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Adherence to prescription regimen 6 ; Drug verification 7 ; Drug interactions 8 ; Product information handouts 9 ; UF College of Pharmacy involvement 10 ; Communication between medical and dental clinics 11 ; Discounted drug pricing 12 ; Medicare Prescription Drug Benefits Plan and its effect on PAP Strategies for providing medication to low-income patients: A major challenge in health care is to provide low-income patients with their medications. This challenge is addressed in many different ways depending on the medication service or pharmacy model. Most medication services use the following sources: Medicaid, Medicare, federal drug pricing, Patient Assistance Programs PAP ; , and samples. Since patients with Medicaid receive prescription coverage, they take their prescriptions to local pharmacies. Patients with Medicare are now eligible for the Medicare-Approved Drug Discount Cards. While these cards have a co-pay, many low-income patients can qualify for free medication through PAP. Thus, ACORN patients are not encouraged to sign up for these cards. In 2006, Medicare plans to start its Prescription Benefits Plan. This plan has a premium, deductible and co-pays that are too high for most low-income patients. For example, premiums are $35 a month, and the patients must meet an annual deductible of $250. However, the Medicare website states that extra help will be available to low-income patients. These guidelines will not be set until 2005.7 Through federal drug pricing 340B drug pricing ; , eligible entities may buy discounted drugs from wholesalers or manufacturers. Federal drug pricing is available only to certain entities such as Federally Qualified Community Health Centers. This pricing option will be discussed later in the paper. Through the Patient Assistance Program, individual pharmaceutical companies offer free brand-name medications to patients who qualify and complete the appropriate paperwork. However, filling out the paperwork can be difficult. First, the applications are found online, and most low-income patients do not have computer access. Second, since PAP is organized by pharmaceutical companies, the patient must find the company that manufactures the prescribed medication. Although this process can be aided certain websites, the process itself requires computer skills and motivation. A solution to this barrier is to hire a "PAP Advocate"--a person to complete the paperwork for the patient. A new program, Rx Outreach, is PAP for generic medications. This program however, has a fairly substantial administrative fee of $18 for a three-month prescription.8 Another source of medications is pharmaceutical samples. Samples are easy to obtain if the medical practice has paying patients; this is a little more difficult if the practice serves primarily uninsured patients. Still, samples can be obtained by establishing relationships with representatives and receiving donations from other medical practices. Medication services vary greatly among clinics. Some clinics dispense under dispensing practitioners, some under pharmacists. Pharmacists may be affiliated with a university or hired privately. For example, UF Family Practice pays the salary of a pharmacist who is a professor at the UF College of Pharmacy. Other clinics such as Neighborhood Health Services or Bell Medical Clinic hire a private pharmacist, for example, lexapro forum.
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Continued from p. 17 ; malignant bile duct stenosis in comparison with endoscopic brush cytology. Malhi and Gores 2006 ; note that advanced cytological tests of aneuploidy and chromosmal aberrations e.g. digital image analysis and fluorescent in situ hybridization ; aid early diagnosis in high-risk patients. Workshops. The summary of the NIDDK, Office of Rare Diseases, and Morgan Foundation sponsored research workshop on Primary Sclerosing Cholangitis held in Bethesda, MD in Sept. 2005 was published in "Hepatology" LaRusso et al., 2006 ; . Kim JY, Kim MH, Jung JH, Song JH, Oh HC, Kwon SH, Lee TY, Lee SS, Seo DW, Lee SK 2006 Comparison of clinical findings between autoimmune pancreatitis with bile duct involvement and primary sclerosing cholangitis. Korean J. Gastroenterol. 48: 104111. Kita R, Takamatsu S, Kimura T, Kokuryu H, Osaki Y, Tomono N 2006 Bezafibrate may attenuate biliary damage associated with chronic liver diseases accompanied by high serum biliary enzyme levels. J. Gastroenterol. 41: 686-692. Kulaksiz H, Rudolph G, Kloeters-Plachky P, Sauer P, Geiss H, Stiehl A 2006 Biliary Candida infections in primary sclerosing cholangitis. J. Hepatol. [In Press]. LaRusso NF, Shneider BL, Black D, Gores GJ, James SP, Doo E, Hoofnagle JH 2006 Primary sclerosing cholangitis: summary of a workshop. Hepatology 44: 746-764. Malhi H, Gores GJ 2006 Review article: the modern diagnosis and therapy of cholangiocarcinoma. Aliment. Pharmacol. Ther. 23: 1287-1296. Melum E, Karlsen TH, Broome U, Thorsby E, Schrumpf E, Boberg KM, Lie BA 2006 The 32-base pair deletion of the chemokine receptor 5 gene CCR5-Delta32 ; is not associated with primary sclerosing cholangitis in 363 Scandinavian patients. Tissue Antigens 68: 78-81. Mendes FD, Jorgensen R, Keach J, Katzmann JA, Smyrk T, Donlinger J, Chari S, Lindor KD 2006 Elevated serum IgG4 concentration in patients with primary sclerosing cholangitis. Am. J. Gastroenterol. 101: 2070-2075. Moff SL, Clark DP, Maitra A, Pandey A, Thuluvath PJ 2006 Utility of bile duct brushings for the early detection of cholangiocarcinoma in patients with primary sclerosing cholangitis. J. Clin. Gastroenterol. 40: 336-341. Rubin DT, Parekh N 2006 Colorectal cancer in inflammatory bowel disease: molecular and clinical considerations. Curr. Treat. Options Gastroenterol. 9: 211-220. Tischendorf JJ, Kruger M, Trautwein C, Duckstein N, Schneider A, Manns MP, Meier PN 2006 Cholangioscopic characterization of dominant bile duct stenoses in patients with primary sclerosing cholangitis. Endoscopy Apr 27 [Epub ahead of print]. Van Buuren HR, Vleggaar FP, Willemien Erkelens G, Zondervan PE, Lesterhuis W, Van Eijck CH, Puylaert JB, Van Der Werf SD 2006 Autoimmune pancreatocholangitis: a series of ten patients. Scand. J. Gastroenterol. Suppl. 243: 70-78. Wiencke K, Muri Boberg K, Donaldson P, Harbo H, Ling V, Schrumpf E, Spurkland A 2006 No major effect of the CD28 CTLA4 ICOS gene region on susceptibility to primary sclerosing cholangitis. Scand. J. Gastroenterol. 41: 586-591. Zollner G, Trauner M 2006 Molecular mechanisms of cholestasis. Wien. Med. Wochenschr. 156: 380-385.
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