Paying for PrEP and PEP: Addressing Financial Barriers through Benefits Navigation

Transcription

1 Paying fr PrEP and PEP: Addressing Financial Barriers thrugh Benefits Navigatin Stephanie Hubbard, MA, MPH New Yrk City Department f Health and Mental Hygiene Bureau f HIV/AIDS Preventin and Cntrl 1

2 Overview The Need fr Benefits Navigatin fr PrEP and PEP The NYC Benefits Navigatin Mdel Strategies fr Success Applicatin t Jurisdictins and Utilizatin fr Technical Assistance Benefits Navigatin Mdel Feedback 2

3 Webinar Objectives 1. Understand the financial barriers t PrEP and PEP 2. Describe payment ptins fr PrEP and PEP 3. Explain the purpse f Benefits Navigatin fr PrEP and PEP 4. Identify strategies t ensure rapid access t PrEP and PEP 5. Apply and adapt the NYC Benefits Navigatin Mdel t yur jurisdictin 6. Utilize the Benefits Navigatin Mdel fr technical assistance 3

4 The Need fr Benefits Navigatin fr PrEP and PEP 4

5 Financial barriers PrEP Retail price up t ~$1,900 USD per mnth Requires clinical visits and labratry tests every 3 mnths PEP Retail price up t ~$3,800 USD fr 28-day supply Requires clinical visits and labratry tests within 72 hurs f expsure + + =$$$ 5

6 Financial barriers PrEP and PEP can be unaffrdable fr uninsured and underinsured clients Underinsured clients: Clients with insurance ften experience many gaps in cverage Medicatin may nt be cvered If medicatin is cvered, c-pays may be very high i.e., current ACA Brnze plans Cst f clinical visits and labratry tests can be high C-pays Frequency f visits Cverage may require prir authrizatin, which may cause delays 6

7 Payment Optins fr PrEP Public and Private Health Insurance Cmmercial Insurance Mst cmmercial insurances cver PrEP. Cverage varies based n plan. There may be deductibles and c-payments. Medicaid PrEP shuld be cvered, but Medicaid cverage f services may vary by state. Medicare PrEP may be cvered if client has Medicare Part D and Medicare Advantage plan, thugh csts and cverage may vary. TRICARE PrEP is cvered, but csts may vary based n beneficiary categry. Veteran s Affairs PrEP is cvered. Patient Assistance Prgrams Gilead Advancing Access Medicatin Assistance Prgram Gilead Advancing Access C-Pay Assistance Prgram Patient Advcate Fundatin C-Pay Relief Prvides medicatin fr uninsured clients, r clients withut medicatin cverage. Prvides c-pay cupns (max $3600/year) fr insured clients t help with medicatin c-payments. Award amunt (max $7500/year) can be applied twards medicatin c-payments, cinsurance and deductibles fr insured clients. 7

8 Payment Optins fr PrEP Public and Private Health Insurance Cmmercial Insurance Mst cmmercial insurances cver PrEP. Cverage varies based n plan. There may be deductibles and c-payments. Medicaid PrEP shuld be cvered, but Medicaid cverage f services may vary by state. Medicare PrEP may be cvered if client has Medicare Part D and Medicare Advantage plan, thugh csts and cverage may vary. TRICARE PrEP is cvered, but csts may vary based n beneficiary categry. Veteran s Affairs PrEP is cvered. Patient Assistance Prgrams Gilead Advancing Access Medicatin Assistance Prgram Gilead Advancing Access C-Pay Assistance Prgram Patient Advcate Fundatin C-Pay Relief Prvides medicatin fr uninsured clients, r clients withut medicatin cverage. Prvides c-pay cupns (max $3600/year) fr insured clients t help with medicatin c-payments. Award amunt (max $7500/year) can be applied twards medicatin c-payments, cinsurance and deductibles fr insured clients. 8

9 Payment Optins fr PrEP Public and Private Health Insurance Cmmercial Insurance Mst cmmercial insurances cver PrEP. Cverage varies based n plan. There may be deductibles and c-payments. Medicaid PrEP shuld be cvered, but Medicaid cverage f services may vary by state. Medicare PrEP may be cvered if client has Medicare Part D and Medicare Advantage plan, thugh csts and cverage may vary. TRICARE PrEP is cvered, but csts may vary based n beneficiary categry. Veteran s Affairs PrEP is cvered. Patient Assistance Prgrams Gilead Advancing Access Medicatin Assistance Prgram Gilead Advancing Access C-Pay Assistance Prgram Patient Advcate Fundatin C-Pay Relief Prvides medicatin fr uninsured clients, r clients withut medicatin cverage. Prvides c-pay cupns (max $3600/year) fr insured clients t help with medicatin c-payments. Award amunt (max $7500/year) can be applied twards medicatin c-payments, cinsurance and deductibles fr insured clients. 9

