FQHCs, Affordable Care Act, and PAPs

Go to the profile of Shane Desselle
Aug 08, 2019
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A previous Tip mentioned Federally Qualified Health Centers (FQHCs). We have also taken a look at the impact of health care policy on medication access. This week’s Tip combines both areas. FQHCs are an increasingly important component of the safety net of care programs for medically indigent patients. Even so, the safety net remains a patchwork of programs. This makes the role of FQHCs that much more important. Likewise, the Affordable Care Act (ACA) represented rather substantial shifts and impact on the nation’s health care system.

Shi et al conducted an analysis and found that between 2012 and 2016 there were 1337 FQHCs serving more than 2.5 million patients, with nearly 29% of them having no insurance.1 These FQHCs primarily used the 340B program and patient assistance programs (PAPs) to help their patients acquire prescription drugs. PAPs are voluntary discount programs by pharmaceutical manufacturers where patients apply and seek to have their out-of-pocket costs (either the drug cost, or the copays for more expensive drugs where the patient has some type of coverage) reduced through coupons or some other mechanism. These programs are effective; however, their accessibility varies widely across states and FQHC resources. Some see PAPs merely as a mechanism for manufacturers of brand-name drugs to get patients established on expensive medications. The ACA brought about a number of incentives to encourage pay-for-performance, such as financial disincentives to hospitals if patients are quickly re-admitted after discharge. There was nothing, or very little expressly in the ACA about PAPs; however, FQHCs were incentivized with enhanced reimbursement rates and positioned better for more grant monies if a greater number of their patients with certain diseases were placed on appropriate drug therapy as per clinical guidelines and/or properly controlled with medication. The study demonstrated the extent of FQHC budgets allocated toward pharmacy expenditures, including PAPs, often times with patients enrolled through pharmacy technicians or social work staff.

Health policy and the acts of other external stakeholders can greatly affect medication access and thus affect pharmacy operations. Pharmacy managers should seek opportunities for involvement with operations such as FQHCs wherein there lies opportunity for diversification of revenue streams, increased profits, integration into funded demonstration projects, and much community goodwill. The right partnership could end up paying the salary of technicians involved in PAP programs.

Additional information about Applications in Safety Net Clinics and Impact of Health policy on Health Care Delivery can be found in Pharmacy Management: Essentials for All Practice Settings, 4e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 4e. If your institution does not provide access, ask your medical librarian about subscribing.

1Shi L, Wharton K, Monette A. Ensuring access to prescriptions in the post-ACA healthcare access landscape: The essential role of FQHCs in the safety net for the underinsured. Am J Manag Care. 2018;24 (5 Suppl):s67-s73.

Go to the profile of Shane Desselle

Shane Desselle

Professor of Social and Behavioral Pharmacy, Touro University California

1 Comments

Go to the profile of Shane Desselle
Shane Desselle 4 months ago

FQHCs are a great place to get more clinical pharmacists involved.