EXPERT BLOG: Provider status for pharmacists — one way or another
You may have heard the good news: through proactive involvement from pharmacists all across the state, California recently passed a law (SB 493 in October, 2013) declaring that pharmacists are healthcare providers who have the authority to provide healthcare services within the state. The law creates a new category of pharmacists by statute, for those who meet the criteria, and as a result creates new opportunities for pharmacists to engage with others more traditionally understood as healthcare providers (physicians, hospitals, clinics and health plans) to assist patients in managing chronic conditions. For more information on the statute and the expected impact of the change, click on the following link provided by the California Pharmacists Association.
All of us understand at some level the significance of what happened in California. But as is often the case, such a law creates a new series of questions. Will this action in California springboard other states to pass similar laws in 2014 and beyond? When will reimbursement opportunities for pharmacists as providers follow the statutes defining them as such? Will the Office of the National Coordinator (ONC) follow suit in later stages of Meaningful Use and recognize pharmacists with provider status? And will reimbursement opportunities follow in later stages of Meaningful Use for pharmacists as a result? These questions are difficult to answer and certainly more difficult to put a timeline on as to when they may happen.
Even if we don’t have the answers to the questions above right now, are there other ways in which we can see pharmacists gaining a greater foothold with provider status across the country? What about seeing examples of reimbursement model changes for pharmacists acting as providers?
As we know, health reform’s “grand experiment” is underway as a result of passage of the Affordable Care Act. And although pharmacists aren’t mentioned specifically as a provider participant within many of the Pioneer ACO models today, this doesn’t mean pharmacists won’t be permitted to integrate in the future or to create a plan for participation in these ACO models. Moreover, this doesn’t preclude pharmacists from the opportunity to be involved with other care coordination models sponsored by the CMS Innovation Center Award Program.
For example, there is a specific model in Hawaii that by design integrates outpatient pharmacists with the inpatient healthcare team (including hospital pharmacists). The model is titled, “Pharm2Pharm” and provides a new context for the community pharmacist to participate as a provider. The goal of the project is to reduce annual medication-related hospitalizations and emergency department visit rates and total cost of care among the elderly and others at risk in rural Hawaii.
This model works by creating a formal hospital pharmacist-to-community pharmacist collaboration. It is designed to address gaps in care among patients at risk as they transition from a hospital to a community setting. In other words, the patient is formally “handed off” to the certified community pharmacist by the hospital pharmacist at discharge to perform similar services in the outpatient setting (medication reconciliation, patient counseling, proactive PCP collaboration) as were performed in the hospital setting. According to information provided by the program, Pharm2Pharm pays community pharmacists $695 per patient enrolled per year on the assumption that there will be ROI to CMS (the award also funds the hospital pharmacists). For further information on Pharm2Pharm, please click here, here, and here.
It seems the industry as whole will likely continue pushing for formal pharmacist provider status changes at the federal and state level via statute. We all know healthcare is changing. It makes financial sense for all the providers across the spectrum to continue experimenting with ways in which they may work together to help improve patient outcomes and reduce costs. Ignoring any provider in the new healthcare continuum may ultimately be counterproductive in obtaining the ultimate trifecta: better outcomes, reduced costs and increased reimbursements.
As Director of Business Development with Pharmacy Services for Emdeon, Nathan Ludvigson directs policy and business development for Pharmacy Services related to electronic prescribing, Health Information Exchange (HIE), Medication Therapy Management (MTM), Prescription Monitoring Programs (PMP), Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS), and other pharmacy services areas. Nathan also identifies, analyzes and makes recommendations regarding key legislative issues and regulatory matters impacting the pharmacy industry as needed with the pharmacy services executive team. Nathan combines extensive pharmacy industry experience with legislative policy experience in both the U.S. Congress and Texas Senate. Nathan earned his Bachelor of Science degree in Political Science from Texas Christian University and a Master’s Degree in Public Administration from the University of Houston.
NCPA: U.S. Reps. contact Medicare in support of proposed changes for 2015 drug plans
ALEXANDRIA, Va. — Members of Congress are contacting the U.S. Centers for Medicare and Medicaid Services in support of pro-patient improvements the agency proposed for Medicare Part D prescription drug plans in 2015, a development applauded today by the National Community Pharmacists Association.
In response to problems with “preferred pharmacy” networks, CMS has proposed allowing any willing pharmacy to offer a plan’s lowest, or preferred, cost-sharing to give seniors more choice and to foster greater competition among pharmacies.
U.S. Representatives Mike Rogers, R-Ala., and Lynn Westmoreland, R-Ga., have written to CMS to back the change.
