The Cost of Prescription Drugs What can we do?

Transcription

1 The Cost of Prescription Drugs What can we do? Lynn D. Silver, MD, MPH Assistant Commissioner Bureau of Chronic Disease Control & Prevention NYC Department of Health & Mental Hygiene

2 Prescription drug expenditures in the U.S, l Drug expenditures ($ billions) Source: IMS Health

3 New York City People who did not fill Rx in last 12 months due to cost (Community Health Survey, 2003) Citywide S. Bronx With Diabetes Hispanics <$25,000 Uninsured Privately or self insured Number ,667 89, , , , ,089 %

4 Nationally 23% of under 65 y.o, lacked prescription drug coverage in % of employer insured workers had such coverage in % of Medicare beneficiaries lacked prescription drug coverage in 1998 One third of drug expenditures was paid outof-pocket in 2000 and 44% by private insurance For poor Medicare beneficiaries, those with coverage used twice as many drugs as those without (29 vs. 15) (Kaiser Family Foundation 2001)

5 NYCDOHMH Response Ensuring low cost pharmaceuticals to all New Yorkers a priority Medication Adherence for chronic diseases is a MUST for New Yorkers 340B one way to achieve this goal Public/Private Partnership (NYCRx & DOH) Other program initiatives: Medication Adherence CHI & Public Health Detailing Campaign Asthma, CVD & Diabetes drug distributions

6 340B: Financial Impact Anita Lee Executive Director, NYCRX

7 900,000 (15%) New York City residents did not fill a prescription during the last 12 months due to cost. -Community Health Survey, 2003

8 Why Not 340B? Busting 340B Myths

9 We don t want to operate a pharmacy You don t need to operate a pharmacy! You can contract with a retail pharmacy

10 We don t have the funds to stock inventory The preferred way to start 340B is through the REPLENISHMENT MODEL

11 Our pharmacy partner is giving us a very good discount Always compare prices

12 We don t have many uninsured patients Every patient that can save money on prescription drugs counts!

13 We don t have many Medicare PART D or commercially insured patients Check again, you ll be surprised!

14 It s too complicated we don t have the staff to implement or manage 340B In can be complicated but there are now resources to make navigating the 340B maze easy for health centers

15 It s illegal to make money from 340B WRONG the federal government encourages health centers to use 340B to generate revenue patients save money & health centers make much needed revenue to improve patient care!

16 Why 340B?

17 Why 340B? SAVE money for your patients MAKE money for your health center CUT costs for your health center IMPROVE medication adherence, DECREASE busy work for providers

18 SAVE money for your patients: Cost Comparison for Diabetes Medications DIABETES DRUGS DRUG QTY TARGET PRICE RETAIL PRICE 340B PRICE METFORMIN 500MG 90 $6.00 $99.90 $1.35 ACTOS 30MG 30 N/A AT $4.00 $ $ GLYBURIDE 5MG 30 N/A AT $4.00 $23.31 $0.30 SIMVASTATIN20MG 30 N/A AT $4.00 $ $0.73

19 SAVE money for your patients Cost Comparison for Cardiovascular Medications CARDIOVASCULAR DRUGS DRUG QTY TARGET PRICE RETAIL PRICE 340B PRICE ENALAPRIL 10MG 30 $4.00 $68.22 $0.34 AMPLODIPINE 10MG 30 N/A AT $4.00 $ $0.52 HYDROCHLOROTHIAZIDE 25MG 30 N/A AT $4.00 $10.99 $0.19 SIMVASTATIN20MG 30 N/A AT $4.00 $ $0.73

20 SAVE money for your patients Cost comparison for Asthma Medications ASTHMA DRUGS DRUG QTY TARGET PRICE RETAIL PRICE 340B PRICE ADVAIR DISKUS 250/50 60 N/A AT $ SINGULAIR 10MG 30 N/A AT $ ALBUTEROL 90MCG 17 N/A AT $

