I thought about continuing my thoughts about giving away the profession in a time when we, as pharmacists, are looking for revenue streams that are separate from the drug product. You know, billing for our knowledge. In case you have been asleep for a while, we are the medication experts so we ought to be compensated for knowledge. If I ask one of my attorney friends a legal question, I know that I'll see a bill in my mailbox in a few days. Why shouldn't we do the same?
I thought about writing on the effects that the free medications will have on MAC drug pricing, especially by insurers who have their own MAC list that may include more medications at lower reimbursement rates that the federal MACs.
But then something came to mind as I was driving home from school shopping with my kids.
This is outright professional negligence.
I had a theory to back up this thought, but I needed to confirm my suspicions. So during a slow moment during Monday's pharmacy fun, I placed a call to Giant Eagle that is close to my home. Ten minutes later, I had my answer.
Let's jump back a few years to a piece of legislation that everybody in pharmacy loves....OBRA '90. Remember the part where pharmacists must perform prospective DURs?
Since OBRA '90, we have become accustomed to the DUR rejects that are returned by insurance companies. Most of the time they are a pain in the butt, but occasionally they alert us to a severe interaction with a medication that the patient is getting filled at another pharmacy. It could be at the Walgreen's down the street or the mail order facility in New Jersey, but we are alerted. We, as pharmacists, can then discuss the issue with the patient and use our professional judgement before dispensing the medication to the patient.
Now back to Giant Eagle.
In my discussion with the pharmacy staff member at my local Giant Eagle, the employee said that the prescriptions are basically entered into the computer and billed as cash, avoiding transmission to the insurance company. Makes sense from a business standpoint since the switch fees will be avoided.
But by not submitting the claim to the third-party, part of the prospective DUR process is being missed. The pharmacist at Giant Eagle is not going to be able to utilize the third-party's DUR process to check for interactions with medications filled at other pharmacies. To me, it looks like the grocery boys are putting the safety of their pharmacy patients at risk in order to get them into the store to but more Pop-Tarts and Doritos.
I guess that's their choice. They can side-step that part of the law. Maybe say that they asked the patient if they were taking any other medications and the patient denied taking any other meds.
But I do have a problem when that patient who had their diabetes medication filled at Giant Eagle comes to my pharmacy to fill something else. I'm going to ask about their other medications and get the I don't know or the the little white ones response. So I'm going to count on their insurance company to help me on the prospective DUR.
I won't have that available to me because Giant Eagle didn't submit a claim to the insurer. They billed it as cash and bypassed the insurance company's collection of the patient's medication history.
Because of their little marketing gimmick, Giant Eagle is endangering the health and well-being of our mutual patient. They are risking the lives of people in order to get them to buy more Jif peanut butter. I can't wait to see the first lawsuit filed over this one.
The non-pharmacists who are currently making decisions for pharmacy need to step back and realize that the products we deal with are powerful. They have the power to keep otherwise unhealthy people alive for years longer than the person may have been able to live if they didn't have the medication.
They also have the power to end a life with a single dose.
That's why trained professionals who are medication experts are the people who handle these products. That's why we need to have a complete medication history available to us. That's why the insurer's DUR is a valuable tool for us when patients jump from pharmacy to pharmacy.
We're not playing with Skittles behind the pharmacy counter.