Subscribe
Share
Share
Embed
340B Insight provides members and supporters of 340B Health with timely updates and discussions about the 340B drug pricing program. The podcast helps listeners stay current with and learn more about 340B to help them serve their patients and communities and remain compliant. We publish new episodes twice a month, with news reports and in-depth interviews with leading health care practitioners, policy and legal experts, public policymakers, and our expert staff.
Narration [00:00:04]:
Welcome to 340B Insight from 340B Health.
David Glendinning [00:00:13]:
Hello from Washington, D.C. and welcome back to 340B Insight, the premier podcast about the 340B drug pricing program. I'm your host, David Glendinning with 340B Health. Our guest for this episode is Carrie Krekeler, the regional pharmacy manager of ambulatory services at Indiana University Health. One of the innovative ways in which IU Health uses its 340B savings is a comprehensive medication review clinic that not only educates patients on their prescription drug regimens, but also connects them to financial assistance when they can't afford to pay for those drugs. Carrie discussed this clinic during a panel at the most recent 340B Coalition conference, and we met up with her there to learn more. Here's that conversation.
David Glendinning [00:01:03]:
I am here with Carrie Krekeler, who is the regional pharmacy manager of ambulatory services at Indiana University Health. Carrie, welcome to 340B Insight. Thank you for being here.
Carrie Krekeler [00:01:16]:
Thank you. It's a pleasure.
David Glendinning [00:01:18]:
We're here at the 340B Summer Conference Coalition Summer conference. And you're here at the conference to speak on a panel about a pretty innovative clinic that you have at IU Health. But before we get to that, if you could please tell us a little bit about IU Health and the patients you serve, we'd appreciate it.
Carrie Krekeler [00:01:36]:
Indiana University Health is the largest healthcare provider in the state of Indiana. It is made up of 15 hospitals, and of those, 11 are 340B eligible. My region is made up of a rural Referral center and two critical access hospitals. When we look at how our 340B savings are used across the system, a lot of that is used for financial counseling programs, medication assistance, transition of care programs. We also have behavioral health liaison services that are supported and we have some trauma services as well as our Riley Pediatric Hospital has a burn unit that is supported by 340B savings. In my region, the 340B savings that we have helped start generating is being pushed back into my medication assistance program and our comprehensive review medication review clinic and expanding that. So we've gone from six employees to 15 employees.
David Glendinning [00:02:54]:
Wonderful.
David Glendinning [00:02:55]:
So let's talk a little bit more about that comprehensive medication review clinic and let's speak about the inspiration for it. How did this come about?
Carrie Krekeler [00:03:05]:
I have another department that's the refill part department for primary care and it is staffed by technicians. They understood that patients were always getting albuterol refills and they weren't getting a maintenance medication. So they would see that patients were getting like rescue medicines, but not controller medicines. And so that kind of helped us think through, like, why is that happening? And one of those things that we researched was that it was happening because patients can't afford their medications. We hear the patients at the retail pharmacy say they can't afford a $600 copay. So how could we change the needle on that? In our region, it was very disjointed on who was helping patients. So the provider sometimes would try to do a manufacturer assistance program or the pharmacy would maybe steer them towards a coupon card, but there was no centralized service to help patients identify where they could receive help. We wanted to help patients afford their medication, increase access adherence, but also provide education for patients.
Carrie Krekeler [00:04:18]:
A lot of times patients don't take their medications properly, so we also look at how are they using their inhalers, how are they injecting their medications. We do a lot of training for patients and we look at side effects and we look at drug interactions. So how could we be that kind of one step? Stop for a patient to get the education they need, but also how can they access the medications too?
David Glendinning [00:04:43]:
Great.
David Glendinning [00:04:44]:
So once you realized there was this great need there, what were the next steps? How did you work to bring such a clinic online?
