MANAGED CARE

How community pharmacy, managed care can collaborate

Are managed care and community pharmacy destined to be adversaries, or can they be partners? While they'll never be bosom buddies, they certainly have many things in common. That's the conclusion of two speakers at the Academy of Managed Care Pharmacy annual meeting in Salt Lake City last month.

In a presentation entitled "Building Constructive Relationships with Community Pharmacy," an executive from Merck-Medco spoke for the payers' side, and a representative from Rite Aid portrayed the position of retail pharmacists. Both are pharmacists with experience in pharmacy benefit management.

According to Greg Drew, v.p. of pharmacy health services at Rite Aid, pharmacists are whipsawed by the R.Ph. shortage and the burgeoning volume of prescriptions. So they are busy enough dispensing drugs without having to explain the intricacies of drug-benefit design to patients. But that's what pharmacists are forced to do, he complained, since so many patients lack a good knowledge of tiered co-pays and other cost controls.

Acknowledging that this is a problem, Bill Strein, senior director of provider relations at Merck-Medco, said payers don't want pharmacists to be caught in the middle between patients and insurers. Payers themselves should do a better job of educating patients about their health plan's features. But how many patients have taken the time to thoroughly read the insurance materials they receive at the start of each year? Strein asked. Some insurers, he noted, are now conducting pilots that involve giving out information to patients at the point of sale. This would spare pharmacists from having to serve as insurance experts.

Another area in which managed care groups (MCOs) and community pharmacists can work together is customer service. Strein admitted that payers have not always had the right systems and help desks in place to support efficient customer service. He urged payers to make a commitment to improve their systems of communicating with pharmacies to reduce member hassles.

Supporting a standardized ID card is another way payers can alleviate community pharmacists' administrative burden. However, not all MCOs are backing this initiative. The reason is that the "real estate on ID cards has great value," Strein explained. Some payers want their names emblazoned on the card, diminishing the room for information pharmacists need to get their jobs done. Strein emphasized that a uniform ID card is key to reducing third-party red tape.

Pharmacists can help payers brake their prescribing waste and drug costs so that everybody wins, Drew said. A case in point is the use of generics. Both parties can make more money if more generics are utilized.

Strein concurred, adding that there are many opportunities to test this out this year with the patent expirations of Prilosec, Zestril, and Glucophage.

Besides cutting costs, pharmacists can also enhance the value of drug therapy through collaboration with physicians, Drew said. The trouble is, they have so little time, and payers aren't paying for nondispensing-related services. Strein acknowledged that some payers still see pharmacy as just a commodity and pharmacists as distributors of drugs, rather than as professionals.

Strein recommended that demonstrations be carried out to show the value of pharmaceutical care. This can be done by taking small steps and starting with regional payers, he suggested. A barrier to this is that performance varies widely between pharmacies, so the challenge is for payers to showcase those pharmacies that outperform the others for targeted pilot projects. He added that a recent trend he is seeing is more payers interested in listening to what pharmacies, rather than PBMs, have to say about how to achieve payers' goals.

While payers and community pharmacists often seem to be on opposite sides of the fence, both speakers allowed that there are many areas they could work on to advance their mutual goals of improved care, reduced costs, and patient satisfaction. Another point both stressed is they have to operate at a price that doesn't put them out of business. Strein said payers construct benefits that deliver patients to pharmacies' doorstep. Drew said the pharmacists' goal is also the payers' goal—that of meeting patients' needs.

Judy Chi

 

Judy Chi. How community pharmacy, managed care can collaborate. Drug Topics 2002;9:72.