Health Calls Season 6, Episode 16 highlights how health systems across the United States are expanding medication access through the nonprofit Dispensary of Hope.
Health Calls Season 6, Episode 16 highlights how health systems across the United States are expanding medication access through the nonprofit Dispensary of Hope.
Host Brian Reardon speaks with Mike Wascovich, Vice President of Medication Management and Chief Pharmacy Officer at Ascension, about addressing one of the nation’s most urgent challenges—prescription affordability. With as many as half of U.S. prescriptions going unfilled due to cost, the Dispensary of Hope connects donated medications from pharmaceutical partners to clinics and pharmacies serving vulnerable populations. Wascovich explains how the program has grown into a national network of more than 300 sites, helping patients manage chronic conditions like diabetes, asthma, and hypertension. By improving adherence, reducing hospitalizations, and cutting unnecessary waste, this collaborative model demonstrates how U.S. health care organizations can work together to lower costs, improve outcomes, and ensure patients receive the medications they need to heal.
Brian Reardon (00:05):
Welcome to Health Calls, the podcast of the Catholic Health Association of the United States. I'm your host, Brian Reardon. Thanks for joining us. For this episode, we're going to be talking about the Dispensary of Hope. It's a program that's started by Ascension and our topic is reducing medication costs and increasing access. And again, this fits into our theme of United for Change. So we're going to talk with Mike Wascovich. He's Vice President of Medication Management and Chief Pharmacy Officer at Ascension. And Mike, we're just going to dive right into the interview. Thanks for being with us.
Mike Waskovich (00:38):
Thanks for hosting me, Brian. I look forward to it.
Brian Reardon (00:40):
Yeah. So the Dispensary of Hope is something actually we've covered over the years. I think, Mike, what, it goes back to the early 2000s that it was founded.
Mike Waskovich (00:49):
Yeah. Dispensary of Hope is a subsidiary of Ascension. We're really proud of it. Started in 2003, so just over 20 years ago. It really started as a local response to patients that couldn't afford their meds. And so there were some medications donated by drug companies or samples from physician offices. We collected those and started to give those to our clinics and say, "Hey, let's use these for low income patients." And it's really grown from there, from that idea of let's not be wasteful stewards of these medications and sort of throw them out. Let's use them for good. And then we've grown from there really across the United States as a national distribution center.
Brian Reardon (01:36):
So really it started with, I guess, identifying an opportunity with excess, maybe some medications that were what, samples essentially?
Mike Waskovich (01:46):
Yeah. I mean, back then, 20 plus years ago, in order to overcome that initial inertia for a patient and a physician to try a new medicine, it was very common for pharmaceutical manufacturers to, I would say, dump a lot of inventory on the office and say, "Hey, let's try our patient on something for a week, for a month. Let's titrate his or her dose." And once you're comfortable and you're writing a prescription, then it would go through a typical big box chain drugstore. And what physicians found themselves doing is they were sort of managing this unruly inventory in their supply closet and they were saying, "What do we do with this stuff? Do we throw it out in the garbage? I mean, there's environmental impact to pharmaceutical waste. Do we send it back to the drug rep?" And which they really didn't want back. And so there was some dot connecting like, well, there's a lot of patient need.
(02:45)
Roughly half the prescriptions in the United States don't get filled even back then because patients can't afford the medicine. Let's come up with a mechanism to give these to patients who truly can't afford them. And then Ascension really just took that idea and expanded it greatly. And so you don't have to be an Ascension hospital to join this network where you go ahead and have access to free medications.
Brian Reardon (03:10):
So 20 years ago, was there some initial conversations with pharmaceutical manufacturers to say, "Hey, listen, there's got to be a better way." Can you walk us through how that conversation started and how those conversations have evolved?
