By Ashley McGrane, Chief Administrative Officer, NaphCare
Most people making decisions about correctional healthcare have never asked their vendor a simple question: who actually fills the prescriptions?
It sounds like an operational detail. It is not. After nearly two decades in healthcare law, operations, and strategy, I can tell you it is one of the most consequential decisions a correctional healthcare program makes.
NaphCare is the only comprehensive correctional healthcare company in the country that owns and operates its own pharmacy, and that distinction runs deeper than most realize.
NaphCare is the only comprehensive correctional healthcare company in the country that owns and operates its own pharmacy, and that distinction runs deeper than most realize. Our founder, Jim McLane, was a pharmacist. In 1989, while running his family’s Birmingham drugstore and serving as Chief Pharmacist at a local hospital, he began providing medications to county jails. Recognizing the broader gap in care, he eventually committed himself fully to correctional healthcare and sold the drugstore to build what NaphCare has become today. The pharmacy was where this company started, and that foundation still shapes how we think about patient care more than thirty years later.
The Incentive Problem Nobody Is Talking About
When a correctional healthcare vendor subcontracts pharmacy services to a third party, that pharmacy’s business model is typically built on rebates - the medications that generate the highest rebates are the most expensive specialty drugs. The financial incentive, in other words, runs directly counter to the clinical goal of getting patients on the most appropriate, cost-effective treatment.
This isn’t a criticism of any particular company. It is a structural problem with how pharmacy services are typically arranged in this industry. When the revenue model rewards high-cost medication volume, that is what gets optimized, whether intentionally or not.
NaphCare Pharmacy operates differently. Our pharmacists are clinically focused on sending out the right medications at the right dose and the most effective price point. The goal is never more medications; it is better care. The industry is beginning to recognize the value of pharmacy in correctional healthcare, and that recognition is long overdue. But acquiring pharmacy capabilities and having a pharmacy that is clinically woven into every aspect of patient care from day one are two very different things.
Integration Cannot Be Outsourced
A third-party pharmacy, even a good one, is always one step removed from the clinical team. There is a handoff and there is a gap. Information that lives in the patient record does not automatically live in the pharmacy, and vice versa.
NaphCare’s clinical pharmacists work within the same system as our physicians and nurse practitioners, reviewing the same patient records in real time through TechCare, our corrections-specific electronic health record (EHR) system. Every month our pharmacy team reviews over 60,000 patient medication profiles. They identify patients with chronic conditions and make sure they get the follow-up they need. They conduct polypharmacy reviews for patients on complex medication regimens to reduce dangerous drug interactions and eliminate redundancies. And they ensure patients on complex psychiatric regimens are on the right medications at the right doses.
This is not a service we offer. It is how we practice medicine.
NaphCare Pharmacy is also the only correctional healthcare pharmacy in the country that provides in-house sterile compounding services. Our pharmacists compound and ship IV antibiotic kits and other sterile medications directly to our partner facilities, which means patients receive treatment onsite rather than being transported outside the facility. That means better care, lower costs, and fewer security risks, all at once. We also provide hazardous compounding services, allowing chemotherapy to be administered onsite and eliminating the expense and security risk of offsite trips for treatment.
Our pharmacy also ensures medications are stocked and ready at every partner facility before they are ever needed, from routine daily medications to emergency response supplies. That is what it looks like when a pharmacy is built into the clinical model rather than bolted on as a separate service.
Continuity of Care Does Not Stop at the Gate
The medications we prescribe inside a correctional facility have to make sense for a patient’s life after release. That is something our integrated pharmacy model is specifically designed to consider.
Not every patient leaving a jail or prison will have Medicaid. Some will, but others will be navigating community health centers, patient assistance programs, or whatever their local safety net can offer. What nearly all of them will not have is access to high-cost specialty medications. Our clinical pharmacists are deliberate about aligning treatment with what patients can realistically continue on the outside, because stabilizing someone on a medication they cannot access or afford after release is not treatment; it is a setup for failure.
A patient released without access to their psychiatric medication doesn’t just struggle; they often cycle back into the system. A patient with diabetes who cannot afford the specialty injectable they received while incarcerated is headed for a crisis. These are the outcomes when the bridge between incarceration and community care is not built thoughtfully.
Getting someone stable on a medication they can actually continue is one of the most meaningful things we can do for long-term public health outcomes. It is also one of the things that is hardest to do without an integrated pharmacy team that is thinking about the whole patient, not just the current prescription.
What This Looks Like in Practice
The numbers tell a clear story.
At a major state department of corrections (DOC) partner, nonformulary pharmaceutical costs exceeded $2 million per month when NaphCare took over. Through systematic clinical pharmacy review, we reduced that spending by over $4 million annually, and we are still finding efficiencies. At a county detention center partner, our pharmacy team achieved nearly $20,000 per month in formulary medication savings. At another major city jail partner, a single clinical review cycle identified patients on high-cost medications totaling over $7,700 per month combined, and through clinically appropriate transitions, reduced that spend to under $60.
The clinical rationale for each of those transitions came first. The savings followed from doing the right thing. That is always the order of operations for us.
What the Field Is Missing
State and local governments managing correctional healthcare are under real fiscal and human pressure. The population they are responsible for is among the sickest and most medically underserved in the country. When pharmacy is fragmented from the rest of care, whether through a subcontractor or a separate facility arrangement, clinical and financial value both get left behind, and so do the patients.
I love what we do at NaphCare because I have seen both sides. I know what fragmented care looks like and what it costs, in dollars and in human outcomes. We built our model around the belief that incarcerated patients deserve the same standard of thoughtful, integrated care as anyone else. Our pharmacy is not a vendor relationship bolted onto that model. It is part of the foundation.
No one else in this industry can offer what we offer from a clinical integration and patient stewardship standpoint. You cannot replicate what we have built through a subcontract. And the patients in these facilities deserve better than a system that was never designed with their whole care in mind.
Ashley McGrane is the Chief Administrative Officer for NaphCare. She has worked in healthcare law, operations, and strategy since 2008.
