Charging for Applications to Free Pharmaceutical Programs

May 1, 2009

Given the economy, we are seeing an increasing number of patients who are likely eligible for no-cost medication programs from the pharmaceutical companies. Most of the forms require some medical information to indicate the need for medication, such as current blood pressure or glucose level, as well as financial information for determination of need. Our nurses and medical assistants fill out the forms. It takes a lot of time, usually on a regular basis for refills. We are wondering if we could code a 99211 as the work directly relates to patient care. Or can we charge the patient?

Question: Given the economy, we are seeing an increasing number of patients who are likely eligible for no-cost medication programs from the pharmaceutical companies. Most of the forms require some medical information to indicate the need for medication, such as current blood pressure or glucose level, as well as financial information for determination of need. Our nurses and medical assistants fill out the forms. It takes a lot of time, usually on a regular basis for refills. We are wondering if we could code a 99211 as the work directly relates to patient care. Or can we charge the patient?

Answer: 99211 requires face-to-face interaction with the patient. Moreover, it triggers a copayment for the vast majority of managed care plans. You also need to consider whether the majority of these patients have an insurance program you could bill for the 99211, even if it was a legitimate code.

Unless I’m missing something, I don’t think that it’s the solution to this problem.

Setting a small, say $5, fee for patients might help and is legitimate if the patient is uninsured. However, this patient is already financially strapped. While $5 for free pharmaceuticals isn’t a bad deal, it is a bit awkward.

Many practices are struggling with this, and some have (unfortunately) had to discontinue their programs, normally directing patients to a community health center.

Some have successfully teamed up with a hospital or community provider to facilitate the process, but it really depends on the situation.

Look into what is available in your community.

If you decide to continue offering the service, make it as streamlined as possible. Patients should be able to fill out most of the form themselves, after all. If they need a prescription immediately following an exam, the physician or nurse can simply note the blood pressure or glucose level on a slip of paper, hand it to the patient, and let them fill in the blanks. Or staff can fill in just those fields.

You can also ask the pharmaceutical reps from the companies you are working with for advice on streamlining things or ask for improvements in the forms.