By BETSY TAYLOR
NASHVILLE, Tenn. — David Troutman, 64, is a former Presbyterian minister who had a 30-year career in religious book publishing and distribution. In 2006, he lost his job. In 2009, a tornado "danced on top" of the roof of his home. He'd kept up his home owners' insurance, which paid for that extensive repair, but he depleted his savings before finally landing a job at a supermarket earlier this year. To make ends meet, Troutman relies on free prescription medications he receives through Dispensary of Hope, a charitable medication distributor based here.
At Saint Thomas Health's St. Louise Pharmacy in Murfreesboro, Tenn., he says of Dispensary of Hope, "They've been nothing but a godsend to me at a time when I really, really needed some help." Troutman explains he comes from a family with a history of heart disease, and he takes medications to mitigate hypertension. Troutman says for about six years he's been getting about 80 percent of his medications at the St. Louise Pharmacy, which dispenses medicine from Dispensary of Hope. He qualifies by completing a financial statement demonstrating need every six months.
Tim Lance, director of distribution at Dispensary of Hope, shows one of the hope boxes that physician practices fill with sample medications and ship back to the Dispensary of Hope's Nashville warehouse. Usable medicines are added to the inventory posted on the dispensary's website, where they can be ordered by member clinics or pharmacies to distribute to the poor and uninsured..
Dispensary of Hope receives medication donations from drug manufacturers and distributors and physician practices into its Nashville warehouse. It redistributes the drugs throughout the U.S. to federally qualified health centers, free clinics and nonprofit, outpatient pharmacies. Clinics and pharmacies in the Dispensary of Hope network use the drugs to fill prescriptions free of charge for poor and uninsured patients. The organization says it helps about 280,000 people annually.
Dispensary of Hope is the 2014 winner of CHA's Achievement Citation, an award recognizing an outstanding program or service that exemplifies the ministry's commitment to carry on Jesus' mission of compassion and healing.
Troutman says of Dispensary of Hope, "It's been a means of God's grace for me. It gave me one less thing to worry about."
Hope in a box
Here's how it works: Medication manufacturers and physicians donate newly manufactured or "short-dated" medicine — which might be within months of reaching an expiration date — to the dispensary. Pharmaceutical companies may mail packages or deliver medicine by truck. Participating physician practices receive reusable red "hope boxes," which they fill with sample medications and ship back to the warehouse. More than 1,000 U.S. physician offices donate using hope boxes. Dispensary of Hope staff tracks every shipment that arrives down to the pill, and post available medications on the organization's web-based inventory list.
Clinics and pharmacies enter into a subscription relationship with Dispensary of Hope, which allows them to select and receive unlimited quantities of medicine of their choosing from the organization's inventory.
Medications and diabetic supplies are distributed to more than 80 access sites, each of which must be not-for-profit and licensed as a health care facility.
Dispensary of Hope says it's able to distribute about 40 percent of the medication it receives. From 2009 through 2013, it received about 14.8 million doses of medicine with a combined average wholesale price of approximately $72 million. The organization estimates that during that same time period $29 million worth of medication, more than 5.8 million doses, was dispensed to patients served by its network clinics and pharmacies.
Bulk shipments
Dispensary of Hope's Chief Executive Christopher Palombo says the organization sees itself as a "vendor" to domestic mission work. He says medication manufacturers tend to deliver in bulk, in volumes that would be too great for a free clinic to use or store, but are readily handled at Dispensary of Hope's secure warehouse. Manufacturers who contribute medication receive a "positive tax benefit in many instances," Palombo says.
Dispensary of Hope began in 2006, when one doctor put a bin inside a Saint Thomas Health system hospital, seeking unexpired medicines that could be given to those in need. The initiative grew over time, and Dispensary of Hope was organized as a subsidiary of Ascension Health's Saint Thomas Health. The program has a staff of 13, and Dispensary of Hope says it runs on an operating budget of $1.6 million. Its budget includes private foundation funding and grant funding from Ascension Health Mission and Ministry and the Foundations of Saint Thomas Health. Annually more than $300,000 in operating revenue is generated through medication subscriptions from its network clinics and pharmacies; it also generates more than $125,000 from the sale of diabetic testing supplies, according to figures provided by Dispensary of Hope.
The work of Dispensary of Hope fits with Saint Thomas Health's mission to work for a society in which all people receive compassionate, holistic and coordinated care, leadership says. Dr. Michael Schatzlein, chief executive and president of Saint Thomas Health, puts it this way: "We think a lot about mission here. It's not just a health system with Holy Water sprinkled on it."
Supply-chain integrity
Because Dispensary of Hope is dealing with prescription medications, it needs to be very careful about tracking where medicine came from, and where it ends up, in order to keep patients safe and so that providers and manufacturers who donate feel confident about the chain of custody, say Dispensary of Hope executives. The warehouse ships medications that are unexpired, that never left ownership of a licensed health care facility and that are in original manufacturing packaging. Nothing moves without being counted, inventoried and tracked. Dispensary of Hope accepts oral, solid medications that can be stored at room temperature. It does not accept controlled substances including narcotics, which have very vigorous regulations governing distribution and require heightened security safeguards.
Some of the medication arrives expired, so it is unusable. The charity has a contract with an outside vendor to safely incinerate medications it cannot distribute. That can be a helpful service, particularly for physician offices when cleaning out their drug sample closets. Scott Cornwall, Dispensary of Hope's chief operating officer, says, "I have yet to meet a potential partner who says: 'Medication waste. We like it. We have it. It's part of our growth strategy.'"
Domestic mission work
Christine Toni is the coordinator of the Hope Dispensary of Greater Bridgeport, a charitable pharmacy in Connecticut that serves the poor and uninsured. The pharmacy receives medications from the Dispensary of Hope to provide short-term and maintenance medication. The Hope Dispensary of Greater Bridgeport has an inventory of the most commonly prescribed medications, but it does not stock every medication.
Toni, a pharmacist, says her job allows her to do missionary work 5 miles from her home. She helps patients overcome medication compliance barriers related to health literacy, language proficiency or motivation. She works to simplify dosing, trying to get patients medicines they can take just once or twice a day, and, in some cases, gives patients pictograms, or charts with a sun and a moon, to illustrate which medications to take and when to take them. Steps like these can help patients remember to take their medications at the right time, in the right dose.
Toni says the work of Dispensary of Hope and its efforts to get medicines that might otherwise go to waste to low-income patients who struggle to afford prescription medicine demonstrates a commitment to social justice and care of the vulnerable. "So many people — the term is they're 'marginalized' — but they're left out," she says. "To offer them a measure of compassion and hope is just the right thing to do."