Addressing Barriers to Rx Access

UConn Health is now part of the Dispensary of Hope Network, which means it can connect qualifying patients with no-cost prescriptions for certain medications that the pharmaceutical companies make available. Emmett Sullivan and Dr. Hetal Patel from the UConn Health Pharmacy explain the program, which is only the third of its kind in Connecticut and joins about 250 other pharmacies throughout the U.S.

(Dr. Hetal Patel, Emmett Sullivan, Carolyn Pennington, Chris DeFrancesco, December 2023)

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Transcript

Chris: We frequently hear about how expensive medications can be and how cost can be a barrier to those who need their prescriptions. Today on The Pulse, we learn about a new program at UConn Health that takes aim at those barriers.

This is the UConn Health Pulse, a podcast to help you get to know UConn Health and its people a little better, and ideally leave you with some health information you’ll find useful.

With Carolyn Pennington, I’m Chris DeFrancesco. When someone is in a position to have to choose between filling a prescription or meeting other needs, there often aren’t any great choices.

Carolyn: But now, UConn Health is partnering with a group that has a mission to overcome those barriers and improve access to medications through what are known as Dispensaries of Hope. Here to tell us more about it are pharmacy director Emmett Sullivan and pharmacy manager Dr. Hetal Patel. Thank you both for being here today.

Dr. Hetal Patel: Thank you for having us.

Carolyn: So why don’t we kick it off with you, Dr. Patel, and tell us what is behind the idea of the Dispensary of Hope Network?

Dr. Hetal Patel: Dispensary of Hope actually came up in 2003, and it was an organization that realized that pharmaceutical companies had a tremendous amount of waste that were not being utilized. So they ended up coming up with an organization where they created a formulary list of medications that probably entail about 400 drugs that are on there, and it impacts multiple disease states, from cardiovascular issues to diabetics, gastrointestinal, dermatology.

So there’s quite a bit of medications that they can choose from, and they just realized that a lot of pharmaceutical companies, when these expiration dates were coming up, they were being underutilized and incinerated. So why not give it back to the public that actually needed these medications? So they ended up coming up with a program that actually involves pharmacies throughout the nation, which could actually utilize these medications.

The downside is, they have a short expiration date, but they’re still getting into the hands of patients and resulting in having them become more adherent to their medications.

Carolyn: How unique is this to Connecticut?

Dr. Hetal Patel: This is actually extremely unique. We only have four locations in New England itself, UConn being the third location in Connecticut. The closest locations that we currently have are Hartford Healthcare and St. Vincent’s out in Bridgeport.

Chris: Alright, so folks around here will have a new option now if they have this more immediate need.

Dr. Hetal Patel: Correct, yeah.

Chris: It almost sounds like this is like, the food bank will rescue food that the grocery stores are going to get rid of. It’s kind of sounds like a similar concept with the pharmaceutical companies.

Dr. Hetal Patel: Yes.

Emmett Sullivan: That is a great analogy to make, for where people might be exposed to something of this nature. There are limitations, obviously, because not every medication, just like not every can of vegetables, is going to be available at the food bank. They have a distinct list that Hetal referred to earlier, but they also will have a flux list that will change on a quarterly basis. So it may not be available this month, but may be available next month for you based off of the oversupply of medications that are in the supply chain.

Carolyn: Could you give us some examples of like patients that can benefit?

Emmett Sullivan: One medication that they always have on their list is warfarin, which is used for, as a blood thinner.

Carolyn: Right, very common.

Emmett Sullivan: But they only have one strength available that’s available all the time. We have to work with what we have to work with. But on a quarterly basis, they may flex up to have other strengths available. So the pharmacist will work with the provider, the prescriber, to adjust the dose prescribed to match what’s available to get the patient the medication.

Now, Dispensaries of Hope get the medication to the pharmacy at no cost, and then the pharmacy passes that medication on to the consumer or the patient at no cost as well. So it’s a true financial benefit for those patients.

Carolyn: That’s great.

Emmett Sullivan: There are limitations on this, that they want to make sure it’s going to the patients of need. So the patients need to sign off on a waiver acknowledging their lower threshold of income for their household, and also lack of insurance, because if someone is insured, they should take full advantage of insurance as well.

Carolyn: So is it the pharmacist that finds the patients in need, or how do patients find out about this?

