340B Implementation: An Opportunity for Improved Health Outcomes in Communities

Todd D. Sorensen, Pharm.D.Associate Professor

University of Minnesota

Medication Access - Required Component of Primary Care?

Access to diagnosis

Access to treatment

Required Component ofPrimary Care?

Economic Disparity• 49 million Americans lacked health coverage in 2002• 23% of American under 65 have no Rx coverage• Drug prices paid by those w/o drug insurance are 15% higher

than those with insurance• UI, non elderly spent an average of $30. 76 for Rxs compared to

$9.96 (insured) and $5.53 (generic) for insured.Clinical Disparity

• 27% UI said needed a Rx drug but did not get it compared to 10% of insured

• 42% of UI with HTN not taking medication compared to 25% of UI

• 43% of UI with elevated cholesterol not taking medication compared to 29% of insured.

The FOUR CORNERSTONES of Medication Management

Access

Outcomes

Efficiency

Quality

340B Meds

Samples

MAPs

QualityAssurance

Formulary

MedicationMonitoring

Expenses/Revenues

Patient Safety

Adverse Rxns

Patient Education

Medication Use vs. Cheap Drugs

ProviderEducation

HealthCollaboratives

Westside Community Health Services - St. Paul

Four Cornerstones at Westside Medication Access

In-house pharmacy Samples in pharmacy Considering expansion to other

sites Pharmaceutical Care

3 FTE pharmacists, 2 FTE technicians

Collaborative Practice Agreements

Dedicated exam room for pharmacy

Efficient Business Practices Medicaid negotiation Bilingual technicians Separation of clinical and

dispensing time of pharmacists

Seeking $ for robotics/telepharmacy

Quality Assurance DUE

Community-University Health Care Center - Minneapolis

Medication Access Contract Pharmacy

Pharmaceutical Care 1 FTE Clinical Pharmacist, 1 resident CPAs, pain contracts

Efficient Business Practices Formulary management Oversight of contract pharmacy

Quality Assurance Sample meds/MAPs Availability of languages

Medication Therapy Management Services (MTM)

Recognizes the role pharmacists can play in improving the health outcomes of patients Example: Clinical Pharmacy Demonstration Projects –

Demonstrated value of pharmacists actively managing diabetes patients

Component of Medicare Part D (Jan. 1, 2006) Established in Minnesota Medicaid by legislation passed July

2005 Compensation for collaborating with prescribers and patients to

manage medication use…compensation is independent of medication dispensing

Commit to more than affordable access Strive for high quality, comprehensive pharmacy

services as the standard of care The most expensive medication is one that

doesn’t work 340B program can be leveraged to increase access

to medications AND improve health in a community Expertise and experience is critical to create a

comprehensive program

Take Home Messages…