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  • 14 May 2019 10:52 AM | Anonymous

    How Physician and Pharmacist Integration generates Innovation

    Physicians didn’t spend long years in school to have two-thirds of their work-day be comprised of data entry task.

    Pharmacists didn't spend long years of school to have two-thirds of their work-day consist of filling and dispensing medications.

    Both professions went to school so that they can perform at the top of their license and modernize today's healthcare era; bringing revolutionary solutions to the healthcare industry. It’s already apparent that we prefer to avoid the administrative burden, as it disrupts our workflow and takes time away from spending with the patient.

    Our reimbursement model has changed and went from fee for service to now value-based care.

    Physicians are the Medicine experts, while Pharmacists are the medication experts. Both professions are considered predominant healthcare leaders in the industry.

    Physicians are the first point of contact to diagnose and assess appropriately, while Pharmacists are the last line of defense to verify that the appropriate treatments were prescribed.

    It’s clear that both professions possess a high pedigree of clinical knowledge.

    Why do we separate the two entities, instead of bringing them closer together?

    Primary-care physicians, participation in a care-team program can ease the burden associated with the management of complex-care patients. It also provides a way to better manage the cost of these patients by optimizing their health and functional status, decreasing excess healthcare use, minimizing emergency department visits and other hospital utilization (including readmissions), and preventing long-term nursing home placement. 

    What’s going on in the Physician private practice world, is also going on in the pharmacy private practice world.

    According to the American Medical Association, less than half of physicians own their medical practice. “First-time ever” its been this low.

    According to the NCPA (National Community Pharmacist Association) digest report, there has been a steep drop in independently owned pharmacy practices compared to previous years.

    Ownership and employment shifts reflect the industry's increasing compliance costs and new payment models.

    Health systems have been aggressively mopping up the physician practices, while the Large-chained pharmacies have been aggressively mopping up the small mom and pop independent pharmacies.

    The common reasons shared for selling their practice:

    • 1.     Low reimbursements
    • 2.     High overhead cost
    • 3.     Burnout
    • 4.     Increased competition by bigger players
    • 5.     Lack of innovation

    With the collaboration of Physician and Pharmacy private practices, it can help eradicate a bulk of the problems both professions face and help revolutionize healthcare.

    Ways a Pharmacist can help improved value-based care models for Physicians:

    • 1.     Disease-state management therapy- Most physicians are trained only to know the contraindications of medications for individual disease states. Where they may lack is the Pharmacokinetics/Pharmacodynamics profile, Medicinal chemistry, and the robust intelligence of clinical literature of drugs in certain classes. All of these small intangible things relating to a drug have a significant impact on its effectiveness.
    • 2.     Primary care Pharmacist plans- Yes, Pharmacist can provide care plans. A clinical pharmacist can also put together a care plan to better assess the patient and provide useful treatment recommendations for the Physicians review. This can help reduce the administrative task physicians may have to deal with, which in return allows the physician to spend more time with their patient to go over the pathophysiology of their condition.
    • 3.     Pharmacoeconomics- the Pharmacist, have the due-diligent training to evaluate the cost and effectiveness of a pharmaceutical agent against another. This can be referred to as a cost-benefit analysis.  Hence, pharmacoeconomics can help guide optimal healthcare resource allocation and provide more buy-in from Insurance companies.

    How can a Physician be of aid to a Pharmacist:

    • 1.     Pathophysiology- Physicians are experts and well-trained in the pathophysiology of a patient. This is knowledge pharmacist may lack the substance of knowledge in pathophysiology. Physicians are sharply intelligent in diagnosis criteria's and general assessment of a patient.
    • 2.     Medical Knowledge- Physicians have the medical knowledge to help consult with patients on preventative skills to live a more proactive healthy lifestyle. The more time the Physician has with the patient, the better the outcomes.

    In hindsight, Physician & Pharmacist collaboration has the potential to create a robust HealthSystem for patients and also produce a stronger buy-in from insurance companies.

    Population health is the current and future trend of healthcare. We can start synergizing our talents and bring out the best in value-based care practice models.

