Doug Hoey, RPh, CEO of NCPA, will join nearly 8,000 other attendees at Cardinal Health's annual Retail Business Conference, one of the nation's largest annual gatherings of community pharmacists, taking place this year July 23-26 in Washington, D.C. Before the big event, Hoey to shares his perspective on how community pharmacists can lead change to improve patient care.
Q: How do you see the role of pharmacists expanding in patient care?
A: Pharmacists are arguably the most under-utilized health care provider today. I believe that's going to change for several reasons. First, our population is aging as an estimated 10,000 Baby Boomers become Medicare eligible every day and will require more care. Second, there will be greater use of health care services as previously uninsured individuals obtain coverage through the Affordable Care Act (ACA). Third, there are not enough primary care physicians to meet today's needs, let alone higher demand for services down the road.
In fact, the ACA mandates coverage by health plans for a number of preventative care services that pharmacists can provide today. These include immunizations, diet and obesity counseling, and screenings for blood pressure, cholesterol, diabetes, and tobacco use.
Of course, today the majority of pharmacists' role is tied to their dispensing of and expertise in prescription medications. There, too, I see a larger role for pharmacists as awareness increases regarding the importance of the proper use of and adherence to prescription drugs. For example, Medicare started applying "star ratings" to prescription drug plans based on a variety of factors, including beneficiaries' adherence to their medication, which pharmacies can help improve.
Patients are already on board, judging by opinion polls. For decades pharmacists have ranked among the most trusted professionals in America for honesty and integrity, according to Gallup's annual survey.
Q: How could legislation for provider status change the future of pharmacy?
A: The lack of federal recognition of pharmacists as providers under Medicare is a barrier. It prevents pharmacists from practicing to the full extent of their licensure. Granting pharmacists provider status has the potential to transform the profession and patient care in a positive way.
Pharmacy revenue from health plans is dependent almost entirely on the prescription drug product itself, not consulting and advising patients. Pharmacies are woefully underpaid when it comes to the professional knowledge and value that the pharmacist provides. Dispensing fees as low as $1 per prescription are not uncommon when the cost of dispensing is consistently estimated in the $12-13 range per prescription and can be much higher in specialized scenarios such as long-term care.
So pharmacies must receive sufficient, positive net profit on the drug dispensed in order to stay in business and continue serving patients. This dichotomy both reflects and fuels the commoditization of the pharmacy practice by pharmacy benefit managers (PBMs), in spite of the views of patients and the faith they place in pharmacists when it comes to their health.
Provider status could accelerate pharmacies being paid for the services rendered by pharmacists. That is one of the reasons NCPA is proud to be a founding member of the Patient Access to Pharmacists’ Care Coalition (PAPCC), comprised of pharmacy associations, pharmacy chains, and other stakeholders. The coalition worked to support introduction of bipartisan provider status legislation in the U.S. House of Representatives and continues to work to grow the number of cosponsors and bring the bill closer to becoming a law. H.R. 4190 was introduced by Reps. Brett Guthrie (R-Ky.) and G.K Butterfield (D-N.C.). Consistent with the precedent established for nurse practitioners and physician assistants, pharmacists would be reimbursed at 85% of the physician fee schedule. If they are operating under the direct supervision of a physician, they would be reimbursed at 100% of the physician fee schedule.
Q: How can community pharmacies lead change to ensure they’re well positioned to not only deliver patient care services, but to be paid for those services?
A: One of the most fundamental building blocks to improve patient care is improving patient adherence with their medications. Pharmacists play the leading role in making sure that patients are taking the appropriate medication regimen. They also play a leading role in helping patients stay on their medication therapy. Everyone's interests align with adherence—patients, payers, and pharmacists.
What's more, many of the current quality measures recognized by the Centers for Medicare & Medicaid Services (CMS) are based on adherence. Not only is adherence a fit in today's pharmacy business model but it also directly ties into how valuable that pharmacy is to a health plan concerned about Medicare Part D star ratings. NCPA's prescription synchronization effort Simplify My Meds® helps pharmacists develop a system in their pharmacy to improve patient medication adherence.
Other ways pharmacists can position themselves to be paid for their services include immunizations and diabetes self-management education and training (facilitated by NCPA's DASPA program ).
These programs don't just have the potential to improve health outcomes and pharmacy profits. They also help increase patient awareness of the larger role that community pharmacists can play. Another great example is the Cardinal Health-NCPA Health on the National Mall event July 23, 2014. Washington tourists will get a dose of education about pharmacists' ability to help address conditions such as asthma management, heart health, and smoking cessation.
Second, community pharmacists can take grassroots action through NCPA and their state organizations to effect change at the federal and state levels. I previously mentioned that H.R. 4190 that is pending in Congress. States are also taking action. Last year, California pharmacists made sure their state enacted expanded provider status for pharmacists. In 2014, Kansas pharmacists accomplished a similar feat. Hopefully these are the tip of the iceberg. Most of all, with a growing percentage of prescription drugs being paid for by federal and state government, pharmacists must be committed to being politically active—for the sake of their patient, profession, and their business.