‘Game Changer’: Removing Medication Cost Barriers
Jun 30, 2021
Sutter Health
Female pharmacist speaking with Female Patient

By Leslie Meiring, Vitals contributor

Disbelief, fear, sadness, anger.

A cancer diagnosis may bring with it a roller coaster of emotions, and so many questions: What are my treatment options? What will the side effects be like? How do I talk to my family about my prognosis?

One thing that patients shouldn’t have to worry about, though, is the sometimes-substantial out-of-pocket cost for lifesaving drugs.

In the Bay Area, Alta Bates Summit Medical Center’s Outpatient Pharmacy, part of the Sutter Health network of integrated healthcare, helps take the financial burden off patients’ plates.

Pharmacists collaborate with physicians, nurses and social workers to decide on the best course of care personalized for each patient, and when necessary, they research financial assistance options—including manufacturer discount coupons, copay cards and state or federal programs.

Beverly Hart-Inkster, R.N., is a clinical educator at Alta Bates Summit’s Comprehensive Cancer Center. She says the collaboration between clinicians and pharmacists has been a major game changer since the program started six years ago.

Rajesh Behl, M.D., Beverly Hart-Inkster, R.N., and Michelle So, PharmD from the Alta Bates Summit Medical Center Outpatient Pharmacy work together to help patients in need.

“The partnership between pharmacists and clinicians is amazing. And patients are very satisfied,” says Hart-Inkster.

In the first quarter of 2021 alone, patients saved $155,000 in out-of-pocket drug costs, according to Sutter’s Outpatient Prescription Management system.

Hart-Inkster says in addition to saving patients out-of-pocket drug costs, the pharmacy collaboration has also resulted in greater convenience for patients. Instead of driving to another location for their medication, patients can instead walk upstairs to fill a prescription. Some patients have their medications safely delivered to them—a major satisfier, especially during the pandemic.

Rajesh Behl, M.D., medical director of Alta Bates Summit’s Comprehensive Cancer Center, notes that bringing pharmacy services in house has improved and integrated providers’ care coordination efforts. Because the pharmacists have access to patients’ medical records in Sutter’s electronic health record, they’re able to review patients’ complete medical charts, monitor labs and quickly communicate with the care team.

In addition to the oncology-specialty outpatient pharmacy, Alta Bates Summit also offers a general retail pharmacy and an HIV and hepatitis-specialty pharmacy on its Oakland campus.

Alta Bates Summit pharmacist Michelle So works closely with providers, discusses ideal treatment plans and helps make sure insurance pays for patients’ often very costly HIV medications.

“If payment is denied we discuss alternatives,” So says. “Sometimes patients’ co-pays are upwards of $3,500. Providers and patients are so happy we can take that anxiety off them in terms of navigating the insurance system and letting them know what their options are.”

Working to Expand the Program throughout the Sutter Network

“Today, these outpatient pharmacy programs are unique within the Sutter system,” says Alta Bates Summit director of Pharmacy Michael Federico, but he adds, “We’re working to change that.”

Federico is working to spread these services to other campuses in the Sutter system. They’re working on a pilot program offering pharmacy services to about 150 oncology patients in Santa Rosa.

“We’ve built tight bonds here locally between providers and pharmacists, and we’re learning how we can get the same level of communication and partnership when we’re not on the same campus,” Federico says. “The pilot will help us understand what it will take to spread this across Sutter’s integrated network of care.”

 

 

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