management tools medicaid and patient€¦ · no ns5a resistance test required unless prescribing...
TRANSCRIPT
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:
701-477-6111 Ext 8426