1. Mike Gifford President & CEO, ARCW Katy Caldwell Executive Director, Legacy Community Health Services Mary Elizabeth Marr CEO, Thrive Alabama Rick Fons Vice President of Pharmacy Services, ARCW

2. Mike Gifford, MBA President and Chief Executive Officer AIDS Resource Center Wisconsin

3.  Pharmacy is among the most important HIV services for our patients and clients. Medications are life-prolonging, life-saving Challenges to access medications remain significant Access and adherence is critical to viral suppression

4.  Truly integrated care is the emerging best- practice model of care for HIV patients and clients. Quality over quantity; improved quality outcomes Pharmacy is still often times left out of health care service delivery models Payment reform

5.  Unpredictable revenue sources risk the sustainability of HIV services Government funding has been level or decreasing Private funding has been stagnant Many AIDS service providers are facing difficult choices because of financial constraints Pharmacy services can be a new, earned, large revenue source

6.  The presentation includes important examples of different models of pharmacy services for HIV patients Contracted pharmacy In-house pharmacy On-site pharmacy Off-site pharmacy  It is important for HIV/AIDS service providers to evaluate and decide the best model of pharmacy services for their organization, patients and clients

7. Katy Caldwell Executive Director Legacy Community Health Services

8.  Ryan White Grantee since the Beginning Parts A, B, C & D  Family Planning Grantee Title V & X  FQHC Status since 2004 First look-alike and then fully deemed  Full 340b Access for all Patients Contract with Walgreens & Wellpoint (mail- order)

9. 2004 CHOICES Contract or Start Our Own Pros & Cons of Each

10. Control Retain Profit Cost Knowledge Drug Pricing Ins. Contracts Liability DEA Raids Class A License Control Retain Profit

11. Control Retain Profit Lack of Control Dispensing Fees Reputation Accountability Ins. Contracts Corp. Decisions No Cost Core Comp Inventory Tracking Shared Liability Buying Power Locations

12.  5 years One location on site  Separate lease Market rate rent  We own inventory  We pay dispensing fee  We contract with distributor At their approval  They bill insurance companies Detailed reconciliation

13.  They prepare/file all docs to OPA  May request staff changes For any reason  Pharmacist must be trained In HIV, Behavioral Health & Hep C  Standard insurance On both sides  Must meet our LEED standards  Must honor all methods of pay Sliding scale, ADAP & grant funded meds

14. Mary Elizabeth Marr CEO Thrive Alabama (formerly AIDS Action Coalition of Alabama)

15.  Ryan White Grantee since 2000 Parts B, C & D  Davis and Hames Clinics 600+ Clients Additional site opening 2015  Full 340b Access for all Patients Contract with Walgreens & Curant Health (mail-order)

16.  Largest independent specialty 340B pharmacy in the nation  Home Delivery – FedEx  In-care Coordinators Client Adherence Collaborate with Clinical staff on adherence issues Clients have $0 co-pay when dispensed Specialty Pharmacy  Throughout 12 county region  Some clients prefer a storefront & direct contact with a pharmacist  Same day pickup Store Front

17.  INFRASTRUCTURE Administrative Costs Finance Staff (3) HR (1) ED (1) Data (1) Vehicles for Transportation Cut our Overall Transportation Costs Building Fund

18.  SMMAP (Sandra Moon Medical Assistance Program) Medical Co-Pays Physician Appointments Medication Co-pays Laboratory Co-pays  INSURANCE Monthly Premiums Insurance Deductibles

19. 29 195 40 325 $3K

20. Viral Load Suppression

21.  Potential Challenges ability to fund PrEP: Costs Physician Costs Laboratory Costs Insurance Assistance Patient Assistance Programs

22. Richard Fons, RPh, AAHIVP Vice President of Pharmacy Services AIDS Resource Center of Wisconsin

23.  Nation’s first CMS Approved HIV Medical Home  191 staff  13 clinics and offices  Operates an in-house pharmacy model  Six pharmacist and ten technician staff  Two pharmacy locations: Milwaukee and Madison

24. ARCW 2009 ARCW 2014 Patients Number served2,523est. 2,950 % with an Undetectable Viral Load69%85% Financial ARCW budget$12.5 million$45.9 million Net Income$303,000$1.8 million Net Assets$4.2 million$8.9 million Cash on hand$653,000$3.4 million Staff Employees132191

25. 1.Expanded our Medical Home model of care 2.Improved clinical outcomes HIV Primary care 3.Improved organizational talent 4.Improved overall margin over outside contract pharmacy model of care

26.  Pharmacist-Driven Institutional Protocols Improved patient outcomes Anticoagulation, Hypertension, tobacco cessations HIV therapy selection/ Adherence  Medical-Home Pharmacist Comprehensive medication reviews Medication procurement Education/research/clinical decision support  Revenue Generation Medical-home patient management fee Clinical outcome incentive bundle payments (Medicare/3rd Party) Prescription capture “Incident to” CPT billing

27. ARCW 2009 ARCW 2014 Patients With an Undetectable Viral Load 69%85% Prescribed HAART74%95% With diabetes that is well managed NA83% Prescribed preventative PCP treatment 91%95% With controlled hypertensionNA59%

28.  Full time, in-clinic pharmacist  Dental clinic in Green Bay office  Expanding behavioral health to 5 more offices  Medication Copayment Assistance Program  Increased number of food pantries  Additional staff: medical provider, case managers and psychiatrist

29. YearPharmacy revenuePharmacy revenue reinvested in patient services 2011$7,019,604$915,322 2014$33,044,565$5,683,483

31.  Webinars are available on our website for on-demand viewing.  You will find slides from today’s presentation posted to the front page of our website: www.nationalhivcenter.org.www.nationalhivcenter.org  Please complete the evaluation at the end of the webinar. Your feedback will inform our programming.  If you are interested in individualized technical assistance, please visit our website and complete a TA Request Form.  Join us for our other webinars this month! Engagement in Care: From Cascade to Continuum to Control Wednesday, May 20, 2015 @ 2:00 PM ET (Registration will soon be open at our website: www.nationalhivcenter.org )www.nationalhivcenter.org Conclusion Slide