A nonprofit organization that began in 2001 to help Iowa seniors manage soaring prescription costs has evolved into a far-reaching initiative to assist some of the state’s most vulnerable populations in accessing low- or no-cost prescription medicines on a temporary basis. 

Now, SafeNetRx is again evolving, as the wholesale pharmacy assistance program launches a safety net initiative that will enable it to dispense pharmaceuticals directly to low-income individuals statewide. 

The Urbandale-based nonprofit, which changed its name on April 1 from Iowa Prescription Drug Corp., already serves more than 10,000 low-income Iowans annually with its flagship Iowa Drug Donation Program. It now hopes to serve an additional 10,000 Iowa residents in the first year of the new safety net program. 

As many community pharmacies in Iowa are bought by large corporations or pharmacists retire, fewer pharmacies are willing or able to handle the federal program known as 340B that provides discounted drugs to qualifying health centers, said SafeNetRx CEO Jon-Michael Rosmann.  

“Our solution is to create a nonprofit safety net pharmacy where we can provide contracted services to covered entities and also provide access to a large number of safety net programs,” said Rosmann, who originally joined the organization in 2005 as a board member and was named its chief executive in 2010. 

The new initiative is funded in part by a $50,000 grant from Telligen Community Initiative, a West Des Moines-based charitable foundation.  

All of SafeNetRx’s programs are designed to provide free and low-cost access to medications, particularly for “safety net” patients, defined as Iowans with an income of zero to 200 percent of the federal poverty level and who are either uninsured or underinsured. 

SafeNetRx also operates a program in cooperation with the Polk County Jail and the Iowa Department of Corrections in which it provides up to a 90-day supply of mental health medications to released inmates, which has been an effective tool for reducing recidivism into the corrections system.  

Identifying the gaps 

The organization was originally created in 2001 as a partnership between state government and the nonprofit sector to help Iowans pay their Medicare prescription costs prior to enactment of Part D plans. After Medicare Part D plans were developed in 2005, the nonprofit expanded its mission to focus on safety net patients. 

“We aren’t trying to provide medications in lieu of Medicaid or other programs,” Rosmann said. “Our job is to identify the gaps in the health care system and fill those gaps.” 

Before the Legislature acted in 2007, it was illegal to re-dispense unused prescription drugs. Now, federally qualified health centers can order and receive them by United Parcel Service Inc. from SafeNetRx for patients within one to three days. Last year, over 10,300 Iowans received free medications through the program. 

“That program is really remarkable in that it’s grown to become the largest state drug donation program in the country,” Rosmann said. The program now accepts incoming medications worth between $2.5 million and $3.5 million annually.  The drugs are donated through various safety net programs that obtain unused medications from hospitals, pharmacies and senior living facilities. 

Although drug donation programs have since been legislatively approved in 44 states, there are probably only about 15 states that have funded, operating programs. “We receive a call every week from a state trying to replicate a program similar to ours or they’re going through the legislative process to get it going,” Rosmann said. “So it’s a model that’s really starting to take off.” 

Working with the justice system 

SafeNetRx has developed two programs to connect released offenders with access to mental health medications. One of those is a partnership between the Polk County Jail and the  federally qualified health center in Des Moines, Primary Health Care Inc. 

Under that program, if the offenders need assistance with medications, they can receive up to a 90-day supply after they’re released, giving them time to establish themselves in a job and with a health care provider. The program, currently in its third year in Polk County, is now being expanded to other counties as well. 

“We’ve found that medication access is actually a very effective tool for reducing rates of recidivism,” Rosmann said. In a 90-day study, program participants had an 8.4 percent recidivism rate, compared with 22.8 percent for nonparticipants.

Part of the nonprofit’s success has been its ability to respond to changes in the health care system, Rosmann noted. And health care has been changing so much recently that new gaps emerge all the time for the nonprofit to address. 

“For example, with the Affordable Care Act, we now have more insured Iowans,” he said. “However, some of those patients, if they have purchased a health insurance product on the exchange and it’s a bronze plan, they would have a deductible of $6,450 before any health or medication assistance kicks in. So clearly, those patients are effectively uninsured unless it’s catastrophic.”

Similarly, with the changeover to the three privatized Medicaid plans, Rosmann anticipates increased demand for his organization’s program as there are delays in getting people covered or shifting between plans. 

Under one roof 

Existing safety net programs are hard for individual pharmacies to handle because they each require separate inventories to be maintained, Rosmann said. 

“Our concept is to bring all of these safety net programs in under one roof and we have a portfolio of safety net programs to fill from that meet the unique needs of that patient,” he said. Instead of reimbursing for the retail cost of the prescriptions, SafeNetRx will fill them itself with  medications it receives at a very low cost or for free. “By doing this, we believe we can stretch the dollars much further,” he said. 

Rosmann said he believes this type of comprehensive safety net pharmacy model is the first of its kind. 

“To our knowledge, there aren’t any other pharmacies that operate with this structure,” he said. “So it’s really a unique opportunity to demonstrate that disadvantaged patients can have their needs met efficiently. This type of pharmacy model should also benefit the covered entities that utilize the pharmacy as well.” 

Rosmann hopes to make the program self-sustaining within three years using a variety of funding sources, among them the Telligen grant. 

“Initially, we’ll start out by serving one or two federally qualified health centers,” he said. “We’d like to expand that to three or four by year two. So it’s going to start small and then grow in concentric circles.”