No one should have to choose between eating this week and filling a needed prescription. That simple belief, coupled with the realization that a significant number of prescriptions languished on his shelf until finally hitting an expiration date, led Bruce Wolf, MD, to take action. What began as a personal mission has grown into the Dispensary of Hope.

 

In early 2009, Jason Dinger was named CEO of the non-profit organization, although he had been involved with the program for several years before that. However, he said the story really begins back in 2003. He jokingly noted the non-profit definitely had a "primordial ooze" stage where Wolf, an allergist with offices in Nashville and Murfreesboro, collected unused, unexpired medicines from his own shelves and asked colleagues to do the same. He rallied Middle Tennessee Medical Center to begin dispensing these sample medications to uninsured patients.

 

Soon Wolf's grassroots efforts took hold. Dinger said, "In late 2004, Middle Tennessee Medical Center opened a not-for-profit pharmacy in Murfreesboro, and it was called the Dispensary of Hope." Within 18 months, Saint Thomas Health Services opened up another site at Saint Thomas Hospital out of their retail pharmacy. From the beginning, Ascension Health has been a major supporting partner.

 

While clearly these sites were meeting a huge need, Dinger said the business model was inefficient. "Pharmaceuticals is one of the most regulated industries in the country," he pointed out. "It started to become a very onerous process, quite frankly."

 

Enter Dinger, Scott Cornwell (now chief operating officer), and other team members with a corporate background. "We did what venture capitalists do … we did a whole bunch of due diligence. We built a whole new business plan," said Dinger.

 

The group began by taking a very pragmatic, businesslike approach to the question — who was providing affordable medications to the uninsured and underinsured? "It turned out, there was nobody really targeting this population," said Dinger.

 

The group met with major pharmaceutical manufacturers and distributors to better understand the supply chain and to see where opportunities existed to divert medications to those in need.

 

"I think most people consider most non-profits to grow organically," noted Dinger. "We had a vision of building an organization to meet this need nationally from the very beginning. We've been very deliberate about this."

 

Today, the leadership team is witnessing that vision become reality. "We now have 49 sites in 10 states. We're adding about four-five sites per month, and we have a waiting list of about 125," Dinger said. "We hope to have a site in nearly every state by the end of 2010." Dinger added the organization is on track to meet that goal.

 

He continued, "Now we have over 1,300 physicians who donate excess, unexpired sample medications to us on a regular basis." Dinger said Dispensary of Hope has a staff person in charge of building the physician network, but the team has been amazed at how receptive physicians have been to the concept.

 

"The people on the ground who are acutely aware of this issue are the physicians," he said. "Physicians are motivated not only from a humanitarian aspect but also from a financial perspective." Dinger pointed out it is a win/win if patients have access to medications to manage chronic conditions or treat acute illnesses before they morph into more medically complex cases.

 

Knowing that proper medication management could keep patients out of emergency rooms, hospitals have increasingly sponsored participating clinics in their community. "For every $1 of medication provided, $3.65 in bad debt is saved," Dinger quoted from research. "We can provide medicine for 10 cents on the dollar so $1,000 will effectively provide $10,000 in prescriptions, which equates to $36,000 in bad debt savings."

 

With medicines coming in from the physicians around the country, Dispensary of Hope built a 10,000 square-foot facility in MetroCenter in late 2007 to aggregate the sample medications. Dinger explained the organization is technically a licensed wholesale distributor in each of the states where they ship medications. Once there is a critical mass of enough clinics, pharmacies and other dispensing sites in a state, the organization applies for licensure. Upon state approval, Dinger said sites could be turned on very quickly.

 

Part of the success comes from the ease of participation. Dinger said all a physician has to do to get started is to send an e-mail stating interest. A red plastic bin is shipped to the physician's office along with the needed paperwork, which Dinger stressed was minimal … about two pieces. From there, he called the process "a combination between Netflix^® and your regular garbage pickup." UPS picks up the red bin … now filled with unexpired samples … at the same time each month, and an empty collection bin comes back to begin the process all over again.

 

On the dispensing end, Dinger said clinics go online with the organization's eHope system to order medication in real time. Dispensary of Hope has built a proprietary software system to manage inventory, track patient access and ensure pharmaceutical pedigree.

 

The Instant Access program, which is on track to provide for more than 125,000 prescriptions in 2009, has recently been joined by the Prescription Assistance Program (PAP) — a pilot program in Tennessee. Dinger said that although physicians have been very generous, there are certain medications that are difficult to come by because they aren't typically handed out as samples. To fill this gap, Dispensary of Hope signed agreements with several manufacturers and launched the new assistance program in November.

 

"A patient fills out an application and provides a $30 (annual) enrollment fee. In exchange, they can get any needed prescription on the formulary … as much as needed at no cost. It's a huge boon to Tennessee," said Dinger. "It's an asset to our entire state."