10 Payment Optins fr PrEP Public and Private Health Insurance Cmmercial Insurance Mst cmmercial insurances cver PrEP. Cverage varies based n plan. There may be deductibles and c-payments. Medicaid PrEP shuld be cvered, but Medicaid cverage f services may vary by state. Medicare PrEP may be cvered if client has Medicare Part D and Medicare Advantage plan, thugh csts and cverage may vary. TRICARE PrEP is cvered, but csts may vary based n beneficiary categry. Veteran s Affairs PrEP is cvered. Patient Assistance Prgrams Gilead Advancing Access Medicatin Assistance Prgram Gilead Advancing Access C-Pay Assistance Prgram Patient Advcate Fundatin C-Pay Relief Prvides medicatin fr uninsured clients, r clients withut medicatin cverage. Prvides c-pay cupns (max $3600/year) fr insured clients t help with medicatin c-payments. Award amunt (max $7500/year) can be applied twards medicatin c-payments, cinsurance and deductibles fr insured clients. 10

11 Key differences fr PEP vs PrEP PEP is cnsidered an emergency medicine Time sensitive! PEP wrks best if started right away, within 72 hurs after a ptential expsure t HIV Multiple PEP drug regimens exist Regimens will determine which assistance prgram(s) are needed 11

12 Payment Optins fr PEP Public and Private Health Insurance Cmmercial Insurance PEP cverage varies based n plan. There may be deductibles and c-payments. Medicaid PEP shuld be cvered, but Medicaid cverage f services may vary by state. Medicare PEP may be cvered if client has Medicare Part D and Medicare Advantage plan, thugh csts and cverage may vary. TRICARE PEP is cvered, but csts may vary based n beneficiary categry. Veteran s Affairs PEP is cvered. Patient Assistance Prgrams Medicatin Assistance Prgrams Mst pharmaceutical manufacturers prvide medicatin assistance fr uninsured and underinsured clients C-Pay Victims Assistance Prgram (varies by state and lcality) Patient Advcate Fundatin C-Pay Relief Mst pharmaceutical manufacturers ffer assistance fr medicatin c-payment fr cmmercially insured clients. Award amunt (max $7500/year) can be applied twards medicatin c-payments, c-insurance and deductibles fr insured clients. 12

13 Payment Optins fr PEP Public and Private Health Insurance Cmmercial Insurance PEP cverage varies based n plan. There may be deductibles and c-payments. Medicaid PEP shuld be cvered, but Medicaid cverage f services may vary by state. Medicare PEP may be cvered if client has Medicare Part D and Medicare Advantage plan, thugh csts and cverage may vary. TRICARE PEP is cvered, but csts may vary based n beneficiary categry. Veteran s Affairs PEP is cvered. Patient Assistance Prgrams Medicatin Assistance Prgrams Mst pharmaceutical manufacturers prvide medicatin assistance fr uninsured and underinsured clients C-Pay Victims Assistance Prgram (varies by state and lcality) Patient Advcate Fundatin C-Pay Relief Mst pharmaceutical manufacturers ffer assistance fr medicatin c-payment fr cmmercially insured clients. Award amunt (max $7500/year) can be applied twards medicatin c-payments, c-insurance and deductibles fr insured clients. 13

14 Payment Optins fr PEP Public and Private Health Insurance Cmmercial Insurance PEP cverage varies based n plan. There may be deductibles and c-payments. Medicaid PEP shuld be cvered, but Medicaid cverage f services may vary by state. Medicare PEP may be cvered if client has Medicare Part D and Medicare Advantage plan, thugh csts and cverage may vary. TRICARE PEP is cvered, but csts may vary based n beneficiary categry. Veteran s Affairs PEP is cvered. Patient Assistance Prgrams Medicatin Assistance Prgrams Mst pharmaceutical manufacturers prvide medicatin assistance fr uninsured and underinsured clients C-Pay Victims Assistance Prgram (varies by state and lcality) Patient Advcate Fundatin C-Pay Relief Mst pharmaceutical manufacturers ffer assistance fr medicatin c-payment fr cmmercially insured clients. Award amunt (max $7500/year) can be applied twards medicatin c-payments, c-insurance and deductibles fr insured clients. 14

