From the 2024 HVPA National Conference
Caitlin Dowd-Green PharmD, MBA (Johns Hopkins Hospital), Rosalyn Stewart MD, MS, MBA (The Johns Hopkins University School of Medicine), Erin VanMeter PharmD, Robert Green PharmD
Background:
The Access Partnership (TAP) is a charitable care program that supports inpatient and outpatient medical care at Johns Hopkins Hospital (JHH). Prior to 2023, there was no consistent medication coverage for charitable care patients in this program. In an initial analysis, researchers determined that the Johns Hopkins Health system spent $111,052.00 in medication expenses for 148 unique patients in the TAP program from 3/1/2019 – 6/30/2021. Since January 1, 2023, JHH has been piloting a program that provides medication access to a subset of patients in the TAP program. The healthcare utilization and financial outcomes of this pilot are of interest.
Objective:
- To determine if the provision of medications for patients enrolled in TAP results in less avoidable utilization in the year post the implementation of the TAP formulary pilot compared to the year preceding the TAP formulary.
- To determine the number and cost of medications provided through TAP after implementation of TAP formulary pilot in 2023 and compare that with vouchered medication expenses in the initial analysis.
Methods:
This was a retrospective cohort study analyzing electronic health record and pharmacy dispensing information.
For utilization information, patients included in this analysis were enrolled in TAP in 2022 and 2023 and had at least one medication filled through the TAP formulary pilot. Review of the patient’s medical record was conducted in 2022 and 2023 to assess occurrence of ED visits and hospitalizations. The number of occurrences was compared between 2022 and 2023.
For the determination of cost and description of the medications provided, pharmacy prescription data was reviewed from 2023, the year of the implementation of the TAP formulary pilot, and compared with data obtained from the initial analysis (described in the introduction). The parameters collected included medication name, prescription cost, total number of prescriptions in study year, average expense per prescription, and the number of unique patients assisted by the TAP formulary, in comparison to the voucher expense from the initial analysis. Descriptive statistics were used to describe the results.
Results:
The utilization analysis included 114 unique patients and found that ED visits were reduced by 22% (88 vs. 69) between 2022 and 2023. Hospital admissions were reduced by 41% (80 vs 47).
Prescription costs of the TAP formulary during 2023 amounted to $65,570.93. While this cost was on pace with what was spent on medication vouchering in the initial analysis ($111,052.00), the TAP formulary was able to provide more prescriptions (1735 vs. 2899) at a reduced cost per prescription while supporting 98% more unique patients (148 vs. 294).