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Case Study: Cooperative Central Pharmacy

Location: Oklahoma City, Oklahoma
Budget:  120,000 for both pharmacy locations (includes 70,000 from HAU)
Prescriptions filled in 2011: 9,972

Abstract

Cooperative Central Pharmacy is a charitable pharmacy operated by the Oklahoma County Social Services Department. In 2008, CCP opened a downtown location to service the largest underserved population in the county. In collaboration with Health Alliance for the Uninsured (HAU) and Good Shepherd Ministries, CCP provides free medication to the indigent including free clinic patients in Oklahoma County. A partnership between HAU and CCP ensures that free clinic patients have access to medication before they are enrolled in a Patient Assistance Program. Over the last two years, the pharmacy experienced a significant increase in the number of patients who require medication assistance. In 2010, the average number of prescriptions filled in one month was 689; in 2011, CCP filled an average of 800 prescriptions in one month.

Increasing access to medication through community collaboration

Established in 2008, the Cooperative Central Pharmacy (CCP) is a free-standing pharmacy that provides free medicines to indigent residents and 11 free clinics within Oklahoma County. CCP was founded by three collaborating partners: Health Alliance for the Uninsured (HAU), Oklahoma County Social Services Department, and Good Shepherd Ministries. Located in downtown Oklahoma City, the pharmacy is open Monday and Wednesday and fills an average of 100 prescriptions each day. The establishment of CCP’s downtown location has greatly increased access to free medication for uninsured and underinsured residents of Oklahoma County.

CCP’s downtown pharmacy is a satellite location. The original pharmacy, which was founded in the 1970s by Oklahoma County, is located approximately 10 miles outside of the city. Both locations are funded by local property taxes. While the need for a charitable pharmacy is justified—nearly 20 percent of the state is uninsured or underinsured—the location posed a significant logistical challenge for individuals who rely on public transportation. Establishment of the downtown pharmacy was a natural fit with the County’s mission and in line with expansion of community services for the medically indigent.

Inception of the downtown pharmacy was initiated by the executive director of HAU, the Chief Pharmacist, and the Director of Oklahoma County Socials Services. In 2007, HAU, an Oklahoma City-based nonprofit that works to improve the delivery of health services and coordination of resources for the underserved, identified medication procurement as the leading resource constraint among Oklahoma’s free clinics. In collaboration with HAU, Oklahoma County, and Good Shepherd’s Ministries, CCP opened its downtown location in 2008, which is within walking distance from many social services agencies and homeless shelters. HAU allocated $90,000 to CCP to provide pharmaceuticals to free clinics within HAU’s network. CCP’s downtown space was donated by Good Shepherd Ministries, which continues to cover general building costs including electricity.

CCP is staffed by one full-time pharmacist, a full-time pharmacy technician, and a County Sheriff. All employees are paid by the Oklahoma County Social Services Department.  CCP has its own inventory of drugs and a separate budget for purchasing bulk medication from organizations such as Minnesota Multistate Contracting Alliance for Pharmacy (MMCAP). The pharmacy also obtains a small amount of donated pharmaceuticals from local nursing homes, assisted living centers, and mental health facilities.

The arrangement between HAU and CCP was created to provide free clinic patients with access to medications before they are enrolled in a Patient Assistance Program (PAP). Enrollment in a PAP is the responsibility of the free clinic and the arrangement was such that a free clinic patient would be considered “active” at CCP for 90 days, after they would be considered “inactive” to allow news patients to enter the system. However, the PAP enrollment process is time consuming and requires substantial documentation. Consequently, many patients were returning to CCP well after the 90 day period. In order to ensure effective collaboration, CCP invoices HAU once a month for drugs that are dispensed as a result of referrals from free clinics. HAU separately maintains a Memoranda of Understanding (MOU) with each clinic in order to track individual costs and distribution. This system has been successful in setting expectations between the clinics and CCP in addition to providing transparency around costs and value of service.

Lessons Learned

  • Develop a formulary and communicate expectations to free clinic partners
    CCP works directly with free clinics and provides medicine to many free clinic patients. At times patients have presented prescriptions to CCP for expensive and hard-to-obtain medications. It is important to develop an appropriate formulary for your pharmacy that relies on generic or less expensive drugs. Circulating your formulary to free clinics can help manage expectations and ensure patients get the medications they need in a timely fashion.
     
  • Set realistic and specific parameters for patients and clinics
    CCP requests that patients patronize only one of their pharmacy locations. There are various options for filling a prescription; however CCP is unable to track drug interactions if a patient frequents more than one location. This can be dangerous for patients taking multiple medications. Establish firm policies and procedures and avoid any deviation.