A Santa Clara County program that assists enrolled members with receiving grants to cover lifesaving medical supplies, known as MedAssist, hit their milestone of enrolling 1,000 members in June. Those who qualify for MedAssist receive up to three grants for high-cost out-of-pocket prescription expenses for diabetes medications, asthma inhalers, and epinephrine auto-injectors.
About 118,900 adults in Santa Clara County have diabetes mellitus, while about 257,000 adults and children are living with asthma. Approximately 21,600 county residents have been prescribed epinephrine auto-injectors. Most of these medications cost hundreds, if not thousands of dollars, and each grant provides about $200 per month.
“The program has taken longer to take hold than I had hoped or imagined. Once we got support from our board of supervisors and not just buy-in, but enthusiastic buy-in from our county staff, I really thought the program would take off and in fact, it took longer for folks to understand that the program was available, and that it was real.”
— Joe Simitian, supervisor of Santa Clara County
The project has been underway for three years. Following a six-month pilot of the program in 2020, the county made tweaks, such as broadening eligibility, simplifying the application process, and marketing strategies before officially implementing it.
“It has taken time to develop and refine the program, but people have hung in there with it, and the staff and our county pharmacies are quite excited about it, as well as the wider administration. So, I think it’s an acknowledgement that there is this very substantial group of folks in that missing middle who really still need our help,” Simitian told State of Reform.
Simitian believes part of the reason why the program was slow to take off in terms of the initial number of enrollees was due to marketing strategies, and a case of the program being “too good to be true,” due to individuals being so accustomed to the high cost of drugs. This past year, however, marketing strategies pivoted, which allowed MedAssist to reach their goal of 1,000 enrollees by the end of this fiscal year, or June 30th.
Simitian applauded the efforts being done to lower out-of-pocket costs of prescription drugs at the state and national level, but acknowledged how the constituents he represents need help now—which is what MedAssist aims to address. He brought up inflated housing costs, and how some have to choose between paying rent and purchasing food or buying life-saving medications.
“I am struck repeatedly by the struggle of folks who are in what I call the ‘missing middle’ of healthcare,” Simitian said. “They don’t have the resources or the job circumstances to have great insurance, or pay these costs out of pocket—but they make a bit too much to qualify for any of the public programs that might give them thorough coverage, so they fall in the gaps.”
To be eligible for this program, individuals must be a Santa Clara County resident; have a valid prescription for asthma inhalers, diabetes medications, or epinephrine auto-injectors; and have a household out-of-pocket healthcare expense from the previous calendar year.
The maximum household incomes to qualify for the program are:
- $138,364 for a household of one
- $187,143 for a household of two
- $235,921 for a household of three
- $284,700 for a household of four
“The goal here is to keep people well. We’re going to get better outcomes. When we talk about medication adherence and people staying on their meds, that doesn’t happen if people are making hard choices between putting food on the table or paying for their meds.”
— Simitian
The original MedAssist program focused on Epi-pens, inhalers, and insulin. Newer diabetes medications are growing in use and effectiveness, but are very costly. Because of this, the program expanded coverage beyond insulin to include other diabetes-related medications. Simitian told State of Reform that the program may expand at some point, but for the time-being, he hopes to keep it simple.
Not only does MedAssist provide financial relief, but it also improves the health outcomes of individuals who are enrolled. The program assists enrollees with staying on their medications, and are not forced to make risky choices, such as paying for lifesaving medications or food. Simitian said this is a net benefit for all involved, including the hospital systems.
“This is not nice to have—this is not want to have [or] like to have—this is have to have. These are chronic conditions. We’ve got the medications that are available that can keep folks not just alive, but healthy and well, but they cost too damn much. You shouldn’t have to pay an arm and a leg to keep yourself alive, and the increases on these drug costs is just extraordinary.”
— Simitian