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Community Access Pharmacy in Review

Written by Dr. Sally Haack PharmD.

Community Access Pharmacy started out as an idea in September of 2002. A local community group, Health Access Partnership, who focuses on issues of access for the uninsured, had a vision to improve patient access to medications. This group was instrumental in establishing the conceptual framework for the pharmacy and in obtaining HCAP funding (Healthy Community Access Program) for start up operations. After numerous hours of dedication and hard work on the part of many community collaborators, the pharmacy opened its doors in April of 2004.

Community Access Pharmacy serves uninsured and underinsured patients in a “closed” pharmacy system. Their patients do not have private insurance and they don’t qualify for Medicaid. Many of them are the working poor. The pharmacy location was chosen due to its proximity to the Des Moines Metro bus route and because it is centrally located between the Primary Health Care clinics. The demand for low cost options for medications among those who lacked insurance was apparent from the very first day. The Community Access Pharmacy found itself understaffed and called a temp agency to quickly add the technician support it needed.

The pharmacy, which is owned and operated by Primary Health Care, Inc., currently serves the patients of three safety net providers in the community: Primary Health Care, Inc., La Clinica de Esperanza, and Proteus. Primary Health Care is a federally qualified health center that provides primary medical and dental care and preventive services to the uninsured and underinsured patients in Des Moines and Marshalltown. The Des Moines clinics are located at 2353 SE 14th St., 3509 E 29th St., 979 Oakridge, and 1500 Morton Avenue, located on Grandview College’s campus. La Clinica de Esperanza is located at 2726 Maury Street and is a comprehensive neighborhood health center that serves the Hispanic community. Proteus Migrant Health Project serves migrant farm workers and has camps in Muscatine and Fort Dodge.

Patients who utilize the Community Access Pharmacy are able to purchase their drugs at cost plus a small dispensing fee. The pharmacy is able to acquire prescriptions at extremely low costs through the 340B Drug Pricing Program. The 340B program is a federal program designed to allow select public health providers access to reduced prices on outpatient drugs. Prices are calculated based on the average manufacturer’s price and the lowest selling price. These prices change quarterly based on the latest information. The pharmacy stocks a limited supply of OTC medications and tries to operate based on a formulary in order to reduce cost.

Since it’s beginning, the pharmacy staff has changed considerably. What started out as a single pharmacist has grown in response to patient needs. Currently, the pharmacy employs a part time pharmacy director, a full time staff pharmacist, three full time technicians, and 1 part time technician. The technician responsibilities vary from a typical retail pharmacy. One technician is a Spanish interpreter, one concentrates in the Patient Assistance Program, and the others process and fill medication orders.

The Patient Assistance Program is a way for patients to receive brand name medications, which don’t have cheaper generic equivalents, at a low price. Patients must qualify for the program by meeting specific income guidelines that are set by the manufacturers. After a patient is determined to be eligible, the necessary paperwork is completed and a prescription is sent by the provider to the company. It generally takes four weeks to process the request before a three month supply of the medication is sent back to the clinic. The prescription is then processed through the CAP computer system to check for any interactions before it is ready to be picked up by the patient.

The pharmacy currently serves over 2,600 patients and fills nearly 3,200 prescriptions each month. The majority of patients served fall below 200% of the federal poverty level. It is approximated that nearly 40% of the patients served are Spanish speaking.