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340B Implementation: An Opportunity for Improved Health Outcomes in Communities Todd D. Sorensen, Pharm.D. Associate Professor University of Minnesota Medication Access - Required Component of Primary Care? Access to diagnosis Access to treatment Required Component of Primary Care? Economic Disparity • 49 million Americans lacked health coverage in 2002 • 23% of American under 65 have no Rx coverage • Drug prices paid by those w/o drug insurance are 15% higher than those with insurance • UI, non elderly spent an average of $30. 76 for Rxs compared to $9.96 (insured) and $5.53 (generic) for insured. Clinical Disparity • 27% UI said needed a Rx drug but did not get it compared to 10% of insured • 42% of UI with HTN not taking medication compared to 25% of UI • 43% of UI with elevated cholesterol not taking medication compared to 29% of insured. The FOUR CORNERSTONES of Medication Management Access Outcomes Efficiency Quality Medication Use vs. Cheap Drugs MAPs Patient Safety Expenses/ Revenues Patient Education Medication Monitoring Quality Assurance 340B Meds Provider Education Adverse Rxns Samples Formulary Health Collaboratives Westside Community Health Services - St. Paul Four Cornerstones at Westside Medication Access In-house pharmacy Samples in pharmacy Considering expansion to other sites Efficient Business Practices Pharmaceutical Care 3 FTE pharmacists, 2 FTE technicians Collaborative Practice Agreements Dedicated exam room for pharmacy Medicaid negotiation Bilingual technicians Separation of clinical and dispensing time of pharmacists Seeking $ for robotics/telepharmacy Quality Assurance DUE Community-University Health Care Center - Minneapolis Medication Access Contract Pharmacy Pharmaceutical Care 1 FTE Clinical Pharmacist, 1 resident CPAs, pain contracts Efficient Business Practices Formulary management Oversight of contract pharmacy Quality Assurance Sample meds/MAPs Availability of languages Medication Therapy Management Services (MTM) Recognizes the role pharmacists can play in improving the health outcomes of patients Example: Clinical Pharmacy Demonstration Projects – Demonstrated value of pharmacists actively managing diabetes patients Component of Medicare Part D (Jan. 1, 2006) Established in Minnesota Medicaid by legislation passed July 2005 Compensation for collaborating with prescribers and patients to manage medication use…compensation is independent of medication dispensing Take Home Messages… Commit to more than affordable access Strive for high quality, comprehensive pharmacy services as the standard of care The most expensive medication is one that doesn’t work 340B program can be leveraged to increase access to medications AND improve health in a community Expertise and experience is critical to create a comprehensive program