Mike Waskovich (03:23):
Yeah. Well, first and foremost, without our partners that are pharmaceutical manufacturers, there wouldn't be the dispenser of Co-op. So we have to really honor their commitment. It went from one-time donations where, "Hey, we have a surplus we made too much or we have these samples and we don't really want them back as they start to expire. It's costly for everybody." To now a much more structured methodical thought process of, let's do some planned giving, let's align with this mission of taking care of poor and vulnerable patients. Let's really think about it differently. Let's try to solve this problem. So that didn't happen overnight. It's taken every bit of 20 years and some would say we're really just getting started. But yes, absolutely. Those drug manufacturers are our partners and we work with them very closely to make sure we're handling the dangerous drugs that they're legitimately manufacturing, spending a lot of time in investment in creating high quality medications and access.
(04:27)
And we're saying we're going to make sure we're going to limit that waste and give it to those most in need, which resonates with our Catholic identity.
Brian Reardon (04:37):
Yeah. And you said a couple of minutes ago that what up to half of patients can't fill their medications because of cost barriers. Talk a little bit more about that. Is that something you've seen in health needs assessments? Is it just what you're hearing from physicians in your clinics? Because to me, it's not a surprising statistic, but at the same time, it sort of is like eyeopening like, wow, that's a lot of people who are not getting basically the treatments that they've been prescribed in a way that's going to bring, again, healing and recovery.
Mike Waskovich (05:11):
That's right. I tend to always parrot this line that the number one interventions that our physicians and our nurses make is write a prescription. So as we've really gotten good at drug design and drug discovery, we can keep you out of the hospital. We can keep you ambulatory and at home with your family surrounded by your loved ones, but we need you to take your medicine. Medicine has gotten very, very expensive and continues to ratchet up. We all know the United States really pays the highest drug prices globally. And so you can have an expert diagnosis with your physician and that plan can be fantastic, but it all falls short when you can't afford it. And you don't sometimes know. You show up in the pharmacy and the pharmacists or the staff say, "This may be $500 a month." And most people can't afford that.
(06:05)
And so we really started to connect the dots here and say, we can lower total cost of healthcare by keeping our patients on their medicines. And so we really try to focus on those chronic disease medicines, blood pressure, diabetes, respiratory disease like asthma. If I can give you a $5 inhaler and keep you away from an emergency room, which can cost thousands of dollars, that's good for you and your family. It's good for that hospital and that community and it's good for our country and the state of healthcare and all the money that we spend on healthcare now.
Brian Reardon (06:43):
Yeah, it makes so much sense. So let's talk a little bit about the patient and how, and I think we've all read the stories about particularly senior citizens on fixed incomes. They may be like cutting pills in half, trying to extend prescriptions. So a patient that may be inclined to do that because of the cost barrier, how do they learn about this program? Can you explain a little bit about the physician patient engagement to make them aware that there is this program that they can take advantage of?
Mike Waskovich (07:15):
Great question because it's sort of we need to an all the above strategy, we need to inform the patient and his or her family or those closest in his network. We need to certainly educate our doctors, our nurses and all of our clinicians, our medical assistants on what is the dispensary of hope and what is this opportunity to close this medication gap. It starts with talking about the gap and being honest about that 50% lack of fulfillment rate. There's some pretty good data a physician has when he or she is prescribing to know, "Are you taking that medicine?" But it's not perfect and we have an interview that we have with all of our patients at Ascension and we ask them, "What medications are you taking? Are you having problems affording your medicine?" And if they say, "Yeah, I'm splitting my pills in half or I'm taking ... And I know you told me to take this twice a day.
(08:14)
I'm taking it once a day or less because it's many times a negotiation across the kitchen table. Do we pay our bills? Do we buy food or do we somehow spread this medicine?" And that can be a dangerous proposition. Some medicines shouldn't be cut in half. Some medicine is long acting release capsules and when you cut it in half, it's a dangerous level to absorb all that in a number of hours versus days. And so we always encourage patients to have that really forthright, honest conversation with their physician and nurse and then how do we connect the dots in Dispensary of Hope? There's over 300 Dispensary of Hope pharmacies or care sites across the United States. We would like that physician to refer his or he patients to one of those dispensing locations. Ascension has 35 of those locations, but again, there's 300 across the United States.