Emmett Sullivan: We’ve just enrolled in this program with Dispensary of Hope in the last month. We’re getting published on their website, and it’ll be searchable through other means. And by doing podcasts like this and getting other media attention, we’ll give patients better awareness that this program exists.

Chris: How did UConn Health get involved with this, and why?

Dr. Hetal Patel: In my previous positions, I was familiar with Dispensary of Hope. When I came on board, I think it was kind of the stars aligned, because this was Emmett’s vision as well for UConn Health’s pharmacy. And one of the things that he was currently doing was, he was trying to move forward with the financially impacted patients and seeing how we can provide medications to them at no cost.

In turn, like I said, it does make the patient more adherent, which improves their disease state, but also it benefits the hospital organization as well, because right now patients that are nonadherent to medications, it’s a huge cost to the hospital organization as well. So I know Emmett was working on it both ways, so we ended up collaborating and we came up — we knew that Dispensary of Hope was out there, it would definitely benefit our patients along with the organization in an impactful way, and we ended up giving it a go and it’s been successful. We’ve launched about almost less than a month ago, and I’d like to say we have at least a good 10 patients so far that are being impacted with this program right now that we’re able to serve.

Carolyn: Do you have a goal in mind of how many patients, or have you heard from the other hospitals or pharmacies involved, like how successful they’ve been?

Dr. Hetal Patel: I haven’t heard from local pharmacies, but I know that there are pharmacies currently that are active with the program. There was an article that I had read about a pharmacy out in Tennessee. They were able to impact about 500 patients through this program, which ended up having a cost on the financial burden to the institution by over $2 million. Because a lot of times when you have these that are nonadherent to medications, you typically tend to see their hospitalizations go up, their ER visits go up, their hospital stay typically tends to be much longer than those patients that are adherent, one to two days compared to up to five to seven days for these patients, and they tend to have annually more hospital visits as well — three more visits, which are up to about $2,000 per visit compared to anyone that is adherent to medications.

Chris: So that example you just gave in Tennessee, the $2 million figure you gave represented savings that were achieved by that particular institution because of a shift more toward preventive care and away from emergency or urgent care or hospitalizations.

Dr. Hetal Patel: Correct. Yes. So I’m not sure about any of the numbers that we have locally, but that was an example of a pharmacy that was very impactful, and hopefully one day we can produce those numbers as well.

Carolyn: So it sounds like a wide variety of patients, too, can benefit. I mean, you had said the warfarin, which is for heart patients, something like that, so it’s the gamut of medications.

Dr. Hetal Patel: And insulin tends to be actually one of the biggest barriers for diabetic patients. These patients, just so you’re aware, they fall into this category of like a Medicaid gap, so you would say, where they can’t afford to be a part of Medicaid, but they can’t afford to take on their own insurances and less than 40 percent of this population with cardiovascular diabetic issues are actually adherent to their medications, because of the fact that they’re stretching out these medications, they don’t want to pay the cost, they’re extending their refills. And insulin is one of the biggest impactful medications that we carry, because of the fact that we are able to have access to this class of medications that would be beneficial to this group of people.

Chris: Let’s use insulin as an example, Emmett. So someone hears this and has a diabetic in the family who falls within the parameters that could be eligible for this. What are that person’s next steps in order to obtain this insulin through the Dispensary of Hope program at UConn Health?

Emmett Sullivan: There are several different formulations of insulin that are available.

We want to make sure that we work with the provider, the prescriber, and get the formulary, or the formulation that’s on our list at Dispensary of Hope prescribed. Patient can present the prescription either electronically or bring in a hard copy, if that exists, and it’ll be filled at the pharmacy at no charge to the patient.

Chris: And this is over the exchange?

Emmett Sullivan: This would be over at 270 Farmington Avenue, in the Exchange building, correct. It’s just that simple. And the provider does not need to be a UConn Health provider. It could be a prescriber in the community. So if there’s a need in an urgent care setting, or wherever a patient may be going for care, that prescription would still be an acceptable order.

Chris: If this is only the third Dispensery of Hope in Connecticut, how well known do you think it is among community providers that this is even an option for their patients who may be struggling to deal with getting a prescription filled?

Dr. Hetal Patel: I think that’s where the barrier lies. And I think that’s, with your help, we’re hoping to get this message out, because I don’t think a lot of providers are aware, especially within our own organization.

