Wednesday, July 6, 2011

Florida pharmacists and the PCMA

A few weeks ago I came across an article that talked about the state of Florida's employee prescription benefits. The jist of the story was that state employees and retirees were being forced into using the mail order option for certain medications. This isn't anything new. Employer groups force their enrollees into mail order all the time.

But the article quoted an organization that I had not heard of previously. The Pharmaceutical Care Management Association (PCMA).

The name of the organization sounds like it has the best interests of the patients in mind. I mean pharmaceutical care is in the name of the organization. But is that really the case. On June 16 and 17, the PCMA came out with guns blazing, attacking independent pharmacies for wanting to protect their profits instead of caring for the patients.

I don't see it that way.

Anybody who has worked in community pharmacy knows of the problems that occur when patients are forced to use mail order options. Hours are wasted every week in efforts to get a two-week supply of medication covered for patients whose mail-order prescriptions haven't arrived.

When community pharmacists are filling prescriptions for medications used for acute situations, we are dependent on the software at the insurance company to flag potential drug-drug interactions since the entire history is not available to the community pharmacist. The PCMA tries to assure us that their software catches all potential interactions and that complete insurance claims history is available to both the mail order and retail pharmacy to screen for interactions.

Did you catch that?

The PCMA says that the insurance claims history is available to both the mail order and retail pharmacy. I've never been provided with a patient's claims history in order to conduct a thorough DUR, but that's not the point.

I don't know about where you work, but in my area a lot of people bypass the mail order mandate and just pay cash for their maintenance medications. Over the last five years, there has been a huge uptick in this practice since four dollar prescriptions have rolled out.

The so-called safety check that the PCMA touts is actually being bypassed. Complete DUR evaluations are not being performed and patients are being put at risk. Pharmacists are not given an accurate picture of a patient's drug therapy.

The PCMA knows, as do community pharmacists, that the best pharmaceutical care is provided when a patient gets all of their prescriptions filled at one pharmacy. The PCMA is just afraid to admit it out of fear of losing money.

I applaud the pharmacists who have spoken out against the state of Florida and the PCMA. Your voice is being heard. Don't give up the fight.


Christina said...

From my experience, Maryland and Delaware state employees are pushed similarly, but not mandated. A local hospital around here uses an MCO that actually refuses contracts to retail pharmacies on the basis that they "have enough retail contracts open" and even at the pharmacies which hold contracts, they are not allowed to fill refills.

And I will also agree that I have never been given access to a claims history to evaluate issues properly.

Anonymous said...

I don't live in Florida but I bypass my mail order plan as often as possible. The copays are ludicrous for most generics, many of which I can get locally for less than the 90-day generic mail order copay. Obviously,the insurance company thinks we're stupid!

The prescription plan I had before allowed 90 day fills at the local pharmacy. I miss that - I felt much better when I had one pharmacist looking out for me.

Anonymous said...

As a hospital pharmacist I hate mail-order from most PBMs.

When my patient enters the hospital, and I see they're getting there drugs there I cringe because the first order of business is trying to obtain a reconciliation record. There are jillions of mail-out organizations, so I have no idea where to start in looking for the patient's record. Sometimes patients get meds from this or that mail-outs plus a retail shop.

Pharmacists are thrown for a loop when we try to contact a mail-our organization because their information is limited to bankers' hours, and techs run the places usually and are afraid to provide history to a registered pharmacist because of HIPAA.

Keeping track of medication changes is an ordeal for patients due to the time lags involved. A patient will usually get drugs that are needed urgently from the local pharmacy or first doses i.e. antibiotics, heart medications, diuretics and no one will know about interactions AT ALL!! In a time and place where drug interactions are only too common, it seems to me that having a mail-out requirement ADDS to hospitalizations for drug interactions.

Sometimes, a patient is on a med from the mail-out on one strength of a med and takes the new change of the very same med from the retail drugstore because they needed to change it right away. How many times have we heard the patient say, 'I'm going out of town, fill all the current prescriptions'.

And, mail-out is just another factor to add to the mix when patients are on several different medications with several different refill times to coordinate.

The most significant argument against mail-out is that it puts important patient information farther away from the patient's health care team. No one to advise the patient on OTCs. No one responsible to provide relatively quick responses for information or to fill prescriptions. No one to take care of emergency fills in emergencies.

When I worked at a VA medical center, the patients often saw VA prescribers at the clinic and this was the missing link for prescription information.

Anonymous said...

This mail-out scenario is just another example of where non-pharmacist managers get in the way of the registered pharmacist, but in this situation, it's more tricky because the scripts are filled somewhere not beholden to any particular State pharmacy laws, unlike the VA which is considered in the realm of US government facilities.