(09:14)
We're coast to coast and then we can have an in- depth assessment and plan. So what are those medications that we can fill at no cost dispensary of hope costs nothing to patients or providers and what is some of that solutioning that we can do around that patient's medication plan?
Brian Reardon (09:35):
So in that situation then they would perhaps get a referral to a dispensary of hope pharmacy. It's kind of like writing them a prescription to say, if you've got, let's take high blood pressure medication, knowing that cost is a barrier, then they would just go to that location and get it filled and there's like a special prescription that's filled out.
Mike Waskovich (09:55):
So when a prescription's presented to the pharmacy, I'm a pharmacist, obviously, and so we get these emailed to us from your provider. And so the patient shows up and we go ahead and we try to use your insurance. And when the patient either doesn't have insurance or it's incomplete and those copays come back, it's significant amount, even if it's $10 and most patients are on multiple medications, we have that conversation right over the counter or in the drive through a very sort of honest assessment of where we're at. When the patient says, "I can't afford that, " or we're already looking that they don't have insurance and they're going to qualify for dispensary hope, we start mapping and saying, "Okay, what medications can we fill right now?" Maybe there's something that we don't have that your doctor ordered with your permission, I want to call your doctor and have that plan, that medication switched to something that we do have that meets our test and then you can leave feeling great about the care that you just received.
(11:02)
We always want to encourage communication back to that physician, "I'm taking my medicine, I'm feeling better," or, "Boy, I'm really struggling. Can we switch to something else?" That honest dialogue is crucial in order to stay healthy and stay out of the hospital.
Brian Reardon (11:21):
Now, Mike, I think that's a really good overview of how that basically reaches the patient. I want to switch now and talk a little bit about the program itself. You mentioned 35 Ascension sites but 300 across the country, which indicates you've got a lot of other than Ascension healthcare providers participating. Can you talk a little bit about the growth of the program over the decades? What other maybe particular Catholic health systems have joined and how has the program grown and really being adopted by more folks?
Mike Waskovich (11:51):
No, love to. It's a great story to tell. So we're in 38 states and again, we feel like we're just sort of starting, why can't we be in all 50 states and can we go even further into some of the US territories? At Ascension or I'm the pharmacy leader. We've added our mail order pharmacy. We can shift to almost every state in the country, but if you're a health system executive listening to this podcast, there's an assessment that the Dispenser of Hope would do with you. So you have to be nonprofit, you don't have to be a Catholic health system, though many this goes right in line with our Catholic identity and our mission. So organizations like Bon Secours, Mercy, Trinity, Common Spirit, they're already in the Dispensary of Hope and they're trying to optimize and grow the plans as well. But any nonprofit provider, hospital, clinic or pharmacy can join the Dispensary of Hope.
(12:46)
So we would do an assessment on your nonprofit tax status. We'd ask you to fill out some forms, share some licensing because again, those pharmaceutical manufacturer partners want to make sure they want to be assured that we have the appropriate licensing across states as a distributor and who we're giving medicine to is a licensed pharmacy or a licensed hospital. We don't work with controlled substances. It's all the benign medications as already mentioned for chronic disease. And then there is a site survey to make sure, again, it's a legitimate provider with the appropriate state license, but fairly straightforward assessment, a small annual fee based on what type of provider you are and then you have access to these medications. There's a real easy ordering platform and that provider can order medicine for his or her patients and really start to get after it. And that's where we get excited that patients leave with medication in hand.
Brian Reardon (13:51):
And roughly how many, and I don't know if it's in the millions, but can you estimate how many patients have taken advantage of the program and been benefited from it?
Mike Waskovich (14:01):
Yeah. We started with those humble beginnings in a few clinics in Nashville, Tennessee, like I said, 20 plus years ago. We now annually see over 160,000 patients. We're dispensing roughly 3,500 prescriptions a day, that's about 1.2 million prescriptions a year. And again, we just want to grow that. We think we're making a dent in the problem, but the problem, especially with changes in Medicaid and reform, the problem is still growing. And so we want to close that care gap. We think it's sort of foolish to spend a lot of time and money and effort in the hospital, thousands, tens of thousands of dollars to sort of fix and repair the patient who let's say had a cardiovascular event and to not give them their $5 heart medicine. It seems like a little foolishness that we're just trying to close that care gap.