    The more prominent players are already adopting vertical integration strategies to help create a more user-friendly and efficient healthcare system. Why can’t we?

    In essence, “we have to STOP advertising and START innovating.” 

  • 4 Apr 2019 6:46 PM | Anonymous

    Unable to fill Specialty Medication?

    How many times has a patient presented to you a prescription for a “specialty medication" that you are unable to fill?  It could be that you are not able to order the medication from your wholesaler. Or worse, the patient’s insurance is mandating a specific pharmacy different than yours.  It can be frustrating when a current or prospective customer is coming to you, the pharmacist, for a solution to their chronic and sometimes rare, condition.

     

             There is no finite definition for what qualifies as a “specialty medication".  In general, specialty medications are used to treat chronic or complex conditions and usually require special handling or administration and close monitoring of the patient.  Sometimes, these prescription medications are indicated for rare diseases, which means that the disease affects less than 10,000 people. And they are therefore given “orphan drug status” under the Orphan Drug Act of 1983.  This Act allows for fast-track FDA approval for drugs intended to treat these rare diseases due to limited therapies available on the market.  Obtaining fast-track approval allows the medicine to be available as quickly as possible to the patients that need it the most.  This also means that the medication does not have to go through as many lengthy clinical studies as the “more” traditional therapies.  Often, as a stipulation of being given fast-track approval status, the FDA may require additional aftermarket studies to be completed, meaning that the drug is available to be prescribed but the patients taking the medicine are monitored for safety and efficacy of the therapy.  This is referred to as a Phase IV clinical trial.  Any pharmacy that dispenses one of these drugs must understand this process and accommodate the patient and drug manufacturer for any required documentation or data.

     

             Some specialty drug manufacturers may limit the number of pharmacies who have access to order their medication.  These are deemed “Limited Distribution Drugs,” or LDDs for short.  When attempting to order one of these medications from your wholesaler, you may notice that the drug’s name is not listed in the system. Or it may take you straight to a screen that reads, “due to manufacturer limitations, this product is only available through a limited distribution network” and to contact the manufacturer directly.  This can be very disheartening for a pharmacist or pharmacy owner.

     

    Upon calling the manufacturer, you may find out that in order to gain access to this drug, there are many rigorous requirements to meet first.  It is also worth mentioning that all manufacturers are different and have different specifications that must be met.  Many require weekly data reports so it would be prudent to know if your pharmacy’s dispensing software can accommodate customized and automatic reports.  The manufacturer may also request proof that you, as the pharmacy, have a way to monitor the patient for adherence and therapy response.  A common theme among these manufacturers is some sort of “specialty accreditation”.  This is often the first step to becoming a Specialty Pharmacy.

     

             Achieving accreditation proves a commitment to quality and standards that are becoming the norm in the specialty space.  Accrediting bodies such as the Accreditation Commission for Health Care (ACHC) and the Utilization Review Accreditation Commission (URAC) are arguably the most reputable in the field.  Both sets of standards set the stage for core activities such as:

    o   Patient Care

    o   Coordination of Care and/or Delegation

    o   Information Management

    o   Compliance Program

    o Quality Management and Continuous Quality Improvement, etc.

    Accreditation is strongly recommended but could become mandatory by payers in the near future in order to ascertain preferred contracts for reimbursement purposes.  This means extra revenue for your pharmacy by adding a specialty line of business.  The entire process can take up to six months to a year for full accreditation and can be very arduous and labor intensive. 

     

    If all of this is intimidating to you, just know that you are not alone.  The key is to connect with a professional who has been through the process. Ideally, they should have been able to achieve and has maintained accreditation for some time.  Embarking on a project like this size could be overwhelming and a competent expert can guide you through the process. 

     

    There are many resources available though, if you choose to take on a project independently.  However, there is a lot of competition out there in specialty pharmacy but accreditation can set you apart from others.  Visit www.ACHC.org or www.URAC.org to learn more about the various programs in accreditation and visit www.HVRSSolutions.com/services-offered to learn more about guidance through the process.  HVRS Solutions provides necessary paperwork required for accreditations such as policies and procedures and staff training documentations and will also assist you in preparing you and your pharmacy staff for on-site surveys.  All services are customizable and personalized to your individual business needs.

