Managing medication costs at Hampton Roads Regional Jail

Deanna LeBlanc/WAVY Photo
Deanna LeBlanc/WAVY Photo

PORTSMOUTH, Va. (WAVY) — The pharmacy at Hampton Roads Regional Jail is a very busy place.

Of the roughly 1,150 inmates confined there, only about 360 are not on chronic care medication. Their conditions range from HIV, to hepatitis, pregnancy, to mental health. Nearly 600 inmates are on psychotropic medications.

“In a way, it’s more like a medical hospital,” said Norfolk Sheriff Bob McCabe, who is also currently interim superintendent of the regional jail.

A hospital that was, until recently, throwing away $10,000 worth of medication every month.

Sheriff McCabe, pointing to a picture of a gallon bag full of pills he said was marked to be discarded, said, “Some of these colored ones are $400 a piece, and I’m counting one, two — holy cow, that’s everyday? Everyday?”

Deanna LeBlanc/WAVY Photo
Deanna LeBlanc/WAVY Photo

McCabe discovered the problem when he took over the jail as interim superintendent two months ago. He says medical staff were punching pills out of blister packs, dropping them into paper cups, then delivering them. So, if an inmate refused to take the medicine, they had to get tossed.

“It was just a waste. Why would we do it that way?” McCabe said.

McCabe says that practice is not used at most area jails, and is also not the way Correct Care Solutions, the jail’s medical staff company, is accustomed to.

“My understanding was, it was to cut down on the length of time it would take to make the medication rounds. Which, to me, was not a satisfactory reason.”

Within three days of taking over as interim, McCabe said he made a change. Now, nurses bring the blister packs to the inmates — only punching out the medicine if the inmate is willing to take it: a simple, but important fix. While the jail was throwing away $120,000 worth of medication a year, it’s also $500,000 over it’s $2 million medication budget.

McCabe says a lot of those costs are due to the fact that the regional jail takes the sickest, most acute inmates from five area city jails, and their medication costs are high.

“We’re spending here is about $177,000 a month on HIV meds,” he said.

Another example McCabe provided: There are three inmates whose medication costs total more than $8,000 per month.

McCabe understands the jail has a responsibility to care for the inmates, and he’s not disputing the medication costs, but is looking to cut back where it’s possible.

McCabe says another budget category that didn’t make sense to him was preexisting conditions. He says the jail was paying out-of-pocket for medical care of inmates’ preexisting medical needs, such as cancer. McCabe says if an inmate had cancer before coming to the jail, the jail is paying for their medical visits and hospital stays. However, he says that’s not normal practice. Now, he is changing that, too. McCabe says jail staff will let hospitals know they must bill Medicaid. He estimates that could save between $2 million and $3 million a year.

McCabe hopes that a new superintendent will be found by the beginning of 2017.