©2007 Walgreen Co. All rights reserved. 1 Patient Focused ADAP Programs Glen Pietrandoni, R.Ph December 4, 2008 ©2007 Walgreen Co. All rights reserved.

©2007 Walgreen Co. All rights reserved. 1

Patient Focused ADAP Programs Glen Pietrandoni, R.Ph

December 4, 2008

©2007 Walgreen Co. All rights reserved.


ADAP BenefitsADAP Benefits

Compassionate…Coordinated HIV CareCompassionate…Coordinated HIV Care

PhysiciansPhysicians Community/ASOsCommunity/ASOs

Retail Stores & Pharmacists

Public Health/Gov’tPublic Health/Gov’t

Medical Medical CentersCenters

PatientsPatients


Today’s Issues

• Many different ADAP models

• Access to services varies

• Providing drugs vs pharmaceutical care

• Public Health systems are complicated

• Quality of life issues

• Respect, privacy, cultural competency

• Changing health care models

• Reporting/Outcomes


HIV/AIDS in the U.S., 2009

• Growing number of people living with HIV/AIDS

• Changing the demographics:▪ Women and minorities▪ Younger and older▪ Rural

• More people on therapy▪ Treatment guidelines suggest starting drugs earlier▪ Drug therapy options increasing

• ADAP funding has been flat

• Human resources are exhausted


Estimated Prevalence Rates for Adults and Adolescents Living with HIV/AIDS

Total Rate=168.8*Rate (per 100,000 population) 2004—USA

<100 100 – 150 >150

Alaska 57.0

99.5

84.724.5

22.3 12.1 48.4

42.0

30.1

147.8

104.8

44.1

17.223.7

60.9139.5

196.0

88.0 74.4

99.7 50.9

66.7

166.3201.7

89.2 129.2 88.9

307.8

198.7

187.8116.9

103.068.0

72.970.4

42.5

145.668.1

44.243.2NH 48.7

MA 152.8

RI 126.9

CT 221.2

NJ 241.7

DE 234.9

MD 283.7

DC 1,960.0

Note: Data adjusted for reporting delays.

*Includes persons whose state of residence is unknown or missing.

Hawaii 120.9

Puerto Rico 324.3

127.5

43.7


HIV Communities:Population needs vary within a given state’s boundaries

•MSM

•Ethnic

•Women

•Religion/Churches

• IDU

•Sex workers

•Transgender

•Socioeconomic groups


HIV Payors

•Medicaid/Medicare▪ Medicaid▪ Managed Medicaid▪ Formularies▪ Rx limits

•Rx benefit▪ Employer plans▪ Mail benefits▪ Specialty Carve outs (United)▪ Major Medical


HIV Payors

•Ryan White Care Act▪ Title I▪ Title II

•ADAP (AIDS Drug Assistance Programs)▪ 340b closed network▪ Open network▪ SPAPs, Medicare wrap arounds, etc

•Local resources (county, city, charity)

•Compassionate Care Programs


Patient Choice Required

• Humanistic approached

• Respectful services

• Remove stigmas

• Convenience

• Quality of life improved

• HIV is a manageable health condition


Patient Centric Care• ADAP today in many states

▪ HIV drugs from one pharmacy▪ All other drugs from many different pharmacies

• What could be: All patient’s Rxs filled together ▪ Drug Interaction review ▪ Missing or duplicate therapies, regimen reviews▪ Adherence monitoring ▪ Monitor side effects▪ Better pharmaceutical care▪ Better clinical outcomes▪ Convenience▪ Face to face care if desired▪ Co morbidities evaluated


Patient Pickup or delivery

Patient Pickup or delivery

ADAP Administration and Pharmacy

Patient Rxs Patient Rxs

Example of many ADAP programs today


HIV Focused Pharmacies: Pros and Cons

Individualized service

Strong Physician communication

Specialized Inventory

Compassion

Educated staff

Provide delivery

Locations inconvenient to some

Limited hours of operation


Today’s technology allows for more options


Pickup anywhere or

delivered

Pickup anywhere or

deliveredData Check

& Drug ReviewData Check

& Drug Review

Clinical reviewClinical review

ADAP

Rx sent to pharmacy

via fax, phone, e-scribe

Rx sent to pharmacy

via fax, phone, e-scribe

Eligability Check & Formulary Review

Eligability Check & Formulary Review



NATIONAL HIVOPT-IN PROGRAM •Physicians•Patients•Nurses•Pharmacists•Patient Support Groups•AIDS service organizations•Church groups



©2007 Walgreen Co. All rights reserved. 1 Patient Focused ADAP Programs Glen Pietrandoni, R.Ph December 4, 2008 ©2007 Walgreen Co. All rights reserved.

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