Dr. Diez worked with the patient to optimize his dose, seeing promising improvements. She called the Lilly Cares program in February 2022 to let them know she’d be sending a new prescription with a dosing change and got verbal approval from the program. But the next month, Heidi’s patient reached out, letting her know that he had no medications.
Another phone call to the PAP hotline revealed that the patient’s eligibility had expired without notice, at the end of the calendar year, just one month after he had enrolled.
The patient would have to reapply. When he submitted a new application, he mistakenly checked “Private” insurance instead of Medicare, a common confusion with individuals who have commercially-managed Medicare Advantage coverage. This delayed his application. The program then also asked for a wet signature for the reauthorized prescription, which delayed it some more.
Heidi reflects on the phone calls, the check boxes, the faxes. “Now I know.” As the pharmacy lead for the Michigan Collaborative for Type 2 Diabetes, she wants to make this process easier for the clinical pharmacists, physicians or care team members who help patients navigate medication affordability.
“The beauty of having a Pharm D is that you get to have 15 to 20 mins with patients to cover one chronic disease - diabetes. Going over how they’re tolerating their medications, adherence, cost, that’s something that the pharmacist truly brings to the team,” Heidi adds. It’s through conversation, listening, and trust building over time that Dr. Diez is able to ask a critical question:
‘How often do you find that you can’t afford your copays?’ If you don’t ask, then you don’t know.If I have an inkling that cost might be an issue, I might ask the same question in a different way, if you don’t get the response.”
It takes time. But Dr. Diez sees it as a major “perk” of the job of what she’s able to do as a clinical pharmacist. “In building that connection, they feel comfortable sharing.”
For all the minutes on hold, all the miscommunications about income caps and ink, Heidi sees the pay off, the real progress that can be made for and with patients.
Suzanne, a former research assistant in a neuroradiology lab, animal lover, is another patient who worked with Dr. Diez to navigate the ins-and-outs of medication assistance programs. She has Medicare and uses an AARP discount card for her prescriptions. We asked Suzanne to rate each program based on how easy or difficult it was to apply and get approved. Suzanne is a member of the MCT2D Patient Advisory Board:
Medication: Basaglar (insulin glargine)
“It kind of went straight through. There were no hitches.”
Suzanne completed the form for the assistance program. Heidi finished it and got sign off from Suzanne’s primary care physician.