Drug Topics Voices 06-10-2015

June 10, 2015

Letters, e-mails, posts, and comments from Drug Topics readers

Only in America?

Re: “ACA opens the door to value-based care” [Cover Story, May 2015]:

We must change the perception that people have of us as healthcare professionals. At the retail level we are overworked and short of help. There is no time to conduct a review in a professional setting without interruptions from the phone or cashiers asking questions. Many stores have minimum-wage techs who are not properly trained to perform even the minimum requirements. We have become problem-solvers for insurance billing, and it shows the public where we stand in the hierarchy of professionalism. No matter how we try to portray ourselves, the retail companies force pharmacists to conduct business in this manner.

To see how business is conducted overseas is an eye-opener. I have seen pharmacists sit behind a desk with a computer in front of them and all they do is talk to clients. Other personnel do the rest. The pharmacy was so busy that it took me 40 minutes to get in. The line was around the block.

We have to get behind the desk and away from the bench.

AnonymousPharmacistPosted at drugtopics.com

Not so simple

Re: “Why pharmacists should endorse healthcare for all” [Fred Mayer, Dispensed as Written, May 2015]:

1. If the single-payer system looks like Part B from the pharmacist’s perspective, it will be a resounding failure. There are too many documentation requirements, many of which are not under the control of the pharmacist, that are being used as a reason to deny payment. I read recently that the denial rate for glucose test strips is in the high 90% range - and this is after the patient has already received the product. Also, most of the Part B-covered drugs are paid by Medicare at a rate that is less than the pharmacy has to purchase them for. 

Single-payer, maybe. Modeled after the current Medicare system, no way.

2. The section about covered services stating that there will be no copays or deductibles is, to me, like fingernails running down a chalkboard. A system where the consumer has no “skin in the game” and the government is prohibited from setting the prices at a reasonable level is the reason for our exorbitant healthcare costs.

If consumers had to pay for their healthcare up front, even if it was reimbursed later at 100%, they would see the cost and be in a better position to determine its value. If the cost is zero, then there is no therapy that fails the cost/benefit test and nothing to keep the manufacturers from charging thousands of dollars for pennies’ worth of medication.

3. For such a system to be sustainable, it should only cover life-threatening conditions. That means earaches, allergies, and acne, among other things, would not be covered. We have to draw the line somewhere, and when we’re asking “someone else” to pay the bill, let’s be reasonable and only ask them to save lives, not foot the bill for comfort, convenience, or lifestyle.

4. The current buzz about “accountability” and paying for outcomes rather than fee-for-service always seems to leave something out - the patient.  The patient needs to be a member of the team as well, and be held accountable for the outcome.

For instance, do we care if the patient refills their simvastatin every month, or whether their cholesterol is lowered? Is it more important that they fill their metformin, or that their A1c is at their target?

My point is, we are measuring the wrong things and holding healthcare professionals responsible for the results, with no expectations toward the patient. We can tell someone all day long the importance of taking their meds, but if they refuse to do so, is that a failure on our part?

Maybe it is time for a single payer system and time to remove the obscene profits of the middlemen who are “keeping the costs down,” but we need to be judicious with what is covered. And consumers still need to be connected to the true cost of their treatment.

Steve Burney, PharmDColumbus, N.C.

 

The future of pharmacy: A primer

Re: “Should pharmacists be entrepreneurial?” [Dennis Miller, April 8, drugtopics.com]:

Yes. Entrepreneurial pharmacy (i.e., owning your own practice) is the way forward. Take control of your destiny.

• Take as many courses as possible at an inexpensive community college. Favor lower-cost pharmacy schools. Get oan payments as low as possible. (This is a form of control; your choices in life and career should not be dictated by banks.)

• Forget about MTM. There is no money in PBM- or government-sponsored MTM.

• The cash model is the only way.

• Develop niche practices - more than one - such as compounding, nutritional counseling, lifestyle management. For the latter, offer diet, exercise, meditation, yoga, strength training; sell high-quality professional supplements/herbs/protein powders and books on health; and give weekly seminars. Charge people to sit in the chairs and collect the nonrefundable fee ahead of time, not at the door.

• Advertise your expertise on the radio, in your own voice.

• Do follow-ups in 6-8 weeks. Do nothing for free. Don’t let them e-mail you or collar you for “just one question.” Do you get to walk into an MD’s office and ask questions? No. “Make an appointment” should be your new mantra.

• Crack the books again: Your education is just beginning when you get your diploma/license.

Don’t try to emulate doctors. Theirs is a failed paradigm. Stop as many drugs as you can. Team up with a naturopath or a nurse practitioner and heal with food, nutrition, lifestyle, exercise, education.

Mark Burger, PharmDPosted at drugtopics.com

See also: Drug Topics Voices 05-10-2015

Other considerations

I agree with you, but I am an independent pharmacist who does not use these tactics to drive sales. Like most independents, I care about my customers’ health. I was doing MTM long before there was such a term for it. I have been doing patient counseling since I finished pharmacy school, and I have never sold tobacco products in my pharmacy.

Consumers must check to see where they get the best service at the fairest cost. Most stores take most insurance plans, and I cannot understand why customers would go to a big-box store and wait hours to get substandard service, when they could go to a local store and get high-quality, friendly service in 15 minutes. All for the same copay. Could it be that their PBM is in the driver’s seat?

Please do not blame all this on pharmacy schools and capitalism in general.

William AdairPosted at drugtopics.com

Tier 1 for me, tier 2 for you

What is actually developing here is a two-tiered healthcare system. The top tier is for the very rich and politicians. The other tier is neglect-care for people like us - good enough to pay for routine physicals and minor problems, OK for sudden emergencies, but not so good for things that gradually deteriorate health, and nothing for prevention.

AnonymousPosted at drugtopics.com

See also: Drug Topics Voices 04-10-2015

Corrections: In the May cover story, “ACA opens the door to value-based care,” the name of Stacie Maass was misspelled. Also in the May issue, the article “Does your pharmacy comply with quality assurance requirements?” by Natallia Mazina gave an inaccurate e-mail address for the author. The correct e-mail address is nmazina@cmpharmlaw.com. Drug Topics regrets the errors.