    We recommend using CSI Specialty Group for all of your specialty needs. Click Here 

  • 14 Mar 2019 2:11 PM | Anonymous

    10 Pharmacy Startups and Innovators

    For a long time, the pharmacy space was dominated by big and long-established pharmacies. There was a major lack of startups and innovators were also lacking.

    It was only recently when there was a rapid growth in pharmacy startups that areas in the pharmacy space, that have remained untouched for a long time, were disrupted. These include medication dispensing, delivery, cost-savings, prescribing, information, storage, vitamins and supplements, and specialty pharmacy services.

    Below is a list of startups that have excelled in one or more areas of the pharmacy industry that are in need of improvement.

    1.   DeliverCareRx

    DeliverCareRx takes medication delivery to another level. Not only does the pharmacy offer free home delivery for more than three prescriptions per month but also synchronizes your prescription needs. This means your prescriptions are delivered to your door at the exact time that you need to replenish your supply.

    This makes prescription acquisition convenient and timely. You never have to miss a refill for any reason. This also saves you money from fare or gasoline.

    DeliverCareRx also offers free prescription management. No need to go to the doctor's office and visit your insurance provider because they will handle the scripts/paperwork for you.

    2.   ZappRx

    ZappRx offers patients a quick and easy way to process the specialty drug orders through the ZappRx digital platform. You can order specialty medications online quickly and easily.

    Considering that specialty prescribing takes time, the shortcut that the pharmacy offers makes a huge difference. Apart from streamlining the process of specialty med ordering, ZappRx also helps with the communication between providers.

    3.   NowRx

    NowRx hand delivers your prescription medication the same day you place your order. Since you only need to use an app to place an order, you can skip the long queues and have your prescription filled without leaving home.

    You can send your prescription to them or have your doctor send it directly to the pharmacy. So after your checkup, you can go straight home instead of going to the pharmacy to purchase your prescription because your doctor can send the prescription on your behalf.

    Upon fulfillment, you will receive a notification. Your card will be charged automatically.

    You also have an option to video chat with your pharmacist for consultation and for whatever queries you might have.

    4.   Blink Health

    Blink Health lets you buy your prescription meds at a more affordable price. They guarantee the lowest drug prices on all generic medications.

    This is one of the startup drug companies dedicated to providing patients with medication cost savings. Unlike other pharmacies offering the same service, Blink Health does not require membership fees or coupons.

    You can also pick up your prescription medication at local pharmacies near you. Just pay online and your order will be ready for pick up. Enjoy an average of 70% cost saving per prescription filled.

    5.   GoGoMeds

    Run by Specialty Medical Drugstore, a full-service pharmaceutical provider based in Greater Cincinnati, GoGoMeds offers low-cost prescription medications and other specialty pharmacy services.

    You can have your prescription filled without the need to leave your home. Just send your prescription via mail or have your doctor fax it directly to specialty medical drugstore.

    If you want to transfer from one pharmacy to GoGoMeds, just provide the name and phone number of the pharmacy when you process your order. Upon fulfillment, your medicine can be shipped to you directly or delivered according to your instructions.

    6.   Alto Pharmacy

    Alto Pharmacy fills your prescription and delivers your meds for free. The pharmacy stocks all common medication and specialty treatments and sells them to you at the best price. With the same copay and free delivery, you're sure to achieve medicine cost savings.

    With the acquisition of Round Health, Alto Pharmacy helps ensure people actually take their medicine. The reminder app not only takes note of your schedule for taking your medication but also the patterns and rhythms of your life. This allows the app to remind you of your medication more effectively.

    You also have the option to have your prescription refilled at a specific schedule and right on time.

    7.   NimbleRx

    Fast and reliable medication dispensing is what NimbleRx is all about. They offer fast delivered pharmacy services that ensure patients get their prescription on time.

    Delivery is always free, and you get to choose when and where you want to receive your prescription. Just have your doctor send your prescription directly to the pharmacy and they will take care of the rest.

    If you need to manage your refills, just use the Nimble Pharmacy app. It's easy to manage and will speed up purchase and delivery services.

