US Pharm. 2014;39(10):8-11.
If asked, what would a pharmacist’s justification be for entering the profession? For many, that answer would be, “I wanted a career where I could help people.” Pharmacy is an excellent way to meet that goal, but it is frustrating at times. One such situation is when patients cannot afford their prescriptions. Even the most altruistic pharmacist cannot stay in business if drugs are given out for free. As a result, patients with no means to pay may leave the pharmacy without their medications, opting to forgo care. Of course, that has the potential to endanger their health if these patients have such conditions as glaucoma, infectious diseases, diabetes, or hypertension.
Fortunately, there are existing options for medically underserved patients. Patients may contact the manufacturer for benevolent care programs, but they may also be able to obtain free medications from institutions known as free clinics.
What Is a Free Clinic?
A free clinic is a safety-net organization that offers medical consultations and medications free of charge or for a small copay.1,2 Free clinics may also offer nursing assessments, dental services, optometric care, laboratory tests, food, and clothing, as well as assistance in finding housing and jobs.3 Most free clinics are created by religious organizations, such as churches, and most operate as tax-exempt entities.
Helping Patients Find a Free Clinic
When pharmacists identify patients in financial need, they can provide a valuable service in referring them to the nearest free clinic for care. Free clinics seldom publicize their services due to the prohibitive cost of newspaper and television advertising. How can the pharmacist discover where they are located? A Google search for “free clinic,” linked with one’s state, may uncover a nearby clinic. The State Board of Pharmacy may also maintain a list of clinics. For instance, free clinic pharmacies in Oklahoma are legally required to register with the Oklahoma State Board of Pharmacy under a special category known as charitable pharmacies. Therefore, their locations are readily available from the state board.3 It might be helpful to contact local places of worship, since many clinics are founded by faith-based organizations; the state department of health may also keep a list of clinics.4-7
As another option, the pharmacist may access the website of the National Association of Free and Charitable Clinics (NAFC) at www.nafcclinics.org. This allows pharmacists to search for a clinic in a specific city/state or zip code.8,9 The problem with this approach is that a clinic may not be able to afford the fee required to join the NAFC, and those that cannot join will not be in its database.
Free Clinic Funding
Free clinics have some of the same expenses as other businesses, such as utilities, upkeep, and computer maintenance. In addition, there are costs unique to a medical clinic and pharmacy, such as medications, pharmacy labels, vials, and state board fees. Many free clinics are not-for-profit and are reliant on donations, which may come from their sponsoring organizations, civic and fraternal groups, fund-raisers, or private individuals. Other free clinics have been started by students at medical, nursing, and pharmacy colleges, which fund them as a component of their mission to provide services to the community.10-18
Volunteer Versus Salaried Free Clinic Staff
At some point, the governing board must decide whether or not to hire administrative staff, or whether to offer a salary to medical personnel. Because of the medical model under which they are founded, free clinics may barely be able to meet their ongoing financial obligations. Decisions regarding salaries must be made with knowledge of the tenuous nature of funding. For this reason, salaried employees are a rarity, and free clinics are sorely in need of professional volunteers such as pharmacists, physicians, nurses, optometrists, and dentists.
Drawbacks to Volunteering at a Free Clinic Pharmacy
Volunteering in a free clinic pharmacy has certain disadvantages. If the clinic hours follow a hard day of work in a busy pharmacy, they extend by several hours the requirement to remain attentive enough to perform pharmacy services. Furthermore, volunteer time is not otherwise available to spend in leisure or with family and friends. The pharmacist who has not been employed for a period prior to volunteering must ensure that licensure and malpractice insurance are current. It is important to note that time spent volunteering is not tax-deductible.
Benefits to Volunteering at a Free Clinic Pharmacy
While there are some drawbacks to volunteering in a pharmacy, the many advantages can easily outweigh them. One great difference between free clinics and typical pharmacies is the general atmosphere. Pharmacists in community pharmacies must ensure that their institutions remain profitable, so they must be constantly aware of the bottom line. In the free clinic, the need to make a profit is eliminated. There is no cash register, unless the clinic requires a minimal copayment. Pharmacists do not have to worry about third-party payers, and insurance is not an issue. Thus, one of the most frustrating aspects of community pharmacy is not present.
Another great difference between the free clinic and the typical community pharmacy is the absence of corporate paperwork and politics. There is no front-end manager to placate, as is the case in many chain pharmacies. There is no district manager to criticize the pharmacy’s performance in regard to sales goals or monthly employee salaries. There are no annual evaluations, and pharmacists do not need to hire, fire, or discipline employees.
Pharmacists volunteering in free clinics will notice a prevailing sense that all are engaged in humanitarian work, as opposed to a typical work-place, where some employees seem to be there only for the paycheck. Further, even though some clinics were founded by a specific faith-based organization, most would be happy to accept volunteers of any faith or religion. Working alongside pharmacists from different faiths in a nonthreatening atmosphere facilitates a greater understanding of each other’s unique perspectives on pharmacy.
