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Prescription Plan Offers Savings to Uninsured

September 24, 2007

By David Pittman, Amarillo Globe-News, Texas

Sep. 23–When Stephen Selzer worked as a chief executive at a Houston hospital, one of his colleagues pointed out that the hospital’s poorest patients had no savings mechanisms to help whittle down their prescription drug costs.

Selzer set out to change that.

Late last year, the company Selzer now works for, Health Plan Partners, teamed with Northwest Texas Healthcare System and began a program to provide uninsured and underinsured patients with a pharmacy benefits plan.

It’s an effort by the hospital to reduce emergency room visits and help the community’s uninsured population.

“The program benefits the uninsured individuals and their families, employees without insurance or they are insured without pharmacy benefits,” Northwest Corporate Communications Director Caytie Martin said.

The program works like a regular prescription benefit health plan.

Health Plan Partners negotiates prices with suppliers that the company and patient will pay for drugs. The company then works with hospitals to register users.

But unlike almost all prescription plans, Health Plan Partners provides coverage to everyone who registers, including uninsured people and those with an existing pharmacy plan.

“This won’t cure the entire problem of the uninsured in the country,” said Selzer, Health Plan Partners senior vice president. “But this is one more quiver in the arrow of things that can help.”

If Health Plan Partners’ plan offers a less expensive payment than a person’s existing plan, that person receives the Health Plan Partners benefit.

The program has no monthly cost and no eligibility requirements.

Officials say savings have averaged 41 percent per prescription. That equates to about $15 a prescription.

Northwest has registered more than 9,500 patients since it started in November.

“To my knowledge, they are the first hospital in the country to offer this kind of program,” Selzer said. “If there are other hospital systems offering similar programs, I’m not aware of it.”

A large percentage of Northwest’s emergency room visitors are uninsured.

“From the hospital’s standpoint, what we are trying to do is proactively reduce the unnecessary emergency room visits,” Martin said.

An ER is a costly place to receive medical attention.

“It’s the most expensive place you can go to for primary care,” Selzer said.

An ER has to stay open and staffed 24 hours a day and be prepared to handle any case that comes in.

People who obtain and take the medications they need are less likely to show up in the emergency room, Selzer said.

The program generates revenue with a flat administrative fee on each prescription filled.

“For us, the revenue is not all that great,” Selzer said. “But I’m not doing it for the revenue. I’m doing it to help the uninsured.”

Selzer said he hopes his form of pharmacy benefits will increase in popularity as the public becomes concerned about rising health care costs.

“From every indication, in terms of current and projected business, it will continue to grow,” Selzer said. “As it continues to grow, so will our revenue.”

QUICK FACTS:

–Access to affordable prescription drugs is one of the top three health care concerns of Americans.

–Prescription drug prices are rising at 12 percent per year.

–47 million Americans have no prescription drug benefits.

–Government and employer sponsored drug benefit programs are increasingly restrictive or being eliminated.

–Prescription drug costs are being quickly shifted to individuals, significantly increasing their out of pocket payments.

–Employment or insurance is no longer a guarantee of prescription coverage.

–The misuse of prescription drugs is growing and a significant cause of inappropriate hospital emergency room visitation and preventable inpatient admissions.

–Web site: www.northernplainsrx.com/NorthwestTexas/

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Copyright (c) 2007, Amarillo Globe-News, Texas

Distributed by McClatchy-Tribune Information Services.

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