A lot of times when we have a patient that comes up with any financial needs, we do send the formulary over to the provider so they are aware that we are part of this program. At this point they can choose from this program as well. So their patients can get overall refills time after time from this program. But I think that that is going to be our biggest barrier, like I said, is educating these providers and just getting the word out letting them know that we are a part of such a great program that will benefit our patients.

Chris: So we really could attack this from multiple angles, right, like educate the patients so they know to ask for it, educate the providers to let them know this is an option, and maybe even like our own community here at UConn Health, when they have a conversation with their parents or their family members, to raise the awareness.

Carolyn: It seems like this fits in with the academic mission that UConn Health has too, that it’s actually helping to, like you said, educate the patients and our public mission.

It seems like this fits very nicely into that.

Emmett Sullivan: It definitely helps the patients, especially when the patients are in that brutal state where their income is not quite enough to make all their ends meet. And yet not low enough, I hate to say it that way, but to where they would fall into other safety net programs that are available for them.

So it’s that gray area that really is beneficial for the, for the patient. And qualification does not depend upon immigration status, does not depend upon any other barrier other than the financial threshold, and also having insurance. So once you clear those two components, the whole program is opened up to the patient.

Chris: It almost seems like it’s kind of reflective of where Connecticut is with a focus on preventive health. But I believe you were telling me before we started that there are several hundred Dispensary of Hope Network affiliates throughout the country. So this is a pretty far-reaching thing.

Dr. Hetal Patel: Yeah, and it’s been out for quite a bit of time. So I think that the word is still getting out there in Connecticut. We are just starting to introduce ourselves to it, but there is other organizations that are out there, nationwide, that do provide this benefit to their community as well.

Chris: How often — I think you said every quarter the list of eligible medications is updated — how does that work? And how much lead time do you get so you can kind of prepare and prepare the potential recipients and prescribers?

Emmett Sullivan: Ideally we’d have the prescriber ordering medications that are on the consistent list. That’s a static current list That does not change from quarter to quarter. But as there is demand, then every quarter they would update from the manufacturers from their excess supply. They then would shift over to the Dispensary of Hope hub what’s available and that information comes out on a quarterly basis. So because we’re just new into this system, we don’t know exactly the pure cadence on it. We haven’t seen the second order come in as of yet. But as we’re getting new to this, I would expect an update to be occurring in the next 10 weeks on other medications that could be added onto the flexible list.

Chris: Would that list be something that’s publicly accessible? Would that show up on a UConn Health website someday once you kind of get up and running with that? Or is that more of a, kind of an inside list?

Emmett Sullivan: No, it’s, we’re not holding any secrets on this. This is too good of a program to hold back. And it not only will be available on our website, but it’s also available on the Dispensary of Hope website as well on a national level.

Carolyn: Are there any medications that will never be on the list?

Emmett Sullivan: You’re probably not going to see narcotics. You’re probably not going to see certain lifestyle medications, which is to say, Viagra, for lack of a better term. I have not seen any class of medication being crossed off the list. Dr. Patel, have you seen anything that was crossed off the list out of those two?

Dr. Hetal Patel: No, there are pain medications that are on there, but just not the Schedule 2 drugs or any controlled medications. But when it comes to any sort of class, I think it’s really what they have access to. So it’s pretty much a big array that they can choose from.

Chris: Before we say goodbye, is there anything else that we need to make sure to let the public know, or anyone who’s listening know, about the Dispensary of Hope program UConn Health is now affiliated with?

Emmett Sullivan: I would say that when you walk up to the pharmacy, it’s not going to say “Dispensary of Hope” on the outside of the pharmacy. It’s still going to say UConn Health Pharmacy Services at the Exchange, 270 Farmington Avenue, so the branding isn’t there. Dispensary of Hope is more of a service that’s provided out of licensed pharmacy that we have here on campus.

Chris: Very good. So we will include in the notes of this show information on how to find out more about that and where they can learn more. So Emmett Sullivan, UConn Health pharmacy director, and pharmacy manager, Dr. Hetal Patel, thank you both for joining us to talk about the Dispensary of Hope here at UConn Health.

That is our time for today and for Dr. Hetal Patel and Emmett Sullivan, and Carolyn Pennington, I’m Chris DeFrancesco. Thank you for listening to the UConn Health Pulse. Be sure to subscribe, so you can catch us next time, and please share with a friend.