Patient Assistance Programs for Intravitreal Injections

By Lindsay Gumersell, Associate Director of Operations, Retina Vitreous Associates

Like many retina practices, Retina Vitreous Associates (RVA), a CVP partner practice located in Toledo, Ohio, offers patient assistance programs to ensure each patient can meet the costs of intravitreal injections for conditions, such as macular degeneration and diabetic macular edema. When a physician determines that treatment should include intravitreal injection, there are many options, some of which are high-cost medications with programs to assist patients. Once the most beneficial treatment is chosen, the patient may enter our assistance enrollment process.

RVA has automated our patient assistance enrollment process using a software program that aids in identifying patients receiving eligible medications. This process has become fast and seamless since introducing this software, which integrates with our EMR system.

As our staff completes patient charts, the software checks specified fields for drug names, such as ranibizumab (Lucentis, Genentech) and aflibercept (Eylea, Regeneron), charted for future use with the patient. When the keywords are detected, the system alerts the clinical team that a program enrollment is available for that patient. The proper enrollment form is generated to a tablet, which we keep in each of our clinics. The physician’s team explains to the patient that the doctor has ordered an expensive medication, and there are programs that can help cover the cost. We do this for patients receiving qualifying intravitreal injections regardless of financial need, as some assistance may be available.

Once the form is available and we have informed the patient of the process, we ask the patient to review and sign the patient enrollment forms. The software inserts all the relevant demographic information into the enrollment forms, leaving very little work for form completion. The completed application is transferred to the appropriate manufacturer for processing and to me for charting. We then monitor the enrollment process to learn patients’ benefits for their injections, special rules their insurance may require for injection, and their assistance needs.

Our commercially insured patients may receive manufacturer’s copay cards for each supported medication. We also work with three nonprofit organizations: Good Days, HealthWell Foundation, and Patient Access Network Foundation. These organizations all offer assistance for medication-related balances. If a patient is identified as uninsured or is rendered uninsured, we refer the patient to the appropriate manufacturer for free medication.

The automated system leaves little room for error and it streamlines our workflow. After years of identifying patients ourselves in the clinic and following a paper, scan, and fax process, the software has improved our efficiency. We appreciate that it removes many steps from our clinicians’ crowded list of responsibilities and makes enrollment and follow up part of the administrative role.

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