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Insurers hope to cut drug costs with talk
Apr. 16, 2009
Insurers hope to cut drug costs with talk
By Getahn Ward • THE TENNESSEAN • April 14, 2009
A push by Medicare and other insurers to control patients' misuse of medications as a way to cut unnecessary drug costs has given many pharmacists a chance to make additional money by getting paid for in-depth consultations or other extra services.
Kroger, for instance, is training more pharmacists to handle up to one-hour consultations with patients that it began offering members of sponsoring health plans two years ago. As profit margins shrink, the new fees could help pharmacists develop another stable source of revenue.
Already, health plans are required to offer such pharmacist-patient chats to members enrolled in private Medicare plans known as Medicare Advantage. Those conversations can produce fees of $160 for up to one-hour conversations covering a patient's medical background and other services.
Other pharmacists perform extras for patients, including packaging patients' drugs in ready-to-use individual dosages to reduce the chances of a patient's taking too many pills or the wrong ones.
"You've got to find creative niches to stay alive," said W. Shane Reeves, co-owner of Reeves-Sain Drug Store, a small Murfreesboro pharmacy chain with two stores.
"Pharmacists have traditionally gotten paid for dispensing medications; now this is a way to pay pharmacists more for being medication managers," Reeves said.
Drug errors are costly
Costs associated with drug errors and improper interactions of medicines may exceed $300 billion a year, according to some analysts.
For pharmacists, the sessions mark a return to their roots and more interaction with patients rather than simply filling orders for pills.
With the number of dispensed medications increasing as baby boomers age, pharmacists — especially those at the bigger chains — have tended to spend more time behind the counter and less time with clients.
"We're trying to use pharmacy technicians in a more expanded way to allow pharmacists to spend more time counseling patients," said Edith Rosato, senior vice president for pharmacy affairs at the National Association of Chain Drug Stores.
Pharmacists generally receive a call from a health plan alerting them that a patient is eligible for the service based on how many medications he or she takes and annual prescription costs. It's up to the patient to come in for the sessions, which are paid for by the insurer in almost all cases.
Kroger said no more than 2 percent of customers pay cash for the consultations themselves.
Plans must do more
Typically, pharmacies make money and cover overhead costs by adding a markup fee to what a consumer pays for his or her drugs. There wasn't a model for paying pharmacists for the consultations before the Medicare Advantage requirement, analysts said.
Now Medicare's overseer is requiring private Medicare plans to do even more under revised guidelines. Starting next year, more beneficiaries should qualify for the sessions because plans must review their patient rolls at least quarterly to identify people who are eligible.
Plans also will no longer be able to limit access only to members with a high number of chronic diseases or medications. And members with at least $3,000 of annual drug costs under Medicare's prescription drug benefit will be eligible — down from the current minimum of $4,000 of annual drug costs.
For reviewing a customer's medications and making recommendations to a person's doctor, the pharmacy is paid $50. It can earn a similar amount if it gets the patient's doctor to put him or her on a cheaper medication that's considered a therapeutic equivalent, Reeves said.
Health plans, meanwhile, benefit from the consultations through potential long-term cost savings, Rosato said. "Once a patient enters into this type of medication therapy management service, they become educated on the prescription drugs they take, the diseases they have, how important it is to stay on therapies prescribed by the physician," she said.
Nashville-based HealthSpring, a Medicare-focused managed care company, offers the consultations to members enrolled in its Medicare Advantage plans, including through pharmacies at its LivingWell health centers, one of which is in Gallatin.
William J. Anderson, HealthSpring's physician director of quality, said elderly patients often take a lot of prescription drugs, which puts them at a higher risk. "It's a documented fact that the most common cause of complications after hospitalization is medication errors," Anderson said.
Generally, pharmacists are paid between $10 and $160, depending how complex a case or consultation session turns out to be.
Sal Giorgianni, assistant professor with Belmont University's pharmacy school, said patient consultations are much needed in Tennessee, where the average resident fills 16 prescriptions at retail pharmacies per year compared with a national average of 12, according to one report.
"It's well documented that when you reduce the number of medications that someone's taking, it also reduces the possibility of side effects and harmful interactions between medications," Giorgianni said.
