By Michelle Rubin

In her retail pharmacy days, Lorrie Jagiello, PH’97, was yelled at, cursed and even spit on by customers who couldn’t afford to pay for their prescriptions.

“Sometimes you felt really beat up on,” Jagiello recalls. “To them, you were the root of their problems. They couldn’t afford their meds, and you were taking their money — even though you were powerless.”

These days, however, Jagiello is no longer powerless, and her customers thank her, praise her and sometimes even bring her food and handmade gifts. As director of Des Moines’ new Community Access Pharmacy, she is finally able to help the underinsured and uninsured.

‘A huge need’
The Community Access Pharmacy opened in April through the efforts of the Health Access Partnership, a local coalition of about a dozen groups, including Drake’s College of Pharmacy and Health Sciences, that recognized a need for the uninsured and underinsured in the area to be able to afford their medications.

The pharmacy has been funded as part of a $2 million, three-year federal grant awarded to the Health Access Partnership to improve health services for uninsured Iowans. One of the coalition’s original grant initiatives was to establish a comprehensive pharmacy program, and Jagiello, who had previously run a free diabetes clinic with her husband, William Jagiello, LA’73, suggested that the partnership start a full-fledged pharmacy.

“I saw that there was a huge need in this area and the right environment,” she says. “We had the right players in place, as well as the funds.”

Jagiello worked with Drake Associate Professor of Pharmacy Practice June Johnson to present a business plan to the partnership in May 2003, and on April 1, 2004, the Community Access Pharmacy opened in a former gas station-cum-doctor’s office near Des Moines’ Broadlawns Hospital.

On opening day, Jagiello and her staff expected to see about 30 people in the pharmacy. Instead, 160 patients sought affordable prescriptions at the pharmacy. These days, the pharmacy fills 1,600 prescriptions a month.

Behind the statistics are the stories Jagiello hears every day. There’s the woman with who broke down in tears when she transferred her prescriptions to the pharmacy and saw her $800 monthly prescription bill drop to $140 — with some of her diabetes and asthma prescriptions filled for 90 days. Or the people who no longer have to make repeated trips to the emergency room because they haven’t been able to afford their blood pressure medicine on a regular basis.

“This is so much more fulfilling than retail and really something I never thought I’d be good at or would be so gratifying,” Jagiello says. “But we do a tremendous amount of good.”

The right to good health care
Primary Health Care holds the license of the pharmacy, which acquires its medications through grants, by buying low-cost generic drugs and by helping patients fill out forms to get free or low-cost drugs from pharmaceutical manufacturers. For instance, the pharmacy participates in a government program known as 340B pricing, through which the pharmacy receives some drugs at a cost 15 percent lower than the lowest price sold to anyone else.

As an example, Jagiello pulls a bottle from the shelf of the 340B inventory (which must be kept separate from the regularly priced inventory) that would normally cost $600 but cost the Community Access Pharmacy only a penny.
Patients who use the pharmacy must be referred by a physician at one of the participating clinics, known as safety-net clinics, that treat the uninsured and underinsured. But Johnson says that local pharmacies needn’t be concerned that they’ll be competing for customers with the Community Access Pharmacy.

“These patients are coming from a free clinic system,” she explains. “These are not patients who are normally covered with any insurance that these other pharmacies would normally see at their stores.”

Another misconception is that patients can get their prescriptions at the clinic free of charge. While it is affordable, there is often a cost associated.

“The reality is that we were trying to make a service that can be sustained and available to this community beyond the grant, and if it’s all free and the money is gone from the grant, it stops existing,” Johnson says.

“It’s important for folks to realize that there is a cost to health care and everybody has some responsibility in that,” adds the Center for Healthy Community’s Chris McCarthy, who oversees the grant. “And while it’s not going to be free, it’s definitely within reach of most folks.”
But as part of the overall effort to improve access to health care in the area, the pharmacy is more than just a place to get affordable prescriptions.

“Not only are the uninsured and underinsured disadvantaged socio-economically, but they’re sort of shuffled through the system in a very fragmented way,” says Johnson. “Sometimes they’re looked at as problematic, and the Health Access Partnership doesn’t want people to feel that they are being treated as second-class citizens because they are uninsured or underinsured. Everybody has a right to good health care in our country, and the partnership is committed to that.”

Student opportunities
“The pharmacy is one of those things that just kind of took off and rode a wave of great collaboration and support. This is a pretty unique model,” McCarthy says, adding that his peers are sometimes envious of the area’s resources. “Not everyone has the resources that we’ve had — a community heath center partnering with a college of pharmacy — to pull something like this off.”

“Drake wanted to help this community improve its health, improve access to services and improve the quality of those services — ultimately improving health outcomes in the community,” says Johnson. “It’s a great example of how the community has come together to meet the needs of the uninsured and the underinsured.”

Drake’s involvement also allows CPHS students to experience the pharmacy through rotations and other learning opportunities. The Drake chapter of the American Pharmacists Association Academy of Students of Pharmacy recently received a $2,000 grant to work with the pharmacy’s 340B program, and this fall the College plans to hire a faculty member committed to teaching at the pharmacy.

“We want our students to see the needs of a population like this and how they can make a difference with the skills and knowledge that they have,” Johnson says.

Because the pharmacy serves a number of Des Moines’ diverse populations, primarily the Hispanic community, it’s an ideal place to expose students to cultural diversity.

“If we want to put out students who are citizens of the world, who are globally educated,” Johnson says, “they’ve got to be culturally sensitive so this environment is perfect for that.”

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