Facility collects excess samples to meet 'growing need'
November 1, 2008
With medication costs rising and the economy faltering, more and more people are having to choose between paying for their prescriptions and paying for daily living expenses. Those who choose to forgo their medications can put themselves at serious health risk.

A dispensary service from Saint Thomas Health Services in Nashville, Tenn., is helping low-income people avoid this dilemma by providing them with free medications culled from the "sample drug" stashes so common in physician offices.

Under the Dispensary of Hope model, doctors' offices are recruited to donate their unused medication samples. The offices regularly receive these samples free from drug companies, and many go unused. The dispensary provides participating doctors' offices with a bin to put in their drug sample closet. The offices "clean out their closets" periodically and fill the bin with unused, unexpired samples. They send the bin to the Dispensary of Hope via a shipping service and receive an empty bin in return to begin the cycle anew.

After receiving the bins, the dispensary sorts and repackages the medications. People whose income is below 200 percent of the federal poverty level can receive these medications at no cost through hospitals, clinics, pharmacies and government health departments that are partners of the dispensary. Prescriptions are filled by mail order.

"If you know how Netflix works, that's how we work," said Jason Dinger, vice president for Saint Thomas Health Services Ventures, which oversees the dispensary. The Netflix movie exchange program mails out the movies that consumers request directly to their homes.
Reduced Waste

The Dispensary of Hope was the brainchild of Dr. Bruce Wolf, a physician who was affiliated with Saint Thomas and who now is the system's director of strategic partnerships and medical director. He was disturbed at the amount of sample medications wasted in the typical physician office. Drug companies provide physicians with large quantities of samples, but those samples do not always match with patients' needs, particularly when it comes to seasonal conditions such as allergies. Also, with new drugs frequently coming on the market, older — but effective — drugs may be overlooked in the sample closet. For these and other reasons, an estimated $16 billion worth of samples is wasted each year nationwide, according to statistics from Saint Thomas.

In an effort to reduce waste, around 2004 Wolf began collecting drug samples from a handful of colleagues and repackaging them for use by people in need. Dinger and his Ventures team took Wolf's model and expanded it. The Ventures team now recruits physician offices, other health care providers and drug companies to donate samples — about 100 physicians sign on each month. Donors and recipients alike can be from any state, although most now are from Tennessee.

The dispensary now has a formulary of about 500 medications, some in multiple strengths. So far this year, the dispensary has provided more than 100,000 prescriptions with an estimated value based on average wholesale pricing of $20 million to $30 million.

"We are fortunate to have a very good supply of medications," said Dinger. "We have had a good response from our community — we've been overwhelmed by the response of our physicians."
Established Partners

Dinger said a key to the dispensary's success has been its practice of working with established partners, when it comes to both the medication donors and to the facilities that dispense the medications. Since the drug industry is highly regulated and the pedigree of drugs is extremely important, the dispensary relies heavily on the expertise of its partners. Partners include physician offices, hospitals, clinics and government-run facilities.

The state of Tennessee has supported the dispensary's work by providing a $1.35 million grant to develop the dispensary network and expand its scope of services. Saint Thomas Health Services has given $1 million to the dispensary.

The dispensary has demonstrated a healthy return on these and other investments. Saint Thomas estimates that for every dollar invested, the dispensary returns $25 in value.

Other partners are community organizations like Nashville's Youth Benevolent Fund and United Neighborhood Health Services, which serve low-income people. The partner organizations sometimes provide volunteers to help at the dispensary.

Dinger said the program addresses a critical gap in the continuum of health care services. "Often as service providers we think about providing a medical home, but we often struggle to think about how to then provide for the medication that that medical home prescribes."

He said that it makes sense for health care providers to take a close look at the medicine needs in their communities. "Providers need to realize what a growing need medication access is. We need to realize that if patients don't get that medication, then they are going to end up in that medical home — or in our hospital ERs — again and again."

The Dispensary of Hope program has been replicated in Tennessee's Johnson City, Knoxville and Murfreesboro, and in New Orleans.
Medication Access Concerns And Price Pressures

* According to statistics from Saint Thomas Health Services of Nashville, Tenn., 23 percent of uninsured people in the U.S. forgo filling needed prescriptions. Because of their payer status, they may have to pay 72 percent more for drugs than the insured.
* From 1997 to 2007, retail prescription prices increased an average of 6.9 percent per year, a pace more than two and a half times the average national inflation rate for that period, according to the Kaiser Family Foundation.
* A 2005 Urban Institute study found that almost half of uninsured adults with chronic conditions forgo needed medical care or prescription drugs due to cost.

Copyright © 2008 by the Catholic Health Association of the United States. For reprint permission, contact Donna Troy at dtroy@chausa.org or call 314-253-3450.
Author:
JULIE MINDA
Original Source:
Catholic Health World
Media Contact:
Lauren Fulton
(615) 254-0575
lfulton@jarrardinc.com