Controlling Rising Pharmacy Costs

• San Francisco General Hospital’s costs for dispensing drugs in the Outpatient Pharmacy have increased since the implementation of the Pharmacy Benefits Management Program in November 2000. Under the Pharmacy Benefits Management Program, the Department of Public Health contracts with a private firm, Pharmaceutical Care Network, to administer reimbursement claims from private retail pharmacies in San Francisco, which provide prescription drugs to medically indigent clients.
  
  
• Because medically indigent clients are eligible to receive prescriptions from private retail pharmacies as a result of the Pharmacy Benefits Management Program, San Francisco General Hospital’s Outpatient Pharmacy prescription volume decreased by approximately 49 percent between October 2000 and June 2002, from 28,551 prescriptions in October 2000 to 14,455 prescriptions in June 2002. However, Outpatient Pharmacy staffing did not decrease correspondingly, resulting in FY 2001-2002 Outpatient Pharmacy staffing levels which were approximately 47 percent higher than FY 1999-2000 staffing levels, when compared to Outpatient Pharmacy prescription volume.
  
  
• In May, 2001, the City entered into a Settlement Agreement of a grievance filed by the Service Employees International Union, that sets staffing levels and staffing ratios in the Outpatient Pharmacy, without regard to the State of California Board of Pharmacy staffing ratios, which were revised in 2001 to permit a higher ratio of Pharmacy Technicians to Pharmacists in outpatient pharmacies. The City can not unilaterally modify the terms of the Settlement Agreement, according to the City Attorney’s Office. Therefore, the City should enter into negotiations with the Service Employees International Union to (a) implement California Board of Pharmacy staffing ratios in the Outpatient Pharmacy, and (b) transfer one Pharmacy Technician position to support the Manufacturer’s Patient Assistance Program, which provides free and low-cost drugs to eligible patients.
  
  
• By implementing California Board of Pharmacy staffing ratios and transferring one Pharmacy Technician position, the Outpatient Pharmacy would save $209,746 annually in personnel expenditures. By increasing personnel support for the Manufacturer’s Patient Assistance Program, the Hospital estimates up to $500,000 annually in drug cost savings from increased research and access to Manufacturer’s Patient Assistance Programs and by increased follow-up of individual manufacturers. Therefore, combined personnel and drug cost savings are approximately $709,746 annually.

Pharmacy Expenditures

Nationwide, drug costs are rising, contributing significantly to the overall rise in healthcare expenditures. Increases in San Francisco General Hospital drug expenditures have been contained in the past three years because San Francisco General Hospital has implemented cost containment programs and received free or low-cost drugs from the Pharmaceuticals and Indigent Care Drug Distribution Program (PIC/DDP). The Department of Pharmaceutical Services has implemented several programs designed to control costs, such as substituting generic drugs for brand name drugs and restricting the drugs contained in the Hospital formulary. Also, San Francisco General Hospital has received free received free or low-cost drugs from the Pharmaceuticals and Indigent Care Drug Distribution Program, which ends in FY 2002-2003. In FY 2003-2004 San Francisco General Hospital will have a spike in drug costs.

In FY 2000-2001, San Francisco General Hospital implemented the Pharmacy Benefits Management Program, which provides drugs through community pharmacies to medically indigent clients. When the Pharmacy Benefits Management Program was implemented, some San Francisco General Hospital Outpatient Pharmacy drug expenditures were shifted to the Pharmacy Benefits Management Program. In FY 2000-2001 and FY 2001-2002, total San Francisco General Hospital and Pharmacy Benefits Management Program drug expenditures increased, as shown in Table 12.1.

Table 12.1

Actual Hospital and Pharmacy Benefits Management Program Drug Expenditures and Drug Assistance
FY 1999-2000 through FY 2001-2002

Source: San Francisco General Hospital

The Pharmaceuticals and Indigent Care Drug Distribution Project and Manufacturers’ Patient Assistance Programs