The free clinic pharmacist volunteer will also experience a greater number of positive interactions with other healthcare professionals during a typical clinic session. Nursing personnel (including volunteer nursing students) enter the pharmacy to ask questions that arise during patient intake. Physicians walk in to inquire whether a specific drug is available and explore therapeutic options.
Attitudes are radically different in patients attending a free clinic, as opposed to those of some customers at community pharmacies. All pharmacists are familiar with patients who become angry, frustrated, and verbally abusive when they are told that their insurance will not cover the entire cost of the prescription, they have no more refills, or they must wait for 10 minutes. By contrast, patients in free clinics seem more mindful of the fact that they are being served by providers who care enough for their welfare to volunteer in the pharmacy. That, and the allure of free medications, seems to make these patients kinder and more tolerant when they are required to wait for their turn to be served.
Free clinics seldom dispense controlled medications due to the potential for drug abuse. This frees the volunteer pharmacist from the endless problems associated with narcotics, such as theft, refill requests before they are due, and forged prescriptions.
Managing a Free Clinic Pharmacy
If the free clinic is registered with the State Board of Pharmacy, it must have a designated pharmacist-in-charge (PIC). The PIC will have numerous responsibilities, some similar to those the community pharmacy manager must undertake. One of the most critical is maintaining an inventory within the budgetary constraints. The PIC should consult with physician volunteers to develop a formulary of drugs that will always be in stock. The PIC must constantly review the formulary. Some medications, such as warfarin, may be inappropriate to prescribe to patients who may only visit the clinic once monthly and cannot be relied on to obtain the necessary laboratory examinations.
There are three major sources that can be explored to stock the pharmacy. The PIC should attempt to establish ties with a local pharmacy that will purchase their routine formulary medications at contract prices. The PIC can also contact local physicians to solicit donations of drug samples that are in date but no longer needed in their practices. Finally, the PIC should determine whether the State Board of Pharmacy allows long-term care facilities to donate unneeded/unwanted medications to charitable pharmacies. The latter two options provide a stable flow of medications that are not on the formulary, which may include expensive and badly needed brand-name products. The manager may be responsible for making the nursing home visits to collect donated medications.
The pharmacy manager will be responsible for recruiting a volunteer pharmacy staff for each clinic session. If the PIC is associated with a college of pharmacy, students and pharmacy academicians are a rich source of volunteers. If the clinic is not associated with a university, it would be prudent to contact all pharmacists in the area to recruit volunteers.
The manager must develop and implement a set of policies and procedures ensuring that the pharmacy adheres to all state and national laws. For instance, expired drugs must be promptly removed from inventory (and disposed of according to the most current recommendations), patient-specific information must be protected, and pharmacy access must be restricted to pharmacists. The PIC must meet the state board officer in the pharmacy for routine inspections. Each pharmacist volunteer must have a current pharmacy license, and the pharmacist (preceptor)-intern/technician ratio established by the state board must be followed. Other aspects of good pharmacy practice must be adhered to. When the PIC or another pharmacist delegated this task collects medications for the clinic, they should be delivered to the clinic immediately rather than locked in a car for several hours. The PIC, in conjunction with the clinic’s governing board, must decide whether the pharmacy will fill prescriptions brought in from outside the clinic.
The manager and other pharmacist volunteers should serve as ambassadors for the clinic to aid in fund-raising and increasing awareness of the clinic’s existence and mission. They may be asked to address civic clubs, faith-based organizations, and other local and state groups or to conduct tours for students and other interested parties. Pharmacy staff may also prepare write-ups for local newspapers and use social media to promote the clinic’s mission and volunteer opportunities.
Conclusion
Many pharmacists choose this profession because they have a true desire to help people. By serving in a free health clinic, pharmacists have the opportunity to not only help people, but also give back to the community in various ways, such as promoting public health, providing health and drug information, and encouraging others to be involved. In conclusion, despite the few drawbacks, the experience of providing services in a free health clinic can be a rewarding one for most pharmacists.
PATIENT INFORMATION
Although you may feel overwhelmed at times, resources are available to help you obtain the prescription medications you cannot afford.
Brand-Name Medications Are Expensive
Many patients know the shock of receiving a new prescription for a brand-name medication, having the pharmacist fill it, and then discovering that its price is far too expensive. In some cases, patients may not have insurance that covers prescription drugs. However, even with health insurance, patients may find that their payment is too high at certain times of the year (e.g, when the deductible has not yet been met). It is devastating to be forced to choose between one’s rent and medications. Low-cost generics may reduce your costs, but they are not available unless your medication is off-patent.
Benevolent Programs From Manufacturers
If you are prescribed an expensive medication, it would be wise to contact the manufacturer to see if you qualify for a benevolent prescription program. Many manufacturers offer these programs, in which you must provide information about yourself to register. It will include such data as your household income. While this process may be cumbersome at first, the payoff can be free medications from the manufacturer.
