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Monday, December 16, 2002

By Christopher Snowbeck, Post-Gazette Staff Writer

In one of the few such programs in the nation, people struggling to afford their medicines can buy prescription drugs at roughly half the retail price, as long as they become patients at a growing list of federally funded health centers in the region.

	Dr. Katherine Homrok, executive director of Metro Family Practice, left, watches as Elaine Parker of Point Breeze plays with her 7-month-old daughter, Marley, at the Wilkinsburg clinic. (Lake Fong, Post-Gazette)

Coordinated Care Network, a Monroeville nonprofit group, created the pharmacy program, which will enable more than a dozen community health centers in Western Pennsylvania to dispense deeply discounted medicines to their patients.

Currently, the system is running only at Metro Family Practice in Wilkinsburg, but it will soon operate in East Liberty, the North Side and at a health center in Sharon, Mercer County. There's also talk of expanding the program to Erie, Ohio and New Mexico.

Community health centers are open to all patients regardless of their insurance status, but the prices the patients pay for the drugs vary with income. And if they belong to an insurance plan with pharmacy benefits, they will make their usual co-payments, and any extra money that Coordinated Care gets through such plans will help to subsidize costs for poorer patients.

The cheap drugs are available because of extraordinary discounts that pharmaceutical companies must offer to federally funded health centers.

The Public Health Service Act, which was passed in November 1992, forced pharmaceutical companies to make a difficult choice: Either provide deep discounts to certain government-supported facilities or lose the Medicaid program as a customer.

Since the Medicaid business represents about 12 percent of all sales, drug companies opted to provide the discounts, said Bill von Oehsen, a Washington lawyer who represents the National Association of Public Hospitals and Health Systems.

Still, most such centers around the nation aren't taking advantage of the drug discounts because they can't afford to operate their own pharmacies and they haven't contracted with nearby pharmacies to offer the more economical drugs.

The Monroeville group's approach is different from clinics that operate their own pharmacies or contract with private drugstores.

Using grants from the federal government and local foundations, Coordinated Care Network has created a central pharmacy that stocks several satellite dispensaries in the community clinics.

"I don't know of any other program that offers on average a 56 percent discount on medicines," said Jeff Palmer, chief executive officer of the network, referring to the overall savings for a group of 28 popular medicines. "The only thing that comes close to it is an international program," such as those that buy drugs from Canada.

Savings dramatic

The savings can be dramatic. A one-month supply of 30-milligram Prevacid capsules, a medicine that reduces the production of stomach acid, costs $118 at the Eckerd pharmacy chain Web site. The price to government clinics participating in the federal discount program is $8.

Not every discount is that vast, but an analysis of the 28 popular medicines by the Coordinated Care Network found an overall savings of 56 percent, compared with prices listed at CVS.com and a local CVS pharmacy.

The analysis also found the network's average prices were about 10 percent lower than those offered by Dr. Joseph Rudolph, an asthma and allergy specialist in Pleasant Hills who dispenses medicines purchased in Canada through his Physician Dispensing Program. That program provides local patients three-month supplies of medicines bought in Canada.

Another study looked at the top 200 prescription drugs and found that the federal discount program price was 18 percent better than the Canadian price, von Oehsen said.

Coordinated Care Network's program began dispensing medicines in Wilkinsburg in September and has filled more than 600 prescriptions. About one-fifth of the prescriptions have gone to people who lack drug coverage. Those patients pay the federal discount price or less, depending on their incomes. Middle-income patients who don't have drug insurance pay slightly more than the federal discount price.

While the program is meant to help low-income people who lack coverage, it also provides medicine to people who have insurance, feeding back to the community centers any surpluses to help patients who can't afford the discounted prices.

Those extra funds help people such as Ron Mitchell, 56, of Manchester, who switched primary care physicians in November so he could take advantage of the savings.

Mitchell is unemployed, but continues to have health and pharmacy benefits through a program that provides him with housing. The Coordinated Care Network program subsidizes his co-payments for the half-dozen medicines he takes for his diabetes.

Ensuring compliance

Dr. Katherine Homrok, executive director of Metro Family Practice, said one of the biggest values of having the drugs available at the clinic is that it boosted patients' compliance in taking their medicines.

When Palmer, director of Coordinated Care Network, was executive director of the East Liberty Family Health Care Center, he regularly found prescriptions stuffed in a lobby garbage can by patients as they left the center. In many cases it was because patients lacked coverage and couldn't afford the medicines.

In other cases, ignorance played a part.

Palmer recalled helping one woman who had taken her four children on two buses to get care for a child with an earache. Palmer watched the children in the waiting room while the mother and her sick child were with the doctor, but was shocked when the group left because the woman threw away her child's prescriptions for an antibiotic and cough syrup.

When he investigated further, Palmer determined the woman had full coverage for the medicines, but didn't realize it. Plus, "She needed to get home to feed her kids and didn't think she could get to the pharmacy," Palmer said. "That's when I said, we've got to install a program to try to avoid this."

Palmer has been working on the concept for the pharmacy program ever since, winning $900,000 in grant money for the project in 2001 from the federal government's Health Resources and Services Administration. The agency gave the project another $700,000 this year. The pharmacy project also has been funded by the Richard King Mellon Foundation.

The money was needed to build, stock and staff the central pharmacy in Monroeville, which was finished in February. Grant money also pays for computers and medicine cabinets placed in the satellite dispensaries.

In the next six weeks, the program will begin at East Liberty Family Health Care Center, the North Side Christian Health Center and a health center in Sharon, Mercer County.

The Sharon health center is the first of 10 centers in the Primary Health Network that will join the program. All of the centers, which are in a region bounded by Crawford County in the north and Beaver County in the south, could be in operation by summer.

Jack Laeng, executive director of Primary Health Network, said his group of health centers couldn't afford to create a pharmacy program without the Coordinated Care Network. Some new patients will be likely to come to the centers to take advantage of the program, Laeng said, but he couldn't estimate how many.

"Those people [who] take buses to Canada, I think they would be very interested in taking advantage of this program," Laeng said. "But it all goes back to the relationship between the individual and the doctor -- you have to be an established patient of our network."

Alma Illery's story

There is one other federally funded clinic in the region that offers the discounted drugs: Alma Illery Medical Center, based in Homewood.

Wilford A. Payne, executive director of Alma Illery, said his main office had its own discount drug pharmacy, but that he might contract with the Coordinated Care Network to provide discounted drugs to some of his 12 satellite clinics.

Payne said he did not want to put the pharmacy program into his Duquesne, McKeesport and Hazelwood offices because it might hurt nearby retail pharmacies, which are important community assets.

Coordinated Care Network also plans to install the program at health centers in McKees Rocks and Lincoln-Lemington.

Rudolph, the physician who runs the local program to buy medicines from Canada, said he welcomed the new option for patients. The two programs might reach slightly different groups of patients, he said, because his program delivers three-month supplies of medicines for chronic illnesses.

There is a four-week lag between when the medicine order is placed and delivered in Rudolph's program, while the Coordinated Care Network program delivers many medicines immediately. Any drugs not stocked in the office medicine cabinet can be delivered the next day to the patient's home. If the medicine is needed immediately, patients are referred to retail pharmacies.

More information about the pharmacy program is available by calling 412-349-6300.