What challenge was your STD program experiencing?

Starting in 2015, the incidence of syphilis has increased consistently across the state of Minnesota. The region that has been particularly affected is northwest Minnesota, which is rural and home to several of our tribal nations. At the Minnesota Department of Health (MDH), we find that providing adequate sexual health care is particularly difficult in this area. There are a wide variety of clinical providers, including county public health, county jails, tribal clinics, tribal jails, and Indian Health Services (IHS). We have continuously heard from a variety of these providers that they find it burdensome to screen and treat for syphilis in a large range of potentially high-risk clients. Because of this, the MDH looked into using funds to provide syphilis tests and treatment. Facing the same issues as these clinical providers, provisions were extremely limited given the low amount of funding dedicated to the project and the high cost of bicillin for syphilis treatment.

Because of this, the MDH has been working to establish a 340b combined purchasing and distribution program to increase our capacity and meet the demands of our providers in northwest Minnesota. This led to a new host of challenges, as we have been coordinating the establishment of this program from square one.

What specific technical assistance tools and resources were provided to you? How did you use the tools and resources to address your challenge?

We have had access to a variety of resources throughout this process. Specifically, we have worked with Stephanie Arnold Pang at NCSD and utilized her expertise to get started. We have attended several of Stephanie’s presentations, including 340b 101 and 340b 102. Stephanie’s ongoing communication was integral to the process, as we hosted many conference calls and sent many clarifying emails. We were able to meet with Stephanie and develop a foundation of understanding and were referred to her contacts at Apexus, an organization that specializes in assisting covered entities.

What are the next steps your STD program plans to take (or have already taken) to address your challenge?

We are still in the initial stages of getting this process operational. First, we are looking to collaborate further with Apexus to get our initial proposal to HRSA established. Additionally, we will need further assistance in establishing the appropriate materials and tools, such as policies and procedures, a memorandum of understanding with our lab, FAQ sheets about the program, a combined purchasing agreement, and a system for maintaining and storing our auditable records.

The establishment of this program also requires a great deal of collaboration with our participating providers. The compliance of our partners will be crucial to the success of this program. We will need to get the appropriate buy-in, which includes the agreement that they will report and bill within compliance and abide by any contractual agreements laid out in the combined purchasing agreement. Likewise, we will need them to participate in in-kind services that establish their eligibility to be a registered entity under our 340b authorization. This means ongoing participation in our partner services, technical assistance for the program, and use of the tests and drugs we send to them.

In the more distant future, we would like to apply this program to other avenues. We are hopeful that we can use what we have and will learn from this process to bigger projects, where we can work with more partners that are in need of discount drugs and begin to purchase medications other than bicillin.