Drug Topics wouldn't touch this idea

The following is the article I submitted to Drug Topics. I asked them to give me a response to see if they would consider using it and they haven't responded yet. Rather than sit and wait for weeks or months for a reply, I'm publishing it here. They can put it in Drug Topics as well, but I feel that this article may help pharmacists to view themselves as individual health care providers instead of as employees of some corporation.

So here, enjoy the post that Drug Topics might be afraid to publish.



Recently I had to take my daughter to the local emergency department for a nasty cough. It was on the weekend and in the middle of the night, so her pediatrician was not available and the urgent care centers were closed.

It’s been a few weeks and the insurance EOBs are starting to arrive in the mail. While reviewing these I had what may be an epiphany.

For our hour or so in the ED, we will be receiving bills from the emergency department, the ED physician, the radiology department, and the radiologist. Two bills from the facility and two bills from the health care professionals.

That got me thinking. On-line and in the pharmacy publications I see pharmacists wanting to be reimbursed for their professional services. Some pharmacists are able to generate an income stream through Coumadin clinics and medication therapy management services, but for a lot of community pharmacists the populations we serve can barely afford their medications, let alone these additional services.

Then it hit me. Why aren’t pharmacists billing the insurance companies for our professional services each and every time we fill a prescription?

We’ve allowed the reimbursements for pharmacy services to be lumped into the reimbursement formulas for the drug product. Guess what people? Those contracts are with the pharmaCIES to provide the product. PharmaCIES are businesses or departments where medications are stored and sold. (A July 12 article by David Witmer on the ASHP blog echoes this thought)

PharmaCISTS are medical professionals who review medication orders for accuracy, perform drug utilization reviews on each and every prescription, and educate patients on the proper use of their medications. The pharmaCY can’t do this, only the pharmaCIST. But only the pharmaCY has a contract with the insurer.

I believe that if we, as pharmaCISTS, want to show our value to the health care system, we need to actually try to get reimbursed for each time that we perform a professional function. Physicians do it every time they take a blood pressure; it increases the complexity of the visit. Why not us? Why aren’t we billing for our services each and every time.

We’ve allowed our professional services to be lumped in with the dispensing fee that is tacked on to the MAC or AWP-minus formula that the insurers set. I don’t know about you, but I feel that my professional expertise is worth more than $2.25 per prescription (0.00 on three month Medicare D orders). Well actually less than $2.25 when you factor in costs of vials, labels, technicians, utilities, etc…

As pharmaCISTS, we need to find a way to bill for our professional services each and every time we fill a prescription. The insurers need to contract with the pharmaCISTS, as well as the pharmaCIES, to provide the entire prescription product (medication, consultation, education). They do it for both the hospital and the physician. Why not pharmaCY and pharmaCIST?

I suggest that software be designed to send the NPI of the dispensing pharmacist to the insurers and that the insurers send reimbursement for professional services directly to the pharmacist of record. If we, as pharmaCISTS, truly want to be reimbursed for our professional services, we need to get serious about it and approach it on a wide-scale.



I don't know if this idea has been proposed before. I don't care if it has been or not. It needs to be discussed now. Right now we, as pharmaCISTS, need to get our act together before it's too late. Don't count on the corporations to look out for the well-being of the pharmaCISTS. They are doing everything they can to get tech-check-tech and other legislation passed so they can decrease pharmacist payroll, if not the pharmacist position completely. Don't count on the pharmacist organizations to do anything for you.

It's up to you.....the PHARMACIST.