No health care program would be complete without the necessary prescription drugs. And, as mentioned earlier, one of the last gaps to be filled during the launch of Project Access was the prescription drug component.

For the pharmacists, it all began when the Medical Society’s executive director, Dwight Allen, contacted a Prescription Benefit Management Company (PBM) called the Prescription Network of Kansas (PNK).

What is a Prescription Benefit Management Company? PBMs manage the prescription portion of a health plan either directly for an employer, or sometimes for managed care organizations such as HMOs or PPOs — and sometimes even specialty or grant programs, like Project Access, that help indigent populations who may not have the ability to get the drug therapy they need on an ongoing basis.

Mr. Allen invited Peter Stern, PNK’s executive director, to come to some organizational meetings and talk about how this would work. This was after Mr. Allen’s trip to Asheville to see what was done on the pharmacy side with respect to contracting, reimbursement, operations and support.

When the people from PNK learned all the details of what Asheville was doing, they realized that the program could very easily adapt to what they were now doing in Kansas. PNK already handled contracting. And they had the ability to electronically program reimbursement as well as other plan specifications, such as the co-pay, the particular classes of drugs they don’t want to cover, and so forth. So everything was in place, ready to be employed in the service of Project Access.

Mr. Stern then had the job of trying to sell the program to the pharmacists. “There’s some marketing involved when you’re telling people that they’re not going to get paid anything except to cover the cost of the product,” Mr. Stern confessed, “and some were skeptical. But with very little explanation a lot of them saw this as a very necessary program.” So, just as it happened with the doctors and hospitals, a large majority of the pharmacies signed on.

The services that PNK offers Project Access include contracting, processing, reporting, and centralized invoicing. Because PNK agreed to work directly in contracting with the pharmacies, Project Access was relieved of a significant administrative burden, allowing Project Access staff to focus on coordination of the overall project. PNK directly bills Project Access, sending them the supportive reports to show what has been done and why. Project Access, in turn, simply sends a check to PNK, which then handles all payments to the pharmacies.

PNK has also given Project Access the capability, through their (Project Access’) own computers, of adding and deleting eligible persons in PNK’s system — so patients can fill their prescriptions the same day they’re enrolled. And then there’s the day-to-day support that PNK provides. Through an 800 number, PNK staff are available to address any questions or issues that may arise from Project Access or any of the participating pharmacies.

PNK also provides an electronic, real-time processing system that not only allows participating pharmacies to instantaneously file their claims online but it captures that information so that detailed reports regarding utilization, provider practice patterns and expenditures can be generated for Project Access. Using these reports, Project Access can continually evaluate the program for needed changes. The reports also provide accountability for Project Access — important since the prescription drug portion of the Project Access program is publicly funded by both the Wichita City Council and the Sedgwick County Commission.

One aspect that’s unique to the pharmacists is that, unlike other Project Access participants who can donate their time and services, the pharmacies dispense to their customers a physical product that comes with an actual, predetermined cost that they (the pharmacies) just can’t absorb. So there had to be a discounted reimbursement — 15% below the Average Wholesale Price — that would cover the pharmacists’ cost of the product. This was a figure used in the Asheville program.

So what’s the benefit to the pharmacists? For them, unlike with the hospitals, it wasn’t an issue of stemming rising costs. Instead, they saw this as an opportunity to show that they’re involved in their community. When they realized that many of their peers were signing up, even the few hesitant pharmacists felt as if they needed to be on board. (In reality, they all wanted to be on board. Some just needed to feel a little more comfortable about what their level of commitment would be. And once they saw that it was going to be spread across multiple pharmacies, they wanted to be included.) “Nobody ever just said ‘No.’ They just wanted to understand how their contribution would help,” said Mr. Stern.

Today, 69 pharmacies participate in Project Access. What’s more, not only do they fill the prescriptions for Project Access patients at 15% below Average Wholesale Price, they go a step further and contribute to the program by not charging any fee to fill those prescriptions. At the end of a year, this is a significant contribution. Likewise, the program receives rebates from pharmaceutical companies on certain drugs. These rebates add to the amount of money that’s available to spend on pharmaceuticals for this population.

Again, one of the keys to this level of cooperation was that, just like with the other segments of the community — the physicians and the hospitals — at least some of the providers had stepped up to the plate and then set about the task of convincing their peers. The other key, for the pharmacies specifically, is that the city and the county also stepped up to the plate — with money.

It should be noted that if there was any doubt about this being the right prescription for everyone, all one has to do now is to look to the state capital, the city of Topeka, where Project Access has since been duplicated — with a similar program called Health Access, being run through Shawnee County’s Medical Society.

Which, of course, brings to mind the old saying: Imitation is the sincerest form of flattery.