A cost-effective way to keep uninsured patients on their medications and out of the hospital

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A cost-effective way to keep uninsured patients on their medications and out of the hospital

A major contributor to preventable emergency room visits and hospitalizations is failure to take prescribed medicines for manageable health conditions, such as high blood pressure or diabetes and many other medical conditions. Cost is often the culprit.

A 2017 survey by the National Center for Health Statistics clearly showed the impact of costs on adherence to medication regimens. Adults without health insurance were twice as likely to ask their doctor for a lower-cost medication than people with private insurance or Medicaid.

The survey also showed that a third of uninsured people opted not to take medication as prescribed to cut costs, compared with 8.4 percent of people with private insurance and 12.5 percent of people on Medicaid.

While private insurance companies and the federal government can negotiate discounted prices for covered patients, people without any coverage pay market price – the highest price available. But hospitals that are eligible for the government’s 340B discount drug pricing program can offer these patients comparable discounts through an innovative technology offered by SUNRx, a leader in 340B administration and a Solvent Networks endorsed partner.

Many hospitals know that 340B is a federal program can also make prescription drugs more affordable to low-income patients by providing access to lower priced drug. Under a 340B drug program, the discounts provide savings to eligible hospitals and help them fulfill their mission of caring for low-income and uninsured populations. Now, the SUNRx discount card for the uninsured (cash card) also lets hospitals easily pass savings along to their uninsured patients.

As explained by John Bretz, SUNRx director of strategic relations, the company now offers hospitals a way to print out the equivalent of a 340B discount  card, which the patient can take to a participating pharmacy and get the benefits of 340B pricing discounts on many prescription drugs.

“The cash card is immediately activated, so that by the time the patient walks into a contract pharmacy, the card is ready to use – just like a traditional insurance card. The system adjudicates the claim in “real-time”, so the patient doesn’t have to wait for needed medications,” Bretz said. “The SUNRx system is unique in the 340B marketplace.”

The program requires the services of a Pharmaceutical Benefits Manager (PBM), and because SUNRx is a wholly owned subsidiary of the PBM MedImpact Healthcare Systems, they are able to seamlessly integrate the card system into 340B programs they administer. SUNRx confirms 340B patient eligibility in real time, at the point of sale at the contract pharmacy, and applies its “lower-of” cost calculation to find the lowest price (including the 340B price) available for the patient. The patient gets the discount price at check-out, without waiting or taking extra steps. SUNRx contracts with retail, specialty and mail-order pharmacies to offer patients and hospitals flexibility and convenience as well as best-possible cost.

The cost benefits to patients are dramatic, as the following example shows. “The market for insulin has gone up significantly over the last 10 to 15 years, so it has become hyper-expensive,” Bretz said. “With our cash card, the price drops from more than $300 a vial to about $40, which makes a major difference for these patients.” Patients who pay full price, who are usually the least able to afford it, may reduce dosages to stretch their budgets, jeopardizing their health, he said. “The cash card is a game-changer.”

In addition to better outcomes for vulnerable patients, the SUNRx automated system benefits hospitals by generating revenue for operations from purchasing power, blocking duplicate Medicaid claims, providing safeguards against drug diversion and maintaining all transactions in an audit-ready format. That helps hospitals ensure that their 340B program is in full compliance with federal regulations and maintain eligibility.  “There’s no additional charge for the technology,” Bretz said. “If we’re your 340B administrator, you get this automatically.”

The COVID-19 pandemic has made the SUNRx program more relevant than ever. Uninsured rates – already high in South Carolina — are soaring because of job losses. Also, people with underlying health conditions are at greater risk for serious illness and death from COVID-19. Faithful adherence to drug regimens for managing chronic health conditions has never been more important. SUNRx’s expertise, technology, pharmacy network and discount card program allow eligible hospitals to take full advantage of the 340B program for their facility and their patients.

Because the 340B program is complex, SUNRx offers workshops to help hospital leaders understand eligibility requirements, the kind of commitment required and the potential benefits for hospitals and patients.

SUNRx is available to set up a consultation on how the 340B Cash program may help your hospital. To schedule a consultation with SUNRx, please contact Kristin Hill at Solvent Networks via khill@scha.org or 803.454.6959.

As a division of the South Carolina Hospital Association, we understand the hospital business. Our ready-to-deploy solutions for your workforce, financial, operational and compliance needs can save money on your bottom line – or generate revenue that you can re-invest in improving healthcare for the people of South Carolina.  For more information, visit Solvent Networks, follow us on Linked In or watch HERE.  Access your network today.

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