San Francisco General Hospital has received free or low-cost drugs through the Pharmaceuticals and Indigent Care Drug Distribution Project (PIC/DDP) and the Manufacturers’ Patient Assistance Programs, helping to contain increases in the Hospital’s pharmaceutical costs. The Pharmaceuticals and Indigent Care Drug Distribution Project, created by the nonprofit public health organization, Medicine For People in Need, offers medications to low income patients as part of the implementation of a litigation settlement against a number of pharmaceutical companies. The PIC/DDP made available and distributed $172 million worth of specified pharmaceuticals over three years to eligible and approved California clinics and hospitals, with a credit limit based on the size of the population served by the facility. Over a three-year period, the PIC/DDP has provided SFGH with $2,450,000 in low cost and free pharmaceuticals. San Francisco General Hospital received $752,000 in low cost and free pharmaceuticals in FY 2000-01, and approximately $748,000 in FY 2001-02. San Francisco General Hospital will receive approximately $950,000 in free and low cost pharmaceuticals in FY 2002-2003. The PIC/DDP program will expire in FY 2002-2003, and in FY 2003-04 PIC/DDP funding will no longer be available to SFGH to subsidize the cost of pharmaceuticals.

Many pharmaceutical manufacturers also offer a limited supply of free or low-cost medications to patients in need through Manufacturers’ Patient Assistance Programs. These programs are generally intended to serve as a "last resort" for eligible patients who are unable to use other programs and who otherwise would not be able to afford needed medications. In FY 2000-2001 San Francisco General Hospital received $28,000 in free and low-cost pharmaceuticals. In FY 2001-2002, San Francisco General Hospital dedicated an existing staff position to work with the Manufacturers’ Patient Assistance Programs and received $742,000 in medications through Manufacturers’ Patient Assistance Programs.

FY 2002-2003 Pharmaceutical Expenditures

The San Francisco General Hospital FY 2002-2003 budget for pharmaceuticals is largely unchanged from the prior fiscal year.

Table 12.2

FY 2002-2003 Pharmaceutical Budget Compared to FY 2001-2002 Pharmaceutical Expenditures

Source: San Francisco General Hospital

Each year, the Department of Pharmaceutical Services estimates costs and utilization for the next fiscal year. The Department projects costs based on industry experience, San Francisco General Hospital cost increases, estimated group purchasing organization cost increases and assumptions about drug usage. Novation, the group purchasing organization through which San Francisco General Hospital purchases pharmaceuticals, provides the Hospital with price forecasts for the coming calendar year in October. Novation has told the Hospital that the projected total increase in drug prices in calendar year 2003 will be approximately 14.53 percent.

Inpatient drug volume has increased over the past two fiscal years and outpatient pharmacy drug volume has decreased. Much of outpatient pharmacy utilization has shifted to community pharmacies under the Pharmacy Benefits Management Program (discussed below). Overall, drug volume increased by 11 percent from FY 2000-2001 until FY 2001-2002.

Table 12.3

Pharmacy Utilization

FY 2000-2001 and FY 2001-2002

Source: San Francisco General Hospital

Pharmacy Policies and Procedures to Contain Costs

Manufacturer’s Patient Assistance Programs Cost Savings

Many drug suppliers offer Manufacturer’s Patient Assistance Programs, which supply a limited amount of free or low-cost medications to qualified low income patients. Currently, San Francisco General Hospital has one Pharmacy Technician, who is responsible for identifying drug suppliers offering assistance to low income patients through a Patient Assistance Program. The Pharmacy Technician fills out required forms with patient information, including financial status and patient diagnosis, and submit applications to the manufacturer.

San Francisco General Hospital proposes to include two new Pharmacy Technician positions in the FY 2003-2004 budget to support the Manufacturer’s Patient Assistance Programs. The Hospital is not able to provide exact estimates on the expected drug cost savings that an additional position supporting the Manufacturer’s Patient Assistance Programs could achieve, although the Hospital estimates savings of approximately $1.2 million. The Hospital bases this estimate on potential savings by increased research and access to Manufacturer’s Patient Assistance Programs and by increased follow-up of individual manufacturers. Any estimated cost savings would be offset by the salary and fringe benefit cost of the position of approximately $160,000.

Purchasing Pharmaceuticals

The Group Purchasing Organization and the Prime Vendor

The Department of Pharmaceutical Services purchases most drugs through the group purchasing organization, Novation and prime vendor, McKesson. San Francisco General Hospital purchases 98 percent of pharmaceuticals from the prime vendor, McKesson, and according to San Francisco General Hospital, the Hospital receives cost savings overall by purchasing through the group purchasing organization and the prime vendor.

San Francisco General can receive special rebates from subvendors, who offer discounts or rebates to the Hospital through the prime vendor, McKesson, and the group purchasing organization, Novation. San Francisco General Hospital also receives a discount of 2.27 percent from Novation and McKesson for paying invoices within 15 days. This discount equals approximately $200,000 annually.

