October 18, 2023
A patient at the Mountain Area Health Education Center (MAHEC) Clinic was scared, frustrated, and unsure of what, if anything, she could do next. Her heart and mind were with the baby she’d delivered just a week before, currently in the NICU, but she also needed to take care of herself. Her doctors had prescribed her anti-coagulant medication but, for some reason, her Medicaid coverage was discontinued and she was facing a cost of $800 for the medication.
That’s when the MAHEC system kicked in and worked exactly as it was built to: The clinic’s embedded pharmacist referred the patient to the newly-opened 340B Pharmacy at MAHEC where she was able to get her prescription filled at no cost. She didn’t even have to leave the MAHEC campus – just walked from the clinic to the pharmacy.
“It wasn’t multiple stops. It was a connection in the clinic to the connection in the pharmacy within a group of people that knew how to help a person just move through it,” marvels Matt Ransom, PharmD ’07, MPH, and Director of 340B Pharmacy Services at MAHEC. “To me that is just incredible.”
Matt is part of a team at MAHEC that has spent the last fifteen months setting up the 340B Pharmacy Program at MAHEC, including locations at both the Biltmore campus and the Enka-Candler clinic. In June of 2022, MAHEC transitioned to become a Federally Qualified Health Center (FQHC) Look-Alike, allowing them to maximize access to care for underserved populations – including uninsured and underinsured.
The next step for MAHEC was obvious; to open a 340B Pharmacy (so-called because of the section of the 1992 Public Health Service Act which created the drug pricing program). Throughout the entire process, UNC Eshelman School of Pharmacy faculty and alumni have been involved.
From the beginning, Mollie Scott, PharmD ’93, BCACP, CPP, FASHP, Regional Associate Dean at the School and Chair of Pharmacotherapy at MAHEC, helped bring together School leadership from the Asheville campus with MAHEC leadership to envision the creation of the 340B Pharmacy Program. To lead implementation, they hired Matt Ransom. Rachel Selinger, PharmD ’09, was hired to serve as Pharmacy Manager for the Biltmore location, and Jenna Caldwell, PharmD ’21, was hired as Pharmacy Manager for the Enka-Candler location.
MAHEC began buildout of the new pharmacies in the summer of 2022, aided by a $150,000 grant from The Leon Levine Foundation. The Biltmore pharmacy filled their first uninsured prescription in February, 2023, and the Enka-Candler pharmacy filled their first uninsured prescription in May. The impact of these locations being open is already showing itself, anecdotally.
Jenna Caldwell shares that she had two uninsured patients in just one week with prescriptions for inhalers. Through the 340B program, her cost is less than a dollar each and the patients only had to pay a dispensing fee on top of that cost. “So it was maybe $10 or so, versus I can only imagine what it would be elsewhere,” Jenna says. “They can get the care they need, and it’s nice that we can actually provide that instead of just doing whatever they can afford or whatever is available . . . we can maybe even treat these patients better because we can do guideline recommended therapy and not let that barrier of access get in the way.”
Services will also develop beyond the walls of the two MAHEC locations, one of many tasks Matt is working on to increase impact for underserved patients in the region. “One aspect of a 340B Program is . . . you can also contract with other pharmacies to fill prescriptions for your patients, and those medications were purchased at a 340B price,” Matt shares. “If we can contract with an independent pharmacy, help support their operations and work, patients are able to go someplace close to home and still get a high level of care.”
Of course, the plan is to expand services for both locations well beyond just dispensing and OTC medications. “We plan to begin offering hormonal contraception services in the pharmacy and grow the chronic condition management program,” Mollie Scott explains. “Our technician program has been wildly successful and our colleagues in Family Medicine and Internal Medicine are already asking for more technician resources because of the positive impact of this program on provider and patient satisfaction.”
The current impact and future plans of the 340B Pharmacy Program will be showcased to UNC leadership when the 2023 Tar Heel Bus Tour visits MAHEC, just one day after publication of this piece. Visitors from the University will learn about the program, the expected outcomes on the health of rural North Carolinians, and some of the program’s plans for the future.
As for that grand vision of the future, Matt Ransom sums it up in just two words: Connection and Simplicity. “To help the hardest-to-reach patients connect to care,” Matt describes. “Those who may have a harder time navigating health systems – maybe substance use disorder or psychiatric illness – being able to connect with those populations in creative ways.”
He goes on, “To take all that complexity . . . and what we present to somebody feels clear and simple, because they’re just getting what they need. But the reality is, it’s never that way. But it’s nice to present it that way – so patients can just get what they need.”