Transcript Medication access at a free, urban clinic: a light in the economic storm

Mary Herbert, MS, MPH
Clinical Director, Program for Health Care to Underserved Populations
Sharon Connor, PharmD
Assistant Professor, University of Pittsburgh, School of Pharmacy
Director, Grace Lamsam Program
Lauren Jonkman, PharmD
Instructor, University of Pittsburgh, School of Pharmacy
Millions falling through the cracks

Sept 2009: 46 million uninsured in US

July 2009: 8.5% of Pennsylvanians
unemployed
 50% increase over 1 year!
increase in unemployment rate 
increase in the number of uninsured 
increased need for safety net services
Community Campus Partnership
=
Safety-Net Provider
University of Pittsburgh
School of Medicine / Department of
General Internal Medicine
Program for Health Care
to Underserved
Populations
University of
Pittsburgh School of
Pharmacy
Grace Lamsam
Pharmacy
Program
Salvation
Army
The Birmingham Free Clinic
Health
Care for
the
Homeless
What do partners bring?
Program for Health Care to Underserved
 Admin oversight; network of volunteer physicians; servicelearning opportunities for medical students; specialty services
and AmeriCorps Members’ service
 Salvation Army
 Genesis and evolution of Birmingham Clinic; in-kind donation of
physical space, maintenance and utilities; provides community
access
 Grace Lamsam Program
 Network of volunteer pharmacy faculty; on-site dispensing and
medication management; service-learning for pharmacy
students
 Health Care for the Homeless
 340B purchasing power
 Annual grant support

Birmingham Free Clinic
Est. 1994
Who do we see?
Homeless = 52%
 Uninsured = 98%
 Male = 69%
 Minorities = 45% African American & 19% Latino
 Low SES = 73% at or below federal poverty limit
 Patient Encounters = ~2,100 annually
 Unemployed = doubled over past year

How do we meet medication needs?
1.
Limited formulary
purchased through:
○
○
340b HCH funding
programmatic budget
Samples
3. Limited $$ through grantfunded vouchers
4. $4 prescription programs
5. Pharmaceutical
Manufacturer
Assistance Programs
(PMAPs)
2.
How much do we receive?
1.
PMAPs = ~ $20,000 estimated monthly value
○
○
2.
139 patients currently receiving meds
~ 60 individual medications received / month
Purchased meds = ~$100 monthly
○
○
antibiotics, miscellaneous
chronic meds not available through PMAPs
How do we do it?

Volunteer pharmacists
○ identify patients with chronic medication needs
○ work side-by-side with clinicians to make best
therapeutic substitutions, and AmeriCorps
members to facilitate PMAP application process
○ provide Streamlined,
patient counseling Efficient,
& medication
reconciliation services
Collaborative Approach

Two AmeriCorps National Service
Members
○ dedicated to processing, coordinating and tracking
applications
○ aide pharmacists in identifying patients &
“paperwork”
What is the impact?

More medication options for patients &
clinicians
○ Increase opportunity for disease control
Expand access with limited impact on
medication budget
 Support addition of specialty clinics

○ mental health services
○ cardiology

Evolve pharmacist’s role
○ medication therapy management
○ refill clinic
What are the “keys to success”

Dedicated, cost-effective staff
○ AmeriCorps Members are key
 Annual stipend = $8,400 vs. $200,000+ annually in free
medications for uninsured patients!

Pharmacist involvement
○ “wrap-around” care

Partnerships
○ Allows for success in making program work within the
processes/structure of clinic itself
 community agencies
 universities
 others
Thank you!
Mary Herbert, MS, MPH
Clinical Director, Program for Health Care to Underserved Populations
[email protected]
Sharon Connor, PharmD
Assistant Professor, University of Pittsburgh, School of Pharmacy
Director, Grace Lamsam Program
[email protected]
Lauren Jonkman, PharmD
Instructor, University of Pittsburgh, School of Pharmacy
[email protected]