Service Area Strategic Plan
11/23/2009   5:02 pm
Department of Behavioral Health and Developmental Services (720)
Biennium: 2008-10
Service Area 1 of 1
Aftercare Pharmacy Services (720 421 01)
Description

The Aftercare Pharmacy, renamed the Community Resource Pharmacy (CRP) in 2005, provides medications for individuals who have been discharged or diverted from a state hospital or training center and are unable to pay for medications that have been prescribed to treat or prevent a recurrence of the condition for which they received state facility services. The CRP is located at the Hiram Davis Medical Center in Petersburg.
Background Information
Mission Alignment and Authority
  • Describe how this service supports the agency mission
    The Community Resource Pharmacy provides medications that enable many individuals with acute and complex needs to be served in community settings. These medications respond to the symptoms associated with serious mental illness, thereby promoting recovery and successful community integration.
  • Describe the Statutory Authority of this Service
    Chapter 8 of Title 37.2 of the Code of Virginia addresses admissions and dispositions of individuals relative to facilities.
    • § 37.2-843 authorizes the Department or CSBs to provide drugs or medicines from funds appropriated to the Department for that purpose for consumers discharged from state facilities when they or the persons liable for their care and treatment are financially unable to pay for or otherwise access them (aftercare pharmacy services).

    Section 54.1-3437.1 of the Code of Virginia authorizes the Board of Pharmacy to issue a limited manufacturing permit to the pharmacy directly operated by the Department that serves consumers of the CSBs for the purpose of repackaging drugs.
Customers
Agency Customer Group Customer Customers served annually Potential annual customers
Individuals receiving Community Resource Pharmacy (CRP) services Individuals served by the CRP 43,200 45,000

Anticipated Changes To Agency Customer Base
The customer service base will expand with the recent approval of the Community Resource Pharmacy as a qualified State Pharmacy Assistance Program by CMS. As a Pharmacy Assistance Program, the Community Resource Pharmacy will cover the cost and supply of medications for Medicare Part D eligible clientele in the community who experience a coverage gap known as the “Doughnut Hole”. (While in this "Doughnut Hole" of Medicare D medication coverage, eligible consumers must pay the full price of their prescription medications.)
Partners
Partner Description
Community services boards and behavioral health authority (CSBs): CSBs access medications through the CRP for eligible consumers.
Department of Medical Assistance Services: For individuals who are Medicaid recipients, the Department of Medical Assistance Services funds covered prescription drugs provided by the CRP.
Individuals receiving services, family members, and advocacy organizations: Individuals receiving services, family members, and advocates provide important feedback to the Department on pharmacy needs and services.
Products and Services
  • Factors Impacting the Products and/or Services:
    Decreasing demand for CRP services due to implementation of Medicare Part D could be offset as local inpatient purchase of service options and community crisis stabilization capacity is increased.• Increasing numbers of individuals who are medically uninsured or underinsured will result in unrecoverable medication costs.
    • Increasing numbers of individuals who are Medicare Part D eligible and experience the coverage gap and, the CRP supplies medications that are not applied towards a person’s true out of pocket cost will result in unrecoverable medication costs.
    • Prescription drugs are the fastest growing segment in health care expenses in the United States. Psychotropic medications account for more than $ 60 billion nationally in annual sales from pharmaceutical companies. As new, more effective but expensive medications are introduced and prescribed, direct pharmaceutical costs will continue to increase.
    • There is a pharmacist shortage in Virginia and nationally. The Department's pharmacist salaries are the lowest in the state, making recruitment and retention of pharmacists difficult.
  • Anticipated Changes to the Products and/or Services
    Implementation of a medication management system as part of the agency-wide electronic health record development process will create efficiencies, reduce costs associated with medication errors, and promote the implementation of best medication management practices
  • Listing of Products and/or Services
    • Medication Management -- The CRP dispenses medications to CSBs for eligible consumers. Prescriptions are mailed or faxed to the pharmacy for dispensing. This includes preparation, packaging, compounding (if needed), labeling and mailing medications directly to the CSB serving the consumer.
    • Provision of Medication Information -- The CRP provides medication information to CSBs, consumers, and family members as required or requested.
    • Utilization of Cost Containment Methods -- The CRP uses of a number of effective cost containment methods, including: maintaining a formulary; package merging; encouraging the use of generic medications; promoting dose manipulation (for example, two 50 mg tablets in the place of one 100 mg tablet) to result in a less costly prescription product; and facilitating the “Medsavers” Program which is designed to conserve unclaimed medication. The CRP also participates in the Minnesota multi-state consortium for the bulk purchase of drugs from pharmaceutical companies, thereby lowering purchasing expenditures; these savings are then passed on to CSBs.
    • Participation in the Department’s Pharmacy, Therapeutics and Formulary Committee -- The CRP participates in the Pharmacy, Therapeutics and Formulary Committee (PT&F Committee), established by the Department and comprised of administrative and clinical representation from CSB and Department staff. The group analyzes access, utilization, and distribution of pharmaceuticals in the community services system.
    • The Behavioral Quality Indicator program is providing information on CRP practice patterns.
Finance
  • Financial Overview
    This service area is funded with 97 percent general funds and 3 percent non-general funds. Non-general funds are derived from the collection of fees from Medicaid, Medicare, private insurance, private payments, and Federal entitlement programs related to patient care.