15 Payment Optins fr PEP Public and Private Health Insurance Cmmercial Insurance PEP cverage varies based n plan. There may be deductibles and c-payments. Medicaid PEP shuld be cvered, but Medicaid cverage f services may vary by state. Medicare PEP may be cvered if client has Medicare Part D and Medicare Advantage plan, thugh csts and cverage may vary. TRICARE PEP is cvered, but csts may vary based n beneficiary categry. Veteran s Affairs PEP is cvered. Patient Assistance Prgrams Medicatin Assistance Prgrams Mst pharmaceutical manufacturers prvide medicatin assistance fr uninsured and underinsured clients C-Pay Victims Assistance Prgram (varies by state and lcality) Patient Advcate Fundatin C-Pay Relief Mst pharmaceutical manufacturers ffer assistance fr medicatin c-payment fr cmmercially insured clients. Award amunt (max $7500/year) can be applied twards medicatin c-payments, c-insurance and deductibles fr insured clients. 15

16 Feedback frm NYC Agencies Cntracted clinical and nn-clinical sites that prvide PrEP/PEP navigatin viced a need fr assistance in navigating health insurance ptins and patient assistance prgrams fr PrEP and PEP Applicatins were cmplicated (i.e., excessive dcumentatin and multiple applicatins denied) Rules and regulatins unclear Eligibility criteria were unclear (i.e., Federal Pverty Level) Needed clarity n hw t determine which patient assistance prgram(s) wuld best meet the client s needs 16

17 Frntline Staff Fcus Grups Cnducted additinal fcus grups with frntline navigatrs t assess cmmn training and TA needs, participants identified the fllwing needs: Benefits Navigatin Prcess Clear steps fr benefits navigatin Rules and regulatins gverning assistance prgrams On the grund tips fr streamlining the prcess Health Insurance Assessing clients current insurance enrllment Understanding insurance eligibility criteria and hw t assess clients eligibility 17

18 Frntline Staff Fcus Grups Frms and Applicatins Understanding what type f dcuments are needed fr applicatins Understanding hw best t fill ut each applicatin Methds fr trubleshting cmmn applicatin errrs Prcesses fr appealing rejected applicatins Case Management Best practices fr tracking the status f benefits navigatin activities t ensure timely prcessing and apprpriate fllw-up Methds fr streamlining benefits navigatin prcesses 18

19 The Benefits Navigatin Mdel 19

20 The Benefits Navigatin Mdel The Benefits Navigatin Mdel was designed t: Prvide an rganized and methdical apprach t Benefits Navigatin fr navigatrs Assist agencies in develping a step-bystep system fr prviding Benefits Navigatin services Respnd t difficulties in navigating clients thrugh the patient assistance prgrams fr PrEP and PEP, as identified by agencies 20

21 Benefits Navigatin Services Benefits Navigatin services include: Assessing a client s insurance cverage and ability t pay fr PrEP r PEP Assessing a client s eligibility fr insurance and available assistance prgrams Navigating clients thrugh the prcess f submitting a successful applicatin t assistance prgrams Ultimately, increasing access t PrEP and PEP 21

22 Benefits Navigatin Mdel Identify Assess Cllect Apply Reassess/ Recertify Identify current insurance status Identify insurance cverage Determine client s FPL Assess which insurance the client qualifies fr, as applicable Step 3: Assess the patient assistance prgram that meets the client s needs, as applicable Cllect and review dcuments required fr assistance prgram applicatins Assist client with filling ut applicatin Review applicatin fr accuracy and cmpleteness Step 3: Obtain required signatures Step 4: Submit applicatin Step 5: Cnduct applicatin fllw-up Reassess client eligibility and enrllment status fr insurance and assistance prgram, as required Assist client t renew enrllment applicatin, as required 22

23 Benefits Navigatin Mdel Identify Assess Cllect Apply Reassess/ Recertify Identify current insurance status Identify insurance cverage Determine client s FPL Assess which insurance the client qualifies fr, as applicable Step 3: Assess the patient assistance prgram that meets the client s needs, as applicable Cllect and review dcuments required fr assistance prgram applicatins Assist client with filling ut applicatin Review applicatin fr accuracy and cmpleteness Step 3: Obtain required signatures Step 4: Submit applicatin Step 5: Cnduct applicatin fllw-up Reassess client eligibility and enrllment status fr insurance and assistance prgram, as required Assist client t renew enrllment applicatin, as required 23

