The Pharmacy Access Continuum

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The Pharmacy Access Continuum

• Paul Freundlich, Mcap
• Margaret Flinter, CHC, Inc.
• January 21, 2004

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Goals For Pharmacy Access At Start Of Mcap Program

• Take advantage of all resources available
• Avoid forcing patients to change providers in
  order to get discounted medications
• Involve pharmacists in the process
• Base prescribing on clinical and cost
  effectiveness
• At worst net neutral to CHC budget

3
Where We Started

• Strong community health center with two sites in
  Middlesex County
• No 340b program
• Samples widely used, but no systematic approach
  to inventory or availability
• Functional pre-filled/pre-labeled generic drugs
  dispensed by provider staff
• Pharmacy Assistance Program dependent on
  providers, nurses, and medical assistants

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Alternative Methods for Access to Medications
1 worst 10 best suggested by a panel
of experts
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Initial Goals Of Program

• Maintain all current programs even the best
  discount exceeds purchasing power of many
  uninsured
• 340b program remains the best discounted drug
  program
• Establishing 340b within first year of Mcap was
  top priority

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Community Health Center
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CHC Service Areas

• 7 Locations
• Middletown
• Meriden
• New Britain
• New London
• Clinton
• Old Saybrook
• Groton

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Starting A 340b Program

• 340b drug pricing program resulted from Public
  Law 102585, the Veterans Healthcare Act of 1992
• Requires an eligible entity (such as FQHC)
• Available to eligible patients the entity has a
  relationship with patient and a medical record
  the patient receives his/her care from a
  professional employed by or under contract to the
  entity.

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The Critical Choice Start Your Own Pharmacy Or
Contract With A Pharmacy?

• Pros and cons both ways. Factors led to CHC
  decision to contract
• Consistent with philosophy of collaborating with
  local businesses
• Pharmacy is not a core competency of CHC
• Multiple, distant sites a problem would require
  starting multiple pharmacies
• Access Commercial pharmacies open seven days
  per week, 14-24 hours per day

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Steps Toward Implementation

• Convent Pharmacy Therapeutics Committee at CHC
  to develop formulary
• Register with Office of Pharmacy Affairs
• Develop Contract, including negotiation of
  dispensing fee
• Educate patients

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Do You Need A Formulary?

• Not required by OPA/340b program.
• CHC would strongly encourage it. Development of
  formulary is a unifying force in emphasizing
  clinical and cost effectiveness. Includes
  providers across disciplines, including
  pharmacist.
• Formulary for 340b decreases expensive inventory
  burden

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First Year Results

• 2500 scripts filled under program (CHC does not
  steer insured patients to the contracted
  pharmacylost opportunity for profit, but
  philosophically consistent)
• Average cost of cash prescriptions for non 340b
  patient utilizing the pharmacy 58.00 vs.
  average cost of 340b cash prescriptions of 25.00
• Minimum administrative burden
• Did not eliminate need for samples, Pharmacy
  Assistance Programs, or Pharmedix

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Interesting Outcomes

• Peltons and Mcap created a discount program for
  all uninsureds holding a Mcap card, extending
  Medicaid drug price to uninsured, non-CHC
  patients
• State Medicaid authority audited in 2003 perfect
  audit
• Inspired us to pursue a bigger project

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Next Steps For CHC

• How to expand 340b to all sites, and assist other
  health centers/communities in implementing 340b
  quickly?
• Major goal achieved Pursuit of national chain
  yields results CHC is first FQHC to get a 340b
  contract with Walgreens4,000 stores across U.S.
• Go live January 1, 2004
• Planned expansion to all sites possible
  co-location.

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Medicaid Rebates And 340b

• Currently, CHCs 340b program excludes all state
  administered drug benefits (Medicaid, GA,
  Conn-pace
• Partnership is an opportunity for significant
  savings on the part of the state of Connecticut
  but should benefit the FQHC as well

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Other Options And Routes To Access

• In-house pharmacy may be best option if adequate
  volume, adequate management, and available
  pharmacists
• Robotic dispensing machines with computer
  link-up to central pharmacy may solve geographic
  and staffing issues
• Co-location (renting space within FQHC to
  pharmacy) is possible

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Resources

• Kathleen McGee, R.Ph, OPA
• KMcGee_at_HRSA.GOV
• 301-594-0318
• Peter Tyczkowski, R.Ph
• Peter_at_Peltons.com
• Rich Mangini, R.Ph
• Pharmedix 800-486-1811

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At the end of the day
It is still about getting the right drug, to the
right person, at the right timeand that means
dealing with the cost issues.