Clinical Practice-Accessing Medication

Accessing Medication

Through the Los Angeles County Department of Mental Health (DMH) Indigent Medications Program (IMP), indigent clients can participate in pharmaceutical companies’ Patient Assistance Programs (PAPs) to receive free medications if the are unable to pay. In an effort to assist indigent clients with the cost of their medications, psychiatrists are required to identify clients eligible for PAPs. Due to recent mental health budget reductions and the need to continue other critically needed mental health services, it has been necessary for DMH to reducing some of its expenditures on medications for indigent clients. To achieve these reductions, DMH established the Indigent Medication Program (IMP), administered by the DMH Medical Director.

As a result of the implementation of the IMP: (1) Each DMH clinic must achieve target expenditure reductions for indigent individuals’ medications; (2) PAPs available through the pharmaceutical industry must be utilized throughout DMH, and (3) DMH mental health providers must aggressively attempt to establish health coverage benefits for individuals participating in the IMP.

Overview of the Process

Clients who are eligible for PAPs are identified in two ways. First, clients are financially screened upon intake at each DMH clinic. Indigent clients are identified by a financial screener, and a letter is placed in the chart informing the psychiatrist of the client’s eligibility for a PAP. Second, existing indigent clients are identified through a monthly report of indigent medications prescribed (HMHPR 934). Again, a letter informing the psychiatrist of the client’s eligibility is placed in the client’s chart. If the psychiatrist determines that a client needs medication, a PATS prescription is written. If the prescribed medication is part of the IMP, clinic staff enter an indicator into the IS identifying the prescription, and all future prescriptions of included medications, as a PAP prescription. The prescription is then entered into the PATS, and the indicator appears on the client’s information screen that is accessible to the contract pharmacy that the client uses to fill prescriptions.

To begin the process, the client applies for the appropriate PAP, with the help of DMH staff who are familiar with the eligibility criteria for each pharmaceutical company. The DMH psychiatrist then writes the prescription onto the client’s PAP application, and DMH staff faxes the application to the pharmaceutical company. An identifier (“Y”) is entered into the DMH computer system and the prescription is entered into the DMH Prescription Authorization and Tracking System (PATS).


Upon determining the client’s eligibility, the pharmaceutical company sends the prescribed medication to the DMH Pharmacy Services Office, a facility licensed by the State of California which is under the direction of a Registered Pharmacist. Medications are logged in by DMH Pharmacy Services staff, and are then sent to the dispensing contract pharmacy to replace the medications given to the client. Clients are able to fill their prescriptions with no delay or alteration in the way they have always filled a DMH prescription.


Medications included in the IMP were selected for the high volume prescribed and their high cost. An analysis of prescribing patterns and costs determined that four medications (listed below) meet the high-cost, high-volume criteria. It is anticipated that all psychiatric medications will be included in the IMP once clinics become proficient in applying for these initially selected medications.

IMP Medications (Generic Name) - Pharmaceutical Company

Abilify (Aripiprazole) - Bristol Meyers Squibb

Geodon (Ziprasidone) - Pfizer

Risperdal (Risperidone) - Janssen

Zyprexa (Olanzapine) – Eli Lilly

Program Outcomes

The table below shows the growth of savings during the first seven months of the IMP (2004).



DMH Medication Costs

IMP Cost Reductions


$ 2,204,236

$ 43,404


$ 2,018,079

$ 40,404


$ 3,812,273

$ 49,613


$ 2,051,104

$ 20,624


$ 1,953,545

$ 30,515


$ 2,158,685

$ 32,589


$ 1,758,961

$ 35,551



$ 252,700

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