Source: Florida/Caribbean AETC
With the recent implementation of the Florida ADAP waiting list and reductions in the medications listed in the ADAP formulary, many Ryan White-funded programs around the state of Florida have been left struggling to re-prioritize spending so that patients can continue to receive the medications they need. The large number of patients placed on the wait list has stressed resources to their limits. Part A and Part B programs are struggling to maximize resources to meet the needs of their patients. Many are now developing formularies, or revising existing formularies, in programs to stretch dollars to pay for as many medications and patients as possible. Prioritizing which medications to pay for is necessary due to limitations in funding.
The Florida/Caribbean AETC (F/C AETC) has been able to provide assistance to programs throughout the state. F/C AETC pharmacist faculty members have reviewed several developed formularies and have provided suggestions for revision. Input on which medications to include, substitute or delete in the formulary have been provided, taking into account several factors, including: 1) cost-effectiveness; 2) drug-drug interactions with ARV medications; 3) availability of medications through pharmaceutical company patient assistance programs (PAPs); 4) clinically equivalent medications available through discounted retail pharmacy medication formularies; and 5) formulary products such as supplements without established benefit that might be considered for deletion. In some instances, dispensing more than one month's supply (eg., 3-6 months) was recommended for certain products (eg., multivitamins) in order to decrease expenditures, as the dispensing fee is what drives the expenditures when the medication themselves are not costly.
Offered as an additional cost-savings measure, the F/C AETC created a compilation of major pharmacy discount plans. The comprehensive listing of several of the larger discount pharmacy programs was compiled to be used as a tool to encourage the utilization of available and existing resources to obtain many concomitant medications in an economical manner. It provides a quick overview of available low-cost drugs that are posted on websites that can be searched by providers, case managers, and others. This listing is available online at http://www.fcaetc.org/pharmacy.
Through these initiatives, and in response to the ADAP waiting list and the ADAP formulary reductions, the F/C AETC strives to assist health care providers in offering the most economical and quality care for their patients.
F/C AETC also offers its region specialized pharmacy chart reviews based on clinic, pharmacy or agency needs. The focus of these reviews is to assure that:
|All medications are dispensed with appropriate drug, strength, quantity and directions.|
|There is no inappropriate therapeutic duplication or significant drug-drug interactions.|
|Allergies are listed in the pharmacy system and consistent with allergies listed in the medical record.|
AETC pharmacist faculty have also conducted targeted reviews of medical records, focusing on suitability of drug therapy with respect to the patient's medical conditions, co-morbidities and concomitant medications (eg., renal and/or hepatic dosing of medications, drug-drug interactions). During these types of reviews, the pharmacist evaluates antiretroviral regimens, laboratory monitoring and opportunistic infection prophylaxis to assure that DHHS Guidelines are being followed.