1. Impact of our 340B Pharmacy on our HIV Program by Gerald Pierone Jr., M.D. 2012 Ryan White Grantee Meeting November 27, 2012 Washington, DC

2. Overview I. AIDS Research and Treatment Center of the Treasure Coast history and background II. Decision to start a 340B pharmacy III. Implementation process for 340B pharmacy IV. Impact of the 340B pharmacy on our Clinic

3. ARTCTC Background: Original involvement with HIV care in Fort Pierce in 1992 under contract with a Part C clinic that was part of a FQHC We had a separate location and provided HIV primary care for about 300 patients with a team of a part-time doctor and 2 full- time ARNPs About 2 years later the agency leadership decided to change the format of clinic care and divide HIV patients among primary care providers This approach was not accepted by the providers and we left the clinic and the majority of patients followed us. We rapidly learned that our payor mix in this impoverished community would not support a private practice model and we formed a non-profit 501C3 agency in 1995

4. ARTCTC Background (cont’d): For the first 10 years we survived (barely) on a hodge- podge of grants, patient care revenues, part B contract, and private charitable donations In 2003 we were approached by the local Health Department to work with them on a part C grant application The grant application was successful and we added part C patients to our patient caseload as a subcontractor to the Health Department These grant dollars provided a small measure of financial stability for our agency and allowed us to add a full-time physician and case manager

5. ARTCTC Background (cont’d): The part C grant was essential for the growth and viability of our agency, but we were still pressed and had no financial latitude We were operating with a very lean staff ratio and there had been no increases in compensation for over 3 years

6. Decision to form a 340B pharmacy In 2008 our Clinic Director was at an all titles meeting and gathered information on 340B Contract Pharmacies I contacted OPA and because of a misunderstanding, was under the impression that our clinic would not qualify for the 340B program. Based on this information I let the matter drop In late 2009 a pharmacist from an HIV specialty pharmacy suggested that I revisit the 340B issue because she knew of a program similar to ours that participated I then contacted Bill von Oehsen and his law firm to determine if our agency was qualified. We quickly learned that we were eligible for the program and were able to move on to the implementation phase (March 2010)

7. Implementation process for 340B We interviewed several contract pharmacies and found many differences in their approach –Different financial terms –Some well versed in 340B program, others quite new We selected Healthstat pharmacy based on their familiarity with the program and reasonable financial terms We negotiated a contract with Healthstat and had the started the pharmacy program in August 2010

8. Impact of 340B Pharmacy on our Agency Started August 2010 and experienced rapid uptake and acceptance from our provider team and eligible patients Within 2 months we generated our positive revenue Over the past 2 years we have seen continual growth of patient enrollment Excellent satisfaction surveys from patients Continued growth of revenue First outside audit showed 100 percent compliance with client eligibility for 340B services We have been able to expand services for our patients and are now financially stable