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Numerous models are employed for medication distribution and pharmacy services management in correctional facilities. Since 2003, the University of Rhode Island College of Pharmacy and the Rhode Island Department of Corrections (RIDOC) have collaborated on a pharmacy management program designed to better integrate medical care, improve medication utilization, and reduce pharmaceuticals costs. The program introduced staff education, waste-reduction strategies, treatment protocols, and a responsive formulary system. RIDOC pharmaceutical expenditures grew at a rate of approximately 1.5% Per Inmate Per Year from 2003 to 2009, considerably below the annual pharmaceutical inflation rate. Analyses of projected and actual drug spending indicate that RIDOC benefited from savings of almost $5 million during this period. This innovative approach to pharmacy management addressed many pharmaceutical care issues that had challenged RIDOC while providing educational opportunities for doctor of pharmacy students in this practice setting.

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Currently, Medicare Part D is the primary payer of pharmaceuticals and driver of formulary selection for most seniors, regardless of their care setting. This primer examines key issues in reimbursement for geriatric care from a historical perspective and how it has affected health care professionals in their clinical and distributive functions. Discussion on how reimbursement trends evolved for older adult patients across care settings such as nursing facilities, assisted living, hospice, and home health are included. Additionally, this primer identifies what is changing across the different care settings, the complexities of medication coverage today, and current trends that may have significant impact on medication cost in the near future if the Affordable Care Act is implemented as currently written. Finally, the primer identifies legislative and regulatory initiatives and reimbursement trends that will continue to pose a challenge in the coming years as Congress and the president address the number of individuals covered by publicly funded programs. This challenge will be amplified in part by a growing biotechnology pharmaceutical pipeline and a rapidly increasing genomics industry.

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