As healthcare reform continues to be implemented over the next few years, the nonprofit clinics and health centers that make up a key component of our nation’s healthcare safety net are projected to be one of the primary access points for health care for tens of millions of the most vulnerable people.

The mission of safety net clinics and health centers is to treat anyone who crosses their doors, regardless of their ability to pay.  They rely on a variety of resources to access needed medications for their uninsured patients, one of which is pharmaceutical sponsored Patient Assistance Programs (PAPs) which provide drug donations to qualifying uninsured, low-income patients.

Earlier this month, Direct Relief launched a survey with the aim of understanding the usage of PAPs at clinics and health centers and what providers were expecting after healthcare reform.  The survey was sent nationwide to the nonprofit healthcare facilities that are part of the Direct Relief Network; responses were received from 350 facilities.  Here are the findings:

• Responses were received from healthcare facilities in 42 states and Puerto Rico. Collectively they serve 2.7 million patients, 1.5 million of whom are without health insurance.

• Facility types were as follows:
  • Free clinics (49.5%)
  • Health centers (39.6%),
  • Community clinics (8.9%)
  • Other (1.4%)

Current Pharmaceutical Services:

• Facilities that responded dispense an average of 2,006 prescriptions per month.  Of those prescriptions, 80.9% are dispensed to uninsured patients.

• Most facilities provided in- house pharmacy services via a dispensary (44.3%) or licensed pharmacy (41.5%).  The remaining 13.5% referred patients to a third-party for prescription fulfillment.

• Ninety-three percent of the facilities utilize PAPs to access medications; they provide 43.6% of the needed medications for their uninsured patients.  The median number of different PAPs utilized by a facility is 10.

• Fifty percent of the facilities had the staff dedicated to managing PAPs.  Of those, 81.9% had 1-2 dedicated staff, and 18.1% had 3 or more.  Seventy-one percent of facilities said they would utilize more PAPs if they had additional staff.

Projected Patient Volume and Anticipated Use of Patient Assistance Programs:

• When asked if the volume of uninsured patients post-healthcare reform would increase, decrease, or stay the same, 74.9% of providers said they expected the number of uninsured patients to stay the same or increase (right, top graph).

• Following health care reform, 96.0% of facilities still expect to use PAPs; only 4.0% anticipated they would not be needed anymore.

• When asked, following healthcare reform do you expect your usage of PAPs to increase, decrease or stay the same, 84.9% of providers anticipated the usage of PAPs to either stay the same or increase (right, bottom graph).

• Overall, providers in clinics and health centers in states where Medicaid is not likely to expand thought they would see more patients and need more assistance.
• Analysis of 16 states that are not likely to expand Medicaid found that their providers were more likely to think their patient volumes would increase after reform – 38.6%  in states not likely to expand Medicaid compared to 31.5% in states where expansion is likely
• Those providers were also less likely to think their uninsured patient population would decrease – 15.7% in states not likely to expand Medicaid compared to 20.9% in states where expansion is likely
• And they were more likely to expect an increase in PAP usage – 39.2% in states not likely to expand Medicaid compared to 33.4% in states where expansion is likely.

Conclusions:

Although healthcare reform is expected to provide coverage to many currently uninsured patients, the Congressional Budget Office (CBO) predicts there will still be an estimated 29 million people in the United States without health insurance by 2019.  Survey feedback revealed that although many aspects of implementation are still unknown, safety net clinics and health centers expect to continue to assist patients who are homeless, undocumented, or will otherwise “fall through the cracks” of healthcare reform, with many reiterating that they will continue to use whatever means they have available to help their patients.

“As long as PAPs are available, we will continue to use them for qualifying patients. While Heathcare Reform will provide some coverage to some patients, we will still have uninsured patients and patients that cannot afford their medication. The need for free and charitable clinics will not go away, nor will the need for PAPs. We may not give away the same amount of medication free of charge, but we still hope to serve the same sub-section of our community after Healthcare Reform that we do now–those that are less than 200% of the federal poverty level.”

-Cape Fear Clinic, Wilmington, NC