Student pharmacist outreach program addresses the Part D affordability and access gap

FEATURES

Stephanie Phung, Catherine Mueller, and Vincent Tran are third-year PharmD candidates at the University of California, San Francisco (UCSF), School of Pharmacy. Rose Pavlakos, PharmD, BCACP, is a clinical pharmacist in the UCSF Division of Cardiology and an assistant clinical professor in the UCSF Department of Clinical Pharmacy. Shalini Lynch PharmD, BCGP, is health sciences associate clinical professor in the UCSF Department of Clinical Pharmacy. Mackenzie Clark, PharmD, APh, BCPS, BCGP, is pharmacy supervisor of UCSF Specialty Pharmacy and an assistant clinical professor in the UCSF Department of Clinical Pharmacy. Judie Tran, PharmD, is assistant director of experiential education and assistant clinical professor at the UCSF School of Pharmacy. Neda Nassr, PharmD, is a clinical pharmacist in the UCSF Division of Rheumatology/Nephrology and an assistant clinical professor in the UCSF Department of Clinical Pharmacy. Marilyn Stebbins, PharmD, is a professor of clinical pharmacy and vice chair of clinical innovation at the UCSF School of Pharmacy.

The Partners in D program started at the University of California San Francisco School of Pharmacy (UCSF) in 2006 when four pioneering student pharmacists and three faculty identified a need to help underserved Medicare patients understand the complex Medicare Part D prescription drug program (Part D). Under the supervision of faculty members Marilyn Stebbins, Helene Lipton, and Timothy Cutler, student pharmacists Dave Smith, Tony Chung, Troy Drysdale, Luke Tsu, and Jesica Mangun began visiting low-income housing complexes in the San Francisco Bay Area to help underserved older adults navigate the complex Part D benefit. The need in the community was enormous, and the impact of the counseling session was significant.

15 years and counting

The overall goal of the Partners in D program is to cultivate an environment where patients feel empowered to take ownership of their health while gaining a better understanding of their medications and prescription drug coverage. Now in its 15th year, the program has evolved over time from an outreach elective for student pharmacists to an interprofessional elective and, most recently, part of the pharmacy school’s core curriculum. The program partners with low-income housing complexes, community clinics, and UCSF primary care, geriatrics, and cardiology clinics to reach older adults who are overlooked during Medicare open enrollment: namely, low-income persons and non- or limited-English speakers.

Student pharmacists who offer this service play a vital role in improving patient engagement, medication access and adherence, and patient outcomes. For many students, the Medicare Part D outreach is their first encounter with direct patient care and provides an avenue to engage in patient advocacy within their community. By visiting the same sites each year, students learn how to talk with patients and develop close relationships with them. 

As part of the core curriculum and interprofessional elective, first-year student pharmacists receive 6 hours of didactic Medicare training followed by case-based skills training using the Find a Medicare Plan tool on Medicare.gov. Students receive interpreter training, and many serve as interpreters to help breach language barriers during outreach events.

Motivational interviewing, medication history taking, cultural and linguistic competence and care for complex geriatric patients are also highlighted in the training. This is followed by 4 to 6 hours of community outreach experience during which expert student pharmacists ensure that patients are enrolled in the most optimal Medicare Part D plan. In our extensive experience, we have found that more than 75% of patients were not in the best plan and needed our assistance. 

Outreach elements

During a typical Medicare outreach visit, student pharmacists

• Provide a comprehensive medication review.
• Evaluate the available Part D prescription drug plans from an individualized search in Find a Medicare Plan.
• Provide medication and insurance plan education.
• Discuss potential cost-effective interchanges.
• Assist patients in applying for Extra Help with Medicare prescription drug plan costs (low-income subsidy as well as patient assistance programs).
• Develop important relationships with patients as a trusted pharmacy provider.

To navigate the Medicare website, student pharmacists must not only understand the patient’s medications and prescription drug plan options, but also individualize the patient's pharmacy choices and address their cost burden. Patient education is key, as patients often do not realize the importance of evaluating their Part D plans annually. Students review multiple plan options with patients and allow them the opportunity to ask questions and choose a plan that best fits their needs.

Small interventions equal tremendous savings

The Partners in D program has shown that small interventions can lead to tremendous savings for our patients. Formularies, copays, premiums, and deductibles change each year and can accrue unexpected changes in cost. By providing this service, students help patients identify cost-saving opportunities while providing invaluable education. Simple educational tasks such as evaluating eligibility, helping patients apply for low-income subsidy, informing dual-eligible patients to use both their Medicare Part D and/or Medicaid cards at the pharmacy, and providing options for patients to use mail order can also lead to improved patient access and adherence.

In previous years, the pharmacy team provided all outreaches in person, but in 2020, shelter-in-place regulations during the COVID-19 pandemic threatened the 2020 outreach efforts, especially in senior communities. True to its dynamic nature, the program quickly adapted to an online virtual format that served more than 100 patients. Students enrolled 5 patients in low-income subsidy programs and helped 42 patients switch to a new plan—resulting in an average annual cost savings of $950 per patient.

One patient in the 2020 outreach was a 71-year-old Medicare beneficiary who completed her first virtual visit with the pharmacy team. As a result, she qualified for assistance and changed to a more cost-effective Part D plan, with an estimated annual cost savings of $6,770.57.

The privilege to serve

Student pharmacists participating in the program say it is a privilege to have the opportunity to serve these patients and create a space where they feel heard and cared for. The Partners in D program urges student pharmacists nationwide to consider implementing this valuable and rewarding service to improve medication access, knowledge, and affordability for Medicare patients. For more information, students can view this short YouTube video describing the Partners in D program and a live patient experience.

Patient kudos

Below are two of many letters received from patients in response to the Medicare Part D outreach: 

“I want to thank you a thousand times for your thorough and kind help. Once I had gone through the process years ago for Part D, I never wanted to do it again. You showed me how much I had ignored through the years! It has been so good to have had you to consult for prescriptions, too.”

 “I want to thank you for your extremely valuable help today with sorting out a new prescription plan for me. I also want to tell you that your sincere concern in finding me the best and most economical plan is much appreciated. I draw strength in knowing that I have medical professionals such as yourself and your team working on my behalf.”