Greater accountability for pharmacy benefit managers? That's just one of the goals of the President of the National Community Pharmacists Association.
Albert Einstein once said, “In the middle of difficulty lies opportunity.” You either shrink from challenges or work to overcome them. For well over a century, independent community pharmacies have delivered vital services to patients in spite of a marketplace littered with economic landmines.
Value-based care brings unique opportunities to redesign our current health care ecosystem. I believe in a world where prescribers, pharmacists, nurses, and payers stop competing and start collaborating to design an improved system of care that benefits everyone and cares for our clinicians in the process. Caring for our caregivers is just good medicine.
As President of the National Community Pharmacists Association (NCPA), my primary goal this year is to work on connections and relationships with everyone who shares similar values and beliefs and who believes in fixing our broken health care system. We must also create greater accountability for pharmacy benefit managers (PBMs), who continue to add cost, not value, to the health care system and who threaten our very existence.
On average, independent community pharmacies derive more than 90% of their revenue from prescription drug sales, leaving us at the mercy of dominant PBMs that dictate the terms of the vast majority of our revenue for the lifesaving products and services we provide. These drug middlemen do not disclose their methodologies for determining reimbursements in pharmacy contracts, leaving small business health care providers working blind when it comes to proper planning and business management.
The list of egregious PBM tactics is long. Independent community pharmacies now cite direct and indirect remuneration (DIR) fees in the Medicare Part D program at the top of that list. Retroactive DIR fees are imposed by PBMs after the medication has been dispensed. These fees are unpredictable in their amount and timing, making it increasingly difficult for independent community pharmacists to manage their businesses.
NCPA helped generate and supported companion bills S. 3308 / H.R. 5951, The Improving Transparency and Accuracy in Medicare Part D Spending Act, (bit.ly/2016dirbills), which are likely to be reintroduced this year. Congress, and will eliminate retroactive DIR fees in the Part D program.
Pharmacies across the country are working together to form local networks focused on delivering care above the norm for more complex patients. NCPA is working with Community Care of North Carolina to support the formation of the Community Pharmacy Enhanced Services Network (CPESN) (www.cpesn.com) and to stitch multiple local CPESNs together to serve payers in larger geographical areas.
The new NCPA Innovation Center is supporting this effort by providing community pharmacies with the learning opportunities, tools, and resources they need to re-engineer their practices for the new marketplace. While we are excited about these efforts, there are other examples of the health care status quo being shaken up for the greater good. A broad-based grassroots movement is being unleashed to promote a new health ecosystem called “Health 3.0.” There is a template for wise health care spending called the Health Rosetta available online at healthrosetta.org. I want independent community pharmacists to be a part of this aggregation of health care providers who want to unbreak health care (bit.ly/unbreakhealthcare).
As pharmacists, we are deeply connected to our patients and we have a core desire to help people be well. That’s our super power in a value-based system of care. It’s also a shared belief with prescribers, nurses, and other health care professionals. Aggregation means to unite people. And people unite when they share a belief. And a shared belief – well, I think it can change the world.