Dr. H. Denman Scott
Position: Director and founder of RxAssist and its parent
organization, Volunteers in Health Care
Background: Scott is Rhode Island’s former public health chief. He
is a professor of medicine and community health at Brown University and associate
dean of medicine (primary care). He recently stepped down as the director of
the Center of Primary Care and Prevention and as physician-in-chief at Memorial
Hospital of Rhode Island. In addition, he was the senior vice president for
health and public policy for the American College of Physicians.
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Education: Medical degree from Columbia University College of Physicians
and Surgeons and a master’s in public health from Harvard University. He received
a bachelor’s degree from Stanford University.
Residence: Providence
Age: 65
RxAssist is a Web-based nonprofit unit of Volunteers in Health Care that connects physicians dealing with low-income patients nationwide with drug assistance programs operated by pharmaceutical companies. These programs offer a company’s brand name medications for free as part of its charitable mission.
RxAssist lists between 600 to 700 drugs from 108 existing programs and Scott says the site, www.rxassist.org, gets about 3 million hits a month.
PBN: Can you describe Volunteers in Health Care?
SCOTT: For the last eight or nine years, I have had extensive funding from the Robert Wood Johnson Foundation that has gone toward creating an entity called Volunteers in Health Care based here at Memorial Hospital at the Brown Center for Primary Care and Prevention. VHC gives technical assistance to organizations around the United States who are trying to develop or improve clinical operations that have some volunteer component to help take care of people without health insurance.
Q. RxAssist is a component of Volunteers. How was it created?
A. One of the biggest problems in any clinical setting is getting the medications to the people that can’t afford them because of the very high costs. We discovered that the pharmaceutical companies have what are called patient assistance programs and they make it available to patients who have no insurance, no state Medicaid and low income. For clinical operations, it’s a very complex process for trying to access them all. There are different forms, different eligibility requirements and you really have a huge learning curve in trying to figure out how you can use these things on behalf of the people you are taking care of. RxAssist puts under one site all of the programs, the drugs available and what you have to do to qualify your patient for one of these programs. We also developed a software package called RxAssist Plus, which is designed to work with the Web-based program for clinical settings that have several hundred or a thousand patients. It allows them to track patients and figure when they are up for renewal. We initially gave it away for nothing because we had plenty of grant support. Now we have a modest fee attached to it because we have to upgrade it. For example, when all the HIPAA (Health Insurance Portability and Accountability Act of 1996) regulations came down, we had to make it compliant and that cost $20,000, $30,000 to do. Now we have to update the fee structure that helps support the software upgrades.
Q. How many doctors’ offices connect to RxAssist?
A. We are not sure, but it has to be thousands. We make this assumption just based on the Web site traffic. We don’t require people to sign on and give a password, we never required that. But we have a client database of roughly 7,000 organizations that we relate to in one way or another.
Q. Can you talk about one of the new income streams you’ve found to fund the site?
A. We developed a contractual relationship with a company called Express Scripts Inc. based in St. Louis; it’s a giant so-called ‘pharmacy benefits management company.’ They do a lot of work with commercial health plans and HMOs and employers to fulfill prescriptions on behalf of all those insured people. But they also have managed over the years a number of these patient assistance programs on behalf of big pharmaceutical companies. Express Scripts is a big New York Stock Exchange-listed company that has annual revenues on the order of $12 billion or $13 billion. They got to know about us through meeting people at conferences and all that. And, the fascinating thing is that in our developing relationship they said, ‘You know, one thing all these patient assistant programs don’t have is a good generic drug program.’ Most of the medicines that are available are brand name medicines that are under patent and are the real profitable drugs for the manufacturers. (Express Scripts) said, ‘Wouldn’t it be great if we could develop a program for generic medicines at a very low cost.’ This Express Scripts program supplies generic medicine for your blood pressure condition or diabetes medicine for $48 a year. There are 35 drugs, absolutely mainstream drugs that a doctor uses for a variety of cardiac and chronic diseases.
Q. How does your program fit into this?
A. What they liked about us is we have the Web site and the client database, which is made up of precisely those people that would want this program. So, we’re a principal marketing arm for this new generic drug program. For every application that is downloaded from our Web site with a Volunteers in Health Care label on it, we get a tiny royalty fee. But, if this is as popular as I think it is going to be – let’s say there are 10,000 forms a month that get filled through us – that’s going to give us $15,000 to $20,000. We’re talking about a big piece of change that we need to keep us going.
Q. There are other drug programs out there, like the drug discount cards
approved as part of the Medicare reform act. Do you see this as competition?
A. So many of the people we deal with fall under a low-income category. There are a huge number of people who are under 65 without health insurance that is probably the core target of our site. There are elderly who have low income and are on 10 medicines and they have $1,000 a month in expenses and they can’t handle (the prescription costs). Certainly those people can also get help from programs (through RxAssist). The Medicare drug program is going to be a great benefit to those people and it might mean they would need us less. That’s fine insofar as this program helps people and I’m all for it. But it’s not going to kill us off because we still have this huge pool of uninsured people.
Q. What is the underlying goal in seeking alternative funding streams?
A. We want to keep the Web site free. We don’t want to make it a subscription-based Web site. A lot of the operations that depend on us are low-budget. So we need to work with companies like Express Scripts and I going to be contacting some of the pharma companies and say, ‘We have a constituency that you might want to talk to, in some way or another, about your programs.’ I don’t think they are going to advertise Lipitor or Viagra on our Web site, but the drug companies may be interested in reaching out to a constituency that’s working very hard with this huge number of people who are uninsured. That’s going to be one of the big challenges for me in the next few months.
Q. When you had grant funding, you could follow a strict ideological approach. There was no need to bend your Web site to the needs of pharmaceutical companies in any way. Now that there has been a shift in funding, do you foresee having to do anything philosophically different?
A. We want to try and maintain the spirit in which we created this thing in, which is a Web site that is free to everybody who wants it. We don’t want it to be viewed as all of a sudden we are going into a fee-based business for your access to all these drugs. I think all our business strategy is related to developing programs and income-generating activities that will support this free Web site so people feel that it’s the same thing as we started out to build. We are not going to commercialize the site itself. We are going to make it clear to people that are a part of this constituency that we now are in a different moment and therefore we have worked with Express Scripts and we are going to be talking about working with Pfizer.
Q. How do the large pharmaceutical companies view your site? It’s as if
you are facilitating access to free medication. Could they see this as a threat
to their bottom line if the site gets too popular?
A. That’s a big worry. However, the pharmacy companies see these drug
assistance programs as an important part of their charitable mission. They were
panicked that this new federal legislation (the drug benefit program attached
to the Medicare reform act) would create a national price list and depress the
prices. They touted these patient assistance programs saying, ‘Hey, we’re helping
out (those who can’t afford prescription medication).’ But the growth in the
number of applications that we are filling out is increasing a lot. I am sure
the executives that are running these programs in the company are going to say,
‘Well, what if it grows to an extent that it’s too much?’ But, we are not there
yet. In the very complex political environment of pharmaceuticals, I think they
see these programs as very important tools to get the message out to various
legislatures and administrations that ¡we are doing something.
Jason Perez-Dormitzer is a contributing writer to PBN.
