Friday, November 27, 2009

A new trend?

Imagine this... just when the United States Senate is preparing to debate the health care bill that was sent over by the House, one of the leading health care providers in the country decides to no longer accept medicare payments. Granted, this is at a single facility but it may become the norm as a government option is becoming a very real possibility.

So what is happening? A branch of the Mayo Clinic will stop accepting payments from Medicare after the turn of the year. Here's the link.

But why would anybody opt out of a contract with the government?

Ummm.. the article tells you exactly why
  • Low payments
  • Slow payments

Personally, I'm happy to see a provider step away from a contract that loses money. It's not a good business model to operate at a loss. I took one economics/business class during my second year of college and if I learned anything it was that you can't continue to run a business if continually loses money.

If only somebody in the pharmacy world would take a look at insurance contracts before just blindly signing on the dotted line. At my previous position, our wholesaler offered a service where they took care of all of our third-party contracts. Nobody at my company even looked at the terms before we were locked into another year of the take-it-or-leave-it terms dictated by the insurance company. And then they wonder why reimbursements are falling.

Pharmacists need to speak up when they see the piss-poor reimbursements from the insurers. Between the $4 generics and the free antibiotics, we're digging ourselves into a hole.

When an insurer sees that one provider is willing to provide a product or service for a low fee, the insurer starts steering the contract language to drive our reimbursements down to that level.

We, as pharmacists, think that we are being competitive by driving our prices down. We think that lower prices will attract more patients, which in turn will increase revenue. We are playing into the hands of the insurance companies. They have teams of accountants, actuaries, and lawyers whose jobs are to decrease the insurers expenditures. Who's looking out for us? Sally at Drug Wholesale Company?

The point of this post is this... we can have a pie-in-the-sky view that people want to pay us based on our clinical knowledge, and that can be our end goal. But right now, our services are tied to a product. And we need to make sure that the reimbursement for the product includes an adequate fee for our clinical skills that we use on each and every prescription that crosses in front of us. If the contract isn't good enough, we don't need to sign it.

Mayo Clinic, I applaud you for having the boys to pass on an poor contract. Hopefully more providers follow your lead.

Monday, November 23, 2009

Hey hey's the APhA

Picture Fat Albert saying the title of this post. It might be amusing. It was for me.

But that's not why I wanted to talk today.

I want to address the impact of the largest organization representing pharmacists on the legislation in front of the United States Senate.

The American Pharmacists Association has a nice building located on the Mall in Washington DC, between the Lincoln Memorial and the Department of State. Being located where it is, you would think that the folks at the APhA might be able to have a little influence on the legislative branch of our government.

Based on the text of HR 3590, I would have to give the APhA a failing grade. HR 3590 is 2074 pages of legislation that is supposed to change the way health care is delivered in the United States.

Pharmacists like to think that they are an integral part of the health care system in the United States. We deliver the medications to keep people alive and healthy. We educate the public on the correct use of their medications. After hours and on weekends, we triage people who don't know if their illness/injury is severe enough to warrant a trip to the urgent care center or emergency department.

We are the most accessible health care providers out there. We give our services away for free. Any money that comes our way is tied to a product that we dispense in the terms of a dispensing fee. For the most part, our professional expertise does not generate any revenue.

So when a two-thousand seventy-four page bill is introduced to the Senate and the APhA has a physical presence in the nation's capital, I would expect to see some things in the bill that would advance the professional side of the profession.

Ummm... not in this bill.

I saved the document in .pdf form and searched for the word pharmacist. In a 2074 page bill, the word pharmacist appeared on 14 pages. Seventeen is the total number of times that pharmacist actually appears.

Of those seventeen times that pharmacist appears in the text of HR 3590, nine times it appears in a list of health care professionals. So over half of the time that pharmacist appears in the bill, it is surrounded by other terms like dentist, nutritionist, nurse, etc...

Just for comparison, the seventeenth occurrence of the word physician occurs at the top of page 13 of the table of contents. Wonder whose lobby was more effective for the health care bill?

But back to pharmacist.

Of the remaining eight times that pharmacist occurs in the bill, seven are tied to Medication Therapy Management (MTM). Since the inception of the MTM programs, I have been contacted a whopping two times to conduct an MTM interview by the PDP providers. Hate to tell you this, APhA, but MTM isn't exactly generating a whole lot of business in my corner of the pharmacy universe. I'd rather see the APhA work on something like dispensing fees that are more than $2.50 on a thousand dollar script.

Wouldn't it be great if dispensing fees were tied to the relative danger of the medications. Dispensing the new TNF blocking medication? Get a higher dispensing fee since you will spend a lot more time counseling the patient on the medication. Basically, if the drug has a MedGuide, the pharmacist receives a higher dispensing fee.

But back to HR 3590.

The final occurrence of pharmacist occurs in a section 3502 of the bill that establishes "community health teams to support the patient-centered medical home". In this section we get to provide medication management services, including medication reconciliation. Doesn't sound like any great advances in the practice of pharmacy.

I don't know a whole lot about the lobbying thing in DC, but the APhA doesn't seem to be doing a very good job of it. Or doing anything to help the individual pharmacists out in the real world.

If the APhA wants to truly impact patient care, they need to get higher dispensing fees for those of us practicing in the real world. If we make a decent margin on our scripts, we'll be able to hire more people and provide better pharmaceutical care. But until the pharmacy organizations in DC step up to the plate to push for this, those of us in the retail world are going to continue practicing Burger King pharmacy.

APhA, from what I see in HR 3590, you aren't exactly impressing the folks on Capital Hill. As of right now, I won't be renewing my membership.

If you want to speak to a real pharmacist email or tweet me and maybe you can see what those of us in the real world expect out of the American Pharmacists Association.

Wednesday, November 18, 2009

Copay cards

In the most recent issue of Drug Topics, an article that I submitted several months ago was published. It was on the topic of copay cards. Here's the link.

The email response that I have received has been far more than I expected. It appears that pretty much every pharmacist that has responded has been in agreement.

Several pharmacists have pointed out that many contracts with insurance companies prohibit anything that will reduce the adjudicated copays. That got me thinking...

The copay card that was the inspiration for the article was the Lipitor card. The largest insurer in my local area distributed these copay cards to all of their enrollees who were taking Lipitor at the start of the benefit year.

I'm just wondering how long it is going to be until this insurance company audits the smaller pharmacies in my area and recoups all of the payments it has made to the pharmacies for Lipitor since the program began, in addition to any and all penalties that may be levied against the pharmacies.

I'm not saying that the insurance company may have planned it this way.

But I'm not not saying it either.