10 th Annual 340B Coalition Winter Conference Expansion of Pharmacy Services Through the 340B Program Binita Patel, PharmD, MS Director of Ambulatory/Retail Services Froedtert & Medical College of Wisconsin (F&MCW) February 7, 2014 Statement of Conflicts of Interest Binita Patel has no actual or potential conflict of interest in relation to this presentation Today s Goals Describe briefly the intent of the 340B program Describe how F&MCW have expanded services to its patients due to the program 1
CE Question Does the 340B program provide disproportionate share hospitals the ability to expand services due to their ability to save dollars on outpatient drugs? True or False? A Patient Story A patient with takayasu arteritis was receiving infliximab, which had been written off at a cost of $20,000/month for the past 5 years. Our prior authorization team worked with the attending physician to identify literature to support use of infliximab for this indication. An application was sent to Medicare, which then began covering patients for use of infliximab in takayasu arteritis Patient was a member of a support group, where she informed other patients with takayasu arteritis of this new coverage Froedtert Hospital 550 bed academic medical center 24,000 annual admissions >140,000 patient days Disproportionate share hospital 17.25% (FY2011) Affiliated with Medical College of Wisconsin Only Level I trauma center in Southeastern Wisconsin Major referral center: 40 specialties and subspecialties >220 Pharmacy FTE s Administration, Pharmacists, Technicians, EPIC team 2
Affiliation with the Medical College of Wisconsin Froedtert Hospital is the major teaching affiliate of the Medical College of Wisconsin (the Medical College ) A majority of Froedtert Hospital s medical staff is comprised of Medical College faculty members (816 faculty) 330 full time equivalent residents at Froedtert Hospital 413 medical students Close working affiliation between the two organizations Froedtert Hospital and the Medical College jointly operate and own a network of clinical sites for primary care and outpatient clinical initiatives How do we support the intent of the 340 B program? Froedtert Hospital s community benefit framework is to improve the quality of life in the communities we serve through health care programs and services that are measureable, accessible and culturally appropriate; recognizing the greatest impact is in Milwaukee s underserved, urban population. The Setting: U.S. 2010 Census: Milwaukee is #4 in poverty among the nation s cities In Milwaukee County, 30% are on Medicaid and 15% are uninsured Our Investments in 2011: $34 million uncompensated care $41 million in government shortfalls Over 10,000 patient accounts adjusted for charity care $400,000 annual support to FQHC s and a $2 million pledge for capital support Over $58 million in health professions education, including college and high school scholarships/internships for underrepresented students Froedtert Hospital 340B Timeline 3
Enhanced Patient Access Through Outpatient Pharmacies Expansion 92 nd Street Pharmacy (1999) Monday Friday: 730am 7pm Sat, Sun, Holiday: 10am 5pm Specialty Clinics Pharmacy (1995) Monday Friday: 830am 6pm Cancer Center Outpatient Pharmacy (2008) Monday Friday: 9am 5pm Mail Order Medication Management (2011) Monday Friday: 9am 5pm Community Benefit from Pharmacy Service Expansion Prior authorization assistance Medication assistance program support Charity Care Medication Management Home Delivery Diabetes Smart Start Program Medication Collection Program Sharps Collection Program Medication Repository Discharge Program (implemented 9/2011) Ambulatory Care pharmacists Blood pressure cuffs (Newly Transplanted Patients) Prior Authorization Services Our specialty pharmacy team acquires prior authorizations for specialty medications infused, administered, or dispensed at any location across the health system Our goal is to provide a seamless process for patients to receive the medications they need in a timely manner 4
Medication Assistance Program Support Our team also applies for medication and/or co pay assistance on behalf of patients who are uninsured or cannot afford the high copays for their specialty medication Furthermore, team works synergistically with social work, case management and financial counselors to discuss various options for acquiring and paying for needed medications Froedtert Drug Repository Program Operated in accordance with the State of Wisconsin Department of Health Services Drug Repository Program Receives approved medications and re dispenses these medications to patients who are uninsured or underinsured for a nominal, state approved $15 co pay By the Numbers Over $1,000,000 in co pay assistance was afforded to our patients Our team has provided over $750,000 in free medications to our patients through enrollment in pharmaceutical industry free drug programs Drug repository has dispensed almost $300,000 of medication since opening in April 2012 Another $1,100,000 of free medication was acquired for patients in our Day Hospital and Infusion Clinic 5
Medication Management Mail Order Service Targets patients with complex medication therapy regimens Transplant HIV Cancer Diabetes Enrollment is free and includes the following services: Medication review in an integrated care setting Patient counseling Home medication delivery Assistance with insurance coverage problems Medication Management Mail Order Service Improved patient outcomes in the renal transplant population in an integrated care setting Pharmacist Managed Hepatitis C Clinic Pharmacist integrated within the GI/hepatology clinic patient care team Provides in depth new start patient education on hepatitis C medication therapy Offers to enroll patients in medication management mail order service and access to specialty pharmacy services Follows up with patients to promote understanding and adherence and mitigate adverse effects 6
Pharmacist Managed Hepatitis C Clinic Increased percentage of patients reaching completion of therapy Pharmacist Managed Hepatitis C Clinic Increased percentage of patients reaching sustained virological response (SVR) CE Question Does the 340B program provide disproportionate share hospitals the ability to expand services due to their ability to saving dollars on outpatient drugs? True or False? 7
CE Answer True Additional Questions? Binita Patel, PharmD, MS Director of Ambulatory/Retail Pharmacy Froedtert & Medical College of Wisconsin 9200 West Wisconsin Avenue Milwaukee, WI 414 805 6512 Binita.patel@froedtert.com 8