Five Tips For Creating The Right Policy For Managing Patient Assistance Programs

Five Tips For Creating The Right Policy For Managing PAPs (Patient Assistance Programs)

We are back for round 2 of 3 on our series covering patient assistance programs! I’m your blog host and physician practice technologist Michael Patrick. Today’s post (a 5 minute read) focuses on the keys to the right policy and procedure framework.

If you missed our last post where we flushed out the problems and negative implications practices face in facilitating enrollment for patients + what to do about it, you can click here to check it out.

And last but not least, next week we’ll wrap our series in part 3 by sharing the story of a practice using technology to transform the use of patient assistance programs from a liability to an asset.

A big part of our first post in the series included “Three things you can do to ease the burden of Patient Assistance Programs.” Below is a quick recap:

  1. Research – thoroughly research and understand the requirements of the programs most relevant to your practice.
  2. Prepare – Understand the gaps in your current PAP management efforts and outline 3 goals for closing them to include documentation of a new policy.
  3. Educate – Educate your team and patients on the keys to success in using a PAP. Seek feedback from both about the results from your change efforts.

A critical component of # 2) Prepare is creating the policy documentation. Of course we can all agree that a Policy inclusive of procedure is a necessary part of defining the management of any PAPs that you may facilitate for your patients. A best practice model for your PAP policy covers:

  • Patient eligibility
  • Application turnaround time
  • Activity recordkeeping
  • Communication approach and cadence
  • Receipt and storage processing
  • Patient responsibilities
  • Document management

As you work to revise or create your policy, here are five tips to help ensure the best possible patient experience.

  1. First create context for your policy and procedure by remembering the persona of your audience. For example, part of the procedure calls for follow up communication. While you may prefer text and/or email for certain types of follow up, if the average age of your patient population exceeds 65, a hybrid approach of secure portal e-communication and phone may be more effective. Each patient population is unique, so be sure to draft your documentation by putting yourself in their shoes as you do it.
  2. Assign and train 2-3 designated team members to “own” PAP processing. Depending on the size of your practice, you need at least one primary and one backup person. Redundancy will protect the practice and the patients in accomplishing the best possible experience for both.
  3. Define a clear number of days (e.ge. three business days) to allow for the completion and submission of an application and the accompanying documentation.
  4. Include a feedback mechanism for both patients and staff about the process and experience and apply that feedback in future policy iterations.
  5. Schedule a defined policy audit at least quarterly. Make time to review the program against the goals and metrics you set (see blog 1 of 3, section #2 on Preparation).

Below is a sample Patient Assistance Program Policy.

PURPOSE

To facilitate meeting the patient's need for medication in a safe and a timely manner.

POLICY

Assist patients with the process of determining eligibility, obtaining and maintaining pharmaceuticals through a qualified Patient Assistance Program.

PROCEDURE

  1. Receive order from Physician and ask patient if they require financial assistance to pay for the prescription.

    Retrieve application via the program website. If the application is not available via the website, call the drug company.Review PAP application requirements, source and populate the application with any available data from patient EHR on behalf of the patient. (Note: Drug companies may require Medicaid denial letter.)
     
  2. Ask the patient to complete the missing information on the application.
  3. Review the application with the patient to make sure all information requirements have been met.
  4. If the patient needs to go home to retrieve items (e.g. proof of income) to meet the application requirements, make sure the application is completed as far as possible before they leave.
  5. Agree on a follow up course of follow up including review of items required and a deadline. If possible, email the patient with a recap.
  6. If the application is not electronic, keep possession of it in the patient record within your EHR.
  7. If application is only partially completed, create a series of 3 follow up tasks and alerts in the EHR. If possible use, both phone and email for follow up.
  8. When they return with the information for completion, make copies of documentation, complete the application with them, and review the final document communicating timeline expectations.
  9. Create a follow up task and alert to check with the drug company around the expected delivery or response date regarding program qualifying.
  10. Contact the patient via phone and secure portal to confirm if they’ve picked up meds from pharmacy. Could supplement this task with a subtask to check with the pharmacy prior to reaching out.

Download this sample policy in a Word Document to get started.

There’s no question that executing best practice in the creation of your PAP policy will go a long way in supporting the best care possible for your patients. And as a reminder, it will also support a healthy reputation and the financial vitality of your practice.

I want to thank Jodi Creighton, COA, Director of Clinical Operations at Texas Retina Associates for her contribution to this post! Couldn’t have done it without you Jodi! Thank you!

Stay tuned for the final post in our 3-part series...a story about a practice using new technology to increase efficiency, reduce error, and improve the experience for the patient and practice team members in facilitating PAPs.

In the meantime, if you want to visit more about best practices in this area or have technology strategy questions, let me know. Otherwise, I look forward to your comments below!

Until next time, this is Michael Patrick, signing off!

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About the Author

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Michael Patrick, President at Systeem

With more than 20 years of technology and technology sales experience, Michael has led Systeem’s operations since day one, connecting our clients with technology, processes and ideas that make their lives easier and happier. 

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