Pharmacy research project concludes with call for reform

June 20, 2014

Alex King never considered a career in the health care field.

The Indiana State University senior from Rockville isn't pre-med or a nursing major. He doesn't even know how to take someone's blood pressure.

But recent research by King will help improve access to medicine for the area's most needy residents, and he is also calling for changes to a federal program that could do even more to improve Hoosiers' health.

"Due to the hard work and extensive research conducted by Alex, the health center will be offering pharmacy services by the end of the year," said Elizabeth Burrows, CEO of Valley Professionals Community Health Center. "He was a great asset and leader for our entire team. I know the work that he did will have a positive impact on many of our patients now and in the future."

During an internship with Valley Professionals, King researched what was needed for the center to establish a clinic-based pharmacy under the federal 340(b) program.

"The 340(b) pricing program allows clinics and pharmacies to purchase pharmaceuticals directly from manufacturers or wholesalers at what is a federally regulated ceiling price," King said. "It's substantially lower than what you would pay retail. That difference in price - between what they pay for it and sell it at retail - is then diverted back to the clinic. And then the clinic can use those funds to further extend their services or further extend those drugs to underserved populations or indigent populations without insurance."

While a 340(b) pharmacy may sound like a straightforward proposition, it's riddled with red tape and a hefty price tag, said King, an information technology major.

"It's really a beautiful program, but it's a really complex program," he said.

During his research, King reached out to other clinics in Indiana - Indiana University Health, HealthNet, HealthLink - and learned that even with these companies' vast resources, it sometimes required the services of a consulting firm to get the program working and to help with compliance.

Additionally, "if you wanted to start your own pharmacy, there's a lot of money - we're talking approximately $250,000 to, I estimated, $300,000 - spread out over a couple of years to start a pharmacy before you can make it revenue neutral," he said.

As a result, most clinics pay for a third-party provider to administer the program, which is what King's recommendation was to Valley Professionals.

"It's easier for them to sign on the dotted line and let an independent or contract pharmacy like Kroger or Walgreens do the billing, fill the prescriptions and mitigate some of the risk for them," King said.

With the services of a third-party provider, however, clinics such as Valley Professionals lose a significant amount of the revenue they could have used to improve or expand services.

"We should be able to have our own pharmacy, but Valley Professional doesn't have a couple hundred thousand dollars to take that sort of risk," he said.

At the conclusion of his internship, King was expected to write a research paper on his findings. King had a better idea - and drafted 36 letters to federal and state legislators, explaining his findings and asking for them to provide clarity and assistance with implementing the 340(b) program.

"Alex's work for Valley Professionals this semester has been exceptional, and his effort to go beyond the requirements of the internship and push for real policy reform is noteworthy," said Nathan Myers, assistant professor of political science at Indiana State, who was the faculty supervisor for King's internship. The political science coordinates internships with area health care organizations to link students - undergraduate and graduate from all majors - who have an interest in public policy.

King, who lives in Clinton, drives by Valley Professionals every day. He's struck by how much good could be done by the 340(b) program - and could help the most unhealthy Hoosiers.

"The clinics could make money off of (a 340(b) pharmacy), but they need a leg up. They need guidance, they need a little financial backing, and they need a little flexibility," he said. "This program is not only financially neutral, but it could be positive and can be used to recognize real revenue streams. These clinics could run their own pharmacies. They could do it all by themselves with a little bit of guidance, maybe some financial assistance such as interest-free or low-interest loans."

After all, the 340(b) program exists to "stretch scarce federal dollars as far possible," but given the current structure - or lack thereof, it's a nearly insurmountable task to achieve.

"It's a good program. It just needs to be ungovernmented," he said.

So, what about that health care career? King said his research showed him health care professionals can be "background agnostic" and still fill vital roles.

"You don't have to know how to take blood pressure," he said. "There are plenty of other places for you. It's a wide-open field, and it's only getting bigger."

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Contact: Nathan Myers, assistant professor of political science, Indiana State University, 812-237-2504 or Nathan.Myers@indstate.edu

Writer: Libby Roerig, media relations assistant director, Office of Communications and Marketing, Indiana State University, 812-237-3790 or libby.roerig@indstate.edu

Story Highlights

Alex King's research into the federal 340(b) pharmacy clinics will help improve access to medicine for the area’s most needy residents. He is also calling for changes that could do even more to improve Hoosiers’ health.

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