    8.   MedAvail

    MedAvail has created medication pick up points, self-serve pharmacy kiosks where patients can pick up their prescriptions and over-the-counter medications.

    The MedCenter, as the kiosk is called, is remotely controlled by a pharmacist who interacts with clients through audio and video network connection. Think of it as an ATM that dispenses medication on the spot instead of notes.

    You can choose from over 500 medications through this 24-hour, on-the-spot pharmacy.

    9.   GoodRx

    With the outrageous costs of drug prices, pharmacy start-ups that offer medication cost savings will save patients from financial worries. GoodRx is one of the drug coupon companies that provides patients with information as to where they can buy the prescription medication for the lowest price.

    Using coupons, clients can save so much more.

    Through GoodRx, you can compare drug prices from over 60,000 pharmacies in the US, print free coupons, and save up to 80% on your medication. You can also save a copy of the coupon on your phone and show it to partner pharmacies.

    10.       Capsule

    With Capsule, your prescription can be filled right from the doctor's office. Just tell your doctor that your pharmacy is Capsule and wait for a text with a checkout link. Here, you can place your order and schedule same-day delivery.

    You can go home right after your checkup and then wait for your prescription to be delivered right at your doorstep.

    But their pharmaceutical services don't stop there. You have the option to transfer a refill from your old pharmacy, have capsule take care of your refills, and ask questions related to your prescription.

     

    Sources:

    https://www.reddit.com/r/buzzfeedbot/comments/8za2wk/10_pharmacy_startups_that_could_be_ma_targets/

    http://www.thedigitalapothecary.com/pharmacy-innovation-news/2017/9/5/the-start-ups-disrupting-the-pharmacy-sector  

  • 1 Mar 2019 11:00 AM | Anonymous

    Where are the Top 5 Medical Tourism Destinations?

    More and more people are traveling abroad to seek medical care. They do so not for a less expensive healthcare but because some countries offer better medical services than what they would find in their own country.

    According to the Medical Tourism Association, approximately 14 million people in the world go on a medical tourism annually.

    A report by McKinsey and Company outlined what patients seek when traveling abroad to receive medical treatment.

    • 40% look for advanced technology procedures that are performed by a country's highly-trained personnel.
    • 32% seek better and more human medical attention, care, and treatment.
    • 15% search for immediate medical service with shorter waiting periods.
    • 13% seek lower economic medical costs.

    Top 5 Medical Tourism Destinations

    1.   Mexico

    When it comes to advanced care and cosmetic surgery and dentistry, Mexico takes the top spot. Tijuana, in particular, is a hotspot for cosmetic procedures.

    The country has 98 hospitals accredited by the Federal Health Ministry and 7 hospitals accredited by the Joint Commission International (JCI).

    With low-cost medical treatments that save patients up to 60% the prices in the US and Europe, it's not a surprise that many people travel to Mexico for medical tourism.

    2.   Costa Rica

    In the last few years, Costa Rica has consistently ranked high in dentistry and cosmetic surgery above Canada and the US. It is also making vast improvements in the fields of bariatric surgery, cancer therapy, and eye surgery.

    Compared to the US, healthcare services in Costa Rica is 45% to 65% lower.

    The CheTica Ranch in San Jose offers medical tourists a unique ranch-style recovery retreat where patients enjoy amenities that rival a hotel and the care of well-trained nurses. 

    3.   Canada

    According to the Medical Tourism Global Market and Figures 2018, Canada highly excels in stem cell treatment at a cost that is more affordable than in the US. In 2016, it was considered a world leader in health tourism according to an index developed by Fetscherin & Stephano.

    With medical tourism considered one way for the country to create another source of revenue, expect more medical treatments to be added into Canada’s medical tourism.

    4.   India

    Healthcare costs in India will save patients 65% to 90% of similar services in the US. The country also uses cutting edge-technology in healthcare delivery. This is why it is one of the key players in the medical tourism industry.

    Many of its hospitals are accredited by the Joint Commission International and the National Accreditation Board for Hospitals and Healthcare Providers. Some private hospitals offer health care packages for foreign patients that include airport-to-hospital pickups, private chefs, and free in-room Wi-Fi.