Carrie Krekeler [00:04:52]:
Actually, one of our first steps was we connected with UC Davis in California, and Tim Cutler there helped us come on site and see a program that they were doing similar in their specialty space. And so they were really instrumental in getting us up and going, understanding how their program worked, how we could use that as a base and then kind of modify it for what we were going to do. So our program didn't start in specialty. It started in primary care, out in our clinics and in our retail pharmacy. So a little bit different, but it's still kind of based off the same premise of how can we get patients their medications using 340B savings to help staff, but also to help put back into medication. Co pays.
David Glendinning [00:05:42]:
So wonderful to hear about that collaboration with one of your peers in the 340B community. That's. We always love hearing about sharing best practices. We certainly try to do that on this program. So that's wonderful. Walk us through a little bit, if you could. What is this like on the business end of things? So what is the clinic experience like for a patient who might be visiting it?
Carrie Krekeler [00:06:06]:
So we will have a referral come into our system. The first step is the pharmacist reviews what the provider wants and then they look to see as well. Are there other Any medications that are high cost, maybe the doctor sent it in for inhalers, but they're also on a diabetes medication that we could help them with. Then it goes to a technician and they will run it through our retail pharmacy system. Really, we're just looking to see what their insurance is going to pay for, what the copay would be, is there a prior authorization? If the insurance doesn't cover this medication, but they cover something else, then we go into changing that to the medication they will pay for. Then they reach out to the patient and they describe our program, let them know that, you know, we've processed your medication, this is what your copay looks like. Is this affordable to you? And a lot of times it's not. You know, when you say a brand Name medication's a $600 copay, they're still going to say, yeah, thanks, but no thanks.
Carrie Krekeler [00:07:11]:
If they cannot afford the medication, then we look at into can they get a coupon card? Do they qualify for a manufacturer assistance program? And we even look to see, is this someone that we could put into our own internal medication assistance program. We reach out, we set up appointments. Not all patients will have an appointment with us and go to our pharmacy for it to be 340B eligible, but they're all offered the opportunity to meet with the pharmacist, talk about what we can offer them.
David Glendinning [00:07:44]:
Okay, so it sounds like the medication assistance part of this goes hand in hand with the medication review clinic. So how, how big of a role does that financial assistance side of things, that medication assistance, how does that play into all of this?
Carrie Krekeler [00:08:01]:
It is a big part of what we do, right, Trying to help patients get the medication that they need. We found that when we were doing a lot of this, helping patients get a copay assistance or a medication assistance program through the manufacturer coupon card that our Medicare patients didn't necessarily qualify for some of that or our underinsured patients didn't qualify qualify. So we came up with our own internal medication assistance program. There's lots of things that, you know, is required for a patient to qualify. They have to bring their tax records in, they have to be within 300% of the federal poverty limit, and they have to have an appointment with us. And that's really, I want to say, self generating because we are qualifying them for 340B, but also using the money for 340B to keep qualifying more people for 340B savings. So it's a great way to, to use that back into the pharmacy system, helping our Patients, you know, all the way, all the way through the program.
David Glendinning [00:09:17]:
So yeah, it's reinvesting those 340B dollars, which is, which is a common theme that we, we hear about how these, these clinics and these other initiatives work. At the end of the day, you're trying really hard to get the drugs in the hands of the patients, give them the education they need to take them correctly and of course making them healthier. So what have the results been like for those patients?
Carrie Krekeler [00:09:40]:
So we have started this almost two years ago and we've pulled some data to look at some clinical benefits that we've had for patients that are now able to get their medications. One of the medications we looked at was Entresto and we looked at the left ventricular ejection fraction of those patients prior to starting Entresto and prior to being able to afford Entresto. And then once they went through our program, we educated them about the medication, we qualified them and they got some form of medication assistance. We looked at the left ventricular ejection fraction of those patients and then once they went through our program, we educated them about the medication, we qualified them and they got some form of medication assistance. We looked six months to a year later to see was there a change in their left ventricular ejection fraction. And we saw that there was a significant change. And we've also looked at our diabetes patients kind of on the same thing. We're looking to see if we give them medication that they can actually pick up and take and they take it, you know, obviously their outcomes are going to be better.
