Alexy Arauz Boudreau, MD, MPH


Associate Director for Pediatric Population Health, Massachusetts General Hospital for Children (MGHfC); Assistant Professor of Pediatrics, Harvard Medical School, Boston, MA

Dr. Arauz Boudreau is an academic community pediatrician focusing her career on improving health disparities for vulnerable children by impacting childhood development through restructuring primary care, research and community initiatives. She has taken a lead role in transforming pediatric practices into patient centered medical homes presenting a holistic system for promoting child development and addressing health disparities.

Her work in practice innovation is informed by her research that focuses on addressing health disparities and studying medical home implementation to enhance child development.   Her research assesses the association of cultural competence with the quality of well-child care, the addition of health coaches and developmental specialists to augment well-child care and an approach to obesity, and most recently, understanding how practices transform into a medical home and its benefits.

She is also an innovative leader at MGH promoting diversity and inclusion. She is an Associate Director of the MGH Multicultural Affairs Office. In addition she is the co-Chair of the MGHfC Diversity Committee where she has spearheaded the development of a vision, mission and implementation of an action plan to promote workforce diversity, cultural competence and address health care disparities within MGHfC.

Dr. Arauz Boudreau is an associated faculty at the Massachusetts General Hospital Center for Adolescent and Child Health Policy and practices as a primary care pediatrician at MGH Chelsea HealthCare Center. She received her medical degree from Harvard Medical School and a Masters in Public Health from Harvard School Public Health. She has completed the Harvard Pediatric Health Services Research Fellowship and the Commonwealth Fund/Harvard University Fellowship in Minority Health Policy. She served on Boston’s Major Menino School Readiness Action Planning Team and served as the Co-Chair of the Ready Systems Implementation Group of Thrive in 5, Boston’s School Readiness Imitative. Additionally she has joined the Board of Trustees of Family Services of Greater Boston, an organization dedicated to providing family development and support services.








Patient Assistance Programs in Massachusetts Community Health Centers


Patient Assistance Programs (PAP) are charitable programs offered by pharmaceutical manufactures. In 2002, Pharmaceutical Research and Manufacturers of America (PhRMA) reported that more than5.4 million patients received 14 million prescription medicines, valued at $2.3 billion.  There are anywhere from 150 to 200 different PAP offering 850 to 1,000 drugs, making available about 53% of the 200 most prescribed medications. Each program has its own eligibility criteria and application procedures making them difficult to operate and requiring resources from providers to process the programs. As the state of Massachusetts places incentives for Community Health Centers (CHC) to offer 340b pharmaceuticals it is unknown how and if PAP will continue to be used.


Our goal is to assess how Massachusetts’ Community Health Centers (MACHC) are utilizing PAPs. In addition, we determined the cost of operating these programs and how they may be integrated with 340b pharmaceuticals. We identified a representative sample of CHC (14/50) based on their location in the state, the number of patients served, and the availability of pharmacy services. We performed guided interviews with the Executive Directors of MACHC.  Executive directors included pharmacy directors and other personal at their discretion. Common themes regarding the benefits and drawbacks of PAP were identified with conceptual analysis. We used costing analysis to obtain the cost per PAP successfully processed and the benefit to cost ratio per site.


Eleven centers accepted interviews with 6 submitting costing data. Nine centers operated PAPs in a systematic manner. Three organizational models were identified: PAP operated manually, computerized, or through existing pharmacies. Four staffing models were found: providers, dedicated personnel (nurses or program managers), pharmacy staff and pharmacy faculty in conjunction with a training program. Common identified benefits of PAPs were: increasing access to care, improving quality of care, preventing CHC’s pharmacy financial loses, and increasing patient satisfaction.  Common identified drawback included: operation of PAP is complex, time consuming, and costly; difficulty in obtaining start-up costs; decreased patient satisfaction due to inconsistencies with PAP and concerns with quality of care and sustainable access. Benefit to cost ratios ranged from $5.41 to $213 for every dollar invested, (mean: $78.53, SD: $111.25). Cost to operate ranged from $10-$18.92 per medication.


PAPs provide health centers with cost-effective ways to help patients access pharmaceuticals. These programs run best with dedicated managers and when they are streamlined into existing operating systems. The greater the number of PAP processed, the greater the benefit to cost ratio. They are more economical to operate through in-house pharmacies, however CHC that started using PAPs prior to obtaining 340b pharmaceuticals are more likely to incorporate PAP into their systems than those with well established 340b pharmacies.

Faculty Preceptors:

Patricia Edraos Linda Clayton, MD
Massachusetts League of Community Health Centers