When a patient who’d previously received help to lower the cost of her medications from an assistance program didn’t requalify, a pharmacy tech wondered why and a patient service representative in the medication assistance program asked some clarifying questions.
Haley Coburn
Haley Coburn works as a pharmacy tech in a small pharmacy at Garfield Memorial Hospital in Panguitch, Utah. She recognized the patient’s name and circumstances from previous interactions and wondered why the diabetes patient had lost coverage in the 340B medication access program (MAP) after previously qualifying.
The pharmacist called Haley to let her know he’d sent in a 340B MAP application for a patient.
When Haley received the denial just 15 minutes later, she thought it was unusual since the patient had received assistance for more than a year. She surmised that something must have changed in the patient’s life and alerted the pharmacist that the patient no longer qualified.
But Haley couldn’t stop thinking about it. “The wheels started turning,” she says. “That’s when I started doing some follow-up. I reached out to Kimberly Barnett who reviews and helps with the 340B MAP access forms.”
The 340B medication access program is possible at Garfield Memorial Hospital because it is a Critical Access Hospital that qualifies for 340B pricing discounts from drug manufacturers. Intermountain can use these discounts to help provide medications to patients who meet the program income guidelines and see a provider located at a 340B site. The patient is approved for six months and can reapply every six months as long as they fit the criteria set by the 340B MAP guidelines.
Kimberly Barnett
Kimberly, a patient service representative in the medication assistance program, reviewed the patient’s previous approval and noticed only the patient’s income was used for that approval, but this time the patient submitted the income from a relative who lives in the same house as part of her income statement. Even though this relative lives in the same house, the patient only needed to provide income information for herself because she isn’t a dependent of the relative.
“After talking with Haley some more, I found out the patient rents an apartment in her family member’s home. I explained that we only need the income the patient receives, not her family member’s income, because they’re actually separate households,” Kimberly says.
Because Kimberly and Haley worked together to correct the misunderstanding, the application was reprocessed with the correct income, and the patient was approved for the program.
“Just asking those simple questions helped save her hundreds of dollars a month. She's able to stay on her diabetes medication because I was concerned she would have just quit taking it altogether,” Haley says. “I was so thankful we were able to clear up the misunderstanding and help her.”
“The patient wouldn't have been able to afford her medication had Haley not done what she did,” says Steve Fowles, pharmacist. “She cried when I initially told her the application was rejected, and she cried again when I called back and told her what Haley was able to accomplish for her.”
“Kimberly is open-minded and was willing to listen and problem-solve when Haley raised additional questions about the application,” says Louise Faughnan, pharmacy technician supervisor. “This is a great example of colleagues working together to ensure our patients have the best experience.”
“No matter how busy we may be, Haley will always stop and take the time to look at the situation from the patient’s perspective,” says Tim Smith, pharmacy director. “She will then take the initiative to solve the problem to the patient’s satisfaction. Quite often, such as in this case, she won’t take ‘no’ for an answer until she’s exhausted every possible avenue.”