# Presentation: 814827

## Healthy Community PharmacyOne Community’s Solution for the Uninsured

- Trisha Rudisill, PharmD, Lead Pharmacist
- Nichole Rineer, Operations Manager

## Who is Eligible

- Patients whose income falls under 300% of federal poverty guidelines
- Patient is not insured or is considered “under-insured”
- Patient who is not eligible for other federal, state and local programs
- Patients awaiting coverage from:
- Medical Assistance
- Veterans Assistance
- Undocumented individuals

## How the program works

- Patient is required to submit one full month proof of income, along with complete Healthy York Network Application
- Income is evaluated
- Patients receive plastic card to verify approval
- Patients reapply every 6 to 12 months based on type of income

## How the program works

- Patient can see participating provider to receive discount on service provided
- Includes family physicians, specialists, ancillary and pharmacy services
- Discounts range from 100% to 25%
- Patient pays $10 office copay

## Healthy Community Pharmacy 

- Open August 18th, 2004
- Pharmacy is a charitable 501(c)3 organization
- Designed to assist low income patients from 2 counties in obtaining free or discounted pharmaceuticals
- Work with providers to ensure patients receive life and health sustaining medications at affordable prices

## Staffing

- 1.1 Pharmacists
- 1 Operations Manager
- 2 Pharmacy Technicians
- 1 Cashier
- 3 Pharmacy Caseworkers
- 3 Healthy York Network Financial Caseworkers

## Two Tiered ProgramTier One:

- All medications can be filled at cost plus a dispensing fee
- 200% of FPL and below - $5 dispensing fee
- 201% - 300% of FPL - $12.50 dispensing fee
- Average script – which includes generics and some brands - sells for $11.75

## Cost Plus Dispensing Fee

_**Medication**__**	**__**	**__**	**__**Amt.**__**	**__**HCP**__**	**__**Retail Chain**_
**Azithromycin – Z-Pak****	****	****6****	****$10.17****	****     $44.32 **
**Fluticasone Nasal****	****	****1****	****$11.40       $69.68****	**
**Furosemide 40****	****	****	****60****	****$6.27****	****     $ 4.00**
**Lisinopril 40mg****	****	****	****30****	****$8.42****	****     $17.72**
**Fluoxetine 20mg****	****	****30****	****$5.79****	****     $  4.00**
**Simvastatin 80****	****	****	****30****	****$ 7.66****	****     $22.88**
**Sprintec****	****	****	****28****	****$16.54****	****      $13.78**

## $4 medications

- Retail chains can sometimes charge lower prices on some generic medications
- Benefits patients due to lower out of pocket expense
- Difficult to ensure pharmacy is aware of all prescribed medications and drug interactions
- Additional time required one on one with patient to discuss going elsewhere or offering therapeutic substitution

## First Tier: Cost Plus dispensing fee

- Fiscal Year 08
- Assisted total of 3,905 patients
- Filled 36,463 prescriptions
- Average cost per prescription was 13.27
- Work with social service agencies via voucher system.

## Second Tier: Patient Assistance Programs (PAPs)

- Staff reviews patients drug profile to determine medications that might be available via PAP
- Patient signs auth form to allow staff to complete form on their behalf
- Participating providers receive completed PAP with specific directions
- Provider returns form and final review is completed by staff
- Staff sends completed application to company

## Patient Assistance Program

- Utilize all available PAP’s
- Track patient specific information using Web based Database from MedBank
- Tells staff when to reorder meds
- Holds patients financial information
- Populates patient information onto applications
- Also use _[www.needymeds.com](http://www.needymeds.com/)_
- Patient pays $5 processing fee per application completed

## PAP Outcomes

- Fiscal Year 08
- Staff completed almost 7,000 PAP’s on behalf of patients and their providers
- Over 1000 scripts filled with available samples
- Saved patients $2.1 million (retail price)
- Average savings per prescription
- Cost - $195
- Retail Value - $277

## Therapeutic Substitutions

- Pharmacist reviews patient’s medications
- Determines if lower cost medication might be available
- Is PAP available/difficulty level
- In 2004 created a “contract” with providers to automatically provide substitution – no longer needed due to providers relationship to pharmacist.

## Diabetic Supplies

- Purchase Advocate meters and test strips – box of 50 cost patient $18.50
- Disease management nurse who speaks to patients regarding care and cost of prescriptions
-  Supplies can still cost patients up to $250 per month
- Working with large company in area to assist patients in paying for supplies

## Medicare Patients

- Medicare patients are eligible for Healthy York Network and Healthy Community Pharmacy
- Utilize the PAP’s as allowed by the manufacturer
- Many patients use the pharmacy while in the donut hole – primarily if they cannot hit the catastrophic coverage – we are unable to bill their insurance

## Customer Service Surveys

- Satisfaction tracked at 96% in 2006 and 100% in 2007
- In 2007 97% felt they could afford their prescriptions
- 2008 survey showed 100% would recommend our service to others

## Financial Improvements

- Before Healthy Community Pharmacy, health system’s retail pharmacy was writing off an average of $750,000 each year in medication alone
- Healthy Community Pharmacy budget for total operation is $350,000
- Discounted pharmaceuticals offered community wide, providing services to patients who had nothing available before

## Improvements

- Current Healthy York Network membership is 5400 patients
- About 50% of patients no longer need us after 6 months
- Improvements made to ED usage and disease management
- Focused effort to lower medication cost to patients

## In four years...

- Served 6,300 individual patients
- Filled 119,707 prescriptions
- Saved patients over $5.3 million in brand named pharmaceuticals
- Completed over 24,000 Patient Assistance applications

## In Four Years...

- Added automation – Fast Fill
- Added Perpetual Inventory ordering system
- Donation of delivery vehicle
- Toys and hats and gloves donated for patients using HCP

## Fundraising

- Double Creek Tour and Run – Biking and Running Event held annually each Fathers Day weekend
- Health System Employee Giving Funds
- Kid’s First Fund
- United Way Funds
- Combined efforts donated $85,000 to pharmacy

## Financial Concerns

- Currently Health System provides funding for salaries and operating expenses
- Dispensing fee does not adequately cover filling expense
- Funding now being sought to create second pharmacy in another county

## American Society of Health System Pharmacist (ASHP)2006 Best Practice Award

## 

Questions

- Questions