Managing the many medications a loved one needs can be challenging enough. Trying to do it with limited or no insurance adds a burden that can have dire consequences. Recognizing that growing need, the Natick Visiting Nurse Association developed the MetroWest Meds program a decade ago to provide prescription drug assistance to uninsured and underinsured individuals in the MetroWest region.

One of the features of this blog will be regular interviews with experts in the many fields that impact the lives and roles of family caregivers. First up is a Q&A session conducted over email with the Natick VNA’s Susan Moriarty, MSW, LCSW.

Moriarty has worked with the Natick VNA since 2004, establishing the MetroWest Meds program and serving as its program manager throughout its decade of existence.

Moriarty earned a Master of Social Work in Community Organizing, Policy, Planning and Administration from Boston College and came to the Natick VNA after working for South Shore Elder Services, the Executive Office of Elder Affairs and the Zero to Eight Coalition. She was kind enough to give the Caregiving Chronicles blog some of her valuable time this past week to discuss the MetroWest Meds program.

1. How long has the program been around?

The program was established in May 2004.

2. Why did you decide to start such a program?

A needs assessment in MetroWest revealed that prescription access was a problem for many in the area. As a result of this assessment, the MetroWest Health Foundation asked the Natick VNA to propose a solution to the problem. Our initial research showed that there were many programs to assist people with cost but that most people were not aware of them and were not accessing them on their own.

3. How is it funded and supported?

The majority of our funding comes from a generous grant from the MetroWest Health Foundation. This year, we also received several smaller grants from the Framingham Union Aid Association, the Rotary Club of Framingham, and the Rotary Club of Natick.

4. How many people have you served in the program’s history?

We have helped over 3,600 unduplicated clients since 2004.

5. How many are currently in the program? Is there a limit to how many can participate?

We typically enroll between 300-400 new clients in the program each year. At any given time, there are also 75-100 clients who are not new to the program but continue to receive assistance over multiple years.

There is no limit to how many clients can enroll in the pharmaceutical company free medication programs. Our pharmacy card enrollment, however, is limited by how much annual funding we receive.

6. MetroWest Meds has a number of programs. Can you briefly outline what they are and how they help people?

The MetroWest Meds program provides assistance in four different ways:

• Pharmaceutical free medication programs – We assist eligible clients with the application process. Most companies that make brand name medications provide them free of charge, to those who meet income requirements and are uninsured or underinsured. If approved, clients are mailed a three month supply of free medication at a time for up to one year; renewal applications can be done annually.
• MetroWest Meds pharmacy card – Our own pharmacy card helps uninsured, low-income clients who are not eligible for Medicare. This card, which can be used at local pharmacies, covers a limited list of medications and has a small co-pay.  The same day as enrolling with us and providing proof of income, eligible clients can use this card with a doctor’s prescription to access their medications.
• Other discount assistance – We inform clients and help them with applications for a variety of programs that are not free but that can reduce a person’s out-of-pocket costs. This assistance includes discount generic drug programs, co-pay relief foundations, the low income subsidy for Medicare D, and Prescription Advantage.  We also assist clients with applications for MassHealth and ConnectorCare plans if they are eligible.
• Community education events –We provide hour-long presentations throughout MetroWest, informing people of prescription cost cutting measures they can access on their own.

7. How do you determine eligibility/qualification?

Most pharmaceutical company free programs require that applicants have an income below $23,340 for an individual and $31,460 for a couple (200% of the Federal Poverty Level or “FPL”). Most also require that applicants are uninsured, although some will help people who are underinsured and struggling with co-pays. There is some variation between companies in terms of these requirements, so we ask clients to give us a call so we can gather the appropriate information to determine whether or not an exception can be made.

Our pharmacy card is for those with no prescription insurance who are not eligible for Medicare. The income cut off for our card is $29,175 for an individual and $39,325 for a couple (250% FPL).

Eligibility for assistance with other discount options varies greatly from program to program. When a person calls us, we evaluate them for all forms of assistance and advise them on the best cost cutting options for their situation. Anyone experiencing difficulty in affording their medications should give us a call.

8. What medications are covered under this program?

The pharmaceutical free programs provide assistance for most brand name medications. There are also discount programs for many generic drugs, which have a low cost associated with them.

Our pharmacy card covers a limited list of medications for common diagnoses like asthma, hypertension, diabetes, high cholesterol, etc.

9. How long does it take to get medications?

It takes about 4-6 weeks to receive medications through the pharmaceutical company free medication programs.

Those with no insurance and who qualify for our pharmacy card can access medications the same day they enroll with us and provide income documentation.

10. Can anyone apply for assistance?

The program is available to those who live in the communities served by the MetroWest Health Foundation and who are having trouble affording their medications can call us. We will let them know about the assistance for which they may qualify. They do not have to be a patient of the Natick VNA to participate.

11. What is the application process like? Is help available?

We help clients through the entire process of applying. Typically, it begins with a phone conversation to find out about their specific situation and the medications with which they need assistance. We then send a letter to the client, informing them of the income documentation required. We coordinate with their doctor if their signature is necessary for the application process and submit completed applications to any programs for which a client is applying.

12. How does someone get started?

Call us at 508-653-3081, and we can begin the process of determining how to cut your prescription costs. We ask that you have your list of medications, including dosages, and your household income on hand when you call.

For those wishing to gather more information, please visit the Natick VNA’s website.