Service Area Strategic Plan
4/19/2014   10:29 am
Department of Behavioral Health and Developmental Services (720)
Biennium:
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 CRP 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
o The customer service base will expand with the recent approval of the CRP 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 individuals receiving community services who are experiencing difficulties meeting co-payment requirements or paying the fees while in the coverage gap. In Medicare D medication coverage gap, eligible individuals 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 receiving CRP services 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:
    o Appropriate medication management has proven to be a significant factor in keeping individuals with serious mental illness in their home communities. The New England Healthcare Institute released a study showing that patients who do not adhere to their prescriptions cost the healthcare system about $290 billion a year. One-third to one-half of patients—especially those with chronic illnesses—improperly follow prescriptions, leaving themselves vulnerable to hospitalizations and medical risk. The larger spending could be avoided if patients adhered to medication orders given by physicians. [NEHI, “Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease.”]

    o The cost to treat Americans under care for depression and other mental illnesses rose by nearly two-thirds to $58 billion from $35 billion in a 10-year period, according to the Agency for Healthcare Research and Quality. A new analysis by AHRQ shows the number of Americans treated for mental disorders, such as depression and bipolar disease, nearly doubled to 36 million from 19 million from 1996 to 2006. Also, researchers found that heart conditions, cancer, trauma-related disorders, mental disorders and asthma ranked highest in terms of direct medical spending in 1996 and 2006, while the relative increase in costs to treat mental disorders topped the list during that period.

    o 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
    o Continued operation of the Community Resource Pharmacy (CRP) may be replaced by allocations for the direct funding for the purchase of medications by the CSBs
  • Listing of Products and/or Services
    • Funding for purchase of medications by CSBs
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 2011    FY 2012
      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 medicatios to individuals receiving CSB services who meet CRP eligibility criteria.
    Objective Description
    The CRP provides 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 CRP has grown to an operation that serves approximately 43,200 consumers and dispenses more than 123,000 prescriptions per year.
    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
    • Work with the CSBs to transition the operation of the Community Resource Pharmacy from a direct pharmacy operation to one that allocates funding for the purchase of medications for individuals who meet eligibility criteria
    • Closely monitor the impact of the closure of CRP operations on state hospital admissions and local inpatient hospital bed purchases.
    • Continue to support and communicate with CSBs regarding consumer eligibility for prescription coverage.
    Link to State Strategy
    • nothing linked
    Objective Measures
    • Percentage of medication dollars that are passed to the CSBs and subsequently expended.
      Measure Class:
      Other
      Measure Type:
      Outcome
      Measure Frequency:
      Annual
      Preferred Trend:
      Up

      Frequency Comment: This new measure reflects the anticipated change in Department's responsibilities for funding medication purchases, beginning in FY 11. FY 12 goal will be a 10% increase in CSB rate of expenditure

      Measure Baseline Value:
      TBD
      Date:
      6/30/2011

      Measure Baseline Description: Percentage of medication dollars that are passed to the CSBs and subsequently expended.

      Measure Target Value:
      TBD
      Date:
      6/30/2012

      Measure Target Description: Percentage of medication dollars that are passed to the CSBs and subsequently expended.

      Data Source and Calculation: Source: Calculation: Medication support dollars allocated to individual CSB divided by CSB expenses for medication support annually


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