Discounts from Other Vendors

San Francisco General Hospital receives discounts from other vendors. Two major discounts are: (a) market share contracts and (b) local contracts. Under market share contracts, the manufacturer gives discounts to the Hospital if the Hospital places the manufacturer’s drug in the Hospital formulary. Under local contracts, the Hospital purchases the drug at a reduced price from a local supplier or manufacturer.

Pharmacy Benefits Management Program

The Department of Public Health implemented the Pharmacy Benefits Management Program in November 2000, to provide drugs to medically indigent clients through community pharmacies. Since implementation of the Pharmacy Benefits Management Program, overall expenditures have increased, due to increased volume and pharmaceutical costs.

Combined Pharmacy Benefits Management Program and Outpatient Pharmacy prescription volume increased by 9.4 percent in FY 2001-2002 compared to FY 2000-2001.

Also, Outpatient Pharmacy staffing levels have not adjusted downward at the same rate as the decline in Outpatient Pharmacy volume. Between FY 1999-2000 and FY 2001-2002, Outpatient Pharmacy prescription volume decreased by 46 percent but staffing decreased by 20 percent. In FY 1999-2000, San Francisco General Hospital staff and registry expenditures made up 21 percent of the total expenditure per prescription. In FY 2001-2002, staff and registry expenditures had increased compared to overall expenditures, making up 26 percent of the total expenditure per prescription (see Table 12.6).

Pharmacy Benefits Management Contract

In November 2000, San Francisco General Hospital entered into a contract with Pharmaceutical Care Network to provide pharmacy benefits management services for indigent clients. Under this contract, Pharmaceutical Care Network manages the provision of prescription drugs by community pharmacies to indigent clients, and reimburses community pharmacies for the cost of the actual medications. The original contract was effective from November 1, 2000, through March 31, 2002 or 15 months. San Francisco General Hospital entered into a new 12-month contract with Pharmaceutical Care Network on April 1, 2002. As noted in Table 12.4 below, San Francisco General Hospital was able to negotiate improved contract terms in the successor contract.

Table 12.4

Comparison of the Terms and Costs of the Initial Pharmacy Benefits Management Contract to the Successor Pharmacy Benefits Management Contract

Source: San Francisco Health Commission

Total annual contract costs increased by $1,320,000 or 16.7 percent, from $7,920,000 under the initial contract to $9,240,000 under the successor contract. Increased contract costs resulted in part from increased prescription volume. Pharmacy Benefits Management Program volume increased from 2,686 in November 2000, to 19,657 in July 2002.

In May 2000, the Department of Public Health reported to the Board of Supervisors that the FY 2000-2001 budget would include a proposal to close the Outpatient Pharmacy at San Francisco General Hospital and transfer Outpatient Pharmacy services to community pharmacies, administered by a pharmacy benefits management contract. The Department expected to achieve approximately $1.7 million in annual cost savings by closing the Hospital’s Outpatient Pharmacy and transferring services to community pharmacies. In response to public opposition, the Department of Public Health agreed to maintain Outpatient Pharmacy services at San Francisco General Hospital.

On May 17, 2001, the City signed a settlement agreement with Service Employees International Union (SEIU), Local 790, which established:

1. San Francisco General Hospital Outpatient Pharmacy hours from 10:00 a.m. to 7:00 p.m., Monday through Friday;
   
   
2. a staffing level of nine Pharmacists (class 2450) and seven Pharmacy Technicians (class 2409); and
   
   
3. an 8 percent wage adjustment for class 2450 Pharmacists and class 2454 Clinical Pharmacists, effective July 1, 2001, and a one-time 8 percent bonus for class 2450 Pharmacist and class 2454 Clinical Pharmacist, payable the first pay period after July 1, 2001.

In addition, under the settlement agreement, the City agreed to the gradual elimination of the pharmacy registry contracts.

The Effect of the Pharmacy Benefits Management Program on Outpatient Pharmacy Services

With the implementation of the Pharmacy Benefits Management Program, much of the outpatient prescription volume shifted from the San Francisco General Hospital Outpatient Pharmacy to community pharmacies. As shown in Chart 12.1, the volume of prescriptions filled by the San Francisco General Hospital Outpatient Pharmacy for medically indigent adult clients declined after the Pharmacy Benefits Management Program was introduced. However, the total medically indigent adult prescription volume of both community pharmacies and the San Francisco General Hospital Outpatient Pharmacy increased by 46 percent after the introduction of the Pharmacy Benefits Management Program. In November 2000, when the program was introduced, the total medically indigent adult prescription volume was 20,368. In July 2002, the combined medically indigent adult prescription volume for San Francisco General Hospital Outpatient Pharmacy and the community pharmacies covered by the Pharmacy Benefits Management Program was 29,752.

