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Access to Pharmaceuticals in Rural Areas
Presentation by Howard Chapman, Jr.
Executive Director
Southwest Virginia Community Health Systems, Inc.
June 12, 2005

Access to Pharmaceuticals in Rural Areas TOP

Slide 1: Access to Pharmaceuticals in Rural Areas Panel Howard Chapman, Jr. Executive Director Southwest Virginia Community Health Systems, Inc.

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Slide 2: SVCHS Site Map Image: Site map of where the Southwest Virginia Community Health Systems are located

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Slide 3: Southwest Virginia Community Health Systems, Inc. Saltville Medical Center - Saltville, VA Troutdale Medical Center - Troutdale, VA Twin City Medical Center - Bristol, VA Migrant Health Network (8 Counties) Mt. Rogers Medication Assistance Program Mt. Rogers Counseling Services *All SVCHS sites are JCAHO Accredited

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Slide 4: Southwest Virginia Community Health Systems, Inc. JCAHO Accredited as an Ambulatory Health Care Facility Provide Comprehensive Services that include Primary Care and Preventative Services Participate in the Health Disparities Collaborative sponsored by the National Institute of Health, CDC, Public Health Service for Chronic Disease Management Have provisions for Dental Services Provide Mental Health Care Counseling on-site Provide Medication Assistance through 340B Federal Drug Pricing or Mt. Rogers MAP Network with private providers, health departments, hospitals, free clinics, and others to care for indigent patients

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Slide 5: Southwest Virginia Community Health Systems, Inc. University of Virginia Telemedicine Program provided at all SVCHS Sites They accept our Sliding Fee Scale for qualified indigent patients Provides access to 30 separate specialties Digital Retina Camera for Eye Exams Telemedicine is also Used for Patient Education Provider and Staff CME Universal Services Administration Grant for T-1

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Slide 6: Pharmaceutical Access Issues Patient Assistance Programs 340B Program

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Slide 7: Southwest Virginia Community Health Systems, Inc Mt. Rogers Medication Assistance Program (MAP) Received a $200,000 state grant in September 2002 Grant is used to pay Patient Advocates to complete applications for free meds through the indigent drug programs in The Pharmacy Connection software Community Partners at 10 sites include CHCs, Local Health Departments, Faith Based Organizations, and a Free Clinic In a 10 month period we served 2,536 Patients with 14,337 prescriptions valued at $3.1 Million

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Slide 8: Mt. Rogers Medication Assistance Program (MAP) Funding Established by a local State Senator from TANF Funds Grant is used to pay Patient Advocates to complete applications for free meds through the indigent drug programs through The Pharmacy Connection software Community Partners at 10 sites include CHCs, Local Health Departments, Faith Based Organizations

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Slide 9: Mt. Rogers Medication Assistance Program (MAP) Image: Map of all the telemedicine sites

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Slide 10: Mt. Rogers MAP Progress Report Year 1 Totals - 10 Month Period Patients Served - 2,536 Prescription Applications - 14,337 AWP Value of Medications - $3.1 Million Year 2 Totals Patients Served - 2,763 Prescription Applications - 23,262 AWP Value of Medications - $6.1 Million Year 3 Totals - (July 1, 2004 - March 31, 2005) 9 Mo. Patients Served - 12,659 Prescription Applications - 26,873 AWP Value of Medications - $8.8 Million

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Slide 11: Mt. Rogers MAP State Return on Investment Year 1 $17.42 for every State $ Invested Year 2 $27.48 for every State $ Invested Year 3 $58.67 for every State $ Invested (Based on 75% of Annual Funding and the Year to Date AWP Value)

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Slide 12: Virginia General Assembly Investment Increased Funding for Medication Assistance Programs in the Commonwealth in 2006 $350,000 for New Medication Assistance Programs $150,000 for Existing Programs (Mt. Rogers MAP Funding to increase by $58,000 Annually in July 2005

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Slide 13: Mt. Rogers MAP Patient Assistance Programs (PAP) have been around for years More than 100 Pharmaceutical Companies have Indigent Drug Programs Software Programs - Help process the applications and compile the application forms into a single source and complete financial eligibility for the patient It is still a paper application process and can take up to 6 or 8 weeks to receive the initial prescription

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Slide 14: Saltville Medical Center before State Funding We used a part-time person that may have spent half her time working on PAP Applications   Before * Now Patients Served 385 1,235 Prescription Apps. 1,941 4,844 AWP Value of Meds $447,887 $1,354,002 *Based on Annual Projections

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Slide 15: Major Reasons for Growth in the Program We have to serve the entire community as part of the state funding (not just our patients). Having a paid Patient Advocate that is only responsible for completing PAP Applications. Growing Number of Uninsured (more than 20 Plant Closings in our area since 1998)

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Slide 16: Benefits Patients do not have to decide between buying food or prescription medications (a local Food Bank Survey noted 66% responded to having to make that choice out of 400 responding) Patients are more compliant with their treatment plan (Many patients were cutting pills in half or taking one every other day to make their meds last longer) Patients Health Status is improved with taking medications as directed That keeps them healthier an not making frequent trips to the doctor Many patients see an improvement in their quality of life (Typical savings are $350 to $400 per month for a patient. We had one cancer patient that saved about $28,000 on his medications)

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Slide 17: 340-B Medications Enacted as Public Law 102-585 the Veterans Health Care Act of 1992 Codified as Section 340B of the Public Health Service Act Also Called: PHS Pricing 602 Pricing

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Slide 18: 340B Eligible Entities Must be a grantee of an eligible grant program FQHC FQHC look-alikes Family Planning Clinics HIV/Ryan White Clinics Black Lung Clinics Hemophilia Treatment Centers Urban Indian Organizations Native Hawaiian Health Centers STD and TB Clinics Disproportionate Share Hospitals

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Slide 19: Selected Public Purchasers Prices as a Percent of AWP AWP (Average Wholesale Price) - 100% AMP (Average Medicaid Price) - 80% Medicaid (Min.) - 67.9% Medicaid Net - 60.5% FSS (Federal Supply Schedule) - 51.7% 340B - 49% FCP (Federal Ceiling Price) - 47.9% VA Contract - 34.6% *Source - Prime Institute, University of Minnesota (2001)

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Slide 20: 340B Restrictions Can only be used for patients of the eligible entity Medicaid Restrictions Medicaid "Best Price" Exemption State Rebate Program (discourages brand name manufacturers from giving deep discounts) Viewed as Double-Dipping with the 340B Discount

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Slide 21: 340B Models In-House Pharmacy Contracted Local Pharmacy (Retail) Arrangements Repackaging Programs You pay for the medications directly to the wholesaler (Cardinal/AmerisourceBergen) You also pay a dispensing fee or repacking fee per prescription Our patient pays the dispensing fee as their co-pay amount in our pharmacy contract

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Slide 22: Repacking Programs Virginia allows Physician Dispensing Licenses for practices more than 15 miles from the neatest retail pharmacy Several Companies participate in the 340B Program Be sure to check references - One company we used sent over $60,000 for our initial $8,000 order Evaluate Prices We currently use Allscripts-Direct and they have exceptional pricing on their generic medications (i.e., Amoxicillin 250 mg. for 10 day supply is $2.12) No repacking Fee

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Slide 23: Questions Contact Information: Howard Chapman, Jr., Executive Director Southwest Virginia Community Health Systems, Inc. T. K. McKee Hospital Building P. O. Box 729 Saltville, VA 24370-0729 Email: hchapman@svchs.com