24 Identify: Step 1 Identify Current Health Insurance Status Why is this imprtant? Insurance status influences the rest f the benefits navigatin prcess All assistance prgrams eligibility requirements are dependent n insurance status Applicatins withut crrect insurance status infrmatin will be rejected 24

25 Benefits Navigatin Mdel Identify Assess Cllect Apply Reassess/ Recertify Identify current insurance status Identify insurance cverage Determine client s FPL Assess which insurance the client qualifies fr, as applicable Step 3: Assess the patient assistance prgram that meets the client s needs, as applicable Cllect and review dcuments required fr assistance prgram applicatins Assist client with filling ut applicatin Review applicatin fr accuracy and cmpleteness Step 3: Obtain required signatures Step 4: Submit applicatin Step 5: Cnduct applicatin fllw-up Reassess client eligibility and enrllment status fr insurance and assistance prgram, as required Assist client t renew enrllment applicatin, as required 25

26 Identify: Step 2 Identify insurance cverage Why is this imprtant? PrEP/PEP medicatin cverage and c-pay csts cverage vary by insurance Knwing what is cvered will help identify if a client needs further assistance Navigatrs shuld check cverage fr: Visit c-pays Lab csts Medicatin csts T identify cverage, navigatrs can: Check insurance website Check insurance drug frmulary Call pharmacy 26

27 Benefits Navigatin Mdel Identify Assess Cllect Apply Reassess/ Recertify Identify current insurance status Identify insurance cverage Determine client s FPL Assess which insurance the client qualifies fr, as applicable Step 3: Assess the patient assistance prgram that meets the client s needs, as applicable Cllect and review dcuments required fr assistance prgram applicatins Assist client with filling ut applicatin Review applicatin fr accuracy and cmpleteness Step 3: Obtain required signatures Step 4: Submit applicatin Step 5: Cnduct applicatin fllw-up Reassess client eligibility and enrllment status fr insurance and assistance prgram, as required Assist client t renew enrllment applicatin, as required 27

28 Assess: Step 1 Determine Client s Federal Pverty Level (FPL) Why is this imprtant? The FPL is a key factr in determining a client s eligibility fr health insurance and patient assistance prgrams FPL sets the stage fr what assistance the client qualifies fr 28

29 Assess: Step 1 Hw t determine client s FPL Task 1 Determine husehld size Definitin varies between patient assistance prgrams! Task 2 Identify husehld incme surces Task 3 Calculate grss husehld incme Task 4 Determine husehld federal pverty level (FPL) 29

30 Assess: Step 1 Task 4 Hw d these FPLs relate t benefits navigatin? Medicaid Expansin Janssen PAF CPR Abbvie, BMS, Gilead, Merck, ViiV FPL 100% 138% 200% 300% 350% 400% 435% 500% ACA Premium Tax Credit Eligibility Range 30

31 Benefits Navigatin Mdel Identify Assess Cllect Apply Reassess/ Recertify Identify current insurance status Identify insurance cverage Determine client s FPL Assess which insurance the client qualifies fr, as applicable Step 3: Assess the patient assistance prgram that meets the client s needs, as applicable Cllect and review dcuments required fr assistance prgram applicatins Assist client with filling ut applicatin Review applicatin fr accuracy and cmpleteness Step 3: Obtain required signatures Step 4: Submit applicatin Step 5: Cnduct applicatin fllw-up Reassess client eligibility and enrllment status fr insurance and assistance prgram, as required Assist client t renew enrllment applicatin, as required 31

32 Assess: Step 2 Assess which type f insurance the client qualifies fr, as applicable Why is this imprtant? Fr uninsured clients, navigatrs can begin t identify apprpriate insurance cverage fr which a client may be eligible Fr insured clients with inadequate cverage, navigatrs can begin t identify ther insurance ptins which may be mre beneficial Fr bth, navigate and link t an insurance cunselr This may be an apprpriate time fr a warm hand-ff 32