    Some of the more popular procedures include eye surgery, orthopedic surgery, bone transplants, and heart bypass surgery.

    Chennai currently ranks number one as the ultimate health care tourism destination in India.

    5.   Brazil

    In Latin America, Brazil is the best in healthcare delivery as noted by the World Health Organization. It is home to some of the world-renowned surgeons and has 43 JCI-accredited hospitals.

    Brazil offers high-quality cosmetic and plastic surgery services that cost about 30% to 50% lower than in the US. This shouldn’t come as a surprise as cosmetic treatments are considered the norm in the country.

    The Ivo Pitanguy Clinic in Rio de Janeiro is well-known for performing more cosmetic surgeries than other places in the world.

    These are the just the top 5 medical tourism destinations in the world. This means you have more options when seeking medical treatments abroad if you look long and hard. What is even better is that you’re not just paying for lower costs but excellent medical care as well.

     

     

    Resources:


    For statistics

    https://hospitalcmq.com/medical-tourism/medical-tourism-global-statistics/

    https://www.medicaltourismindex.com/health-tourism-canada-uk-israel-top/

     

    For the content

    http://www.medicaltourismmag.com/top-10-medical-tourism-destinations-world/

    https://artoftravel.tips/top-medical-tourism-destinations-for-2018/#.W0vzktIzbct

    https://internationalliving.com/countries-best-healthcare-world/

    https://www.netdoctor.co.uk/healthy-living/home-and-travel/a29006/medical-travel-popular-destinations/

    https://www.thenational.ae/lifestyle/travel/five-star-treatment-top-10-destinations-for-medical-tourism-1.679880

    https://worldsbesthospitals.net/

    https://www2.deloitte.com/ca/en/pages/life-sciences-and-healthcare/articles/evolving-medical-tourism-in-canada.html

     

  • 20 Feb 2019 3:34 AM | Anonymous

    How Pharmacy Benefit Managers Impact Drug Pricing, Hospital and Patient Care, Payers, and More

    In the United States, the cost of diabetes-related drugs, such as insulin or Victoza, cost 10 times as much than if you were to buy them outside the US. Price inflation of prescription drugs are not new but it is a unique problem for the United States.

    Who's to blame for the skyrocketing costs of prescription drugs?

    Pharmacy benefit managers (PBMs)

    They may not be the only culprit, but they contribute largely to the problem. Competing drug companies buy access to PBM formularies so their products will be chosen as the recommended choice.

    By paying rebates and other fees to a PBM, a drug manufacturer can take a bigger piece of the sales pie. To recoup the large rebates and other fees paid to the PBMs, drug manufacturers have to increase the list price of drugs.

    The result is skyrocketing drug prices.

    But the cost of prescription drugs is not the only thing that PBMs can impact in both negative and positive ways.

    How Pharmacy Benefit Managers Work

    Historically, PBMs act as middlemen entities that process prescription medication claims and plan sponsors for a small fee. They provide services and educational programs to aid patient. They also serve as an intermediary between insurers and other healthcare members. This allows them to negotiate large customer contracts and for pharmaceutical companies and pharmacies to get the best rate.

    What PBMs do

    • Negotiate rebates to get the most affordable option
    • Operate mail order pharmacy to deliver medications directly to patients
    • Ensure patient compliance in taking prescribed medications
    • Manage formularies and process claims from patients and pharmacies
    • Manage distribution among pharmacies, connect pharmacies to orphan drug supplier, and provide other specialty services.

    The role was clear-cut and clean until they leveraged their position as middlemen to impact nearly every aspect of the prescription drug marketplace. Even an independent pharmacy is not spared from the impact that PBMs make.

    Impact of PBMs on hospitals and patient care

    PBMs are exploiting a Medicare provision that allows them to charge remuneration fees directly and indirectly to pharmacies within their network. To price out the competition, particularly a local independent pharmacy where patients have a personal relationship with pharmacists, they increase the fees for using in-house and member pharmacies as part of Medicare reimbursement.

