UI pharmacy professor works to improve access to lifesaving medications

University of Iowa pharmacy professor Bernard Sorofman studies how different groups of people, such as those who live in poverty and criminal offenders, access medications. His research has done more than garner journal headlines, however—it’s changed state policy and even saved lives.

Since 2008, Sorofman has worked to expand a statewide drug repository for unused medications that in the past decade has distributed medicine and medical supplies worth $18 million to Iowans who otherwise might not have had access to them. The repository also keeps unused drugs out of sewer systems, landfills, and waterways.

Sorofman has worked to improve health outcomes for Iowa’s criminal offenders as well. In 2009, he played a key role in reforming the pharmacy division of the Iowa Department of Corrections, action that streamlined health care services at nine state prisons and produced an initial savings of $2 million.

And, in 2013, he helped launch a program that provides offenders with free mental health medications for up to three months after their release. Now in its fourth year, Iowa’s offender prescription program has reduced recidivism rates and is regarded as a national model. This summer, the program will expand to county jails and juvenile detention facilities, a move that state officials hope will help offenders stay on track to rehabilitation.

“Bernard played a key role in centralizing the state prison system’s pharmacy activities,” says John Baldwin, director of the Illinois Department of Corrections and former director of the Iowa Department of Corrections. “That was a big deal for the department because we were facing a budget crisis and knew that we had to cut costs.”

Baldwin says the prescription program has had “very positive results.” Offenders who agree to voluntarily participate receive a month’s worth of drugs upon release, as well as vouchers to cover an additional two months of medications. Initial results show that offenders who participate in the program are less likely to commit new crimes. The current program is offered at state prisons and five county jails. The cost to cover prescriptions at the jails is less than $20,000 a year. The cost to keep one person in prison for a year in Iowa is $35,000.

“If we can keep one person out of jail for a year, we’ve covered the costs of the program,” says Sorofman, who in addition to teaching duties also serves as executive associate dean of the UI College of Pharmacy, a role he has held since 2009.

Sorofman, who has a bachelor’s degree in anthropology, always has had an academic interest in human behavior in relation to pharmacy medicine.

“I’m fascinated by the reasons people take medications, why they trust a pharmacist who tells them to take a drug that will have a physical or mental effect on them,” says Sorofman. “I’m also interested in how we, as a society, can get medications to people in unusual situations, people in rural or low-income communities. I’m a pharmacist, but also a behavioral scientist.”

Sorofman started working with state officials to resolve pharmacy issues in 2008. At the time, state legislators were looking for ways to reduce costs within the Department of Corrections, where medical expenses were skyrocketing. Sorofman, among others, proposed a centralized pharmacy system and suggested changes in pharmacy management, including an increase in the use of generic drugs and low-cost alternatives. In the first year, the changes netted nearly $150,000 in savings. The second year, savings increased to $2 million.

The idea to create a 90-day prescription safety net for offenders came out of a 2009 report co-authored by Sorofman for the Iowa State Attorney’s Office, which at the time was considering how to use money from a court settlement with two firms that handle pharmacy-benefit management.

Roughly half of the state’s prison population has some form of mental health disorder, according to corrections officials. While in prison, inmates receive medical care that helps manage and even eliminate behavioral health issues, which often are at the root of errant behavior. But upon their release, many offenders quickly run out of mental health drugs, symptoms reemerge, and they have no way to refill prescriptions.

“In the past, offenders only received a 30-day supply of mental health medications when they left the prison system,” says Jon-Michael Rosmann, CEO of SafeNetRX, a nonprofit organization that provides affordable medication access and works with the corrections department. “That wasn’t enough, and offenders were going off their medications and winding up back in prison. It was a violent cycle of failure.”

Rosmann says Sorofman provides expertise and analysis that has helped SafeNetRX and the state improve the prison program as well as the county jail program, which is set to expand this summer. Sorofman’s research into the programs, which he conducts with UI student pharmacists, provides proof that they are working.

A 90-day study of the prison program by Sorofman and his students found that of the 119 offenders who participated, only five returned to prison with new criminal charges. A similar look at the program at the Polk County Jail found that of the 115 participants, only nine returned to jail within the first 90 days of release. During the same period, of the 3,210 offenders who did not participate in the prescription program, 687 committed new crimes and returned to jail.

“The University of Iowa and the College of Pharmacy are a tremendous resource for us,” says Rosmann. “We have created a very productive relationship, and we’re doing some really innovative work together.”

In addition to his work with criminal offenders, Sorofman has played an important role in the success of Iowa’s drug donation repository, the largest in the country. An estimated $5 billion in medication is wasted annually in the U.S., with much of the waste going into waterways and landfills. But in Iowa, a significant amount of unused medication comes to the drug repository, where it is inspected for safety and processed for redistribution. The medications then are sent to certified pharmacies that work with patients who don’t have the financial means to pay for medications or who don’t have adequate health insurance.

Since its creation a decade ago, the repository has received an estimated 10.3 million units of drugs worth $18 million. Last year alone, the program helped 11,590 Iowans get medications needed to maintain their health. In some cases, the recycled drugs are used by people fighting advanced diseases, such as cancer or diabetes. For these individuals, the drug repository is a lifesaver.

“Cancer-fighting medications can cost thousands of dollars, so no one wants to see them flushed down the toilet, which is what often happens when drugs go unused,” says Sorofman. “The drug donation repository lets us reuse these medications by getting them into the hands of the people who need them the most.”

Sorofman, who plans to retire at the end of the year after 33 years at the UI College of Pharmacy, recently received the Robert Gibbs Award from the Iowa Pharmacy Association. The award, named for a past director of the organization, is presented to pharmacists who have gone above and beyond in their service to the state and its citizens.

“For Bernard, it has always been about making a contribution,” says Tom Temple, CEO emeritus of the Iowa Pharmacy Association and part-time faculty member at the UI College of Pharmacy. “He has an ability to see the big picture and to look at issues in a broader context than a lot of people do.”