Information for Physicians and their Staff

Project Access Dallas is a physician-led, community effort to provide health care for low-income, working but uninsured Dallas County residents—those people trying to get ahead through hard work. It is managed by the Dallas County Medical Society, and funded through grants and donations to DCMS’ foundation, the Dallas Academy of Medicine. The backbone of PAD is the volunteer physicians who donate just one to three office visits each month.

PAD volunteer physicians demonstrate their commitment to the ideals of their profession in an organized, efficient, and rewarding way. PAD was designed to make physicians’ volunteer work easier for them and less of a burden on his office staff. Instead of the physician being responsible for coordinating further care, a Care Coordination Team provides support services, including case management, low-cost pharmaceuticals, transportation and translation.

The following steps will help volunteer PAD physicians and their practices, when accepting a PAD patient.

1. The PAD physician and ancillary network manager will provide an orientation for you and your staff, before any patients are assigned to the physician. At that time you may consider designating a contact person in your office for us to call when we schedule appointments for PAD patients.

2. For PCP appointments, at the time of the patient’s enrollment into the program, an Enrollment Coordinator will call to schedule the patient’s initial appointment with your office. After the initial appointment, all other PCP appointments can be made by the patient, rather than the enrollment coordinator. However, please note that for specialty, ancillary and hospital referral requests, the patient’s PAD PCP, must complete a PAD Referral Request Form and fax it to Sharka Jones, Project Access physician and ancillary network manager at 214-941-3351. Ms. Jones and her team will schedule all specialty, ancillary and hospital referral requests for PAD. After the appointment(s) have been made, your office will be notified by fax regarding the patient’s appointment information. PAD will also notify the patient of all specialty, ancillary and hospital appointments made on behalf of the physician who requested the procedure.

3. PAD patients should receive the same experience as an insured patient. Schedule PAD patients as you would any other patients.

4. Patients must show a current PAD ID card at each office visit (see front of card for expiration date). If the patient does not have a current PAD ID card, you may call a PAD staff member from 9 a.m. and 5 p.m. Monday through Friday at DCMS to verify enrollment (214-413-1439).

5. Do not bill patients for PAD services. Your physician has agreed to provide these services as a goodwill gesture in the community. However, to track the care contributed, practices are asked to submit a standard HCFA 1500 claim form for services provided to:

Project Access Dallas Claims
5919 Greenville Avenue, #326
Dallas, TX 75206

6. At checkout give patients a PAD Patient Payment Form in place of requesting a co-pay. Instruct them to mail the payment to the address on the form. Project Access patients are requested to donate $5 per office visit, which goes directly to the pharmacy program. Your office is not responsible for collecting this money.

7. To report NO SHOWS or patient non-compliance, contact Sharka Jones, Project Access physician and ancillary network manager, at 214-413-1439 or via email at sharka@dallas-cms.org.

8. REPORTING
PAD office tracks all commitments of physicians. Physicians can contact the PAD office to obtain a report of their patient list/commitments and remaining commitments.

9. MEDICATION
Patients enrolled in PAD are given a PAD Caremark pharmacy card, which is honored at any of the 40,000 retail pharmacies that accepts Caremark within the United States. Patients will be required to pay a $10 co-pay for each prescription at the pharmacy. The card is valid as long as their enrollment in PAD has not expired. The expiration date is listed on the PAD ID card. All prescriptions automatically will default to generic because of our generic only formulary. However, occasionally, a brand-name drug does not have a generic alternative or the physician might feel that it is therapeutically necessary for the patient to receive the brand name drug. In those cases, the physician will need to fill out a Brand Over Generic Request Form, which he can obtain from Kambria Kennedy, PAD utilization manager, at 214-413-1440 or from the PAD web site.

11. HOSPITALIZATION
For hospitalization, prior approval from the hospital access services and authorization from the DCMS Medical Director are required. Contact Sharka Jones, Project Access Dallas physician and ancillary network manager at 214-413-1439.

12. LABS
Physicians may donate lab services provided in their office to PAD patients. However, PAD has a relationship with LabCorp to provide services for PAD patients. Please note that even if the physician is a LabCorp client, the physician still will be required to sign the Indigent Contract Agreement Form so a new account number will be generated specifically for use with PAD patients. If you have questions, contact Connie Webster, director of community services, at DCMS, 214-413-1426, or connie@dallas-cms.org.