21 SAVE money for your patients: Pharmacy Assistance Program (PAP) The program offers free or low cost drugs to low income individuals who have no prescription benefits (exceptions apply). PROS Free or low cost brand name medication 90 days of medication Active for one year Rapid refill process Flexible income criteria

22 MAKE money for your health center Health Center X Retail Pharmacy located in the lobby 340B implementation results: 1117 total number of Rx s filled in March number of Rx s filled to uninsured patients $18,000 in net revenue in March 2008 Health Center X s total net revenue since start of program (3 months): $59,000

23 Potential applications for 340B funds Cross subsidize patient prescriptions Improve Access Improve Medication Adherence Improve Patient/Provider Relationship IMPROVE PATIENT CARE

24 CUT costs for your health center OWN USE DRUGS DRUG QTY 340B PRICE NON-340B PRICE HEPATITIS A VACCINE 5X1ML $94.61 $ TETANUS DIPHTHERIA TOXOID 2-2LFU 10x.05M L $ $ PPD APLISOL 5TU/0.1ML 10 TEST 1X1 $1.37 $ EGENERIX-B 10x1ML $ $ DEPO-PROVERA 25x1ML $0.01 $42.00 MICROGESTIN MG 6 x 21 $45.26 $ NOVOLIN 70/30 10ML $0.10 $34.63

25 Do you want to 340B?

26 Tips on implementing a successful 340B program Establish a 340B own use account with a pharmaceutical distributor Assess your uninsured patients prescription burden (individual & aggregate) Assess your 340B revenue generating potential Select a pharmacy service option that meets your situation Include medication adherence services in your 340B program

27 TIP Selecting the Right Retail Pharmacy Identify the pharmacies closest to your health center (location, location, location!) Send out an RFP Collect data to determine the pharmacies capture of eligible prescriptions Negotiate a rate for dispensing & other services Contract with a company to set up a system to collect monthly reports (dispensing report, financial statement, drug consumption report & inventory report)

28 TIP Other Pharmacy Service Options In house pharmacy Conditions: space, loyal patients, substantial commercial & Medicare PART D volume Dispensary/Physician Dispensing Mail Order Pre-package samples ONLY FOR UNINSURED PATIENTS

29 What can a 340B support service offer? Selection of a 340B contracted pharmacy Establish Wholesale account Data management & analysis Recommendation for 340B optimization Continuous technical assistance

30 Issues to Evaluate when choosing a 340B support service Compare Administrative Fees Do they offer medication adherence support? Do they provide pre-implementation services? Do they provide post-implementation technical assistance & quality control? Do they provide contract management? Do they provide provider/staff/pharmacist education?

31 Issues to Evaluate when choosing a Pharmacy Partner Proximity to Health Center (location is key!) Compare dispensing fees Ethical reputation Patient capture rate Other services: Refill reminders & other medication adherence interventions Delivery service Language capabilities

32 Health Center Program Expectations (as per PIN 98-23) Performance measurement and quality improvement are critical elements for excellence in the health care industry Since successful utilization management is an effective means of delivering appropriate services and maximizing value, quality improvement studies addressing utilization management of appropriate specialty, pharmacy, hospital and other services is key. -HRSA Regional Office 3/31/2008

33 FQHC Required Services (as per PIN 98-23) Health centers must provide required health care services as described in statute and regulation. All health center programs must provide, directly or through contracts or cooperative arrangements, basic health services including: primary care; diagnostic laboratory and radiologic services; preventive services including prenatal and perinatal services; cancer and other disease screening; well child services; immunizations against vaccine-preventable diseases; screening for elevated blood lead levels, communicable diseases and cholesterol; eye, ear and dental screening for children; family planning services; preventive dental services; emergency medical and dental services; and pharmaceutical services as appropriate to a particular health center. -HRSA Regional Office 3/31/2008

34 CONTACT INFORMATION: ANITA LEE, RPH, MPH EXECUTIVE DIRECTOR, NYCRX TELEPHONE: MOBILE:

35 For more information visit the NYCRx exhibit table