33 Benefits Navigatin Mdel Identify Assess Cllect Apply Reassess/ Recertify Identify current insurance status Identify insurance cverage Determine client s FPL Assess which insurance the client qualifies fr, as applicable Step 3: Assess the patient assistance prgram that meets the client s needs, as applicable Cllect and review dcuments required fr assistance prgram applicatins Assist client with filling ut applicatin Review applicatin fr accuracy and cmpleteness Step 3: Obtain required signatures Step 4: Submit applicatin Step 5: Cnduct applicatin fllw-up Reassess client eligibility and enrllment status fr insurance and assistance prgram, as required Assist client t renew enrllment applicatin, as required 33

34 Assess: Step 3 Assess the patient assistance prgram that meets client s needs In Identify Step 2, the navigatrs are instructed t lk at insurance cverage fr PrEP r PEP services: Visit c-pay Lab cst Medicatin cst This infrmatin is used t assess which patient assistance prgram is best suited fr the client Cnsideratins fr deciding which is the best prgram fr the client include Insurance status Medicatin cverage C-pay csts Lab csts 34

35 Benefits Navigatin Mdel Identify Assess Cllect Apply Reassess/ Recertify Identify current insurance status Identify insurance cverage Determine client s FPL Assess which insurance the client qualifies fr, as applicable Step 3: Assess the patient assistance prgram that meets the client s needs, as applicable Cllect and review dcuments required fr assistance prgram applicatins Assist client with filling ut applicatin Review applicatin fr accuracy and cmpleteness Step 3: Obtain required signatures Step 4: Submit applicatin Step 5: Cnduct applicatin fllw-up Reassess client eligibility and enrllment status fr insurance and assistance prgram, as required Assist client t renew enrllment applicatin, as required 35

36 Cllect: Step 1 Cllect and review dcuments Why is this imprtant? Accurate dcumentatin is essential fr a successful applicatin Many applicatin rejectins are a result f missing r incrrect supprting dcuments Navigatrs help the client: Identify what supprting dcuments the client needs fr their applicatin Cllect as many dcuments as pssible in the sessin Prvide a list f dcuments the client still needs t cllect befre their next appintment Assist the client with ntarizatin, as necessary 36

37 Benefits Navigatin Mdel Identify Assess Cllect Apply Reassess/ Recertify Identify current insurance status Identify insurance cverage Determine client s FPL Assess which insurance the client qualifies fr, as applicable Step 3: Assess the patient assistance prgram that meets the client s needs, as applicable Cllect and review dcuments required fr assistance prgram applicatins Assist client with filling ut applicatin Review applicatin fr accuracy and cmpleteness Step 3: Obtain required signatures Step 4: Submit applicatin Step 5: Cnduct applicatin fllw-up Reassess client eligibility and enrllment status fr insurance and assistance prgram, as required Assist client t renew enrllment applicatin, as required 37

38 Apply: Step 1 Assist client with cmpleting the applicatin Why is this imprtant? Increases the accuracy f the infrmatin submitted in the applicatin Allws the client t ask questins and ensures they understand what they are filling ut 38

39 Apply: Step 2 Review applicatin fr accuracy and cmpleteness Why is this imprtant? T cnfirm accuracy and avid applicatin rejectins due t errrs Even small errrs can cause an applicatin t be denied Ultimately decreases barriers t accessing PrEP/PEP services This step shuld be cmpleted n matter wh filled ut the applicatin 39

40 Apply: Step 3 Obtain required signatures Why is this imprtant? Depending n the prgram, the final applicatin may need t be signed by bth the client and the prescribing clinician Navigatrs at nn-clinical sites may need t: Cnduct a warm hand-ff t a clinical site Instruct the client t nt sign until ready t submit Navigatrs at clinical sites can btain the required signature frm clinician Encuraged t get t knw each clinician s preference fr hw t manage this step This step requires cmmunicatin between sites! 40

41 Apply: Step 4 Submitting PrEP Assistance Prgram Applicatins Assistance Prgram Frms Prescriber Signature Applicatin Frmat PrEP Gilead Advancing Access Medicatin Assistance Prgram 1 frm (client & prescriber sectins) Yes Paper & Web Gilead Advancing Access C-Pay Cupn Prgram N Paper, Web, Phne PAF C-Pay Relief Prgram 3 frms (client, prvider, pharmacy) N Web & Phne 41

42 Apply: Step 4 Submitting PEP Assistance Prgram Applicatins PEP Assistance Prgram Frms Prescriber Signature Applicatin Frmat Gilead Advancing Access Medicatin Assistance Prgram 1 frm (client & prescriber sectins) Yes Paper, Web ViiV Healthcare 1 frm (client & prescriber sectins) N Paper, Web, Phne Merck 1 frm (client & prescriber sectins) Yes Paper, Web 42

