Problem Identification
The Rhode Island Department of Corrections (RIDOC) provides pharmaceutical care for about 3,700 inmates in seven correctional facilities. Before 2002, RIDOC managed pharmaceutical services in-house, while contracting with a for-profit entity for drug products. The Department noted significant annual increases in its pharmacy budget, overuse of medication in several therapeutic classes, excessive waste, and inefficient management of care. A meeting with consultants from the University of Rhode Island College of Pharmacy uncovered an opportunity for improvement through a unique higher education/state agency management model.
Objectives
· Improve efficiency of the pharmaceutical care system in all state correctional facilities.
· Manage pharmaceutical costs overall and in specific therapeutic classes (HIV, Hepatitis C and psychotropics).
· Decrease pharmaceutical waste (discarded medication).
· Enhance quality of inmate pharmaceutical care.
· Create a teaching model for URI PharmD students and RIDOC health professionals.
Target Audience
RIDOC healthcare staff, URI PharmD and graduate students, and the pharmaceutical products vendor are key audiences in this collaborative management model.
Solution
Following a competitive bidding process, RIDOC awarded the College of Pharmacy a contract to oversee its pharmacy program. The College’s Healthcare Utilization Management Center (HUMC), staffed by consultants with pharmacy benefit management expertise, clinical pharmacists and research assistants, collaborates with the RIDOC medical staff to design and manage the pharmacy program. The Center provides an on-site pharmacist manager and extensive data analysis, reporting, clinical support and utilization management resources.
A unique feature of the collaboration is the involvement of PharmD and pharmacoeconomics graduate students. They work with Center staff to develop all aspects of the RIDOC program and support ongoing projects including formulary development, clinical reviews, data analysis, utilization management, and program evaluation.
Critical success factors include:
· A management team composed of RIDOC medical staff, a pharmacist representative from the product vendor, the onsite pharmacist and other HUMC staff.
· Redesign of the RIDOC formulary and drug product selection processes.
· New metrics and reports to guide decision-making.
· Improvements in medication security and disaster/emergency policies.
· Proper record-keeping and new procedures for medication disposal.
· New medication administration services and documentation system.
Results
Since the collaborative management model was implemented, the RIDOC pharmacy budget has remained stable, even in the face of significant drug product cost inflation and an increase in the inmate census. (See table below.) This trend carries through to HIV and Hepatitis C treatments and antipsychotic medications. Utilization of pharmaceuticals, as measured by prescriptions per inmate per month, also remained constant. A small spike in drug spend for 2007 was attributable to the incarceration of one hemophiliac. Finally, the amount of medication waste (discarded medication) decreased by nearly 75 percent from 2004 to 2008.
RIDOC Rx Expenditures Compared to U.S. Pharmaceutical Cost Trend (2001-2007)
The Department of Corrections attributes $8 million in savings for the State of Rhode Island to the successes of the collaborative pharmacy management program during its first five years. The URI College of Pharmacy’s work with the Department of Corrections has led other state agencies to seek their advice on innovative ways to approach pharmaceutical program initiatives and the possibilities of collaboration with the College.
The opportunity for PharmD and graduate students to gain real-world experience in managing the pharmaceutical component of health care is a great benefit not only to the students, but also to their future employers and the College of Pharmacy. Approximately 12 students per year are able to hone their clinical and management skills at the Department of Corrections. This kind of experience represents an innovation in pharmacy education.
