The Complete Guide to Starting and Sustaining a Charitable Pharmacy
This charity pharmacy playbook is a comprehensive guide to establishing a charitable pharmacy in your community. From fundraising and operations to regulatory compliance and human resources, the playbook is a clearinghouse of experience, best practices, case studies and guidance from our members and partners. Explore the sections below, or download the complete playbook for your reference.
In the last half of 2019, the Center for Disease Control (CDC) estimated that approximately 35.7 million people of all ages living in the United States did not have health insurance. This does not include people over the age of 65. Some are ineligible, some cannot afford, some are in cities, some are in rural communities, some are our neighbors and friends.
This charity pharmacy playbook is designed to help guide communities, health systems, clinics, and pharmacists in their mission to provide medication access and pharmacy services to a vulnerable population: the uninsured and underinsured. The playbook is compiled by members of CharityPharmacy.org, an organization dedicated to connecting and supporting charitable pharmacies throughout the country, with a vision to create a network of charitable pharmacies that reaches every underserved patient in the United States.
- Christine Toni, BS Pharm.- former Pharmacist Coordinator, Hope Dispensary of Greater Bridgeport, Bridgeport, Connecticut
- David Neu, Pharm. D., MSHSA – Vice President Pharmacy, Saint Thomas Health, Nashville, Tennessee
- Christopher Palombo, MA, MSHM – CEO Dispensary of Hope, Nashville, Tennessee
- Shearie Archer – Executive Director, Ozanam Charitable Pharmacy, Mobile, Alabama
- Natasha Gallizzi. Pharm. D.– former Program Manager, Wyoming Medication Donation Program, Cheyenne, Wyoming
- Jon Michael Rosmann – CEO, SafeNetRx, Des Moines, Iowa
- Phil Baker, Pharm. D.– Custodian, Good Shepherd Health, Memphis, Tennessee
- Hillary Blackburn, Pharm. D.– Director of Pharmaceutical Services, Dispensary of Hope, Nashville, Tennessee
- Carol Risaliti, MA – Executive Director, Beacon Charitable Pharmacy, Canton, Ohio
- Donney John, Pharm. D.– Executive Director of NOVA Scripts Central, Falls Church, Virginia
- Yolanda Tolson, BS Pharm.- Manager, St. Vincent de Paul Charitable Pharmacy, Madison, Wisconsin
- Amy Kurzatkowski, BS Pharm.- Manager Outpatient Pharmacy Service, St. Vincent’s Medical Center, Bridgeport, Connecticut
- George Wang, PhD. – Co-Founder and Director, SIRUM, Palo Alto, California
- Dorothy Daigle Pak, J.D., – Partner Bradley, Birmingham, Alabama
- The Pharmacy School Students at Lipscomb University, Belmont University, University of Tennessee at Nashville and Virginia Commonwealth University, and students at Fairfield University.
- The Dispensary of Hope associates, and many, many community leaders, pharmacists, and charity medication program leaders.
This charity pharmacy playbook was last updated June 1, 2020.
Browse the Playbook Sections
So you want to build a charitable pharmacy? Great news! That is a noble effort, and certainly worth your time. A charitable pharmacy (also known as a charity pharmacy) is a world-changing enterprise for your community’s uninjured, low-income population. Unlike other safety net services located in towns and cities, a charitable pharmacy is the single best way to ensure stable access to consistent supplies of medications for those unable to afford purchasing. Among other benefits, a community charitable pharmacy will provide a massive new resource serving medication access, will benefit the financial position of your local healthcare industry, and provides a substantial impact on the health and well-being of the community. While a great deal of work and funding will need to go into building a community charitable pharmacy, there is a powerful return. Further, completing this effort adds you to the ranks of many other leaders in the United States who have also built a charitable pharmacy. Among that community, you will find fellowship, shared vision, and a community that is excited to learn with and from you. We applaud your vision and welcome you to this effort.
A champion is a coach, visionary, manager, and lead encourager to the work of building a safety net enterprise. Building a charitable pharmacy can take anywhere from a few months to several years of work, depending on the readiness of your community and the engagement of the much-needed resources. You and your leadership collaborative will establish operational aspects that are as varied as hiring the right staff, finding a suitable facility, creating a nonprofit corporation, raising adequate charitable dollars, and managing the supply chain. This playbook attempts to take the learnings of dozens of established community charitable pharmacy programs and the expertise of a large number of veteran leaders, and roll all of that learning into a usable document and toolset. Our hope is to make your work easier, less risky, and happen faster. So, in the spirit of collaboration, we wish you the very best and hope to help you along the way with the following material.