43 Apply: Step 4 The applicatin is submitted, navigatrs are dne! 43

44 Apply: Step 4 But are they? 44

45 Apply: Step 5 Cnduct applicatin fllw up Why is this imprtant? T cnfirm assistance prgrams have received the applicatin Via prgram s cnfirmatin page, , r fax By fllw-up phne call Address issues identified by assistance prgrams Dcument all crrespndence t track fllw-up, such as Apprval by patient assistance prgram Additinal infrmatin needed Denials 45

46 Benefits Navigatin Mdel Identify Assess Cllect Apply Reassess/ Recertify Identify current insurance status Identify insurance cverage Determine client s FPL Assess which insurance the client qualifies fr, as applicable Step 3: Assess the patient assistance prgram that meets the client s needs, as applicable Cllect and review dcuments required fr assistance prgram applicatins Assist client with filling ut applicatin Review applicatin fr accuracy and cmpleteness Step 3: Obtain required signatures Step 4: Submit applicatin Step 5: Cnduct applicatin fllw-up Reassess client eligibility and enrllment status fr insurance and assistance prgram, as required Assist client t renew enrllment applicatin, as required 46

47 Reassess/Recertify: Steps 1-2 Reassess client eligibility and enrllment status and assist with reapplicatin, if necessary Why is this imprtant? Sme patient assistance prgrams require clients t recertify their applicatin within a particular time perid Can vary state-t-state Medicaid expansin states smetimes have a 3-mnth recertificatin Navigatrs shuld carefully reassess the client fr changes that impact what benefits they are eligible fr, specifically PrEP patient assistance prgrams Health insurance Navigatrs shuld assist client t renew enrllment applicatin, r apply fr additinal assistance prgrams, as needed 47

48 Benefits Navigatin Mdel Identify Assess Cllect Apply Reassess/ Recertify Identify current insurance status Identify insurance cverage Determine client s FPL Assess which insurance the client qualifies fr, as applicable Step 3: Assess the PAP that meets the client s needs, as applicable Cllect and review dcuments required fr assistance prgram applicatins Assist client with filling ut applicatin Review applicatin fr accuracy and cmpleteness Step 3: Obtain required signatures Step 4: Submit applicatin Step 5: Cnduct applicatin fllw-up Reassess client eligibility and enrllment status fr insurance and assistance prgram, as required Assist client t renew enrllment applicatin, as required 48

49 Strategies fr Success fr Navigatrs 49

50 Strategies fr Navigatrs: Client-Centered Apprach D nt assume that clients can navigate the system, read, r cmplete the frms Cnversely, d nt assume that clients cannt navigate the system Use standardized frms t cllect cnsistent infrmatin Ensure frms are linguistically apprpriate Address the varied literacy level f clients Ensure materials are inclusive 50

51 Strategies fr Navigatrs: Streamlining the Prcess Learn hw t access e-verificatin systems t rule-ut current insurance enrllment Encurage staff t get t knw their clleagues wh d this wrk! Develp and leverage relatinships between agencies t facilitate linkages and warm handffs Imprve referrals t Certified Applicatin Cunselrs fr ACA enrllment nt all navigatrs will have this certificatin Create a streamlined navigatin prcesses in cllabratin with ther Benefit Navigatrs Encurage navigatrs t knw prcesses bth at their agency and t where they might link clients t 51

52 Strategies fr Navigatrs: Streamlining the Prcess Align medical r ther appintments with benefits navigatin visits, if pssible Set alerts in EHR r client management system t best crdinate Benefits Navigatin appintments with ther services Practively mnitr client appintments in the EHR t schedule appintments When pssible, use web-based applicatin frms t reduce paperwrk 52

53 Applicatin t Jurisdictins and Utilizatin fr TA 53

54 Applicatin t Yur Jurisdictin Find ut lcal laws gverning PrEP and PEP Laws related t a minr s ability t cnsent t medical care, including HIV diagnstic testing and treatment, has implicatins fr their access t PrEP and PEP services These laws vary by state 54

55 Applicatin t Yur Jurisdictin Find ut which patient assistance prgrams are available in yur jurisdictin Besides natinal prgrams, jurisdictins ften have their wn state-run prgrams New Yrk: PrEP AP Washingtn: PrEP-DAP Others include: Clrad, Illinis, Massachusetts, etc. Identify available insurance ptins in yur state Marketplace ptins Medicaid expansin State cverage f PrEP and PEP under Medicaid can vary 55