    With the way the incentives are structured, PBMs retain more of the discounts and fees, driving up costs on Medicare. Since the pricing model used is fiercely guarded, pharmacy benefit managers continue to hide the costs paid by health insurance companies, patients, and the government.

    Impact of PBMs on American Health Care

    PBMs generate revenue in three ways—administrative fees, pharmacy spread, and rebates.

    • Administration fees are charged to plan sponsors and manufacturers. The additional fees and payments go straight to PBM pockets.
    • Pharmacy spread is a PBM practice where the plan sponsor is charged a higher price than what is reimbursed to the network pharmacy. The difference, also known as a clawback, is pocketed by the PBM.
    • Rebates are discounts on a mediation that drug manufacturers provide in exchange for PBMs covering a drug product from a paying manufacturer. Since the formularies that the plan sponsors cover are made by the PBMs, they can choose which drugs will be used even when there are less expensive drug alternatives.

    All these resulted in high prescription drug prices, restricted patient access to pharmacies, and the negative impact of limited formularies.

    Impact of PBMs on employers/payers

    Payers can benefit from a PBM through management of prescription drug benefits for members. Because the contracts are often one-sided and complex, partnering with PBMs often results in limited savings.

    Only 30% of employers understood the clauses of their PDM contracts, according to a study by the National Pharmaceutical Council.

    Research from Cigna showed that employers sponsoring their own health plans can save annually with integrated medical and pharmacy benefits. They can also bolster member patient care and self-management.

    Although tackling prescription spending without the help of a PBM is beneficial, employers/payers still need to weigh the pros and cons of partnering with PBMs.

    Lack of Regulation and Transparency

    Through all these scenarios, a commonality is the lack of federal regulation and transparency that allowed PBM practices to take advantage of their role in the healthcare marketplace and make money at the expense of patients, payers, and pharmacies.

    Something needs to be done.

    Lawmakers are pushing to fill in what's lacking and make PBMs more accountable.

    In California, legislations are being proposed to boost transparency in PBM dealings. One of these legislations require pharmacy benefit managers to provide information about how much they paid for a drug, including administrative fees, acquisition costs, and rebates received.

     

     

     

     

  • 17 Feb 2019 5:15 PM | Anonymous


    The Pet Medication Market Is

    Growing, Providing Opportunities For

    Independent Pharmacies

    In 2015, Market research firm Packaged Facts published a report called Pet Medications in the U.S.: Over-the-counter and Prescription Remedies as Consumer Products, 3rd Edition which estimated the pet medication market to be a $10 billion industry by 2018. More families are now keeping pets and are treating them as members of the family which means that owners are willing to spend for grooming and medication for their furry creatures. It’s this concern for the welfare of animal companions that will drive the growth of the pet medication market. In fact, the American Pet Products Association estimates expenditure in the pet industry to be $69.36 billion in 2017.

    In 2013, pet medication sales hovered at $7.6 billion. That figure is now bound to increase at an annual growth rate of 5% by 2018 to $10.2 billion. The study by Packaged Facts looked into different areas including parasite prevention and control, behavioral health, cognitive dysfunction, heart health, ear care, obesity/overweight, and allergies.

    Veterinarians have, for years, dominated sales of veterinary prescription and over-the-counter drugs. However, that started to change in the late 90s when establishments such as brick-and-mortar shops and online retailers began to take larger control of the market share. In 2013, veterinarians accounted for 58% of pet medications – although still a large amount, the percentage two years prior was 63% which shows that there is growing competition from retail stores.

    Independent pharmacies can take advantage of the growth of the pet medication industry by offering pet prescription medication. This idea could work best in areas where residents need to travel many miles just to get to a specialist store that sells medications for pets. Doing this is advantageous for local pharmacies because they will be making it more convenient for pet owners to get prescription medication for their dogs or cats without having to travel a long way.

    Providing pet prescription medication also allows an independent pharmacy to build relationships with the local veterinary clinics. Clinics can refer their pet owners to an independent pharmacy which provides the prescriptions they need for their furry companion.

