Prescription Assistance in Puerto Rico

Prescription Assistance in Puerto Rico

October 8, 2017

An important, but sometimes little known, program has been activated for the healthcare response to Maria – the Emergency Prescription Assistance Program (EPAP). EPAP allows uninsured patients who have been impacted by a federally declared disaster to receive an up to a 30-day refill of their prescriptions and some vaccines and durable medical equipment (crutches, wheelchairs, etc.) at no cost. The program was activated on October 4th, 2017. Read more on HHS's website - Emergency Prepscription Assistance Program. Information is available in Spanish as well.  

How it works

EPAP is not activated for all declared disasters. States and territories must formally request the Federal government to turn the program on. Once turned on, the program allows enrolled community pharmacies to process claims for prescriptions and other medical supplies for uninsured patients. EPAP engages existing claims processing procedures, so little burden is placed on pharmacies when the program is activated.

Express Scripts and HHS have issued guidance for pharmacies and pharmacists on how to process claims for patients who are impacted in the Puerto Rican zip code areas included in the disaster declaration – Express Communications – EPAP Guidance for Hurricane Maria. This document provides step by step information for pharmacists on how to process prescriptions for uninsured patients as well as guidance on eligible durable medical equipment (DME).

While eligibility for the program is based on home location, services are paid for no matter where the patient currently is. This is a critical component of the program, as it allows patients from Puerto Rico who have evacuated to stay with family in Florida or other CONUS locations to benefit from the program. As long as EPAP is active, patients may continue to renew prescriptions.

Why it is important

During disasters, medicines and medical supplies are often damaged or lost. Patients without prescription assistance may not be able to replace critically needed medicines for financial or other reasons, and so may unnecessarily go without them. Alternatively, they may seek them at the only place they can – the emergency room. Going without their medicines may result in a trip to the ED in any event, as conditions that were once under control could become exacerbated without needed medicines. Emergency departments are crowded during disasters and EPAP can help ensure patients can get the medicines they need, when they need them, without a trip to the hospital. This has the dual benefit of keeping space in emergency departments available for those who truly need the services.

It is estimated that 6% of Puerto Ricans are without health insurance. The activation of EPAP means prescription assistance in available for over 200,000 people.

Sarah Baker, MPP

Sarah Baker is the Programs Manager at Healthcare Ready. In this capacity, she leads the policy development, research, and programmatic efforts to the organization's preparedness initiatives. Prior to joining Healthcare Ready, Sarah served as a consultant to the Department of Homeland Security and a variety of private sector organizations, during which time she supported the design, conduct, and evaluation of scores of preparedness exercises. Sarah received her Masters in Public Policy from Georgetown University's McCourt School of Public Policy and holds a B.A. degree from the University of Notre Dame.