56 Applicatin t Yur Jurisdictin Verify jurisdictinal eligibility criteria Eligibility criteria fr natinal assistance prgrams may be different acrss states, fr example Recertificatin prcess and timeline Key tip: get t knw yur state cntact fr each assistance prgram and cntinuusly verify criteria and prcedures 56

57 Applicatin t Yur Jurisdictin Cnduct a needs assessment t Identify specific resurces that are available in yur jurisdictin and hw t leverage them Inquire abut cmmn barriers and issues in yur jurisdictin 57

58 Applicatin t Yur Jurisdictin Hld fcus grups with Clinical and nn-clinical agencies Prviders and clients Develp questins t Assess which types f prvider netwrks might exist Hw d these netwrks wrk tgether t ptimize patient care? What prgrams d they ffer? Where are the gaps in these netwrks/prgrams? Find ut what navigatrs and frntline staff might already be ding Assess hw t leverage these effrts 58

59 Benefits Navigatin Mdel: Implementatin Prvide fcused technical assistance depending n individual needs f agencies and prviders within yur jurisdictin Develp resurces and materials Benefits Navigatin Mdel Manual Checklists Templates f supprt letters Webinars Frequently asked questins Website fr up-t-date infrmatin Learning cllabrative 59

60 Benefits Navigatin Mdel: Implementatin Develp and cnduct trainings NYC develped a 2-day training fr frntline staff Applies the mdel utilizing individual and grup activities Develps skills thrugh unique case scenaris Case Scenari Activity Examples Activity 1: Intrductin t Cases Activity 2: Determining Husehld Size Activity 3: Determining Husehld Incme Activity 4: Determining Federal Pverty Level Activity 5: Selecting Assistance Prgrams t Best Fit the Clients Eligibility Activity 6: Cllect dcuments Apply t Assistance Prgrams fr Each Case Activity 7: Planning Fllw Up with Cases 60

61 Benefits Navigatin Mdel: Case Scenari Example Meet Eddie 36-year ld undcumented, uninsured man (prnuns: he/him/his) wh has decided t seek services at the lcal Sexual Health Clinic Frequently has cndmless anal sex with his main partner f eight mnths, Rland Eddie ccasinally has utside partners and is unaware f their HIV status

62 Benefits Navigatin Mdel: Eddie Activity 1: Intrductin t Cases Eddie: Uninsured, undcumented, indicated fr PrEP Activity 2: Determining Husehld Size Eddie: 1 Activity 3: Determining Husehld Incme Eddie: $18, Activity 4: Determining Federal Pverty Level Eddie: 138% - 200% Activity 5: Selecting Assistance Prgrams t Best Fit the Clients Eligibility Eddie: Gilead Advancing Access Medicatin Assistance Prgram and NY PrEP-AP Activity 6: Cllect dcuments and Apply t Assistance Prgrams Eddie: Gilead Advancing Access Medicatin Assistance Prgram and NY PrEP-AP Activity 7: Planning Fllw Up with Cases Eddie: Eligibility is reassessed when his husehld changes

63 Benefits Navigatin Mdel: Implementatin Training enhances cmmunicatin between navigatrs Affrds the pprtunity t build r strengthen partnerships and relatinships between agencies Recgnizes trainees as key resurces fr each ther Builds capacity fr warm hand-ffs t agencies skilled in ther services, such as: Insurance enrllment Clinical service prvisin 63

64 Benefits Navigatin Mdel Feedback 64

65 Participant Feedback Befre the training, participants said Benefits Navigatin felt: Frustrating 65

66 Participant Feedback After the training: 66

67 Participant Feedback Qutes frm ur evaluatin I fund the Benefits Navigatin Mdel t be helpful in rganizing the detailed and cmplicated prcess I like the step-by-step explanatin and applicatin f the mdel The Benefits Navigatin mdel makes the prcess easier I learned the skills invlved in Benefits Navigatin and hw t apply them 67

68 Acknwledgements Maria Ma Carly Skinner Lena Saleh Julia Hidalg Ieshia Sheppard NYC DOHMH Bureau f HIV Preventin and Cntrl Training and Technical Assistance Prgram Preventin Technical Assistance Prject Officers 68

69 Thank yu! Questins? 69