Marcus Cox, Chief Pharmacy Officer, Klamath Health Partnership, Inc

Marcus Cox

Q: Where did you go to college/graduate school?

I graduated Pharmacy school from Oregon State University in 1999. I first graduated with a BS in Chemistry from Southern Oregon University. 

Q: Where do you live?

I live in Klamath Falls, Oregon. We’re a small rural town in a large service area in south-eastern Oregon. 

Q: If a friend came to visit you in your hometown, where would you take them? Where would you take them in your state?

Depends on the time of the year!  We have some great seasons here.  The lake, fishing or golfing, or maybe we should go skiing!  If they never been to my town, we’ll have to take a visit to Crater Lake (national park and deepest lake in America) at least once.

Q: Tell us about your health care facility.

We are Klamath Health Partnership, an FQHC established in 1998, serving an extensive service area of south-central Oregon and northern California. Our mission is to provide accessible, culturally sensitive, affordable, quality-driven, patient-centered health services to the community, with an emphasis on the underserved.  We currently have five clinic locations, served 11,000 patients in 2020 and 15,377 in the past three years. We started small with a small medical clinic staffed by two family nurse practioners, adding dental services in 2000, behavioral health in 2001, and eventually partnering with four local contract pharmacies in town. In 2017, we added an in-house pharmacy. This spring, we are adding another large multidisciplinary clinic in our downtown area which is an identified area of need.  

Q: What are some concrete examples of how your facility has benefitted from the 340B program?

Over the years, it’s helped us add clinic sites, staffing and our in-house pharmacy.  While federal funding and reimbursement are significant, it truly doesn’t (nor intend to) pay for everything we really need to provide the services. 

Recently, through this pandemic, we’ve been able to financially sustain our service programs that are vital to our patients. It’s been said, and it is true, that our in-house pharmacy has financially pulled our organization through this past year.   

Our in-house pharmacy would absolutely not exist without the 340B program.  We could not afford the startup costs, nor the operational costs.  In our pharmacy, we are able to serve our patients in unique ways, differently than other pharmacies.  About 25% of our prescriptions are to people with income levels below 200% FPL, and these are provided at a low flat price (or no cost). We are able to provide competitive and affordable prescription prices, help navigate insurance coverage, manufacturer assistance plans and medication management. 

Taking the time to solve problems is much of what we do.  This includes helping patients understand their treatment plan, manage meds, recommend care, triage, counsel and afford prescriptions.  We provide free prescription delivery to patients as many of our patients are without transportation or means to reach a pharmacy.  We provide a medication management and monitoring program for all patients that integrates with our pharmacy “Med Sync” refill program. Within the last year, we’ve been able to treat almost 50 Hep C patients with assistance from our pharmacist team.

Q: What makes you most proud of your work and your organization?

Our providers and organization really care and it makes a difference in patients’ lives.  From seeing patients in the hospital, helping them when they get out, and taking on new patients that couldn’t get into any other behavioral health provider in town.  Providers working hard for their patients and crying when they get ill.  These are things that industry won’t see.  During this pandemic, we have staff volunteering their time go reach out to our rural areas and businesses to vaccinate the population.

Q: How has your facility benefitted from the services of your 340B vendors/contractors?

Our CaptureRx representative was especially helpful to me when I was new to 340B. Our customer representative spent time with me and was patient helping me understand 340B and our contract pharmacies arrangements.  

FQHC 340B Compliance helped us with our mock 340B audit in 2021.  We realized that the audit wasn’t only that, but also a consultation, and helpful resource offering suggestions to improve.  We’ve since decided to participate in their monthly service. They now help with our monthly 340B audits, and have helped with things like the development our Prescription Assistance Program and revising our 340B P&P’s.

Apexus has been invaluable in answering my questions.  The responses I have received are thoughtful and helpful.  Several times, they have followed up with me by phone.

 

Q: What advice do you have for 340B covered entities or staff that are new to the program?

Dream and envision how 340B will help your services. Gather input from others in similar sites, and work to create vision with how you’ll implement use of 340B within your organization.

Be sure to seek input from peers and other sites. CHC and other grantees should be sure to sign up for the NACHC NoddlePod community, read the NACHC 340B Manual for Health Centers, and attend the NACHC monthly office hours. If possible, attend the 340B Coalition meeting (held twice yearly) and if you go, make sure to attend the live full day 340B University. While you’re at this meeting, take a long moment to just look around – all the people, locations, and what they do.

Stay compliant with the 340B program and be aware of the time commitment it takes.  Be aware of the recent and significant challenges to 340B. These challenges have had a major impact on our small non-profit community health center. Pay attention to your PBM contracts, and manufacturer restrictions for replenishing with 340B drug at contract pharmacies. Watch PBMs not wanting to contract with pharmacies because you participate with the 340B, or reimbursing less when a 340B drug is used. These actions threaten our organization. 

For questions, Marcus can be reached at mcox@kodfp.org.

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