    Note: The information on the following tables is presented at the service area level. However, funding by fund source is appropriated at a higher program level. This results in the allocation of the non-general fund amounts to the various service areas within the program level in accordance with reasonable allocation methodology. This methodology has been applied and is represented in these amounts.
  • Financial Breakdown
    FY 2009    FY 2010
      General Fund     Nongeneral Fund        General Fund     Nongeneral Fund  
    Base Budget $24,003,458 $719,438    $24,003,458 $719,438
    Change To Base $0 $0    $0 $0
               
    Service Area Total   $24,003,458  $719,438     $24,003,458  $719,438 
Service Area Objectives
 
  • Provide appropriate pharmacy services to individuals receiving CSB services who meet CRP eligibility criteria.
    Objective Description
    Section 37.2-843 authorizes the Department to provide drugs or medications for consumers discharged from state facilities when they or the persons liable for their care and treatment are financially unable to pay for or otherwise access needed medications. Since its inception in 1968, the Aftercare Pharmacy (now the Community Resource Pharmacy) has grown to an operation that serves approximately 17,000 consumers and dispenses more than 300,000 prescriptions per year. Antipsychotic polypharmacy, the taking of two or more antipsychotic drugs at the same time, is a concern for state facility prescribers and consumers alike as evidence of effectiveness of this practice is limited. Data suggests that the results of prolonged antipsychotic polypharmacy may lead to increased adverse effects. Consensus guidelines recommend monotherapy as the standard of care, with antipsychotic polypharmacy as the last resort, in order to reduce medication complexity and reduce the risk of adverse events.
    Alignment to Agency Goals
    • Agency Goal: Expand and sustain services capacity necessary to provide services when and where they are needed, in appropriate amounts, and for appropriate durations.
    • Agency Goal: Assure that services system infrastructure and technology efficiently and appropriately meet the needs of individuals receiving publicly funded behavioral health and developmental services and supports.
    Objective Strategies
    • Continue to support and communicate with CSBs regarding consumer eligibility for prescription coverage from the Community Resource Pharmacy.
    • Implement a Pharmacy Assistance Program to cover the cost and supply of medications for Medicare Part D eligible clients when they reach the Medicare Part D coverage gap.
    • Implement an inventory monitoring process that reduces excess inventories while ensuring the availability of normal stock levels for medications.
    • Continue to enforce the "90-day return policy" to decrease turn around time for unused medications, thereby decreasing the amount of wasted or destroyed medication
    • Implement an automated strategy for identifying individuals seeking CRP services who are eligible for Medicare Part D services.
    Objective Measures
    • Percentage of individuals who have been identified as receiving more than two antipsychotics.
      Measure Class:
      Other
      Measure Type:
      Outcome
      Measure Frequency:
      Annual
      Preferred Trend:
      Down

      Frequency Comment: Fiscal year

      Measure Baseline Value:
      .73
      Date:
      6/30/2006

      Measure Baseline Description: Percent of individuals prescribed more than 2 antipsychotics

      Measure Target Value:
      .35
      Date:
      6/30/2010

      Measure Target Description: Percent of individuals prescribed more than 2 antipsychotics

      Data Source and Calculation: Source: MEDIs and CRP pharmacy system Calculation: Add the monthly number of cases that triggered the measure of taking more than two antipsychotics and divide by 12 to calculate the mean for the fiscal year. Add the monthly number of individuals receiving Community Resource Pharmacy prescriptions for antipsychotics and divide by 12 to determine the mean for the fiscal year. Divide the mean number of cases that triggered the measure of taking two or more antipsychotics by the mean number of individuals receiving precriptions for antipsychotics from Community Resource Pharmacy. To calculate percent change from the baseline, subtract the baseline percent of individuals taking two or more antipsychotics from the percent in the current fiscal year and divide the difference by the baseline percent.


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