ISAC Spring Conference March 15 2018 Donated medications save lives Iowa Heart utilizes the Drug Donation Repository to provide enoxaparin injections to patients pre and post cardiac procedures ID: 683924
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Medication Access for Patients in Need
ISAC Spring ConferenceMarch 15, 2018Slide2
Donated medications save lives.Iowa Heart utilizes the Drug Donation Repository to provide enoxaparin injections to patients pre and post cardiac procedures. Without the donated enoxaparin between 50 to 75 patients annually would be unable to undergo life saving procedures. In most states these medications would be discarded.Slide3
Safety Net Services
Address issues of pharmaceutical access through innovative, non-traditional partnerships.
Leverage scarce resources and create value for all stakeholders in our health delivery systems.
Short-term, Gap Assistance
Focus: Safety Net Patients – High cost users
Uninsured and Underinsured
Medicare eligible IowansIndividuals with Chronic Behavioral Health DisordersState and Local Offenders
501(c)(3)Established in 2001 as the Iowa Prescription Drug Corporation to provide pharmaceutical access to Iowans who cannot afford prescription drugs.Serve Iowa’s Safety Net Patients - uninsured or underinsured Iowans with incomes 200 percent of the federal poverty level or belowSlide4
BMJ2014, 349:g7677
Medication Waste in the US:
An estimated $5B in medications are wasted annually in the United StatesSlide5
Medication Waste in the US:
The Environmental Protection Agency (EPA) estimated in 2015 that about 740 tons of drugs are wasted by nursing homes alone each year.
The US Food and Drug Administration advises consumers to dispose of unused medications in the household trash or flushing meds down the toilet.
The EPA identified 56 active pharmaceutical ingredients in samples taken from 50 very large municipal waste water treatment plants in the US.Slide6
Consequences of Inappropriate Medication DisposalAccidental poisoningUnintended overdosesPrescription drug diversionEnvironmental contaminationCoggins, Today’s Geriatric Medicine, Vol 9, No 1, P8.Slide7
Patient Need in the US:
40 percent of adults in the US delayed or did not get a needed prescription drug due to costSlide8Slide9
Donate Meds. Change Lives.Slide10
Iowa Drug Donation RepositoryOverview: Iowans in need of assistance can receive medications and medical supplies for little or no cost. Donations are received from long-term care dispensing pharmacies, medical facilities, and individuals. The medications and supplies are inspected by a pharmacist, distributed to medical facilities or pharmacies, and dispensed to Iowans in need.
Recipient Eligibility: Iowans at or below 200% of the federal poverty level who are uninsured or under-insured are eligible to receive donated drugs. Donor Eligibility: Any organization or individual in the country can donate medications in their original sealed container or in tamper-evident packaging. Dispenser Eligibility:
Any pharmacy or medical facility with authorization to dispense per State administrative rules may re-dispense donated medications.
Administrative Rules established in 2007
Public Health Department 641-Chapter 109
Regulated by the Iowa Board of PharmacySlide11
donor eligibilityMost Common Donors:Long-term care dispensing pharmaciesMedical facilitiesInstitutional careCommunity pharmaciesPrimary care clinicsSpecialty clinics (Oncology, Neurology, Gastroenterology)
Community mental health centersAny organization or individual in the country can donate medications Donation Requirements:Non-controlled medications packaged in their original sealed container or in tamper-evident packagingNon-expired or short-dated medications dated 6+ monthsMedical supplies and over-the-counter medicationsMust not require refrigerationSlide12
Some Major Disease States Covered by Donated Medications
Alzheimer’s
Asthma
Behavioral Health
Cardiac/Hypertension
Cancer/Chemotherapy
Depression
DiabetesMultiple Sclerosis Parkinson’s
Renal Failure
Seizures
Transplant RejectionSlide13
drug donation repository processSlide14
receiving & sortingOnce medications are received from a facility, medications are sorted prior to inspectionDrugs not kept:Tablets with no markingsBroken/split tabletsControlled substances (CS)
Drug/label do not matchShort-dated or expired medicationsUnusable packagingUnused medications are sent to incinerator, controlled drugs sent back to facilityDrugs kept are sorted by name, strength, and dosage formSlide15
inspectionOnce sorted, the pharmacist inspects each card to determine whether the drug is correctly labeledDrug is identified using Facts and Comparisons/LexicompPharmacist looks at pill color, shape, imprint codes, and NDCDisposal of cards
Split or broken pillsDamaged/deteriorated Packaging is punctured or rippedUnidentifiable/no markingsSlide16
inventoryFollowing inspection, the number of tablets or capsules on each card is counted and entered into inventory
Medication and supply inventory is available online using a username and passwordAn average retail value is assigned to each unit
Inventory is then organized and put on the shelfSlide17
processingAfter inventory, all medications are processed in accordance with Iowa Code 135M.4 and Iowa Administrative Rule Chapter 109All patient information is removed from each card per HIPAA compliance
Drug name, strength, quantity, expiration and NDC remain on cardMedications and supplies in bottles and all other forms undergo same processSlide18
filling & shippingLicensed as a Wholesale DistributorMedical facilities submit orders to SafeNetRx online, via email, phone or fax
Approximately 250+ orders are filled each monthAll orders are filled and shipped via courier service or mail. In the event of an emergency, an order will be hand-deliveredOrders are generally received 1-3 days after being placedSlide19
Drug Donation Repository: Historical Performance
Over 78,000 Iowans have benefitted from donated medications and suppliesSlide20
Drug Donation Repository: Historical Performance
$23.8 Million in donated medication and supplies Slide21
drug donation across the country
Nationwide Rx Reuse Snapshot
As of mid-2016, 42 states had passed laws establishing drug redistribution programs.
