Larmie County Centralized Pharmacy

The prescription assistance program that was formerly managed by Cheyenne Regional Medical Center has been moved to Laramie County Centralized Pharmacy.  The program is located in the “old DePaul Hospital” or CMRC East at 2600 E. 18th Street, Cheyenne, WY.   Currently we are still using the same telephone and fax number that CRMC was using (ie: Phone:  (307) 633-7407 
FAX #:  (307) 633-7253)

 

Please note the following program changes:

 

Contact information about the program can be made to:

           

            Program Director:  Natasha Gallizzi, PharmD 

 

                                                or

           

            Program Coordinator:  Kathy Carr, MA 

 

at Centralized Pharmacy (307) 637-7000 /  Fax #: (307) 637-7002

 

Patients will be screened for prescription assistance needs upon intake at the Centralized Pharmacy or walk-in to the prescription assistance program office.  If they are in need of long-term assistance they will be moved into the prescription assistance program.  Short-term needs will be met by the donation pharmacy if possible.  Centralized Pharmacy will continue to help eligible patients with their prescription needs while they await medications from the drug companies.  In the event that the patient is not eligible with the drug company but remains eligible for the pharmacy, the patient may continue to utilize the medication donation pharmacy for their medication needs.

 

Patients that are eligible for assistance from the drug companies will be given  applications for the medications they need.  They will take their applications to their doctor’s clinic for signature.  After signature the patient will bring the applications back to the prescription assistance program to be forwarded to the drug companies with other required documents.  The drug companies then approve or deny the applications and the patient is notified by the drug company of their status.  Medications will be shipped to the patients’ doctor’s office unless otherwise requested.  The patient is asked to notify prescription assistance when they receive any documentation from the drug companies and when they receive their medication so that the program can assist in tracking and getting refills. 

 

Failure of the patient to notify the prescription assistance program of any notifications or shipments will result in a delay of their next medication shipment.

 

Patients can best be assisted when they bring in initial paperwork (required forms and all necessary supporting documents) needed for processing their eligibility.  The following is a list of documentation that is needed:

 

For your convenience, the various forms for this program are available for you to download, print, and fill out ahead of time so that your request may be processed as quickly as possible.  All of these forms MUST be filled out in order to process your request.

 

Application (Please download, print this out, and bring it with you).  Please note, this is a big file [about 1.1 MB, so be patient].

 

Release of Information Authorization  allows this program to contact the pharmaceutical companies and your doctor in order to help you.

 

Patient Agreement - terms of how services are provided. 

 

There is additional help available and if you are willing to complete a needs assessment this program might be able to assist you in getting additional help from other appropriate agencies.  Doing this is optional, but highly recommended.   The other three forms must be completed.

 

1) Valid Photo ID

 

2) Proof of income  for the ENTIRE HOUSEHOLD (ie.: last 3 months pay stubs, current pay stubs, last filing of income tax return statement, W-2’s, SSI or SSDI award letter stating amount of income received, unemployment documentation/award letter, statement from employer of wages earned or loss of job of all household adults)

 

3) Proof of residency (i.e.: rent receipt or bill with current name and address on it) or proof of residency  via a letter or statement that you are living with someone else rent free or living in a shelter or residential treatment center)

 

4) Medication list that includes the following:      

            1. Medication name

            2. Dosage (strength)

            3. Directions for use

            4. Dr. name and DEA# (for processing applications to drug companies)

            5. Clinic name, address, phone number, fax number

 

5) Allergy list 

 

Here is a checklist you can download and print out to help you keep track of what you need to bring.   Here is a one page summary of the application process you can download and print for yourself.

 

Eligibility is determined by residency and income; each drug company has their own eligibility criteria with income from below poverty level to 350% above poverty level.

 

Patients may best access these services during Centralized Pharmacy hours or by appointment; the prescription assistance office will be open between the hours of
9:00 a.m. – 4:00 p.m. Monday through Thursday unless otherwise posted.

 

To referral agencies:

            Please ask your patient to bring in their eligibility documentation for their first visit.  This will speed processing for the patient.  Also, please advise this agency if you can or are assisting the patient with any of their medication needs through samples or patient assistance programs.  We are trying to avoid duplication of services.  There are hundreds of active patients in the program at this time and many more awaiting eligibility status.  We are doing our best to serve patients as we work towards improving the program. Patients that are eligible for PAP will have a wait time of 3-7 weeks for drug companies to process their applications once they are received.

 

Kathy Carr, MA                                              Natasha Gallizzi, PharmD

Program Coordinator                                   Program Director

 

More information about this program from the Wyoming Dept. of Health

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