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Rural Health Information Hub

Nov 18, 2013

Network Dispenses Hope, Prescription Drugs to Low-Income Patients

by Candi Helseth

At the Volunteers in Medicine Free Health Clinic in Lebanon, Penn., Dr. Victoria Brown treats impoverished patients who often can't afford prescription drugs because what money they have goes first to feeding and housing their families. The majority of patients treated at the clinic suffer from primary diagnoses of asthma, diabetes and hypertension—all chronic conditions that can be managed with appropriate medications. But thanks to the Dispensary of Hope (DoH), Brown's patients are receiving medications now at no cost. DoH collects surplus drugs and redistributes them to charitable clinics and pharmacies, which then dispense the medications to poor, uninsured patients.

A clinic staffer unloads a shipment of medications from the Dispensary of Hope network; as a member of the network, the clinic receives the drugs at no cost.

Established in 2003 as a 501(c)(3) charity, DoH recovers donated surplus medications from physician offices, hospital pharmacies, manufacturers and other licensed healthcare providers. DoH inventories and tracks the medications in its Nashville-based center before distributing them through its national network of licensed nonprofit clinics and charitable outpatient pharmacies. In fiscal year 2013, DoH provided $34,618,433 worth of brand and generic drugs to its network members.

“We depend on the clinics and pharmacies to qualify uninsured patients, who must be at or under 200 percent of the Federal Poverty Level,” said Anita Stanford, Director of DoH Site Network Development. “Our members pay an annual $7,500 subscription fee for unlimited amounts of medications. In 2012, these in-network clinics received an average of $102,000 worth of medications. Pharmacies in the DoH network received even more.”

Like many clinics serving low-income patients in rural and underserved areas, the Volunteers in Medicine Clinic operates on a limited budget. But its DoH network fee is greatly offset by the value of the medications, Brown said.

“Without proper medication, our patients subsequently get worse and need more medical care,” she said. “If we paid for all of the amount of medications that we need, it would cost us more than our membership fee. DoH is responsible about how they distribute meds, too. If we are not going to use everything they send, they ask that we return them before the expiration date so they can be appropriately used elsewhere.”

Unrecovered medications typically go to waste, Stanford said. “Conservative estimates indicate that at least $2.2 billion in sample medications is wasted annually in the United States. An estimated 14 percent of all sample medications expire in the physician's office.” Stanford said that, in fiscal year 2013, DoH received $8,020,228 worth of sample brand drugs recovered from more than 1,000 physician practices, and $26,598,205 in surplus generic medications from generic drug manufacturers, who donated surpluses.

More than 1,000 physician practices currently partner with DoH. Termed “Providers of Hope” by DoH, these members agree to check sample drug closets and donate all overstock within six months of expiration. (Pharmaceutical representatives have provided these medications at no cost to the physician practices.) DoH supplies postage-paid boxes for shipping the samples so physician practices have no out-of-pocket costs. Physician costs are also reduced because they must dispose of samples when they expire, following regulations that Stanford said can be costly.

“We reduce waste and these participating physician practices are helping the poor in communities across the country,” Stanford said. “We consider it our failure if a single pill expires on our shelves.”

DoH also offers a free, non-subscription program for reduced-price diabetic supplies. “We leverage very aggressive pricing from manufacturers for meters, strips and other diabetic supplies, and offer these to clinics and pharmacies, invoicing them just for what they order,” Stanford said. “That option is very attractive to smaller rural clinics that have a lower patient volume or can't afford the subscription fee.”

Currently, DoH is licensed by 35 State Boards of Pharmacy to send medication to clinics and pharmacies in those states. Clinics can and do still use other assistance programs, such as the Wal-Mart $4 medication list and the pharmaceutical manufacturer Medicine Assistance Tool (MAT), which provides free medicines for qualifying patients.

“But patients often have more than one prescription—so instead of $4, it may actually be $20 and they may not have it,” Stanford said. “Not every town has a Wal-Mart or the local Wal-Mart may not be on the bus line. Also, our program lets providers immediately dispense medications for patients waiting for their PAP drugs to arrive, which can take up to six weeks.”

Brown prescribes low-priced medications wherever possible, but she said costs add up quickly. For example, inhalers for people with asthma can run over $200 apiece and need to be replaced multiple times in a year. Access can also be a problem; about one-half of their patients live in rural areas.

“Many rural clinics do not have medication to dispense to patients who cannot afford to get their prescriptions filled at the local drug store, if there is even one in their community,” Stanford asserted. “However, we have few rural clinics in our network because they often don't have the $7,500 a year to join our collaborative. We are working to address that by seeking grants to assist clinics in funding their subscriptions.”

Saint Thomas Health of Nashville, an affiliate of Ascension Health, sponsors DoH. DoH is seeking additional philanthropic funding as well as new network partners. Stanford is available to provide additional information about DoH through webinars, conference calls and presentations.

For more information, contact Anita Stanford at 615-248-0101 or  To learn more about MAT, see Medicine Assistance Tool at or call 1-888-477-2669.

Back to: Fall 2013 Issue