    There is growing concern among veterinarians that pet owners will no longer be turning to them for advice to rely on lay people instead. Independent pharmacies can address this concern by establishing relationships with veterinarians in their local area. For example, pharmacies can supply the medication prescribed by a vet for a local resident’s pet. The scenario would be one of collaboration instead of competition.

    Independent pharmacies can even partner with local veterinarians to provide information needed by pet owners to keep their companions happy and healthy. On top of that, local pharmacies can also supply specialty pet products.

    While it’s true that some veterinarians might lose profits with pharmacies and other retail outlets taking a share of the pet prescription market, there are always areas where they can join heads for the benefit of local pet owners and their furry creatures. Besides, the Federal Trade Commission criticized the established policy of selling medications only through veterinarians in 2015. In a report called Competition in the Pet Medications Industry Prescription Portability and Distribution Practices released in May 2015, the FTC cited broader access to portable prescriptions, greater choice of generic drugs, and wide access by non-veterinary retailers to supplies as consumer benefits of the increased completion in the pet medications market.

  • 14 Feb 2019 6:14 PM | Anonymous

    How Pharmacists Can Survive Amazon


    Darshan Kulkarni Pharm.D, MS, Esq.

    Amazon has made several recent moves including hiring new health IT experts, and physicians to make a big foray into health. Their recent disclosure that they want to enter the pharmacy world and their recent acquisition of PillPack makes pharmacists go - what does this mean for me? Will there be a reduced need for pharmacists?

    As Global Positioning Satellites (GPS) became increasingly popular, the demand for cartographers dropped significantly. Digital maps created and updated in real time compared an individual’s current location to their desired location and told the individual how to get to the final location. Cartographers began to worry about their jobs and livelihood. Amazon’s overtures into pharmacy have similarly concerned pharmacists. However, since the concerns are similar, maybe the results will be too. There is a projection that between 2016 and 2026, the demand for cartographers will increase by 19%. This is attributed to an increased use of maps by government planning such organizations and the realization that there are some responsibilities that cannot be automated and delegated away. Similarly, pharmacists who hope to operate like they did 20 years ago are unlikely to survive. However, those who adapt, would likely be very much in demand.

    What Amazon taketh away, Amazon may also giveth

    Amazon has rarely been a manufacturer. Amazon typically connected businesses with potential clients and served as a marketplace. The marketplace originally started as being a place for them to sell their wares, but eventually expanded to become the Amazon Marketplace where anyone can use Amazon as a virtual store and sell their goods. As most know, goods sold by sellers on Amazon often compete against goods sold by Amazon itself, and the orders may often even be fulfilled by Amazon. Amazon has been happy to do this because they still make a profit with such an arrangement. So, one must wonder whether the pharmacy of the future will become a competitor to PillPack or will instead partner with them.

    Accordingly, pharmacists may be able to compete or deal with a post-PillPack pharmacy in one of the four following ways:

    • 1)     Amazon Marketplace

    Competing against PillPack in the near future will likely require demonstrating specialization and knowledge. Cartography grew because of the creation of Hyper-Local Communities (HLCs), These HLCs looked at the location of the nearest Dairy Queen but also looked for shops surrounding the Dairy Queen? This was unable to be achieved by large mapping companies. In the case of pharmacy, pharmacists could develop a specialization by connecting with unique providers or providing unique services or simply products that cannot be easily mailed. This may include veterinary prescriptions, schedule II drugs, specialty drugs, emergency antibiotics, compounding or providing uniquely personalized care.

    • 2)     Delivering Services

    While Amazon has excelled at delivering goods, it has not demonstrated expertise in delivering services. As a result, CVS and Walgreens are looking to capitalize by partnering or hiring nurse practitioners or other mid level professionals and enabling them to engage with patients. Because these providers may be more likely to educate their patients at the pharmacy, diagnosed patients may find fulfilling their prescriptions on site to be more convenient.

    • 3)     New Partners

    Pharmacists traditionally think of Prescription Benefit Managers (PBMs) as their enemies. However, despite PBMs and Group Purchasing Organizations (GPOs) who are all supposed to theoretically help patients by keeping costs down, pharmacists feel squeezed and don’t have enough of a margin. With a new Amazon entrant, a pharmacy may now effectively assert that PBMs, GPOs and Pharmacies are likely to perish if they don’t survive together. Accordingly, this may enable better pricing opportunities and better opportunities for patients.

