177695 Kentucky Prison Pharmacy Services: Accomplishments, Issues and Recommendations

Sunday, October 26, 2008

Peace Jessa, MD, DO, PharmD , College of Public Health, University of Kentucky, Lexington, KY
Scott A. Haas, MD , Medical Division, Kentucky Department of Corrections, Frankfort, KY
Sandra J. Winter, PhD, MHA , Department of Family and Community Medicine, University of Kentucky, Lexington, KY
Cheryl L. Nieters, MPH , College of Pharmacy, University of Kentucky, Lexington, KY

The national prison population is increasing, is aging, is disproportionately minority, and has a higher prevalence of substance abuse, infectious diseases, mental health problems, chronic diseases and reproductive and sexual health problems. These conditions are exacerbated by high risk health behaviors, lack of access to continuous medical care and low socioeconomic status prior to incarceration. The majority of inmates are released back to their communities although high rates of recidivism result in the “revolving door” phenomenon. These factors result in substantial financial pressure for corrections medical systems. The three largest components of health care costs are hospital care, physician and clinical services, and pharmaceutical services. Health care costs comprise the fastest growing budgetary component of total inmate costs.

A public/private partnership has been formed between the University of Kentucky (UK), the Kentucky Department of Corrections (KyDOC) and a private health care management company, Correct Care Integrated Health (CC-IH). This partnership seeks to develop an improved, cost effective, and more integrated healthcare system for the state's inmate population.

Study Site

There are 13 state operated prisons in Kentucky housing just over 12,000 inmates.


Using reviews of medical and pharmacy records, interviews, facility tours, observations, and quantitative/qualitative analyses of available data this research investigates the various strategies the Kentucky Department of Corrections has implemented to contain the costs of pharmaceutical services, while simultaneously promoting high quality inmate medical care.


Improvements in the pharmaceutical service delivery system have included the negotiation of a well defined and closely monitored contract with a pharmaceutical company, the use of an electronic medical record system, the formation of a Pharmaceutical & Therapeutics Committee, the utilization of a drug formulary, and a formal utilization review and pre-authorization processes.

The challenges facing the system include over-utilization and poly pharmacy, delay in initiation of therapy at intake facilities, non compliance by inmates and an inefficient medication administration system.

Future opportunities include greater use of medical information technologies; the implementation of ongoing quality improvement initiatives such as clinical audits, educational programs for providers, and reviews of provider prescribing patterns; updating of clinical pharmacy standards and protocols; the implementation of a 340b program and case management for high cost acutely ill inmates.


Despite the unique challenges faced by health care providers in the corrections environment, many quality improvement and cost containment strategies used in the non incarcerated environment can be successfully implemented in this setting.

Learning Objectives:
1. Identify pharmacy service issues unique to the corrections environment 2. Identify strategies that can improve the quality of pharmacy services provided to inmates 3. Identify strategies than can contain rising pharmacy costs in state prisons 4. Recognize the role improved medical information technologies can play in enhancing accuracy, improving documentation and compliance and reducing waste

Keywords: Correctional Health Care, Quality Improvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a physcian and a pharmacist with extensive experience in Pharmacy Services. I have been working closely with the Kentucky Department of Corrections reviewing their pharmacy services for over a year.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.