“One thing we fight is that people think it’s too good to be true,” Darryl Munden, the new president of Rx Outreach, said of the company.
Michael Holmes, founder and chairman of Rx Outreach, brought Munden with him from Express Scripts when he negotiated with the Express Scripts board and CEO George Paz to spin off the non-profit organization in 2010.
Rx Outreach started as a patient assistance program at Express Scripts, a $93.9 billion Fortune 100 company based in St. Louis County. Now it is a stand-alone company that provides 280 often steeply discounted, mostly generic medications (in more than 680 strengths) to qualifying low-income patients in all 50 states, Puerto Rico and the U.S. Virgin Islands.
Rx Outreach is eligible for individuals and families who earn up to 300 percent of the poverty line (see sidebar).
One major problem, Munden discovered, is that many of the people who most need Rx Outreach’s services find it difficult to trust a company promising them the same medications for much less money than they are accustomed to paying (or not being able to afford to pay). Many drugs can be purchased for $20 for a 180-day supply.
Of many examples, Munden recalled a couple from North Carolina. They had lost their health insurance. They earned low income as missionaries and were finding it “cost-prohibitive,” he said, to continue with medications prescribed for their chronic conditions.
Researching their options, the couple called a friend who sold veterinarian drugs. He knew about Rx Outreach and suggested they look into its services.
“We read everything – were amazed – but still there has to be a catch,” the couple wrote to Rx Outreach. (Their names were redacted, out of respect for their privacy, in the copy of the letter provided to The American.) When they got their new prescription, they mailed it to Rx Outreach with a check – “and waited for the catch,” they wrote.
What they could not have imagined was that Holmes conceived of the company while praying. Munden only agreed to follow Holmes to the start-up after praying on his offer. And every single medication that goes out the door from Rx Outreach comes topped with a cap that reads, under the company brand, “Honoring God by serving others.”
The couple wrote, “Praise God we received a package from you with my medicines. I cried with joy” – still suspecting their check would be cashed, with no medication provided – “and when I opened it, it was absolutely beautiful: Rx Outreach, honoring God by serving others.”
Robots serving others
Rx Outreach’s services led this missionary couple to praise God (and the company itself), but a very sophisticated in-house supply system was responsible for delivering those medications with the faith-based pill-bottle top.
That top was screwed on by a robot, not a loving pair of human hands. The highest-volume medications at Rx Outreach go from storage dispenser to pill bottle to heat-sealed shipping package without a human being doing anything other than (methodically and repeatedly) checking that the automated process resulted in no errors.
The production line in the Rx Outreach facility in Maryland Heights even has a station that weighs each package and calculates the most cost-effective shipper, based on weight and destination, and assigns each parcel to the most efficient carrier that can get it there within five business days.
Efficiency – including critical efficiencies of scale – help to explain how Rx Outreach can fill prescriptions for qualified patients at comparatively low prices. Munden said the company receives about 5,000 requests for service per week, from all over the country and a variety of sources: individuals, clinics, physicians, social service agencies. They also come in a variety of forms: automated entries from a voice-prompted phone system, e-prescriptions and emails, as well as phone calls, faxes and paper mail that require data entry.
Pharmacists – four staff and five “per diem” – are stationed throughout the office and production facility, available to field questions at any production point from any of its 60 employees.
In 2014, according to Rx Outreach’s annual report, it filled 383,013 prescriptions for 82,791 people, saving them $78.7 million compared to retail costs. Since its founding in 2010, according to Rx Outreach, it saved 220,000 people $360 million for 1.7 million prescriptions.
Munden may be the new president, but he is not new to operations. Interestingly, he was new to Express Scripts when Holmes lured him away, but he brought his developing system knowledge with him and now clearly knows every detail of the production process.
As someone who spent 19 years at Anheuser-Busch as an operations executive, including a stint in packaging, Munden has a professional appreciation for an automated production line that can put the right pill in the right bottle, photograph it and then heat-seal it in the right package routed through the most efficient mail carrier. But he is also capable of a childlike wonder at the process.
“Remember when you were a little boy and you marched your Army figures around?” Munden asked a male visitor. “It’s like that when you see all those vials traipsing on the conveyor.”
Munden had to ask his visitor to imagine the pill bottles being moved along the conveyor because it was a Thursday (January 7). At present, the production line only runs on Tuesday, Wednesday and Friday, and not even for all of those days.
That means two things. For one, the company has room to grow without expanding or moving. “Even maxing out days of the week and shifts in the day, there is a tremendous amount of additional volume we can handle,” Munden said.
However, it also means that not enough people and providers know about Rx Outreach. “It’s a travesty,” Munden said, “that more people don’t know about us.”
