Working Together To Improve Access To Care Presentation to Center for Business Intelligence Patient Assistance Programs Conference March 11, 2003 Alexandria,

Working Together To Improve Access To Care

Presentation to Center for Business Intelligence

Patient Assistance Programs Conference

March 11, 2003Alexandria, VA

Ted SlafskyDirector

Public Hospital Pharmacy CoalitionPowers, Pyles, Sutter & Verville, PC

[email protected]

Powers, Pyles, Sutter & Verville, PC www.phpcrx.org Ted Slafsky - [email protected]

(202) 466-6550

The Public Hospital Pharmacy Coalition

• Established in 1992 When 340B Law Passed• Section 340B of Public Health Service Act (Section 602

of VHCA)• DSH Hospitals in 340B Drug Discount Program• Part of National Association of Public Hospitals and

Health Systems• Formed to Increase Affordability and Accessibility of

Rx Care for Poor and Underserved

Powers, Pyles, Sutter & Verville, PC Ted Slafsky – [email protected]

(202) 466-6550

340B Program

• Created in 1992, Two Years After Passage of Medicaid Drug Rebate Law

• Rx Companies Required to Give Best Price to Certain DSH Hospitals, FQHCs, ADAPs, Other Public Health Clinics Receiving Federal Grants

• Operated by Public Health Service’s Pharmacy Services and Assistance Branch Within Health Resources and Services Administration

• Minimum 15% Discount Off of Average Manufacturer Price and 11% Discount for Generics


(202) 466-6550

Eligibility Criteria for Hospitals

• Owned or Operated by State or Local Government• Granted Governmental Powers by State or Local

Government• Private Non-Profit with Contract With State or Local

Government to Serve the Indigent – Must Be Receiving No or Very Little Reimbursement

For Services• Medicare DSH Adjustment % of 11.75 or Greater • Must Withdraw from GPO for Outpatient Purchases • Only 160 of the 5,800 U.S. Hospitals Participate in 340B


(202) 466-6550

Importance of 340B Program and PAPs to our Hospitals

• Public Hospitals Provide Care to All Regardless of Ability to Pay

• 44% of Outpatient Visits by Uninsured • NAPH Hospitals Represent Only 2% of Hospitals

in U.S. but Provide ¼ of Uncompensated Care• Treat Patients with Multiple Complications

(AIDS, TB, Diabetes)


(202) 466-6550

Importance of 340B Program and PAPs (cont’d)

• 41 Million Under 65 Uninsured

• Another 13 Million Medicare Beneficiaries Have No Drug Coverage

• A Good Portion of These Patients Come to DSH Hospital Pharmacies for Care


(202) 466-6550

Importance of 340B and PAP Programs (cont’d)

• Federal and Local Funding Evaporating

• Many Outpatient Pharmacies Have Been Forced to Close

• Others Adopting Restrictive Formularies and Increased Cost Sharing

• Many Considering Closing Their DoorsPowers, Pyles, Sutter & Verville, PC Ted Slafsky – [email protected]

(202) 466-6550

Importance of 340B Program and PAPs (cont’d)

• 340B Program Saves Hospitals Over $2 Million Annually

• Saves Medicaid Over $50 Million Each Year by Billing at Acquisition Cost

• Saves Millions to State ADAP Programs Each Year

• PAPs Save Hospitals Millions Each Year• Enables Pharmacies to Remain Open and

Improves Access to Care

Powers, Pyles, Sutter & Verville, PC Ted Slafsky – [email protected] (202) 466-6550

Joint Survey Between UHC and PHPC Summer 2002

• 80% Utilizing PAPs– Down From 90% in Year 2000

• University of New Mexico Saved $3.7 Million in FY 02 From PAPs– 43% of All Outpatient Drugs


(202) 466-6550

Ways to Reduce Burden on 340B Hospitals and Their Patients

• 1) Modify PAP Application Process To Coordinate With Hospitals Existing Procedures

• 2) Accept Hospital’s Definition of Indigence. Take Advantage of Existing Financial Screening

• 3) Provide Bulk Shipment Replacement– Product Inventory Is Front-Loaded– Products Replaced In Bulk Based On

Documented Usage• 4) Allow Electronic Submission of Forms


(202) 466-6550

Ways to Reduce Burden on 340B Hospitals and Their Patients (cont’d)

• 5) Reports Submitted To Rx Companies Include Data To Allow Monthly or Quarterly Audit and Review

• 6) Do Not Require Re-Application Every 30 Days

• 7) Help Hospitals Treat Growing Number of Undocumented


(202) 466-6550

Most Popular Institutional Programs

• 1) AstraZeneca

• 2) Bristol-Myers Squibb

• 3) Ortho McNeil

• 4) Merck

• 5) AventisPowers, Pyles, Sutter & Verville, PC Ted Slafsky – [email protected]

(202) 466-6550

Merits of AstraZeneca Program

• Patient Confidentiality Maintained

• Bulk Replacement on a Quarterly Basis

• Entire Product Line is Available for Bulk Replacement


(202) 466-6550

Bulk Replacements are a Win Win

• Improves Patient Compliance and Quality of Care• Reduces Risk of Untreated Diseases and Adverse

Consequences• Lowers Labor Costs for All• Opens Opportunities For Patients To Have Access

To The Newest (And Potentially Best) Drugs• Patients May Become Paying Customers • Increases Brand Loyalty


(202) 466-6550

Bulk Replacements are a Win Win (cont’d)

• Increased Feeling of Partnership With Rx Company

• Hospitals Provide Support To Prescribers- Pocket Card and Posters

• Corporate Partners Recognized

• Tax Write Off


(202) 466-6550

Alternatives to Free Drugs

• 1) Nominal Prices

• 2) 340B Subceiling Discounts

• 3) Drug Discount Cards?


(202) 466-6550

Alternatives to Free Drugs

• 1) Nominal Pricing Will Not Impact Price Given To Government Purchasers

– Exempt From All Federal Discount Programs VA 603 Program (Federal Ceiling Price) Medicaid Rebate 340B AMP and Best Price


(202) 466-6550

Alternatives to Free Drugs (cont’d)

• 2) 340B Subceiling Discounts 340B Law Creates Ceiling, Not Floor Exempt From Best Price Hospitals Saved $21 Million In Additional

Discounts in 2001

• 3) Drug Discount Cards? Members and Patients Have Some Concerns

• 4) Other Suggestions?Powers, Pyles, Sutter & Verville, PC Ted Slafsky – [email protected]

(202) 466-6550

Other Issues

Where Can PAP Drugs Be Dispensed?

• Perception That Bulk Shipment Arrangements Only Allowed With Hospitals With Outpatient Pharmacies

• However, Hospitals Often Can Dispense PAP Drugs Through Its Acute Care Pharmacy Even Without Licensed Outpatient Pharmacy

• Depends on State Pharmacy LawPowers, Pyles, Sutter & Verville, PC Ted Slafsky – [email protected]

(202) 466-6550

Resources

• PHPC Web Site – www.phpcrx.org

• Ted Slafsky – [email protected] or (202) 872-6742

• Bill von Oehsen – [email protected] or (202) 872-6765

• OPA Web Site - www.hrsa.gov/odpp/

• 340B Coalition Conference July 14-16, 2003

www.340bcoalition.orgPowers, Pyles, Sutter & Verville, PC Ted Slafsky – [email protected]

(202) 466-6550

Documents

Working Together To Improve Access To Care Presentation to Center for Business Intelligence Patient Assistance Programs Conference March 11, 2003 Alexandria,