Ohio's AZT/Retrovir Fund opts for direct mail delivery

Drug Store News, Jan 9, 1989

Ohio's AZT/Retrovir Fund opts for direct mail delivery

CLEVELAND -- Ohio's AZT/Retrovir Fund, which had been providing the drug to AIDS patients through retail pharmacies in the state, will now continue as a direct mail delivery program.

Last year the federal government appropriated $30 million to purchase AZT/Retrovir for patients who were ineligible for Medicare coverage but had no other source of third party-health insurance. The prescriptions were dispensed through community pharmacies.

After negotiations with the government, according to Jerry Friedman, assistant to the director of the Ohio department of Human Services, which focused on the obligation of the residual funds in the account, the department decided to use a single vendor system. Friedman said that all pharmacies currently providing services had a chance to bid on the contract.

"We got six responses," said Friedman. "Four were mail order and two were from retail. We received the lowest bid from a mail order firm, National Rx Services, Inc."

Ohio pharmacies which have been serving AIDS patients all along are not too happy about the change. Michael Bukach, director of pharmacy and home health care for Medic, a 20-store pharmacy chain in Cleveland, claims that Medic was not informed of the competitive bid and will now lose the chance to serve AZT patients.

"It's the principle more than anything else," said Bukach. "Even if we are losing one patient, it's too much. A year ago, when no one wanted that patient, we were providing services."

Bukach said the situation is confusing. Citing a letter sent to pharmacists by the under-secretary of the Federal Department of Health and Human Services (HHS) praising their community leadership and compassion, Bukach said "on one hand, he (the under-secretary) and the HHS are asking for our help and support in educating the public, while at the same time, the HHS in Ohio is pulling the rug out from community pharmacy saying the services are not needed and the mail order program better fits their needs."

Ohio HHS's Friedman maintains that the move to a single source provider was necessary in this instance. "We were looking for a program which would provide confidentiality, direct delivery for patients who are too ill to go to the store and a price we could get the most for," he said. "Under this program, we are reimbursing at AWP minus 17 percent with a $3.25 dispensing fee. That is a considerable cost reduction from the AWP minus 7 percent and $3.12 dispensing fee we were paying."

In addition to the lower cost per prescription, the single source system lessens the state's administrative burden, according to Friedman. "Federal funds did not provide for administrative fees. With limited funds, we did not have the flexibility to take on additional administrative fees."

Does the move to mail order spell future troubles for Ohio pharmacists? Friedman is reassuring. "I think this is a case of the camel with its nose under the tent," he said. "The pharmacists' concern, and rightly so, is for when the department looks to the plan and likes the way its saving money. They are concerned that we may try to look to a similar plan for Medicaid."

Friedman said that mail order is appropriate for this particular situation, but not for all situations. "This program only provides one drug," he said, "and the patients are seeing their doctors weekly if they have AIDS. I don't think this program is subject to the same complaints others would be if they were switched to mail order."