Charitable Pharmacies: A means to bridging accessibility to prescription drugs

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A charitable pharmacy may be defined as a not-for-profit pharmaceutical premises or pharmacy location where prescription drugs and other approved medicinal products are supplied directly to a specific population of qualified persons as allowable under the law.

In the USA, for instance,  pharmacy laws vary from state to state; and in those states where regulations permit the operation of a charitable pharmacy, specific guidelines may limit the scope of prescription drugs that could be dispensed from the medicine bank.

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Regulations on charitable pharmacies in states where medicine banks or drug product recycling is permitted typically cover operational areas related to:

(a) Whether individuals, manufacturers, wholesalers, hospitals or business corporations MAY or MAY NOT donate drug products to a charitable pharmacy.

(b) Whether a charitable pharmacy may or may not charge a FEE for the dispensing processes.

(c) The prescription drug products that may be: donated, received and dispensed in a charitable pharmacy.

(d) Exclusion of controlled drug substances in the list of drugs that may be stocked by a charitable pharmacy.

(e) The type of non-governmental organisations (NGOs) that are allowed under the law to operate a charitable pharmacy

(f) Whether The charitable pharmacy MAY receive donations in monetary terms or not in the operations of its free service.

(g) Geographical locations permitted by law for the charitable pharmacy because of the specific population group it is intended/allowed to serve. Cities appear more probable due to high population.

(h) Whether the patient population served in the charitable pharmacy may or may not participate in manufacturer sponsored drug-product clinical trials OR if manufacturer drug samples are allowed for distribution in the premises of the pharmacy.

(i) Time interval to product expiration (in months) permitted for DRUG donations to a charitable pharmacy; And, whether specialty medicines or refrigerated products are allowed or not.

(j) Staff recruitment, tenure of employment, volunteer services and whether workers in a charitable pharmacy may receive remuneration for work or not. For example, interns or students on attachment.

(k) Scope of services to be offered outside of prescription drug dispensing, that is, if the services includes medication therapy management, vaccination and or the dispensing of “non-proprietary” products aka over-the-counter drugs.

(l) Whether a charitable pharmacy may or may not receive and or transfer prescription products to a “for-profit pharmacy” or such other profit oriented health centers and vice versa.

(m) A clear definition of the physical appearance and or characteristics of products that may or may not be donated to a charitable pharmacy. For example, “must” be in original manufacturers’ pack unopened. Or, “may” be in original unbroken packaging from the: pharmacy, wholesaler, distributor, or manufacturer.

(n) Whether the recipient(s) of prescription products dispensed by the charitable pharmacy” must” be present in person as “proof of need” or whether a care giver or family member may present the drug-order on their behalf.

(o) How the charitable pharmacy will dispose of expired medications to a reverse distributor for destruction?

(p) The operational hours of a charitable pharmacy especially as relates to weekends and holidays.

According to a study by the Congressional Budget Office (CBO) up to 18 million persons may lose Health Insurance coverage following a repeal of The Affordable Care Act (ACA), and five million more who receive coverage under The ACAs Medicaid expansion programme could be negatively impacted in addition.

The same study estimates that by 2026, the numbers of uninsured may reach 59 million individuals. Free clinics and medicine banks therefore have a progressively complementary role in increasing patients’ accessibility to healthcare and medications, particularly in circumstances such as the flu epidemic, when emergency room ER services are typically overstretched.

A Report by The National Conference Of State Legislature 03/31/2017 titled “State Prescription Drug Return, Reuse and Recycling Laws” reveals some interesting data on the positive impact of Charitable Pharmacies in some States where the Law has been operational:

  1. State of IOWA Drug Recycle Program began in 2007, served 70,000 patients and redistributed drugs and supplies worth $15 million to people in need.
  2. Wyoming’s Drug Donation Program started in 2005, provided 125,000 prescriptions worth $10 million to Wyoming residents.
  3. State of Oklahoma which started a similar programme in 2004 filled 193,926 prescriptions worth an wholesale price of $19,151,731.

For NGOs that may be interested in the project of a charitable pharmacy, that is, in places where legislation or enactments permit; For emphasis, other important considerations of note relevant to a successful outcome shall include:

(i) How to secure a safe and adequate building (possibly a donation) towards the project?

(ii) How to recruit a volunteer team of interested professionals and how to ensure adequacy of staff once the project kicks off?

(iii) How to raise FUNDS (possibly from corporate sponsors and individuals) by philanthropy, towards the take off and for operational expenses per projections of community need?

(iv) How to identify people who are favorably disposed to charitable services in the community and those including students who may be willing to volunteer towards the initial development of the project?

(v) Identifying the type of professional manpower needed for a successful operation of a charitable pharmacy, that is, other than the pharmacist, since, state and federal law requires filing annually and appropriately too, a statement of income and or expenditure showing value of Inventory held per year.

(vi) How to screen prospective patients for eligibility and how to define eligibility criteria for a charitable pharmacy particularly in accordance with state or federal law?

In conclusion, a charitable pharmacy, as the name rightly suggests, is a pharmaceutical premises established primarily for the needy in our communities, and, it serves as a unique means of providing much needed prescription drugs to the indigent in a community so that healthcare does not elude them and their families.

By Oluwole A Williams, B.Pharm(Ife), PharmD (Howard)

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