “We’re currently at a 46-to-1 return on investment year-to-date. There’s no other state supported program that has anything close to the return on investment that this one does.”
And Baisden said that’s not the only return on investment.
“We can’t calculate the total savings to the hospital system, to the overall health care system,” he said. “How many people have not been going to state mental health facilities because they’ve had their meds? Or we’re keeping out of jail for the same reason?
“It’s hard to prove a negative,” Baisden said.
Phones ring constantly
Late on a Friday afternoon, the door at the Franklin County Volunteers in Medicine Clinic office is shut, and the sign states office hours are over, but people still knock.
Beverly Kegley and Angela Herring open the door anyway, and Herring ushers a woman in jeans and flip flops into the back room to give her medications that were delivered to the clinic.
“We could be open 24/ 7,” said Kegley, the clinic’s director. “I’ve pulled into the parking lot of the grocery store and had three people standing in line when I opened my door.”
Kegley explains the MAP is important to their patients, and those who come to the county’s health department clinic because often patients are tight, really tight, on money. More than 25 percent of non-elderly adults Franklin County are uninsured, according to the N.C. Institute of Medicine.
“We had a woman who came in yesterday, and she was in tears,” Kegley said. The woman’s doctor had written a prescription for a brand-name drug and had not checked the box on the prescription form that allows a pharmacist to replace a brand-named drug with a cheaper generic.
“She told me she had borrowed $20 to get here, and the one med was going to be $26,” Kegley recalled.The woman told Kegley she had enough money to get gas, and two $4 prescriptions at Walmart. Her leg was swollen, she was in pain and hadn’t slept for several nights.
“She told me “I don’t think I could stand another night without medicine,” and she was sobbing” Kegley said. “I think we use more Kleenexes than a funeral home.”
Kegley called her medical director who called the pharmacy with an order for the generic replacement.
Drugs are free, but the process is complicated
The MAP does not pay for medications, explains Herring, after returning from the helping the woman in the back room. The program pays for her to help people complete applications for the free medication programs offered by many pharmaceutical companies.
“It isn’t an easy process at all,” said Herring. “Each drug company has a different application. And they change the applications.”
When the Health and Wellness Trust Fund still supported the MAP, organizers paid to develop a computer program that takes an applicant’s information and plugs it into many of the pharmaceutical company applications.
Herring said that theoretically, it’s possible for patients to fill out their own applications, but but each company has a different procedure, and she explains the process is cumbersome.
“First, I put the medication (into the computer program), it calculates to see if it’s offered free, or at a reduced rate,” Herring said. “Then, I gather the patient’s financial documents. Then I have to go to the doctor to get a signature. Then, when I receive the application back, I have to make copies, send them to a couple of different places… and they send the medications to us at the clinic.”
Herring explained most drug companies want to ship to a doctor’s office, not directly to the patients.
“And some doctors do not want it to come to their facilities,” she said. “They feel a little more comfortable to have patients come in here because there’s a licensed pharmacist at the clinic. So, the drugs get sent here, we call and (the patients) come to pick it up.”
Some companies won’t even accept applications from individuals, Herring explained, only from approved advocates, like her.
Last year, Herring, who makes $31,000 a year, helped patients access a total of $993,000 worth of drugs.
“Every practice in the county has access to us through the Franklin County collaborative,” Herring said. “So any practice in the county can send us their uninsured, or their seniors in the donut hole. Sometimes, people have some insurance but don’t have drug coverage.”
“You’ve got applications that change every month, or two, or three,” said Kegley, who said their patients receive 4.7 medications on average through the program. “For a lot of our patients it’s just… not to say that they could not learn to do this, many just don’t have access to the technology.
“This program streamlines things,” Kegley said.
The story has been updated to show the correct rate of 25.5 percent of non-elderly adults in Franklin County lacking insurance. An earlier version said 21 percent.