Medicare Part D: Community CCRX offers incentives to pharmacies

Key Points

Amid the array of Medicare Part D prescription plans, only one operates in partnership with pharmacists - Community CCRx, which, in addition to a generic dispensing rate incentive program, now offers pharmacies a new category designed to boost savings by increasing the percentage of maintenance supply fills.

2009 incentives

The purpose of the incentive is to remain competitive with Part D programs that promote mail order, as Community CCRx believes in delivering prescriptions through community retail pharmacies. The program is for patients who are stabilized on a maintenance medication and are able to move to a maintenance supply schedule, according to a MemberHealth press release.

The generic incentive program continues in 2009, with the purpose of rewarding pharmacies that are able to control drug spending through the appropriate use of generics. Pharmacies are tracked and evaluated quarterly, giving them the opportunity to improve performance and earn higher incentives throughout the year.

"Pharmacies are evaluated based on individual improvement rates, time frame over time frame," Wardle said. "So, let's say a pharmacy is at 65 percent and they move up to 66 or 67 percent. That is an improvement. We are looking at a pharmacy's overall improvement."

Pharmacies can monitor their progress by viewing their scorecards at http://www.mhrx.com/pharmacists/, as well as find opportunities to increase use of generics and maintenance supplies and compare their rates with regional benchmarks.

Though pharmacies are rewarded for individual improvements, the incentive plan is reviewed annually to ensure that it rewards only those pharmacies that are actively managing their patient drug expenditure above the Medicare average. Often, this has meant raising the bar each year to stay ahead of industry averages, according to the National Community Pharmacists Association (NCPA) Web site.

A "Fast Pay" program was launched in 2009, bringing a new payment schedule that expedites contracted reimbursement payments to the pharmacy in 7 to 10 business days. The new schedule provides two additional payments in 2009.

Background

More than 63,000 pharmacies nationwide participate in the program, including all major chains and community pharmacies. In terms of pharmacy success, Wardle said many of the chain pharmacies are doing well. He would not comment on which chains were ahead.