Brian Reardon (14:58):
Yeah. I mean, just common sense. It's just kind of the takeaway. So you've mentioned this a couple of times, you've scratched the surface, you feel like you've got a lot more you can do as we kind of wrap up the conversation, what will it take to grow this to really reach more patients, to get in, like you said, all 50 states to get maybe every Catholic healthcare provider in the country on board?
Mike Waskovich (15:21):
Well, I think you're helping and CHA is wonderful about promoting the Dispensary of Hope and just letting people know who we are, what we do and how it already aligns with our Catholic identity. Again, if you're a nonprofit and you're not part of CHA, that's okay. We want to talk to you and unpack our program and really talk about how it's helping people. We're saving the healthcare system in the United States roughly $200 million a year. We're saving on readmissions. We're saving on overall hospital overutilization by 25 to 30% annually. So if those numbers are something that you want to be part of, we want to work with you. We want to partner with you. If you're a manufacturer and you're thinking, I've done some of this or my peers have and this comports with my social responsibility as a manufacturer, this is who we are at the end of every dose that we manufacture is someone that is getting care, that person is someone's grandfather or someone's daughter or someone's best friend and this aligns to your mission.
(16:32)
We want to talk to you about planned giving and really thinking about production and what are some of those medicines that the Spencer Hope is missing on their formulary that that company is experts at. So we're just really excited to get the word out and expand all states, as many suppliers as we can, as many hospitals and clinics as we can because again, the care gap is growing. It's not decreasing.
Brian Reardon (17:00):
Yeah. And I think to conclude, again, the theme this year, this season for health calls has been United for Change and really talking about various collaborations. And what I like about this conversation is it really points to working together with the pharmaceutical industry. A lot of times you see insurance, providers, pharmaceutical kind of in their own silos and sometimes pointing fingers at each other, but this is really an example of where I think there's some good collaboration where the patient really is at the center of the work. So I guess can you leave us with maybe a little bit of perspective on that and maybe there's some hope for us working together in areas that we traditionally may not be working together in.
Mike Waskovich (17:40):
Yeah. I mean, I'll probably restate what everyone already knows, I believe we're all in this together. We're all being asked to respond to God's call to help and heal our country. We spend phenomenal investment on discovering and creating these medicines just for it to be available but yet unattainable for the most vulnerable and we're all paying for that. So why don't we do better, sort of knock the walls in the traditional silos down and meet in this venue or this shared platform called The Dispensary of Hope and let's solve it together. And I think that's truly exciting. That's why we all went into healthcare.
Brian Reardon (18:28):
Mike, really appreciate you taking time to speak with me, to share about this program. As I mentioned, CHA has covered this dispensary of hope in Catholic health world. I think we've maybe done some webinars over the years. So it's something we're very familiar with and it's always nice to kind of check in and get an update. And so congratulations on the growth of it. In the show notes on our website, we'll have links to past articles. But again, I want to thank Mike Wascovich. He's Vice President of Medication Management and Chief Pharmacy Officer for Ascension. Again, great to have you on the show.
Mike Waskovich (19:00):
Thank you, Brian. I appreciate all you're doing and all the CHAs doing the good to word out.
Brian Reardon (19:05):
And this has been another episode of Health Calls, the podcast of the Catholic Health Association of the United States. Again, I'm Brian Reardon, the host. Josh Matejka serves as our executive producer. Sarah Marchant is our scheduling assistant. Health Calls is produced here in St. Louis at Once Studios. You can of course access health calls through the CHA website and that website address is chausa.org/podcast and you can get this podcast, of course, on all of your favorite podcast streaming services. And if you do so, we'd love to hear back from you. Give us a five-star rating, give us some comments. We really appreciate that. And as always, thanks for listening.