By Yen Duong
The first time Natalie Holloway’s heart failed, her husband of 38 years drove her the 33 miles from their hometown of Columbia to an emergency room in Edenton.
“We was the only ones that night on the road,” Holloway recalled. “I couldn’t breathe so I had to roll down the window. I don’t really know how I made it. When I woke up, I was in the emergency room and I don’t remember much after that.”
Holloway stayed at a hospital for five days in November 2017, then went home. She received prescriptions for medicines to help with cholesterol, high blood pressure and heart failure but couldn’t afford to fill them. In April 2018, she landed back in the hospital for 11 days after another episode.
Facing costs of $900 a month for one medication and over $300 for a separate one, Holloway prayed for a solution. That’s when she heard about MedAssist.
“[MedAssist] kept me alive,” Holloway said. “Today I can knock on wood that I [won’t be] going back [to the hospital] ‘cause I been getting my medicine.”
MedAssist is a non-profit pharmacy, partially funded by the state, which ships 90-day supplies of free prescription medications to people in need across all 100 counties of North Carolina.
Based in Charlotte, the program also runs a free “store” for over-the-counter medications for local residents, a mobile free pharmacy with OTC giveaways and a consultation program for seniors who fall in the Medicare “donut hole.” Last year, MedAssist served more than 37,000 Tar Heels across its three programs and gave out $68.5 million worth of medications.
Unifying different requirements
Pharmaceutical companies run patient assistance programs for those who cannot afford their medicines, but each program has different requirements on income or insurance status.
“Let’s say a patient is on five medications, and you have to apply to three different drug manufacturers, that’s three different applications you’re going to have to use,” said Nicole Banahene, who works for MedAssist. “But with our program, […] a patient only needs to apply once and they have access to the generics and the brand-name medications.”
MedAssist acts as a middleman–the companies ship drugs in bulk for free to MedAssist, which makes sure that patients who qualify for each company’s program get the medications.
If a patent expires or brand-named drugs are no longer available for free, MedAssist purchases generic drugs for its patients. About 77 percent of drugs shipped by MedAssist are generic, Banahene said.
“This is the only place in North Carolina where you can get multiple generic medications from one place and they’re free if you’re low-income and uninsured,” Banahene said.
Free for low-income, uninsured
To qualify for MedAssist’s free pharmacy program, North Carolina residents must be uninsured and fall at or below 200 percent of the federal poverty level, which comes out to $24,980 for one person or $51,500 for a family of four. Banahene said that about 84 percent of MedAssist patients live below the federal poverty level of $12,490 for individuals.
Across the state, 109 partner agencies help find and guide potential patients such as Holloway through the enrollment process, which involves tax returns, proof of citizenship and original prescriptions. Last year, partners referred about two-thirds of the 15,818 free pharmacy patients; the remaining third enrolled directly.
“We work with all different types of organizations that are serving those patients in their community that are uninsured, and they will send their patients to us,” Banahene said. “They could be a hospital or a free clinic, or a community health center, or a shelter or a health department that still does primary care or transition clinic or rehab center.”
Scaling up
The program began in 1997 as Mecklenburg MedAssist to help local low-income seniors get their prescriptions. After initial success, it expanded to cover all low-income residents of Mecklenburg County in 2001.
By 2009, then-N.C. Attorney General Roy Cooper granted more than $2 million to MedAssist over two years to expand statewide.
“The programs complement each other to meet the needs of North Carolina,” said Stephanie Nantz, an assistant director in the N.C. Office of Rural Health, part of the Department of Health and Human Services. “There’s such a high need to assist individuals with obtaining the medications that they’re prescribed.”
MAP helped over 32,000 patients get the equivalent of $223 million in medications in fiscal year 2018, according to their report.
Last summer, MedAssist opened its free store in Charlotte. Nearby residents can come once a month to pick up over-the-counter drugs, subject to some limitations.
“People can abuse pain medicine and abuse allergy and cold [medicines], so we make sure that folks are not taking away a whole slew of one type of item,” said store manager Renée Warner. “I won’t give out three sleep aids at one time.”
Hitting the road
Roughly every week, MedAssist partners with a local agency and sends out a truck to a different location in the state with 140 boxes of over-the-counter medications, from prenatal vitamins and allergy medications to wart removers and diaper cream.
“We take about $100,000 worth of over-the-counter medications in a truck, and we get about 75 to 150 volunteers and we set up basically a pharmacy,” said Sheila Kidwell, director of communications for MedAssist. “When we have these events, about 23 percent of the people who come […] identify as uninsured. That is the best way to identify who needs our free pharmacy.”
The mobile free pharmacy often acts as a nexus for more public health resources. For instance, past organizers have given out hepatitis A vaccines, checked blood pressure and brought a vision van for on-site eye exams and same-day glasses.
Patients, pharmacy students and civic organizations made up many of the 5,352 volunteers from last year. Volunteers sort medications into boxes at the Charlotte warehouse and help give out medications at the mobile free pharmacy events, which reached over 20,000 North Carolinians last year.
For Holloway, volunteering is a way to give back to the program which helped her through her darkest days.
“I tell anybody that I don’t wish this [illness] upon my enemies. It was a rough time,” Holloway said. “This is my way of saying ‘thank you’ because I’m so grateful. They didn’t have to [help me], but they did. That’s why I volunteer.”
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It’s great that they help the uninsured but what about the people who make just above the income level? What about them? They are the ones who are still having to pay out $500 for just two medications, cannot receive help and still have to pay bills. It seems you have to do really, really well meaning being extremely healthy or you have to do nothing to be able to live. It’s not right.