gary director pharmacy mateo medical center - 340b...
TRANSCRIPT
Gary L. Horne, R.Ph., MHSADirector of Pharmacy
San Mateo Medical Center
Statement of Conflicts of Interest Gary L. Horne has no actual or potential conflict of interest in relation to this presentation
Today’s Agenda Describe our services and contract pharmacy arrangements
How we ensure compliance How we pass 340B discounts to patients
San Mateo Medical Center County system of healthcare
DSH hospital FQHC clinics Long‐term care/Skilled Nursing 1 in‐house pharmacy 8 340B contract pharmacies 4 Non‐340B contract pharmacies
70,000+ lives 250,000+ patient encounters
San Mateo Medical Center Main Campus
Adult Primary Care OB/GYN Pediatrics Senior Care Specialty Dental STD
San Mateo Medical Center Daly City
Adult Primary Care Teen
South San Francisco Coastside Clinic
Adult Primary Care Pediatrics Dental
Fair Oaks Health Center Adult Primary Care Teen & Pediatrics Dental
Services Provided Wide range of healthcare services without regard of the ability to pay Primary Care Specialty Care Dental Care Infusion Center Outpatient Surgery
Services Provided Charity Care – 100% of Federal Poverty Level (FPL) Access and Care for Everyone (ACE)
ACE Fee Waiver – 133% of FPL no co‐pay for medical or pharmacy benefits
ACE ‐ 200% of FPL – Annual fee. $7.00 co‐pay for prescriptions and $10.00 co‐pay for office visits.
Discounted Health Care (DHC) – 400% of FPL 65% discount off of usual and customary
Services Provided Because of savings realized through 340B program
2 Ambulatory care pharmacists Rx drug benefit to members of ACE and DHC
Contract Pharmacies 6 Chain pharmacies 2 Independent pharmacies 4 ”Network” Pharmacies (no 340B drugs)
Ensuring Compliance Limited contract pharmacy to ACE and DHC only
Contract with HPSM Eligibility file Photo in EHR ACE program participants issued card
DHC participants issued card
Ensuring Compliance ACE claims are adjudicated by PBM
Eligibility file ACE program participants issued card with BIN & PCN
Pending status issued temporary card
Ensuring Compliance Services provided by County or contracted provider only
E‐prescribing or County Rx form If not from County, pharmacies contact SMMC (referral in EHR)
PBM adjudicated claim Checks eligibility Checks formulary
DHC plans Audit Rx transactions to verify eligibility
Ensuring Compliance Regular communication External audits Contracted with Third Party Administrator
Eligible 3rd party plans Cash plans
Savings to Patients ACE program
$0.00 co‐pay $7.00 co‐pay
DHC programs 50% discount of U & C 65% discount of U & C
Charity care Discharge Rx
Additional Questions?Gary L. Horne
Director of PharmacySan Mateo Medical Center
222 W. 39th Ave.San Mateo, CA 94403Phone: 650‐573‐[email protected]