Chart 12.1

Medically Indigent Adult Prescription Volume at the San Francisco General Hospital Outpatient Pharmacy and Community Pharmacies under the Pharmacy Benefits Management Program

November, 2000, through July, 2002

Source: San Francisco General Hospital Department of Pharmaceutical Services

Although the San Francisco General Hospital Outpatient Pharmacy serves clients in addition to medically indigent adult clients, the reduction in medically indigent adult client prescriptions, resulting from the introduction of the Pharmacy Benefits Management Program, has contributed to an overall reduction in prescription volume in the Hospital’s Outpatient Pharmacy.

Chart 12.2

San Francisco General Hospital Outpatient Pharmacy Prescription Volume for Medically Indigent Adults and Other Clients

January, 2000, through July, 2002

Source: San Francisco General Hospital Department of Pharmaceutical Services

Outpatient Pharmacy and Pharmacy Benefit Management Program Administrative Expenditures

The Pharmacy Benefits Management Program administrative costs for handling prescriptions are lower than Outpatient Pharmacy costs.

Table 12.5

Comparison of the Outpatient Pharmacy and Pharmacy Benefits Management Program Prescription Administrative Expenditures FY 2000-2001 and FY 2001-2002

Source: Based on data provided by San Francisco General Hospital

Between FY 2000-2001 and FY 2001-2002, Pharmacy Benefits Management program expenditures per prescription decreased due to reduced claims processing fees (from $0.55 per claim to $0.39 per claim) and prescription handling fees (from $2.25 per prescription to $2.00 per prescription).

Outpatient Pharmacy personnel expenditures per prescription increased in FY 2001-2002 compared to FY 2000-2001. Outpatient Pharmacy personnel expenditures, including both registry and regular staff, made up 21 percent of the expenditures per prescription in FY 1999-2000, and 26 percent in FY 2001-2002.

Table 12.6

Outpatient Pharmacy Personnel and Registry Expenditures per Prescription

FY 1999-2000 through FY 2001-2002

Source: Based on data provided by San Francisco General Hospital

Outpatient Pharmacy volume has decreased at a much higher rate than Outpatient Pharmacy staffing, contributing to higher personnel expenditures per prescription. FY 2001-2002 Outpatient Pharmacy staffing levels were approximately 1.47 times FY 1999-2000 staffing levels, when compared to Outpatient Pharmacy prescription volume. In FY 1999-2000, the Outpatient Pharmacy had 22.50 FTEs for an annual prescription volume of 350,628, and in FY 2001-2002, the Outpatient Pharmacy had 18.00 FTES for an annual prescription of 190,166.

The May 2001, settlement agreement between the City and Service Employees International Union fixes pharmacist and technician staffing in the San Francisco General Hospital Outpatient Pharmacy. The agreement defines the "desirable level" of staffing in the Outpatient Pharmacy as nine Pharmacists and seven Pharmacy Technicians and the minimum staffing level as seven Pharmacists and six Pharmacy Technicians. Under the terms of the agreement, if Outpatient Pharmacy falls below nine Pharmacists and seven Pharmacy Technicians, the Department is required to fill vacant Pharmacists and Pharmacy Technician positions as a priority.

When the City signed the settlement agreement with SEIU in May 2001, the monthly Outpatient Pharmacy volume was 17,145. This monthly volume has declined by 2,690 prescriptions or 14 percent to 14,445 in June 2002. In May 2001, the Outpatient Pharmacy had 19.5 full-time equivalent positions (FTEs) and in June 2002, the Outpatient Pharmacy had 18.0 FTEs. The monthly number of prescriptions per FTE was 879 in May 2001 and 803 in June 2002. This represents a 9 percent decrease in workload, equivalent to 1.62 FTE.

Ratio of Pharmacists to Pharmacy Technicians

In 2001, the California Board of Pharmacy revised Outpatient Pharmacy staffing ratios. Previously, the Pharmacist to Pharmacy Technician ratio for Outpatient Pharmacy services was 1:1. Under the revised statute, the Outpatient Pharmacy ratio of Pharmacists to Pharmacy Technicians is 1:1 for the first Pharmacist and 1:2 for each additional Pharmacist. If San Francisco General Hospital were to implement the California Board of Pharmacy staffing ratios for Outpatient Pharmacy, the Hospital would achieve $129,848 in cost savings, as shown in Table 12.7.

