Implementation of a comprehensive pharmaceutical care program for an underserved population

Area of Science:

• Health Services Research
• Pharmacy Practice
• Health Economics

Background:

• University of Iowa Hospitals and Clinics (UIHC) established a prescription benefit program for indigent patients via the IowaCare Medicaid waiver.
• Rapid enrollment growth and budget cuts necessitated cost-control measures for the UIHC pharmacy program.

Purpose of the Study:

• To describe the implementation of a prescription benefit program for low-income patients.
• To review program expenditures and cost avoidance strategies.
• To assess the impact of clinical pharmacist services and formulary control on program costs.

Main Methods:

• Established an ambulatory care clinic staffed by clinical pharmacy specialists.
• Increased reliance on a generic formulary.
• Collaborated with social services for brand-name drug assistance.
• Optimized purchasing via the federal 340B Drug Pricing Program.
• Implemented medication copayments and mailing fees.

Main Results:

• Expanded indigent patients' access to pharmaceutical care services.
• Reduced patients' use of hospital and emergency room services.
• Lowered program medication costs by an estimated 50% (from $2.6M in FY09 to $1.3M in FY10).

Conclusions:

• The UIHC ambulatory care pharmacy successfully addressed medication needs of low-income and uninsured patients.
• The program achieved fiscal responsibility through managed purchasing, formulary revision, copayments, and medication profile reviews.
• The initiative demonstrates effective cost-management strategies in public health pharmacy programs.