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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Access
to Pharmaceuticals in Rural Areas TOP |
Slide 2: SVCHS Site Map
Image: Site map of where
the Southwest Virginia Community Health Systems are located
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Access
to Pharmaceuticals in Rural Areas TOP |
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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to Pharmaceuticals in Rural Areas TOP |
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
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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:
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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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Access
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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
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