Table 12.7

Comparison of Current Outpatient Pharmacy Pharmacist to Pharmacy Technician Staffing Ratios and California Board of Pharmacy Staffing Ratios

Source: Based on data provided by San Francisco General Hospital and the Annual Salary Ordinance

Meeting and conferring with Service Employees International Union

Changing current Pharmacist to Pharmacy Technician staffing ratios would require the City to meet and confer with the Service Employees International Union. The City should either:

• Enter into the meet and confer process with Service Employees International Union prior to expiration of the Memorandum of Understanding (MOU) between the City and Service Employees International Union on June 30, 2003, or
  
  
• Negotiate new language in the successor MOU, commencing July 1, 2003, converting three Pharmacist positions to Pharmacy Technician positions.

Conversion of the Pharmacist to Pharmacy Technician positions should occur through attrition to prevent disruption of current staff.

San Francisco General Hospital Outpatient Pharmacy Staffing and the Pharmacy Benefits Management Program after April 1, 2003

Pharmacy Benefits Management Program contract

San Francisco General Hospital Outpatient Pharmacy qualifies for Federal Public Health Service discounts, which are not available to community pharmacies under the Pharmacy Benefits Management Program contract. In order to qualify for the Public Health Service discounts, the Department of Public Health has proposed redesigning the Pharmacy Benefits Management Program. Under Federal regulations and California law, individual Department of Public Health clinics can contract separately with one community pharmacy to dispense Public Health Service-priced drugs.

The Department of Public Health issued a Request for Proposal (RFP) on November 1, 2002, to replace the Pharmacy Benefits Management Program contract, which expires on March 31, 2003. According to the Department of Pharmaceutical Services, the new contract will be structured differently from the existing contract. Under the RFP, each Department of Public Health clinic would contract separately with a community pharmacy to provide prescriptions to clinic patients. Under this contracting arrangement, community pharmacies would receive Public Health Service discounts, which are not available to community pharmacies participating in the Pharmacy Benefits Management Program.

If the Department of Public Health enters into separate pharmacy contracts under a new Pharmacy Benefits Management Program, these separate contracts will not be subject to Board of Supervisors approval if they do not exceed $10,000,000 in value. These new proposed contracts may have a cost advantage over the existing Pharmacy Benefits Management Program contract if the participating pharmacies can apply for Public Health Service discounts. If the Department of Public Health successfully contracts with community pharmacies to provide services to individual clinics, the Department should present a detailed analysis of the contract costs and benefits during the FY 2003-2003 budget review.

According to the Department of Pharmaceutical Services, if the Department of Public Health does not receive sufficient response from the RFP, the Department will renew the current Pharmacy Benefits Management Program contract for six months to one year.

The existing Pharmacy Benefits Program contract has potential for increased cost savings. If the Department of Public Health renews the current Pharmacy Benefits Management Program contract, the Department of Public Health should negotiate new terms to contain costs.

• Under the current contract, the claims processing fee is $0.39 per claim, but the actual average claims fee is $0.93. According to the Department of Pharmaceutical Services, the higher average claims processing fee results from more than one transaction (such as phone calls from San Francisco General Hospital pharmacists to community pharmacies) per claim.
  
  
• Also, the Department of Public Health should pursue prescription cost discounts, such as volume discounts by consolidating pharmacies participating in the program.

The Department of Public Health should provide an analysis of the Pharmacy Benefits Management Program benefits and costs to the Board of Supervisors, if the current contract is renewed. The Department should also provide a long range plan for providing outpatient pharmacy benefits cost effectively to the Board of Supervisors. The Department of Public Health needs to show if the benefits of the Pharmacy Benefits Management Program support the costs.

Outpatient Pharmacy Staffing

Because Outpatient Pharmacy workload has decreased by 9.4 percent, equivalent to 1.6 FTE, we recommend that one Pharmacy Technician position be transferred from the Outpatient Pharmacy to support the Manufacturers’ Patient Assistance Program. San Francisco General Hospital could potentially achieve $170,000 to $320,000 in net drug cost savings by expanding the Manufacturer’s Patient Assistance Program.