Carrie Krekeler [00:10:57]:
Right. So we looked at the A1Cs there. Within six months of starting and being able to afford their medication, the average was a 1% reduction in their A1C. You know, when you have a better handle on your health because you can take your medications, you're also going to feel better, but you're not going to go back to the hospital as often too. So we're trying to now pull data to see what kind of readmission rates we're affecting. So when we first started the comprehensive med review clinic, we actually started with an anti coag clinic. And we thought about how could we change those patients lives too because they were really only on warfarin because they couldn't afford a doac. And so those were our first patients that we started to try to help find them different options for assistance for their cost.
Carrie Krekeler [00:11:55]:
And those are the ones we're trying to look at. Have we changed their readmissions for bleeds. How many hospitalizations did patients have on warfarin versus now after it's been about two years and patients have been on a doac. So those are some of the data we're trying to pull and be able to report out on.
David Glendinning [00:12:18]:
It's interesting to see how that grows over time and how the patient succeeds. Success stories grow over time. And what about from the provider side? What has this clinic meant for all of you as health providers?
Carrie Krekeler [00:12:30]:
It has been so rewarding as a pharmacist to hear the stories, having patients tell you what an impact in their life. It has been. We've had people come back at least once for a renewal and just hearing how it's built blessed them in so many ways. We had a patient that actually had put her car up for sale within a week before she had her appointment with us because she couldn't afford her medication. And so she was going to sell her car and take the bus, she said, and we were able to get her assistance with the cost. And so she was able to keep her car. She's been back and so happy that she could keep driving. It's so rewarding to tell people that versus telling someone that their copay is $1,800 because they have a deductible.
Carrie Krekeler [00:13:25]:
And now we cover all of that. We have a clinic called the Connected Care Clinic that really helps the sickest of our sick patients that have diabetes, copd, have chronic medical conditions, that they're the patients that are typically in the hospital. More so they have a dedicated physician that really sees them quite often and makes sure that they're doing well. From her office. We've gotten a lot of positive feedback just that her patients can now use their medications better. They can pick up their medications. And she actually sent us an email earlier this year that last year, last year was the first year that her clinic met quality metrics. Our physicians are our biggest champions.
David Glendinning [00:14:14]:
Thinking again about what you said earlier about that collaboration with UC Davis, and I'm wondering how now, how does Indiana University Health pay this forward? So what advice might you have for other hospitals on using 340B to pair medication review with assistance?
Carrie Krekeler [00:14:34]:
One of the biggest hurdles that you may face at the beginning is finding that executive, that leader who's going to be your champion. Having someone within Finance understand 340B and help you with the program is invaluable. Sometimes we think of 340B as like a pharmacy program, but really it includes so many different areas. Billing, rcs, finance, patient access, registration. There's just so many different people involved in this program that we have kind of gotten on our side and, you know, they've helped us build this to what it is right now and into the future as well.
David Glendinning [00:15:20]:
So Carrie was very interesting hearing about this innovative clinic, hearing about all your success. Glad you're gonna be able to bring it not just to our listeners, but to the panel here at the conference and hopefully inspire some of them to explore this concept further. So thank you so much for being with us today.
Carrie Krekeler [00:15:40]:
Thank you.
David Glendinning [00:15:43]:
Our thanks again to Carrie Krekeler for taking the time to share her health system story. We are glad to hear IU Health's medication review clinic concept is resulting in demonstrated improvements in outcomes by ensuring patients get the drugs they need and learn how they need to take them. Do you have a 340B funded program at your hospital or health center that helps improve patient outcomes? If so, you might be a perfect candidate to speak on a panel at the 340B Coalition winter conference. The call for speakers for that event is open and you can learn more by visiting 340bwinterconference.org. We will be back in a few weeks with our next episode. In the meantime, as always, thanks for listening and be well.
Carrie Krekeler [00:16:31]:
Thanks for listening to 340B Insight. Subscribe and rate us on Apple Podcasts, Google Play, Spotify, or wherever you listen to podcasts. For more information, visit our website at 340bpodcast.org. You can also follow us on Twitter @340bhealth and submit a question or idea to the show by emailing us at podcast@340bhealth.org.