The University of North Carolina's Health Care Pharmacy Assistance Progam.

303 I 2010 an estimated 52 million Americans had no health insurance for at least part of the year [1]. Uninsured or underinsured adults are economically vulnerable, and compared with those who have adequate health insurance, they are likely to have a greater number of chronic medical conditions, less access to appropriate care (including prescribed medications) to help them manage these conditions, and worse clinical outcomes [2-4]. Thus those who might benefit the most from prescribed medications are least able to afford them. The Patient Protection and Affordable Care Act of 2010 (ACA) has attempted to bridge these access barriers by offering affordable coverage options for uninsured individuals through the expansion of state Medicaid programs and the creation of state and federal health insurance marketplaces [5]. Although the ACA has decreased the number of uninsured individuals, many individuals remain uninsured, particularly in states that have chosen to not expand Medicaid. In 2010–2011, more than 1.5 million North Carolinians aged 64 years or younger (18.9% of the nonelderly population) were uninsured [6]. Although expansion of the North Carolina Medicaid program through the ACA would have provided insurance coverage to 42% of uninsured adults aged 18–64 years [6, 7], North Carolina decided to opt out of the Medicaid expansion. Thus the state will have to continue to rely on a patchwork of programs to provide health care services to uninsured patients, who are often socioeconomically and medically vulnerable. Several existing programs are offered through free clinics, federally qualified health centers, and hospitals; these programs help provide uninsured or underinsured patients with access to medical treatments or medications. Two such programs are offered to North Carolina residents through UNC Health Care: the UNC Health Care Charity Care Program and the UNC Health Care Pharmacy Assistance Program (PAP). The Charity Care Program subsidizes the cost of health care services such as inpatient hospitalizations and outpatient clinic visits for North Carolina residents with incomes at or below 250% of the federal poverty guidelines. PAP provides prescription benefit services to North Carolina residents with incomes at or below 200% of the federal poverty guidelines (regardless of employment status) who are uninsured and are ineligible for federal or state insurance programs such as Medicare Part D, Medicaid, or Veterans Affairs health benefits. Patients who meet the PAP eligibility criteria do not need to be legal residents of the United States, as long as they are residents of North Carolina. Those meeting enrollment criteria for PAP receive a renewable 1-year prescription benefit that provides 30-day supplies of any formulary medication for a copayment of $4. Patients enroll in the program by completing an The University of North Carolina’s Health Care Pharmacy Assistance Program