The Department of Pharmaceutical Services expects Outpatient Pharmacy utilization to increase if Department of Public Health clinics contract separately with community pharmacy for outpatient benefits. If the Department of Public Health increases Outpatient Pharmacy services, then the Department needs to provide a detailed cost analysis of Outpatient Pharmacy volume and staffing needs during the FY 2003-2004 budget review.

Conclusions

Nationwide, drug costs are rising, contributing significantly to the overall rise in healthcare expenditures. Increases in San Francisco General Hospital drug expenditures have been contained in the past three years because San Francisco General Hospital has received approximately $1 million annually in free or low-cost drugs from the Pharmaceuticals and Indigent Care Drug Distribution Program (PIC/DDP). The Pharmaceuticals and Indigent Care Drug Distribution Program ends in FY 2002-2003 and in FY 2003-2004, San Francisco General Hospital will have a spike in drug costs.

The Department of Pharmaceutical Services needs to contain costs to offset increasing drug costs and the loss of the Pharmaceuticals and Indigent Care Drug Distribution Program free and low-cost drugs. In FY 2001-2002, Department of Pharmaceutical Services expenditures were $19 million, which was an increase of $3 million, or 18.75 percent, from FY 2000-2001. Much of the increased costs are due to increased outpatient prescription volume, resulting from the implementation of the Pharmacy Benefits Management Program.

The Outpatient Pharmacy should reduce costs by implementing California Board of Pharmacy staffing ratios. By increasing the ratio of Pharmacy Technicians to Pharmacists, the Pharmacy could save approximately $129,848 annually in personnel costs. Also, in response to declining Outpatient Pharmacy prescription volume, the Pharmacy should transfer one Pharmacy Technician position to support the Manufacturer’s Patient Assistance Program, resulting in total Outpatient Pharmacy personnel expenditure savings of $209,746.

By transferring one Pharmacy Technician position to the Manufacturer’s Patient Assistance Program, which provides low-cost or free drugs to qualified patients, the Hospital estimates up to $500,000 in drug cost savings. Therefore, combined personnel and drug cost savings are approximately $709,746 annually.

The Department of Public Health has issued a Request for Proposal to replace the current Pharmacy Benefits Management Program contract with individual contracts between a community pharmacy and each Department of Public Health clinic. This proposal would allow community pharmacies to apply for Federal Public Health Service discounts, reducing prescription costs. If the Department of Public Health successfully establishes separate contracts between clinics and community pharmacies, the Department should present a detailed analysis of the contract costs and benefits during the FY 2003-2003 budget review.

Recommendations

The Department of Public Health should:

Costs and Benefits

San Francisco General Hospital would save approximately $209,746 annually in staffing costs by implementing California Board of Pharmacy staffing ratios in the Outpatient Pharmacy, and transferring one Pharmacy Technician position to support the Manufacturer’s Patient Assistance Program. By increasing personnel support for the Manufacturer’s Patient Assistance Program, which provides low-cost or free drugs to qualified patients, the Hospital estimates up to $500,000 annually in drug cost savings. Therefore, combined personnel and drug cost savings are approximately $709,746 annually.

1. As discussed in Section 9, San Francisco General Hospital is a member of the Novation group purchasing organization. McKesson provides pharmaceuticals to the Hospital as the prime vendor. If the Hospital purchases through the group purchasing organization, Novation, the Hospital receives the contracted price negotiated by Novation with the prime vendor.
2. San Francisco General Hospital provided copies of reports from the National Institute for Health Care Management and the American Journal of Health-System Pharmacists. The National Institute for Health Care Management study showed nationwide pharmaceutical expenditure increases of 18.8 percent in 2000 and 17.1 percent in 2001. The American Journal of Health-System Pharmacists reviewed four prescription drug expenditure studies. Two of these studies projected drug expenditure increase projections for 2003, which ranged from 12 to 16 percent.
3. FY 2000-2001 staffing consisted of 1 supervising pharmacist, 9.5 pharmacists, 7 pharmacy technicians and 2 clerical support. FY 2001-2002 staffing consisted of 1 supervising pharmacist, 9 pharmacists, 7 pharmacy technicians, and 1 clerical support.
4. Under California Senate Bill 340, each Department of Public Health clinic would be authorized to contract with one local community pharmacy to dispense Public Health Service-priced drugs.
5. Estimated Manufacturer's Patient Assistance Program drug cost savings are approximately $1.2 million, offset by the cost of two Pharmacy Technician positions of approximately $160,000.