Mark, a patient suffering from a life-threatening chronic condition transferred his prescriptions over to his hospital specialty pharmacy after feeling exasperated with the service he received from his previous local pharmacy. When he came in for his clinic appointment at the hospital last week, he was greeted in the exam room by his designated pharmacy liaison and his provider. Mark explained to both of them that, several months ago, he had lost his insurance coverage and his previous pharmacy made no effort to help him or accommodate his needs during that difficult, uncertain time. Because of this lapse in coverage, he was forced to go a month without his necessary medication, which completely upended his treatment plan. His previous pharmacy had failed to look into possible coverage alternatives to solve his insurance issue, leaving him with no choice but to abandon his treatment for the month.
Mark’s pharmacy liaison decided to dig a little deeper into his situation to put his mind at ease. When she looked into it, she found out that he had a temporary health safety net plan (HSN) through his state insurance plan. Only when he communicated to his local pharmacy that he had a temporary HSN, were they willing to fill his medication, which unfortunately had been over a month since his last dose. The most frustrating part to Mark was that it only took a little bit of time and research on the local pharmacy’s part to find out that he was covered by temporary Medicaid the entire time, and that he didn’t need to suffer through a lapse in treatment. Mark’s liaison understood his frustration and explained to him the services their hospital specialty pharmacy offers, such as refill reminders, medication management, and home delivery of medications and what makes them different from other specialty pharmacies that aren't located within the health system. His liaison explained to him that in a situation where he lost his insurance for any reason, they would work tirelessly with financial assistance programs and alternative insurance options to get him the medication he needed at an affordable co-pay, so that he never has to go through a lapse in treatment again. Mark was ecstatic about this idea and felt secure knowing that he had a stable support system behind him to help with whatever he needed. He mentioned to his liaison that his income falls right on the threshold with Medicaid and if he averages just one more hour per week at work, he could lose his coverage completely and would then be forced to apply to a connector plan, which would cost him over $300 a month. He's aware that his coverage can sometimes shut off without notice, so having a pharmacy that will do everything in their power to help him stay adherent to his medications and treatment plan was so important to him. With the stress of insurance coverage and high co-pays gone, Mark can now focus on what’s really important in life and continue to stay healthy.