Many of these programs are not operational or small; a few successful programs are growing. A few measures have been repealed.
Twenty states currently have enacted laws with operational repository programs.
Nineteen additional states are categorized as having non-operational enacted laws
.Slide22
drug donation across the countryWyoming’s Medication Donation Program was created in 2005 and has helped Wyoming residents fill over 125,000 prescriptions, adding up to over $10 million.
Oklahoma created its program in 2004 and has filled 193,926 prescriptions, worth about $19,151,731 based on the average wholesale price of medication, through the end of June 2016.New York and New Hampshire are the latest states to enact return and reuse programs.Tennessee is refining administrative rules to launch a donation program.Florida and Vermont are developing legislation for adoption.Slide23
Update on Cancer Medication DonationsSince 7/1/16 distributed 4500 units of anticancer medication @ $840,000 26 donations receptacles sent to 11 participating sitesSlide24
Drug Donation Repository: Return on InvestmentIowa’s Drug Donation Repository Program is the largest drug repository in the country. Over 78,000 have been provided medication and supplies since the program was established in 2007.*
Over $21.5 million in free medical supplies and medications has been shipped to participating medical facilities and pharmacies.Over 230 medical facilities and pharmacies partner with
SafeNetRx
to dispense donated medications to Iowans in need.
Every
$1
used to administer the program yields over $8 in donated medications and supplies.*Total based on number of patients served quarterly as reported by participating medical facilities and pharmacies. Slide25
Drug DestructionSlide26
Medication Collection and DisposalSlide27Slide28
Acceptable
Not Acceptable
Unused or expired medication, prescription (Rx) or over-the-counter (OTC), including:
Pills, tablets, capsules
Ointments, creams, lotions and powders
Inhalers, nebulizer solutions
Liquid medicinesSolutions, suspensionsLiquids must be wrapped in a paper towel and placed in a sealed plastic bag before being placed in a EcoReturns container.Controlled Substances* including Adderall, Vicodin, Demerol, Hydrocodone, MS Contin
, Ambien Any sharps (syringes, lancets, etc.) Home based care (HBC) or durable medical equipment (DME) supplies, such as rubbing alcohol.Slide29
Funded by the Iowa Board of Pharmacy
Partnership with the Iowa Pharmacy Association400 units placed in service across the stateIncinerated over 2,000 lbs. of medicationSlide30
Justice ProgramsSlide31
ADDRESSING HIGH RATES OF RECIDIVISMTo effectively reduce the rates of recidivism in Polk County, offenders identified as mentally ill should be targeted. Polk County Jail: 25% of Inmates, those potentially having mental illness, accounted for 45% of All Bookings
During the last seven and one-half year period, since the new Polk County Jail opened, 25% of Polk County inmates identified as mentally ill (16,632 of 66,069 total inmates) accounted for 45% of the bookings (70,207 bookings of the 156,098 total bookings). Of the 16,632 inmates identified as mentally ill, 74% of this group are recidivists (12,306 inmates). Consistent finding over timeSlide32
Program UsageStudy period March 4, 2013 – December 31, 2016575 program participantsUp to 3 – 30 day supplies of psychotropic prescriptions; some have used the program more than once or received a partial scriptSlide33
Recidivism analysisProgram completers recidivate significantly less than non-participants with a mental illness indicator.Slide34
Program Participants Who Have Stayed out of Jail203 Participants have stayed out of jail since interacting with the program42 with 3 or more 30-day scripts161 with Less than 3 30-day scripts
Many have stayed out for a relatively long timeMany had more bookings than the average MI inmate : 4.01Slide35
Iowa Department of Corrections Central Pharmacy PilotProvide 90 days of behavioral health prescription drug coverage for transitioning State offenders.
Upon Release:Individuals given a 30-day supply of all current medications. Eligible behavioral health prescriptions (30-day RX with one 30-day refill) are transferred directly from DOC Pharmacy to a participating local pharmacy.
Extends behavioral health medication benefit period to a full
90 days
.
Program launched April 1, 2013Slide36
Iowa Department of Corrections Central Pharmacy Pilot
2,162 DOC Patients served since April 2013.Slide37
discussionJon Rosmann, CEOJon.Rosmann@safenetrx.org515.327.5405Laura Sands, Senior Program ManagerLaura.Sands@safenetrx.org
515.327.5405