Transcript Walgreens Health Services PowerPoint Template Concepts for

Patient Focused ADAP Programs
Glen Pietrandoni, R.Ph
December 4, 2008
©2007 Walgreen Co. All rights reserved.
©2007 Walgreen Co. All rights reserved.
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Compassionate…Coordinated HIV Care
Patients
Medical
Centers
ADAP Benefits
Physicians
Community/ASOs
Retail Stores &
Pharmacists
Public Health/Gov’t
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Today’s Issues
• Many different ADAP models
• Access to services varies
• Providing drugs vs pharmaceutical care
• Public Health systems are complicated
• Quality of life issues
• Respect, privacy, cultural competency
• Changing health care models
• Reporting/Outcomes
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HIV/AIDS in the U.S., 2009
• Growing number of people living with HIV/AIDS
• Changing the demographics:
▪ Women and minorities
▪ Younger and older
▪ Rural
• More people on therapy
▪ Treatment guidelines suggest starting drugs earlier
▪ Drug therapy options increasing
• ADAP funding has been flat
• Human resources are exhausted
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Estimated Prevalence Rates for Adults and
Adolescents Living with HIV/AIDS
Total Rate=168.8*
Rate (per 100,000 population) 2004—USA
Alaska 57.0
<100
100 – 150
>150
99.5
22.3
12.1
48.4
84.7
24.5
42.0
17.2
23.7
196.0
30.1
44.1
60.9
Hawaii 120.9
74.4
147.8
50.9
66.7
166.3
70.4
116.9
89.2
145.6
127.5
68.0
104.8
129.2
88.0
99.7
43.7
68.1
72.9
139.5
44.2
43.2
103.0
187.8
NH
48.7
MA
152.8
RI
126.9
CT
221.2
NJ
241.7
DE
234.9
MD
283.7
DC
1,960.0
88.9 198.7
201.7
Note: Data adjusted for reporting delays.
*Includes persons whose state of residence is unknown or missing.
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Puerto Rico 324.3
HIV Communities:
Population needs vary within a given state’s boundaries
• MSM
• Ethnic
• Women
• Religion/Churches
• IDU
• Sex workers
• Transgender
• Socioeconomic groups
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HIV Payors
• Medicaid/Medicare
▪ Medicaid
▪ Managed Medicaid
▪ Formularies
▪ Rx limits
• Rx benefit
▪ Employer plans
▪ Mail benefits
▪ Specialty Carve outs (United)
▪ Major Medical
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HIV Payors
• Ryan White Care Act
▪ Title I
▪ Title II
• ADAP (AIDS Drug Assistance Programs)
▪ 340b closed network
▪ Open network
▪ SPAPs, Medicare wrap arounds, etc
• Local resources (county, city, charity)
• Compassionate Care Programs
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Patient Choice Required
• Humanistic approached
• Respectful services
• Remove stigmas
• Convenience
• Quality of life improved
• HIV is a manageable health condition
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Patient Centric Care
• ADAP today in many states
▪ HIV drugs from one pharmacy
▪ All other drugs from many different pharmacies
• What could be: All patient’s Rxs filled together
▪
▪
▪
▪
▪
▪
▪
▪
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Drug Interaction review
Missing or duplicate therapies, regimen reviews
Adherence monitoring
Monitor side effects
Better pharmaceutical care
Better clinical outcomes
Convenience
Face to face care if desired
Co morbidities evaluated
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Example of many ADAP programs today
Patient Rxs
ADAP
Administration
and Pharmacy
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Patient
Pickup or
delivery
HIV Focused Pharmacies: Pros and Cons
Individualized service
Strong Physician
communication
 Specialized Inventory
 Compassion
 Educated staff
 Provide delivery
 Locations
inconvenient to some
 Limited hours of
operation
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Today’s technology allows for more options
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Rx sent to
pharmacy
via fax,
phone,
e-scribe
ADAP
Eligability Check
& Formulary Review
Pickup
anywhere or
delivered
Data Check
& Drug Review
Clinical review
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NATIONAL HIV
OPT-IN PROGRAM
•Physicians
•Patients
•Nurses
•Pharmacists
•Patient Support Groups
•AIDS service organizations
•Church groups
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