A 35-year-old woman presented to the emergency department in cardiac arrest after ingesting large quantities of powdered cocaine. With an initial rhythm of ventricular fibrillation, emergency medical providers were able to achieve return of spontaneous circulation prior to hospital transport. Shortly after emergency department arrival the patient experienced pulseless electric activity arrest. Despite routine advanced cardiac life support, she remained critically ill and intermittently achieved palpable pulses before returning to pulseless ventricular tachycardia. She received intravenous lipid emulsion and dual defibrillation therapies without clinical improvement. After a lidocaine bolus and intravenous infusion, she had a sustained return of spontaneous circulation. The patient was taken to the intensive care unit before withdrawal of care two days later due to a poor prognosis for recovery.

BACKGROUND: National spending on specialty medications accounted for approximately $193 billion in 2016. The coverage design for Medicare Parts B and D has shifted medication costs to patients, which may prohibit patients from starting or maintaining therapy due to affordability. As a result, patients have enrolled in safety net financial options, such as patient assistance and foundation programs. Safety net options may provide savings not otherwise realized by Medicare; however, they may have a negative financial effect on health systems and pharmaceutical manufacturers.OBJECTIVES: To (a) quantify financial savings to Medicare as a result of patient enrollment in patient assistance programs and (b) quantify the financial effect of safety net options for patients, manufacturers, and the academic medical center that participated in this study.METHODS: A single-center, nonrandomized, retrospective pilot study of Medicare beneficiaries was conducted. Patients who were prescribed hematology/oncology specialty medications and enrolled in safety net options between July 2015 and June 2017 were included. Investigators collected data related to fill history, drug cost, and prescription coverage. The primary outcome was the overall cost savings to Medicare as a result of patient enrollment in patient assistance programs. Secondary outcomes included total patient out-of-pocket savings as a result of foundation copayment support, financial effect on manufacturers as a result of patient assistance programs, and health system revenue impact as a result of safety net options. Descriptive statistics were used.