St. Louis patients are saving thousands of dollars on critical medicine, thanks to a program now used by some hospitals in the SSM Health system.
SSM Health DePaul Hospital in Bridgeton launched the “pharmacy concierge” program about two years ago. The goal was to help patients overcome financial barriers that could prevent them from getting effective medical care, especially for patients with chronic illness.
“We saw that our patients, particularly here at DePaul and some of our other entities in St. Louis, they were having real struggles just getting medications,” said Subash Maddipoti, the team lead for DePaul’s pharmacy concierge service.
“In some specialties, like endocrinology for diabetics and pulmonology for COPD, all their medications are branded medications, no generics,” he said. “They’re multiple hundreds of dollars per month. Our patients were really struggling, they were having to choose between basic life needs and medications,” he said.
The pharmacists are embedded in doctor’s offices, specifically doctors for primary care, pulmonology and endocrinology. There, doctors and pharmacists worked together to find for cost cutting measures most patients couldn't find on their own.
For uninsured patients, or patients on Medicare, the pharmacy concierge program often found patient assistance programs provided by the drug manufacturers. For commercially insured patients, Maddipoti and his team look for co-pay cards and saving incentives.
The pharmacists also conduct “formulary investigations” with the patient’s physician to figure out which drugs will be covered under a patient’s insurance and which will not. The team will look for generic versions or cost-saving alternatives.
Bob Fortner was paying thousands of dollars for medication to manage his diabetes.
“My insurance is on a high deductible,” he said “And thanks to the high cost of the insulin, I was meeting the deductible sooner than anyone would guess.”
Through the concierge program, pharmacists helped Fortner meet his deductible, without paying out-of-pocket costs. Maddipoti and his team also found one of Fortner’s medications would soon be removed from insurance coverage. Rather than have Fortner pay full price for the drug, they looked for alternative options.
In all, DePaul’s team saved Fortner thousands of dollars last year.
“Just that peace of mind, that they’re working for you and in the end making a great positive difference,” Fortner said.
The pharmacy concierge program isn’t for every patient, it's doctor recommended for those needing chronic care medication. It started at DePaul Hospital, and has expanded to other hospitals and doctors’ offices within the SSM system.
Maddipoti said the program saved patents with insurance about $60-70 monthly. For patients without insurance, he said they provided about $6 million dollars in free medications.