1. 340B Implementation: An Opportunity for Improved Health Outcomes in Communities Todd D. Sorensen, Pharm.D. Associate Professor University of Minnesota

2. Medication Access - Required Component of Primary Care? Access to diagnosis Access to treatment

3. 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.

4. The FOUR CORNERSTONES of Medication Management Access Outcomes Efficiency Quality

5. 340B Meds Samples MAPs Quality Assurance Formulary Medication Monitoring Expenses/ Revenues Patient Safety Adverse Rxns Patient Education Medication Use vs. Cheap Drugs Provider Education Health Collaboratives

6. Westside Community Health Services - St. Paul

7. Four Cornerstones at Westside  Medication Access u In-house pharmacy u Samples in pharmacy u Considering expansion to other sites  Pharmaceutical Care u 3 FTE pharmacists, 2 FTE technicians u Collaborative Practice Agreements u Dedicated exam room for pharmacy  Efficient Business Practices u Medicaid negotiation u Bilingual technicians u Separation of clinical and dispensing time of pharmacists u Seeking $ for robotics/telepharmacy  Quality Assurance u DUE

8. Community-University Health Care Center - Minneapolis  Medication Access u Contract Pharmacy  Pharmaceutical Care u 1 FTE Clinical Pharmacist, 1 resident u CPAs, pain contracts  Efficient Business Practices u Formulary management u Oversight of contract pharmacy  Quality Assurance u Sample meds/MAPs u Availability of languages

9. Medication Therapy Management Services (MTM)  Recognizes the role pharmacists can play in improving the health outcomes of patients u Example: Clinical Pharmacy Demonstration Projects – Demonstrated value of pharmacists actively managing diabetes patients u Component of Medicare Part D (Jan. 1, 2006) u Established in Minnesota Medicaid by legislation passed July 2005 u Compensation for collaborating with prescribers and patients to manage medication use…compensation is independent of medication dispensing

10.  Commit to more than affordable access u Strive for high quality, comprehensive pharmacy services as the standard of care u 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 Take Home Messages…