virginia s spap a year of success l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Virginia’s SPAP A Year of Success PowerPoint Presentation
Download Presentation
Virginia’s SPAP A Year of Success

Loading in 2 Seconds...

play fullscreen
1 / 15

Virginia’s SPAP A Year of Success - PowerPoint PPT Presentation


  • 119 Views
  • Uploaded on

Virginia’s SPAP A Year of Success. Steven S. Bailey, LCSW Assistant Director, HIV Care Services Virginia Department of Health July 17, 2009 – Washington, D.C. . Background. Virginia’s SPAP provides ADAP eligible clients with Medicare Part D financial assistance with prescription drugs.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Virginia’s SPAP A Year of Success' - dunne


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
virginia s spap a year of success

Virginia’s SPAPA Year of Success

Steven S. Bailey, LCSW

Assistant Director, HIV Care Services

Virginia Department of Health

July 17, 2009 – Washington, D.C.

background
Background
  • Virginia’s SPAP provides ADAP eligible clients with Medicare Part D financial assistance with prescription drugs.
  • Medicare prescription legislation allows SPAPs to “wrap around” Medicare Part D benefit to fill gaps in coverage.
  • SPAPs must be considered “qualified” through CMS.
eligibility
Eligibility
  • Set forth in state budget amendment
    • Virginia resident
    • Must be enrolled in ADAP
    • Must be enrolled in a Medicare Part D plan
    • Household income must be between 135% and 300% FPL.
virginia legislation
Virginia Legislation
  • Budget Amendment: Chapter 3, Item 289 E, of the 2006 Acts of Assembly provides ……
    • Out of this appropriation, $300,000 the first year and $300,000 the second year shall be provided to establish a state pharmaceutical assistance program (SPAP) for insurance premium payments, co-insurance payments, and other out-of-pocket costs for individuals participating in the Virginia AIDS Drugs Assistance Program (ADAP) with incomes between 135 percent and 300 percent of the federal poverty income guidelines and who are Medicare Part D beneficiaries.
what is covered
What is covered
  • Monthly Medicare Part D Premiums
  • Medication Deductibles
  • Medication Copays/Coinsurance
  • Medication Costs during Coverage Gap
benefits of an spap
Benefits of an SPAP
  • Clients may obtain policies with higher premiums, lowering medication copays
  • Costs incurred count toward TrOOP
  • Clients meet catastrophic coverage quicker
  • Fewer clients reliant on ADAP and other public funding
  • Clients receive assistance with ALL medications through their plan
cost savings projected 2006 2007
Cost Savings(Projected, 2006-2007)
  • ADAP Cost per Client: $15,600/annually
    • Additional funds for non-ADAP medications
  • SPAP Cost per Client: $5,000/annually
    • $3,850 TrOOP (2006/07)+premiums+copays
    • Saving about $10,600/client/year
  • Example: 60 Clients
    • ADAP = $936,000/annually
    • SPAP = $300,000/annually
cost savings actual 4 1 2008 4 30 09
Cost Savings(Actual, 4/1/2008-4/30/09)
  • 4/08=52 Clients
  • By 4/09, increased to 125 Clients
    • By 9/08, cost-sharing assistance more fully utilized
  • n=54 Clients (using only the ADAP formulary)
    • Cost Avoidance of $94,370.34
cost savings actual 4 1 2008 4 30 099
Cost Savings(Actual, 4/1/2008-4/30/09)
  • n=80 Clients (accessing all medications)
  • Average monthly ADAP cost = $1,300
  • Average monthly SPAP copay = $383.95
  • Cost Savings
    • $916.05/client/month
    • $879,408 annually for 80 clients
  • Note: Not all client utilized the SPAP for all medications
challenges to the state
Challenges to the State
  • Legislature (Virginia General Assembly)
    • Funding
    • Language of the Law
  • Federal Match
  • Agency infrastructure/technology

Strategies

    • Stakeholders, Community Partners
    • Support of Business Staff
    • Contract Out (PSI)
challenges to the vendor
Challenges to the Vendor
  • Staff Time with Clients
  • Relationship Development with Clients
  • Data management and exchange
  • Strategies
    • Investing up front
    • IT Support
challenges with pharmacies
Challenges with Pharmacies
  • Client Choice
  • Pharmacy trust
  • Method of payment
  • Strategies
    • Outreach
    • Electronic Billing Options
challenges with providers
Challenges with Providers
  • Apprehension
  • Change in Medication Access Mechanism
  • Dissuaded Clients from Enrolling

Strategies

    • Statewide Education Methods
    • Communication with Key Contacts
challenges to clients
Challenges to Clients
  • Trust
  • Fears of Decreased Access
  • Education
  • Last Minute Refills

Strategies

    • Consortia and Client Groups
    • Education Strategies
    • Direct Client Contact
questions and comments
Questions and Comments

Steven S. Bailey, LCSW

Assistant Director, HIV Care Services

(804) 864-8065

Steve.Bailey@vdh.virginia.gov

Patient Services Incorporated (PSI)

(800) 366-7741