Explore Free Clinics in Your Area
During the late 1960s, concerned health professionals established a new kind of healthcare clinic, one whose mission was to provide people with free medical checkups, free medications, and other free services (e.g., nursing assessments, optometric services, dental work, clothing, food, and help in finding jobs). These “free clinics” number in the hundreds, and their services have been useful to hundreds of thousands of patients over the years, regardless of the current economic situation. Large metropolitan areas will have one or more free clinics, and they will be scattered around each state, with many being in small communities.
A first step in locating a free clinic might be to contact physicians or pharmacists in your area. Some may volunteer at such facilities or be aware of their locations. A county health department may also be able to direct you to a free clinic.
Your Free Clinic Visit
If you are able to locate and visit a free clinic, there are several things to remember. One is that there is a critical need for free medication. Another is that most free clinics operate on a shoestring budget. The clinic must help as many people as its funding allows. As a result of those two factors, expensive brand-name drugs may not be available—they are simply beyond the clinic’s limited budget. Also, you may find the waiting time for your prescriptions is longer than at a community pharmacy. The demand for free medication is high, and most free clinics run at full capacity, often being overloaded with requests.
Remember, if you have questions, Consult Your Pharmacist.
REFERENCES
1. Free clinics. Health Resources and Services Administration. http://bphc.hrsa.gov/ftca/freeclinics/?lsPopUp=true. Accessed August 25, 2014.
2. Pray WS. Funding and staffing the free clinics. Paper submitted to the University of Oklahoma Graduate College in fulfillment of the requirements for the degree of Master of Public Health; 1976.
3. List of charitable pharmacies. Oklahoma State Boards of Pharmacy. http://lv.pharmacy.state.ok.us/osbpinquire/PhrmcySearch.asp?s_PhcyDesc=C&s_CountyAndLic=&s_DBAName=&s_LicenseName=&tblPharmaciesPageSize=&s_City=&s_State=&Button1=Bottom+of+Page#BottomOfPage. Accessed August 25, 2014.
4. Free clinics. Oklahoma State Department of Health. www.ok.gov/health/Community_Health/Community_Development_Service/Primary_Care_&_Rural_Health_Development/Free_Clinics_in_Oklahoma/index.html. Accessed August 25, 2014.
5. Dunn LL. Making a difference: initiating and maintaining a faith-based health clinic. Fam Community Health. 20-09;32(4):339-344.
6. Carey RA, Fricke J. Free health clinic links college, church, and community. J Christian Nursing. 2011;28(2):88-91.
7. Ashai SA. The Muslim Community Center Clinic: a Maryland safety net clinic, achievements and challenges. J Islamic Med Assoc North Am. 2010;42(3):117-123.
8. What is a free or charitable clinic? National Association of Free & Charitable Clinics. www.nafcclinics.org/about-us/what-is-free-charitable-clinic. Accessed August 25, 2014.
9. Find a free or charitable clinic? National Associa-tion of Free & Charitable Clinics. www.nafcclinics.org/clinics/search. Accessed August 25, 2014.
10. Zucker J, Lee J, Khokhar M, et al. Measuring and assessing preventive medicine services in a student-run free clinic. J Hlth Care Poor Underserved. 2013;24(1):344-358.
11. Shuman AG, Aliu O, Simpson K, et al. Patching the safety net. J Hlth Care Poor Underserved. 2014;25(3):1110-1117.
12. Butala NM, Chang H, Horwitz LI, et al. Improving quality of preventive care at a student-run free clinic. PloS One. 2013;8(11):e81441.
13. Rebholz CM, Macomber MW, Althoft MD, et al. Integrated models of education and service involving community-based health care for underserved populations: Tulane student-run free clinics. South Med J. 2013;106(3):217-223.
14. Farokhi MR, Glass BJ, Gureckis KM. A student operated, faculty mentored dental clinic service experience at the University of Texas Health Science Center at San Antonio for the underserved refugee community: an interprofessional approach. Tex Dent J. 2014;131(1):27-33.
15. Gorrindo P, Peltz A, Ladner TR, et al. Medical students as health educators at a student-run free clinic: improving the clinical outcomes of diabetic patients. Acad Med. 2014;89(4):625-631.
16. Ojeda VD, Eppstein A, Lozada R, et al. Establishing a binational student-run free-clinic in Tijuana, Mexico: a model for US-Mexico border states. J Immigrant Minority Hlth. 2014;16(3): 546-548.
17. Kibria F, Peters JL, Shulman C, et al. Assessment of hypertension guidelines adherence at a free clinic serving a predominantly Latino population in Providence, RI. RI Med J. 2014;97(3):43-47.
18. Shurman AG, Kupfer R, Simpson K, et al. Implementation of a novel otolaryngology clinic for indigent patients. Laryngoscope. 2013;123(9): 2142-2147.
To comment on this article, contact rdavidson@uspharmacist.com.
