UPDATES ON 340B Where do we go from here?

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Mercy Taylor
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1 UPDATES ON 340B 2011 Where do we go from here?

2 Brief Review of 340B Initiated during Clinton administration Who can participate? (FQHC, Family Planning, Ryan White, Black lung, Hemophilia, Urban Indian, TB, DSH, STD, Hawaiian health centers) Newly Eligible Critical Access Hospitals, Rural Referral Centers, Sole Community Hospitals, Free Standing Cancer Hospitals, Children s Hospitals What does 340B Program provide? How are prices derived? What drugs are covered? How good are the prices?

3 How does a CHC participate in 340B? Register with Office of Pharmacy Affairs Register with Prime Vendor Obtain an account with wholesaler

4 Why Participate in 340B Program? Tremendous discounts on pharmaceuticals Discounts on other items through Prime Vendor Stretch dollars in order to serve vulnerable patients (low prices for uninsured)

5 340B Implementation Options Can utilize in-house pharmacy Can utilize Contract Pharmacy Arrangement or Multiple Contract Pharmacies Can obtain Alternative Method Demonstration Project approval

6 Office of Pharmacy Affairs (OPA) Administers 340B Program Serve as Federal resource for pharmacy practice Develops innovative pharmacy service models and supports technical assistance PSSC (Pharmacy Services Support Center)

7 Operating a 340B In-House Pharmacy Must have low inventory Must have a sliding fee Accept Medicaid, Medicare Part D, and various private insurance plans Pfizer Share the Care AZ and Me Patient Assistance Programs Samples

8 Optimizing 340B Purchasing Strong P&T Committee Formulary Management is imperative! Inventory Control Constantly check prices on 340B purchasing Use wholesaler programs to always have access to lowest price Use wholesaler to automatically update 340B quarterly prices Utilize Prime Vendor program Maximize use of extremely low prices ($0.01 items) Utilize Pfizer Share the Care, AZ&Me

9 Prime Vendor Program Saves money on major expensive items oral contraceptives, syringes, insulin, diabetic testing supplies, etc. Negotiates sub-ceiling prices Offers value added products and services Services offered at no cost to entity Provides access to drug distribution solutions Can save important dollars on printer cartridges, prescription bottles, flu vaccine, etc. Prime Vendor has Advisory Committee for CHCs Pharmacy Flash Newsletter

10 Medicare Part D Participate with Medicare Part D Plans!! Establish your health center as Medical Home for Medicare patients Additional revenue Prevents loss of patients

11 Pay Attention to Your Uninsured Patients! 340B makes it possible to bring low cost medications to your patients. Don t send your uninsured patients to your pharmacy with expensive prescriptions! You have to pay attention to area $4.00 prescription prices!

12 Pharmacy A Revenue Producer CHCs should not use federal funds to subsidize patients above 200% of poverty level. Should provide discounts based on income to those between 100% and 200% of poverty level. Should provide full discount or nominal price to those below 100% of poverty Must charge adequate dispensing fees for prescriptions (including Patient Assistance) Third parties not entitled to 340B discount (except Medicaid)

13 Administration Must Understand Pharmacy Work closely with administration to enhance their understanding of pharmacy costs and revenue potential Administration must understand pharmacy recruiting and pharmacist salary levels. Salaries have to be competitive! (Perks!) Include pharmacists as part of management team.

14 Make a Contract Pharmacy Work! Your Contract Pharmacy has to understand the 340B Program. With the 340B Program, only the entity (CHC) can purchase the drugs. The drugs always belong to you! Contract Pharmacy must understand that the only revenue that goes to the pharmacy should be the dispensing fee! You want all third party prescriptions to create revenue for the CHC! An outside contractor can be helpful with a Contract Pharmacy. Don t overlook formulary management and clinical pharmacy services. Pay attention to your uninsured patients. You will need a competitive low-prices prescription plan ($4.00) Your Contract Pharmacy arrangement should produce revenue for the CHC.

Patient Safety and Clinical Pharmacy Services Collaborative HRSA initiative to improve patient safety issues and initiate greater level of clinical pharmacy services

15 Patient Safety and Clinical Pharmacy Services Collaborative HRSA initiative to improve patient safety issues and initiate greater level of clinical pharmacy services in the safety net environment Opportunity to join now for a new collaborative. Great opportunity to change pharmacy practice in CHCs and to greatly enhance patient safety

16 Future of 340B Every agency wants it! Every state wants greater access to 340B prices for state Medicaid programs, prisons, etc. Pharmaceutical industry does not want expansion! Possible deeper discounts? NACHC wants to assist more health centers in understanding 340B and how to utilize the program!

17 Changes for PSSC Still has Call-Center Support Offers Technical Support Policy interpretation Networking opportunities Peer to Peer Program

18 340B Peer to Peer Program 2011 Leading Practice Sites Carolinas Medical Center Children s Health Center of Atlanta Community Care/Central Health Harris County Hospital District Health Partners of Western Ohio Holyoke Health Center, Inc. New Hanover Regional Medical Center Park Ridge Health Piedmont Health Services, Inc. Shands Jacksonville Zufall Health Center

19 NCCHCA Pharmacy Directors Group We have a small group of Pharmacy Directors that meet quarterly. Need more Pharmacists to join even by telephone if possible. Want to create a viable organization that can assist all CHCs in N.C. with pharmacy services.

20 Contacts: HRSA Office of Pharmacy Affairs Pharmacy Services Support Center pssc.aphanet.org Prime Vendor Program

21 Presenter: Carl D. Taylor, Pharmacist Director of Pharmacy Services, Piedmont Health Services, Inc. Chapel Hill, N.C. Consultant, HRSA Pharmacy Services Support Center Clinical Assistant Professor, UNC School of Pharmacy Tel

PHARMACY CARE ----- FQHCs AND 340B PROGRAM

PHARMACY CARE ----- FQHCs AND 340B PROGRAM HISTORY OF 340B PROGRAM Initiated during Clinton administration Who can participate? FQHC, Family Planning, Ryan White, Black Lung, Hemophilia, Urban Indian,