Mail Order Charity-Only Pharmacy

Wyoming Medication Donation Program

Natasha Gallizzi, Pharm.D.

Program Manager

The Wyoming Medication Donation Program, a program of the Wyoming Department of Health, is a state-wide mail order charitable pharmacy. The program is a comprehensive drug donation, re-dispensing, and disposal program that improves prescription access for Wyoming’s low-income patients, up to 200% Federal Poverty Level, who lack adequate prescription coverage while reducing medication waste.

Bubble wrapped medication donations received from extended care facilities and others across Wyoming to be used for prescription filling at the WMDP.

Wyoming has a state-wide donation network that collects sealed, in-date medication donations, excluding refrigerated medications and controlled substances, which are shipped to the central location for processing. After processing, acceptable medications are made available to fill prescriptions for eligible patients throughout Wyoming.  Unacceptable medications are disposed of via incineration (See: Medication Destruction). To fill gaps in the donated inventory, additional medications are acquired through the Dispensary of Hope membership.

The Wyoming Medication Donation Program (WMDP) started as a pilot program in Laramie County with a typical retail pharmacy model under a non-profit agency. After showing positive results, the pilot pharmacy continued (under the non-profit) and the statewide mail-order pharmacy branched off under the Wyoming Department of Health (WDH) in a new facility with a new pharmacy license. Both pharmacies are still flourishing.

As of 2017, WMDP serves approximately 3,000 patients annually. More than 700 of these patients are served via mail only, mailing over 1,000 prescriptions per month. The remaining patients are serviced at our Dispensing Sites. The Dispensing Sites are Wyoming clinics or pharmacies registered with WMDP to order donated medications to maintain at their site. Each site is responsible for verifying patient eligibility and dispensing the medication according to prescription. The sites send quarterly reports to the WMDP on the number of patients served and number of prescriptions filled. There are currently six active Dispensing Sites, including two free clinics, a homeless clinic, and the pilot program pharmacy mentioned above. State-wide data is compiled and shared with WDH administration, legislators, and supporters.

Staffing

The WMDP pharmacy is open 30 hours per week. Staffing consists of one pharmacist/program manager (0.75FTE), one fill-in pharmacist (0.25FTE), and three pharmacy technicians (2.25 FTE). Several volunteers help process donations and disposal. Volunteer hours average 35 hours per month. The program was recently approved for expansion that will provide more space and staffing, as well as adding a service to help patients apply for manufacturer prescription assistance programs. This is especially needed for insulin and inhalers.

The Wyoming Department of Health, Division of Healthcare Financing, and Pharmacy Services serves as a rotation site for pharmacy students from the University of Wyoming. The students spend one week of their rotation with WMDP. In the summer, pharmacy student interns volunteer.

Marketing

Local collaborations are very important for success.  In the beginning, education of local providers, the hospital, and safety-net services were the most impactful. The program has focused a lot of education and marketing to state networks to spread the word about what we do and increase utilization of the program. Some examples are the Wyoming Hospital Association, Wyoming Primary Care Association, Prevention Management Organization, hospitals, PCMH’s, Wyoming Pharmacy Association, Public Health, Nursing Home Association, and various state health advisory groups.

Collaborating and coordinating messages with existing agencies and programs with statewide contacts has been a key to the program’s success. Venues include our website, presentations, e-newsletters, vendor booths at conferences, involvement in task forces that have similar goals. For example, the pharmacist is on the Wyoming Prescription Drug Abuse Stakeholders group, making many good contacts during the drug disposal discussions.

Patient Services

Case workers from 45 hospitals, clinics, and mental health centers around the state refer patients to the pharmacy. Enrollment is done via fax or standard mail. Online enrollment is not used due to unknown security of the sender’s internet connection for private parties (See: Appendices\Eligibility\WMDP_Application_Packet_02_27_2017.pdf for example of enrollment forms).

To assist communication via mail, we have several different colored notes that we send along with the patient’s prescription to notify them about issues. Notifications include:

  • 90-day supply dispensed
  • Dose substitution (e.g. lisinopril 20mg 1 orally daily to lisinopril 10mg 2 orally daily)
  • Notification that the requested medication is not in stock and we put them on the waitlist
  • Additional eligibility information required
  • Notice of eligibility renewal needed (sent along with application for renewal)
  • Notice to request refills together so we don’t have to ship so many packages per month for the same person
  • Notice of PAP paperwork (e.g. Eliquis, insulins, etc.)

Notes are color coded, making it easier to find the correct note to send. The prescription vial and notes are placed inside a plastic bag then placed inside the mailing envelope. Patients seem to notice the notes bagged with the prescription separately better than when the notes were included with all of the other prescription paperwork just inside the mailing envelope.

Documentation is placed in the patient profile of the pharmacy software system regarding date eligibility expires, requests for additional information, and other care notes. All notes are dated to facilitate follow-up communication with patients and/or providers. Staff checks the patient profile each time the patient is on the phone to verify any changes in address or phone number to save on returned mail and keep all files as current as possible.

Mail Order Process

Prescriptions are sent to patients free of charge via certified mail. A signature is required, and packages can be tracked. During the holidays we get a lot of mail status questions due to mail delays. Bigger boxes are typically sent via United Parcel Service (UPS). In the very rural towns, UPS has provided the most reliable carrier. Most packages take two days or longer to be delivered. In December and when there are federal holidays more delivery time is allowed. Refills are sent up to ten calendar days prior to due date.

Special equipment is utilized in a mail order practice, including a postage meter, certified mail stickers, and a contract with a courier for incoming donations. Ideally, the pharmacy has a designated shipping area, both for arrival of donations and for outgoing prescriptions. In the shipping area are kept mailing envelopes, package tape, boxes for shipping, and other mailing supplies. Meds for disposal are segregated to their own area as well.

Metrics

In addition to metrics other charitable pharmacies keep, we track the number of cities served. A reporting feature in the software tracks by zip code or city name. This was especially helpful as we were growing our state-wide program to determine if the program was achieving a state-wide reach.

The medication dollar value dispensed to each county as well as the dollar value donated from each county is tracked. State leadership has been interested to see if the incoming donation value correlates with outgoing in each county. Wyoming has 23 counties. See How Much Did We Do or How Many?. We are researching other software options to recalculate more information into county metrics.

Another metric helpful for gaining support has been breaking down the number of prescriptions by therapeutic class, especially to see how many mental health medications are dispensed. See How Much Did We Do or How Many?.