NCPA seeks special enrollment period for Part D patients from CMS
ALEXANDRIA, Va. — The National Community Pharmacists Association is calling for the Centers for Medicare and Medicaid Services to allow senior patients to enroll in a new Medicare Part D prescription drug plan via a special enrollment period, particularly if patients believe that "material misrepresentations" led them to sign up for a "preferred network" plan with inadequate pharmacy access.
The NCPA said many patients claimed that at the time of enrollment, they relied on Medicare Plan Finder, the online portal maintained by the government agency, as well as online plan advertising and/or enrollment agents regarding the availability of low, advertised medication co-pays. Through misrepresentations from these sources, NCPA said, seniors have found themselves experiencing issues with access because when they visit their pharmacy of choice in the plan’s network, the advertised co-pays are not available because that provider is not one of the plan’s “preferred” pharmacies.
NCPA said it recently sent a letter to CMS asking the agency to agree to a special enrollment period for these patients this year and to take action to prevent similar, misleading marketing practices in future years. The letter also was accompanied by a compilation of problems patients and pharmacists are experiencing.
“NCPA previously warned that these overly restrictive Medicare drug plans were being deceptively marketed to patients and lack adequate pharmacy access for Americans in rural or underserved areas. While not surprising, it is unfortunate that our concerns were validated within the first few days of the 2012 plan year,” NCPA CEO B. Douglas Hoey said. “Now, seniors are going to the community pharmacy that they have relied on for years, sometimes decades, only to be told that they must travel 20 miles or more to obtain the lowest-advertised co-payments for their medication.
“While CMS is working with us to address individual patient concerns, we believe as a matter of fairness that all enrollees in these restrictive network plans should have the chance to reevaluate whether this is the right plan for them,” Hoey added. “Every day about 10,000 Americans turn 65 and are eligible to enroll in a Medicare drug plan. Medicare should allow seniors who feel that they’ve been duped the same choice as those just entering the program. In addition, CMS should implement preventative steps to avoid a repeat of this situation next year.”
NACDS Foundation announces grant opportunity to study impact of medication management services
ALEXANDRIA, Va. — The National Association of Chain Drug Stores Foundation has announced a $750,000 grant opportunity to conduct research examining the impact of medication management services on patient health outcomes within existing medical homes or accountable care organization delivery models, and released a corresponding request for proposal.
Many public and private demonstration projects exploring patient-centered care teams currently are under way. Medical homes and ACOs are comprised of medical teams, led by physicians, that coordinate patient care across the entire healthcare continuum. Experts have called for the evaluation of medication management as a quality improvement strategy within these models as a way to improve patient health outcomes. Evidence shows that when physicians and pharmacists work collaboratively to optimize medication use, better patient health outcomes are achieved. Currently, poor medication adherence costs the nation approximately $290 billion annually resulting from avoidable and costly health complications, worsening of disease progression and hospital stays.
The NACDS Foundation intends to fund, over a two-year period, approximately two grants to nonprofit research organizations or academic institutions. This research will help identify whether pharmacist-led interventions within team-based healthcare delivery systems improve patient health outcomes.
Selected research projects are anticipated to begin this fall and last approximately two years in duration to capture long-term health outcomes and the impact of medication management services.
Pharmacy can claim their stake with emerging technologies
As we welcome a new year, it is exciting to see all the changes headed our way. With all the movement around healthcare reform and technology, we in the pharmacy industry are quick to point out that this industry is years ahead of the rest of health care in terms of payment solutions and automated workflow. The rest of the industry is running to catch up — but right now the pharmacy industry is far from where we need to be to address critical factors in our industry. That said, there are tremendous opportunities that several companies are bringing forward with new technology that can truly revolutionize the delivery of health care.
Recently, I had the opportunity to participate in a roundtable discussion with retailers and a handful of solution providers to discuss where the pharmacy industry is headed and the technology that will help retail pharmacies be successful, even with ratcheting of third-party margins and the world of $4 generics.
Everyone at the technology roundtable envisioned pharmacy in 2012 as an exciting innovative industry. How can your pharmacy stake its claim to the emerging technologies? Let’s look at some key areas.
What are some of the newest technologies and their key considerations?
I could give you a laundry list of new technologies in their infancy or on the horizon. Below are some that I think have high potential value to the pharmacy industry, not listed in order of importance because ultimately your pharmacy needs to determine what’s most important to you and your patients:
- The key is how to engage the patient.
- Communication needs to include the physician, pharmacy and patient collectively.
- Utilizing existing network protocols, such as Network Management System (NMS), as well as moving to more innovative ideas, including launching video messages with Video Management Software (VMS).
- Trigger communications with new QR codes, those obscure computer graphics that are popping up in everything from magazine ads to airport wall posters.
- Voice recognition is an important way to communicate. New technology, including Apple’s Siri, is changing the way that we interact with the technology.
- Keep in mind that 65% of people in the United States are still not using smart phones, but 95% of cell phones are capable of receiving text messages.
- Fastest growing population on Facebook is women over 50 years old. Pharmacies can create communications and outreach programs specific to people within this demographic.
- Social media allows patients to set goals and track results, create a fun experience and involve their social circle for reinforcement.
- Mobile solutions can help remind patients to take or refill their medication and offer related education.
- Pharmacists and/or patients can track ailments and health between physician visits (e.g., blood pressure, blood sugar, weight, prior conditions and health events), creating interesting medication therapy management (MTM) opportunities for pharmacies.
- Healthcare tools communicate with patients to allow providers to ask important questions and enable interactive decisions based on information received, such as giving patients up-to-date information about their prescription prior to filing or after the prescription has been picked up.
- QR codes on prescription bottles allow for personalized information beyond what can fit on a bottle and allows the source to easily change information tied to QR codes even after the prescription has been picked up (e.g., notice of drug recall, refill incentives or possible drug interactions based on medication prescribed since a drug was dispensed).
- Medication therapy management — Given that patients are only 50% compliant with their medication directives, this is a key opportunity for pharmacies to be passionate about MTM.
- Medication reconciliation enables healthcare providers to know what medications are dispensed.
- New solutions are becoming available to improve tracking and submission for reimbursement.
- Pharmacists can monitor compliance and consult with patients between physician visits (e.g., blood pressure, blood sugar, weight, prior conditions and health events).
How can your pharmacy stake one or more claims to new technologies?
First, pharmacies should make a “favorites list” of technologies they want to implement given available resources, ROI and patient value. Next, they should talk with their technology vendors to better understand what’s available and coming down the pike. Whatever new technologies your pharmacy chooses to implement needs to be integrated with your existing workflow and where possible, should enable you to leverage your technology investments. For example, all pharmacies have a way to submit claims in real-time to pharmacy payers. If your pharmacy wants to start administering vaccinations, ask your pharmacy network if you can use your pharmacy system to bill vaccinations to medical payers. NCPDP is also a great resource and can help you understand how changes to the transaction standards will accommodate new technologies and market needs.
Emerging technologies can help make pharmacies more profitable, their operations more efficient and enable them to have a more active role in overall patient care. Now is the time for pharmacies to evaluate, communicate and stake their claim.
Rick Sage is VP pharmacy strategies for Emdeon. He directs the company’s clinical pharmacy initiatives with a focus on developing programs, standards and partnerships to improve patient outcomes and reduce healthcare costs.