Healthy Community Pharmacy One Community’s Solution for the Uninsured

1. Healthy Community PharmacyOne Community’s Solution for the Uninsured Trisha Rudisill, PharmD, Lead Pharmacist Nichole Rineer, Operations Manager

2. 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

3. 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

4. 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

5. 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

6. Staffing • 1.1 Pharmacists • 1 Operations Manager • 2 Pharmacy Technicians • 1 Cashier • 3 Pharmacy Caseworkers • 3 Healthy York Network Financial Caseworkers

7. Two Tiered ProgramTier 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

8. 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

9. $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

10. 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.

11. 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

12. 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 • Patient pays $5 processing fee per application completed

13. 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

14. 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.

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

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

25. Questions