In the introductory section of this charity pharmacy playbook, you will find:
- What is a charitable pharmacy?
- What to expect in championing a community pharmacy
- Collaborative building
- Step-by-step overview
- Establishing a business plan
- Local factors to consider for community charitable pharmacy implementation
Fund development is a process of letting the best ideas compete for limited resources. Before we talk about funding, let’s talk about how we lead. We are leaders. That means that in our work, we must always discern and call others to discern the deepest principles driving the work. In fund development, the principle that should guide us is that the resources at our disposal should always be invested in a way that best serves the patient.
Resources are limited. In small, financially limited free clinics, even to the financially comfortable health system, every dollar is and should be scrutinized. Said in one way, the “idea” of a community charitable pharmacy should be compared against all other good ideas. On their merits. Our role is to let the ideas compete. And ideas that bring the highest value are those which should be funded.
As you and I talk about fund development planning, we are conscious that ideas like a community charitable pharmacy are worth putting forward for funding because they out-compete other ideas by their measure of patient health impact. As leaders, it is our job to discern the best ideas, and to strive to gain funding for those that are most effective for the patient.
In this section, you will find:
- Fund development and relationships
- Speaking the language as you market your fund development need
- Initial funding vs. ongoing funding
- The fund development plan and the fund development planning process
- Funding resources
- Return on community investment (ROCI) funding
- Outcomes measurement in fund development relationships
- Fund development decision tree
Locating your charitable pharmacy will take creativity, consideration of community needs, and close collaboration. Be creative when you think of space. Charitable pharmacies are located in churches and thrift shops as well as departments of health and clinics. Where do the people you plan to serve go?
In this section of the charity pharmacy playbook, you will find:
- Hours of operation
A charitable pharmacy program serves uninsured or underserved patients with low-income. The charitable program may be a pharmacy’s exclusive focus, or it may be incorporated into pharmacy with a broader business plan with many agendas. Pharmacies dispensing solely to patients under the charity program will be referred to as “Charity-only” pharmacies, whereas pharmacies dispensing to both insured and uninsured patients and engaging in other for-profit activities in addition to the charity program will be referred to as “Mixed-Model” pharmacies. A charitable pharmacy program may be successfully operationalized in many different types of pharmacy models and settings with a stipulation that each must segregate charitable medications from the for-profit medications.
Some charitable pharmacies are independently funded, stand-alone, not fully supported by a hospital or health system. All charitable pharmacy models can be open-door: serving eligible patients from the entire community or state. Clinic or hospital models may or may not limit their patients to those referred from a specific source. Most models limit the geographical population they serve (city, county, state, etc.) due to limited resources.
In this section, you’ll learn about the different models of charitable pharmacies, including:
- Charity-only pharmacy
- Collaboration charity-only pharmacy
- Mail order charity-only pharmacy
- Clinic-based mixed-model charitable pharmacy
- Hospital-based mixed-model charitable pharmacy
In this section, we detail the following regulatory considerations for charitable pharmacy operations:
- Legal considerations int he development of best practices for charitable pharmacies
- 501(c)3 nonprofit status
- Steps to obtaining a pharmacy license
- Donation of prescription drug samples from licensed practitioners
- Drug reclamation/donation regulations
- Collaborative practices
- Pharmacy technician status
Although the primary objective of a charitable pharmacy is not to make money, the organization must be managed and operated like a small business. Charitable pharmacies have revenue streams, operating costs, and other financial obligations. As such, the organization must be responsibly managed and include mechanisms to ensure appropriate oversight is provided.
In this section, we detail the following financial management considerations for charitable pharmacy entities:
- Separation of duties
- Routine bookkeeping and payroll
- Account or credit references
- Start-up costs
- Example of an initial budget
- Safety net charitable pharmacy
Even a small organization benefits from having guidelines regarding mission, hiring, training, staffing, and other employee practices. Training becomes more efficient and standardized. There is a reference for policies and questions. Employees who understand the pharmacy mission are empowered to incorporate this mission into all aspects of their work. Clear guidelines demonstrate to potential employees, communities, stakeholders, and donors that the organization has a commitment and policies for treating all persons with dignity and against discrimination.
