management tools medicaid and patient€¦ · no ns5a resistance test required unless prescribing...

Accessing Meds, State of Medicaid and Patient

Management ToolsAuthored and Presented by: LT Neelam Gazarian, MS, PharmD

LCDR Jonathan Owen, PharmD

Quentin N. Burdick Memorial Health Care Facility

Indian Health Service

Belcourt, ND

Conflict of Interest Disclosure Statement

► None

Objectives

► Participants will be exposed to ideas to approach their state medicaid with regards to drug access issues

► At the end of the presentation participants will be better equipped to manage hepatitis C patients at their service unit

http://www.hepatitiscentral.com/wp-content/uploads/2015/04/expenisive-hepatitis-c-medication.jpghttp://aph.org.ua/wp-content/uploads/2016/08/Bez-nazvanyya-4.png

Who are we?

Medicaid Letter – Balancing Act

Medicaid letter.pdf

State

Federal/You

Prior to HCV Clinic

With Insurance (Pvt./Federal)

Referred to Medical Specialists

$10,000-$15000/referral

DistanceLost to follow-up

Without Insurance

Very Few Options

Rationing Care

Poor outcomes

Success Story

Drop minimum fibrosure score requirements

No NS5A resistance test required unless prescribing Zepatier®

12-months abstinence requirements remains

ND Medicaid and Expansion

Patient Management Tools

ConsultsiCare Panel

NICE Hep C Tool

Identifying Patients with Hepatitis C

iCare

168 patients• 25% screening rate

VGEN

155 patients

Inter-collaborative Approach

Primary Care Provider Pharmacist

Behavioral Health Public Health

Laboratory Services

Patient

Challenges in Starting Clinic

Labs do not exist in system

NS5A Resistance TestFibrosure Test

EHR Documentation

Initial Visit

PHQ-9 screen

AUDIT-C

Order labs from Hep C Menu

Comprehensive visit

Project ECHO recommendations

Start Medication Authorization

End of Treatment

Follow-up labs ordered

throughout the process

SVR

Patient is cured!

Counsel about re-infection and

prevention

Consults

► Snapshot add

Hep C Order Menu

EHR Note Templates

Managing Patients

Excel document for patient management

Created by Jessica Leston, Brigg Reilley, and David Stephens

Automatically calculates APRI, FIB 4 scores

Excellent for helping to prioritize patients based on liver function and viral load

Hep

atit

is C

Pat

ient

Pan

el L

ist

Managing Patients

New panel created by Neelam ‘Nelly’ to help manage patients referred to the clinic

Spin-off of previous panel, automatically calculates APRI, FIB 4 scores

Organized by stage in the treatment processes

Reminders for labs while in treatment, immunizations, notes

Hep

atit

is C

Pat

ient

Pan

el L

ist

Managing Patients

Snapshot of stage in treatment process drop down menus (these can be adjusted)

Appointment Calendar

Patient Panel

Individual Patient Data

NICE Hep C Tool Demo

NICE Project- Hep C Patient Management.xlsm

Navigating Insurance

Stage of fibrosis score

• APRI, FIB 4

Abstinence

• Differs by state

Patient Assistance Program

Gilead’s Support Path

• Sovaldi®, Harvoni®, Epclusa®

AbbVie Patient Assistance Foundation

• Viekira Pak®, Mavyret®

Patient Assistance Programs

► Tribal ID card

► Income documents

► Max income allowed differs by program

► Proof of no insurance

► American Indians/Alaska Natives (AI/AN): Indian Health Coverage Exemption

► “American Indians and Alaska Natives (AI/ANs) and other people eligible for services through the Indian Health Service, tribal programs, or urban Indian programs (like the spouse or child of an eligible Indian) don't have to pay the fee for not having health coverage. This is called having an Indian health coverage exemption.”

Current Status

• Pending

4

• Project Echo

3

• Treatment

1

• ETR

2• SVR

“cure”

1

Screening Rates

Investment Cost Analysis

Acquiring the medication

Case presentation

Education

Consultation request

from provider

Cost Analysis of Medications

Acknowledgement

Quentin N. Burdick Memorial Health Care Facility Eliminate Hepatitis C Team:

◆ Neelam Gazarian, PharmD. MS Pharmacology/Toxicology

◆ LCDR Jonathan Owen, PharmD. USPHS

► Thanks to:

► Molly Steen, PharmD. Pharmacy Clinical Services Director

► CDR Tyler Lannoye, PharmD. Chief of Pharmacy, USPHS

Special Thanks

► Jessica Leston , HCV/HIV/STI Clinical Programs Director for the Northwest Portland Area Indian Health Board

► Brigg Reilley, National HIV/AIDS Program

► David Stephens, BSN, RN, Case Manager for the Northwest Portland Area Indian Health Board.

Questions

Thank you

► Contact Info:

Neelam.Gazarian@ihs.gov

Jonathan.Owen@ihs.gov

701-477-6111 Ext 8426