‘Make a real difference’
The toy soldiers that Munden imagines when he sees upright pill bottles marching along the Rx Outreach conveyer mask the memories of a very real soldier he also harbors. He served in Operations Desert Shield and Desert Storm with the U.S. Army’s 24th Infantry Division out of Fort Stewart, Georgia. He enlisted after graduating from Old Dominion University then completed Officer Candidate School, finally leaving the service in 1992 as a 2nd lieutenant.
He worked in communications as the division rolled from Saudi Arabia to Iraq, from August 1990 to April 1991. He commanded 50 soldiers, and they all stayed alive, but he saw enough death to last a lifetime.
“We passed a lot of elements that had been bombed out, sometimes only hours before,” Munden said. “You would see a lot of soldiers hanging out of trucks, dead.”
Having seen so much sudden, violent death, it may be therapeutic for the Desert Storm veteran to fill thousands of prescriptions intended to make people feel better and live longer. Rx Outreach fills prescriptions in 45 therapeutic categories, including medicines that treat conditions that can result from the trauma of war, such as anxiety and depression. But its highest volume lies in medicines that treat chronic conditions such as diabetes, hypertension, high cholesterol and heart disease.
Munden has a deep personal source for the value of providing this service, though it dates back further than his military service.
Growing up in Hampton, Virginia, he had an especially close relationship with his grandmother, Lucille Moore. “I was her favorite,” he still remembered as a grown father of three in his fifties. “She used to do my chores for me at the kitchen sink.”
She moved in with Munden’s family when he was 15. She was suffering from congestive heart failure. “Repeatedly, we would have to call an ambulance to the house and she would have to go to the hospital,” Munden said. “Many times I would go see her in the hospital.”
He remembered what would be her last trip to the hospital in the intricate detail reserved for our most powerful memories.
“That last time, something was different with me,” he said. “For over a week, I didn’t go.” One day his mother returned from a hospital visit and said, “Look, you better go see your grandmother in the hospital today.”
“Begrudgingly,” he said, he drove to the hospital along with his brother, Eric. His grandmother had a heart attack while he was in her hospital room and died that day – “a week before my 16th birthday,” he said. She was 66.
He still thinks about her passing and wonders what might have prolonged her life and improved its quality in her last years.
“My grandmother was poor,” Munden said. “She had 13 kids.” His grandfather, Fred Moore, was a Baptist preacher with a limited income.
“It was a struggle for them to put food on the table, clothes on the back, shoes on the feet,” Munden said. “I heard many stories. She did not have a lot of time or attention for her own health. She developed chronic conditions that should have been treated much earlier – but she couldn’t afford to.”
The grandson of a pastor who had to pray on the offer to start Rx Outreach with Michael Holmes, Munden now sees a path leading from his grandmother’s hospital room to his (modest) corner office as president of a non-profit pharmaceutical company. Even 19 years spent making, selling, packaging and distributing beer prepared him for this role.
“I think of the other grandsons and grandmothers out there and the ability of Rx Outreach to improve their lives on a day-to-day basis and, in some cases, even save lives,” Munden said.
“I know we’re all going to die at some point, but if we can make medicine affordable, we can make a real difference in people’s lives. So my goal is to make more people and more organizations aware of who we are and what we do so we can change more peoples’ lives.”
For more information, visit www.rxoutreach.org or call 1-888-RXO-1234 (796-1234).
How to access Rx Outreach
“Someone can go the doctor today, call us, enroll, get a prescription, place an order, and their medicine leave that day in the mail,” said Darryl Munden, president of Rx Outreach.
Patients qualify for Rx Outreach as long as their annual household income is:
* $35,310 or less for a single person
* $47,790 or less for a family of two
* $60,270 or less for a family of three
* $72,750 or less for a family of four
* Add $12,480 for each additional person.
Medicines available are listed at www.RxOutreach.org or you may call 1-888-796-1234.
“We advise that people take our formulary list to their doctors,” Munden said. “How many things treat high cholesterol? Why not have your doctor see if you can be treated by something in our formulary so you get the most benefit from the money you spend on your prescription medication?”
Prescriptions may be written with refills available for up to one year. Rx Outreach advises that you ask your doctor about a 180-day supply with one refill or a 90-day supply with three refills. It also advises that you ask your doctor to e-prescribe your prescription.
Rx Outreach is in the Surescripts network under NCPDP ID 2635855. Or, your physician may fax your prescription and application to 1-800-875-6591.
To submit the application and payment (and prescription if not sent by physician):
* By mail: Rx Outreach, P.O. Box 66536, St. Louis, MO 63166-6536
* Online at www.RxOutreach.org
* By phone at 1-888-796-1234.
Rx Outreach by the numbers
In 2014, according to Rx Outreach’s annual report, it filled 383,013 prescriptions for 82,791 people, saving them $78.7 million compared to retail costs.
Since its founding in 2010, according to Rx Outreach, it saved 210,000 people $320 million for 1.7 million prescriptions.