In this section, we will explore:
- Staffing policies
- Job Descriptions
- Students and volunteers
- Sources for volunteers
- Productivity metrics
Standard Operating Procedures (SOPs) are established or prescribed methods to be followed routinely for the performance of designated operations or in designated situations (Merriam-Webster Dictionary). In healthcare, the aim of SOPs is to achieve efficient, quality, safe, and uniform performance in compliance with state and federal regulations and in accordance with established best practices. They serve all employees as a reference for clear performance of processes and procedures, especially those used infrequently, and a defined standard of expectations. Documentation of training employees in facility SOPs acts as a safety guideline, performance review standard, and legal grounds in case of accident or violation.
In this section, we will explore the types of standard operating procedures, including:
- Assistance Programs
Additionally, we’ll cover staff competencies relating to processes and procedures.
Inventory Management is one of the keys to a successful charitable pharmacy. Devolving and maintaining inventory processes will allow the pharmacy to maximize the use of limited resources and to serve patients to the best of their ability.
This chapter will cover concepts that may be considered when developing and managing an inventory including: developing a formulary, sourcing medications which may include donated medications, prescription assistance programs, developing standing orders for therapeutic substitution, proper drug disposal, computer systems, and routine inventory management tactics.
In this section of the charity pharmacy playbook, we will cover:
- Developing a formulary
- Pharmacy management systems
- Routine inventory management
- Sources for medications
- State drug donation programs
A goal of improving medication access is to help patients without insurance become eligible for charitable pharmacy services. This may involve providing medication directly, enrolling patients in a manufacturer patient assistance or bulk program, or directing them to a mail-order or other discount programs. There are transitions of care involved. Frequently special services are required such as translation, interpretation, dealing with illiteracy, arrangements for homeless or those who have been incarcerated. The charitable pharmacy is in a unique position to address these needs and create reasonable options for their patients.
In this section, we’ll cover:
- Record keeping
- Flowchart for external referral
- Eligibility guidelines
- Further assistance with medication
- Transitions of care/handoffs
- Pharmacy translations
- Services offered and special populations
Metrics, evaluation and outcomes are essential to measuring and sharing your successes and opportunities and demonstrating what is actually being done. They are useful to:
- Attract funding – If your idea is successful as determined by evaluating metrics, it will attract potential funders who want to support good ideas.
- Spread the vision – Great outcomesfrom established programs encourage new programs to start and existing programs to improve and expand.
- Deepen integration locally – Sharing outcomes with free clinics, Federally Qualified Health Centers (FQHCs), hospitals, departments of health and others help them understand the impact of your work.
- Credibility – Your credibility establishes trustworthiness for the charitable pharmacy and the services
In this section, we’ll cover:
- Benchmarks for community charitable pharmacy testing
- Dispensary of Hope Results
- Results-Based Accountability
- Drug Reclamation/Donation Performance Metrics
- Data collection
- Development of a community-based, multi-disciplinary research project
- Sharing results
Community outreach is a great way to reach to more patients within the community, county, or state. Partnerships with other healthcare facilities, whether clinics with hospitals, pharmacies with clinics, or other combinations can help to promote a charitable pharmacy allowing more patients to learn about the services available to them. Promoting the program through community outreach can help to spread the word, serve more patients, and generate a better return on investment. Healthcare doesn’t stop at the four walls of the hospital, clinic, or pharmacy; it extends into homes, schools, and neighborhoods.
In this chapter of the charity pharmacy playbook, we’ll cover:
- Where to start
- Communications systems
- Internet accessibility
- Tracking the impact of marketing
- Stakeholders and funders
- What to include in a newsletter
After opening the doors to your community charitable pharmacy, mechanisms need to be put in place to ensure your continued involvement for the health of the patients and community you serve. Develop an informed, dedicated, and dynamic governance board. Plan for implementation of growth and sustainable funding. Build relationships and collaborations with healthcare providers and others who are mission-minded within the community and beyond. Be a voice for those you serve and the impact of the service.
In this section, we’ll cover:
- Governance board
- Funding sustainability
- Growing the charitable pharmacy practice
- Challenges and opportunities
Looking for more information? This section provides an exhaustive list of external online resources relating to topics covered in this playbook.