“I was encouraged to hear that the proposed rule for Part D dealt with many of the concerns that [community pharmacists] shared with me,” Rep. Rogers wrote. “Not only were these community pharmacies not allowed to even try and compete with lower co-pays that larger stores can offer, but many seniors signed up for these plans not realizing they would no longer be able to continue using their community pharmacy after signing up.”
Rep. Westmoreland wrote to CMS that, “Your agency’s recent release of its proposed rule on Part D has some very encouraging language that addresses” concerns raised by community pharmacists and patients, adding that “I believe the work is not yet complete and that it is crucial that Congress and the Executive Branch make sure small business pharmacies have the ability to compete on a level playing field with all the entities involved.”
Both lawmakers represent rural communities and noted that independent community pharmacies often serve such areas where national chain pharmacies may not exist.
“We commend these lawmakers for voicing their support on behalf of their constituents for the common-sense enhancements that Medicare has proposed for drug plans next year,” said NCPA CEO Douglas Hoey. “Patients will benefit from more choice and competition among pharmacies if CMS’ proposal is made final. Independent community pharmacies deserve the opportunity to match the contract terms and conditions, including pricing, of ‘preferred’ pharmacies. As Medicare officials have noted, this is ‘the best way to encourage price competition and lower costs in the Part D program.’”
In March 2013, 31 U.S. representatives sent a letter to CMS to express concerns over exclusionary preferred networks in Medicare Part D. In particular, the lawmakers said, “We fear these networks could lead to a decrease in access to quality care and threaten the survival of community pharmacies” and further demanded a response from CMS. Shortly thereafter, the agency received a similar letter from 16 U.S. senators. CMS subsequently issued the proposed rule open until March 7, 2014 for public comment.
While preferred pharmacy networks have been championed by pharmacy benefit managers as producing astronomical cost savings, a series of analyses of Medicare data have found repeated instances where preferred pharmacy plans and PBM-owned mail order are more expensive for Medicare.
Mallinckrodt to acquire Cadence Pharmaceuticals
DUBLIN — Mallinckrodt and Cadence Pharmaceuticals on Tuesday announced that they have entered into a definitive agreement under which a subsidiary of Mallinckrodt will commence a tender offer to acquire all outstanding shares of Cadence Pharmaceuticals for $14.00 per share in cash or approximately $1.3 billion on a fully diluted basis, which represents a 32% premium to the trailing 30-trading-day volume weighted average price of $10.62 per share for Cadence Pharmaceuticals.
Subject to customary terms and conditions, the parties expect the transaction to close in mid- to late-March.
Cadence Pharmaceuticals is a biopharmaceutical company focused on commercializing products principally for use in the hospital setting. The company’s product Ofirmev (acetaminophen injection) is a proprietary intravenous formulation of acetaminophen for the management of mild to moderate pain, the management of moderate to severe pain with adjunctive opioid analgesics and the reduction of fever. Since its introduction, Ofirmev has experienced strong growth. In a press release issued Jan. 13, Cadence reported that it expects net revenues of $110.5 million for Ofirmev in calendar year 2013, compared with 2012 reported net-product revenues of $50.1 million.
Ofirmev currently is on formulary in more than 2,350 U.S. hospitals and has been used to treat an estimated 6 million to 7 million patients since its launch in January 2011. A New Drug Submission for the product has been approved by Health Canada.
This transaction accelerates growth in Mallinckrodt’s Specialty Pharmaceuticals segment in key ways. First, the company adds another powerful growth product, Ofirmev, to the segment’s portfolio of core controlled substance generics and its growing roster of such brands as Exalgo, Gablofen, Pennsaid 2% and, if approved, Xartemis XR and longer term MNK-155. Additionally, with the strong presence Cadence has established in the adjacent hospital market, the acquisition adds another potential growth dimension for the segment, providing Mallinckrodt an opportunity to expand the company’s reach and penetration in this channel.
“The acquisition of Cadence Pharmaceuticals is consistent with our goal of becoming a leading global specialty pharmaceuticals company,” said Mark Trudeau, CEO and president of Mallinckrodt. “Ofirmev’s growth is driven by an expanding base of physicians who are prescribing the product for an increasing number of surgical patients, and we believe the product will be an outstanding addition to the brands component of Mallinckrodt’s Specialty Pharmaceutical segment. We have been impressed with the strong relationships that Cadence’s commercial organizations have established with customers in the hospital channel and are excited by the opportunity to build on these relationships to expand our platform in this area. We believe Mallinckrodt is well-positioned to further accelerate the trajectory of Ofirmev and realize the full value of this product in the marketplace.”