13. RADIOLOGY
Physicians may donate radiological services provided in their office to PAD patients. However, PAD has a relationship with certain radiology centers to provide services for PAD patients. However, these services are limited. To schedule a radiological service, complete a PAD Referral Request Form and fax it to Sharka Jones, Project Access physician and ancillary network manager at 214-413-1439.

14. ENROLLING PATIENTS FROM YOUR PRACTICE
By enrolling in the program, Project Access physicians also can enroll a limited number of their personal patients who qualify for the program. These can be patients they already are treating for free and can get “credit” for seeing them, as part of their pledge in participating in Project Access. For more information, contact Connie Webster, director of community health/PAD director of operations, at 214-413-1426 or connie@dallas-cms.org.

Project Access Dallas Formulary Information

• $750 Maximum Pharmacy Benefit per year, per patient
• Co pay is $10 per prescription
• When possible, please provide the patient with samples

All prescriptions for PAD patients are filled by Caremark. Caremark is the largest pharmacy benefits manager in the United States, with more than 40,000 retail pharmacies. When a patient is enrolled in PAD, he is given a Caremark medications assistance card, which is honored by participating pharmacies in Dallas County. While he is enrolled in PAD, he can receive prescribed medications for $10, if the medication is on the PA formulary. The patient pays $10 per prescription and PAD pays the remaining amount of the pharmacy charge.

In an attempt to make the patient’s pharmacy benefits last longer, effective January 1, 2004, our PAD formulary, became an all generic formulary. Although most of the medical services are donated to PAD, one that is not is the pharmacy piece of the program which, as you can imagine, is tremendously expensive. This means the project will pay for only medications that are NOT brand names. Additionally, we are asking, when possible, for you to provide sample drugs to the patients. The formulary rejects all brand single/multi-source drugs and allow generics only to be processed. The only exception to the generic only formulary will be for brand insulin (which, includes brand Insulin/Insulin cartridges used in pen-devices/ Insulin prefilled syringes). However, occasionally, a brand-name drug does not have a generic alternative or the physician might feel that it is therapeutically necessary for the patient to receive the brand name drug. In those cases, the physician will need to fill out a Brand Over Generic Request Form, which he can obtain from Connie Webster, DCMS director of community service, at 214-413-1426 or from the PAD web site.

Pharmacy Benefits Maximum

So we can serve as many Project Access Dallas patients as possible, there is $750 per year maximum pharmacy benefit, per enrollee, on what the project will pay in pharmacy costs. That means once a patient has reached their$750 pharmacy limit, the patient must pay for all their medications. Project Access pharmacy benefits are managed on a calendar basis -- from January 1, 2007, through December 31, 2007. That means that if the patient goes over their $750 maximum pharmacy benefit before December 31, 2007, their pharmacy benefits will not be turned back on until January 1, 2008 – and, only if their enrollment in the program is still active. Once our Pharmacy Benefits Manager has identified that a patient has exceeded the $750 per year maximum, the patient is sent a letter and given 30 days for filling and refilling his prescriptions. The patient still will be enrolled in the PAD program until his six-month enrollment cycle ends. For the remaining of the patient’s six-month enrollment cycle, the patient will still have access to the PAD network, which includes a comprehensive list of physicians, hospitals, mental health services, ancillary service providers (such as diagnostic radiology centers), and pathology and laboratory services. When a patient exceeds the limit, he is sent a letter, telling him to:

• Contact his neighborhood Parkland Health & Hospital System, Community Oriented Primary Care (COPC) health center, to see if they might qualify for Parkland Health Plus, or
• Get sample drugs, when possible, from their physician, or
• Contact the PAD Care Coordination team to get their assistance in making contact with a pharmaceutical company’s patient assistance program.

We know you understand that costs of medicines are high, and we are grateful for the funding that provides all Project Access Dallas enrollees access to limited pharmacy benefits.

If you have any questions regarding the formulary, please contact the Project Access Dallas medical director, Jim Walton, DO, at 972-860-8606 or Connie Webster, DCMS director of community health/PAD director of operations, at 214-413-1426.

Click here for the PAD Generic Formulary List