    • 4)     Branded Prescriptions

    Being a pharmacist in the Amazon Marketplace may enable prescription fulfillment across the state if not the country. Amazon Marketplace may enable a pharmacist sitting in New York City to sell a prescription to a patient in Albany. In some cases, the pharmacy itself may deliver to the new patient, or create a new category of “celebrity pharmacists” who simply are trusted to provide appropriate care, while a PillPack may do the actual fulfillment and delivery of the prescription.

    Concerns

    While Amazon’s entry may provide interesting partnering opportunities, it is important that pharmacists consider relevant laws. The stark, anti-kickback, False Claims Act and civil monetary penalties law will each come into play. Accordingly, pharmacists hoping to partner with other providers, but should be careful with such endeavors since it may expose them to potential legal liability.

    The Future

    It seems likely that a push by Amazon into pharmacy may impact individual pharmacists who may see a decrease in patient volumes. This is likely to scare pharmacies and pharmacists. However, it seems like this may be a temporary situation and lead to more opportunities in the future.

    If you are interested in hearing more about how Amazon affects pharmacists, the implications of an Amazon Pharmacy and patient centricity, or how Amazon’s Prime membership discounts might work with medications, search for the Pharmacy Podcast Network wherever you listen to your favorite podcasts or reach out to me directly on Twitter (@DarshanTalks).

     

  • 7 Feb 2019 6:22 PM | Anonymous

    The Pharmacists Role in Disease State Management Programs


    Disease management aims to prevent or minimize the effects of a disease through integrated care. This involves disease management programs that are designed to improve the quality of life and health of persons with chronic conditions and to reduce healthcare costs associated with complications that are completely avoidable.

    The idea is to treat chronic conditions more quickly and more effectively so disease progression can be slowed down.

    Disease management uses a system of coordinated health-care interventions and one that empowers individuals to work with different health care providers to prevent complications and manage the disease. It operates on the basis that educated individuals are better able to manage their disorder because they know where to seek and receive better care.

    A comprehensive disease management program comes with more benefits.

    • Improve access to care
    • Improve patient self-management
    • Improve safety and quality of care
    • Save patients from high financial costs without sacrificing quality or patient satisfaction

    Furthermore, it enhances the efforts of healthcare providers to improve the healthcare programs offered on a population basis. Care coordination is one of the primary concerns of these providers and an integrated multidisciplinary disease management program is the solution.

    One of the members of the multidisciplinary team of providers are pharmacists who play a role in assisting individuals in managing their conditions.

    What is their role in disease management programs exactly?

    Pharmacists in Disease Management Programs

    A pharmacist deals with both patients and health care providers, making them a link between the two even when the interaction is not linear.

    Trained pharmacists, for example, can evaluate medication therapies and identify drug-related problems, enabling them to help patients manage these problems.

    On the other end of the spectrum, a pharmacist can educate physicians about treatment guidelines based on outcomes research conducted.

    This is why pharmacists have a significant impact on the development and implementation of disease management programs. Whenever improvements are needed, they can also provide expert information, especially on medications and pharmacotherapy.

    In a published study entitled Pharmacist-Led Chronic Disease Management: A Systematic Review of Effectiveness and Harms Compared to Usual Care, increased involvement of clinical pharmacists are encouraged.

    It is believed that their role in patient care will enable patients to have access to primary care services and improved health care.

    This was backed by the H.R.592 - Pharmacy and Medically Underserved Areas Enhancement Act that was recently introduced in House. The bill aims to improve access to health care through the patient care services offered by pharmacists.

    It will also help established two things:

    • Pharmacists as healthcare providers
    • Pharmacists’ services covered through Medicare part B, especially in medically underserved communities.

    It is clear that pharmacists must be involved in disease management programs. Their involvement varies depending on each practice setting.

    • Assists in the identification of patients
    • Conduct monitoring for specific diseases
    • Provide patient education
    • Provide direct patient care
    • Help ensure medication adherence
    • Help reduce inappropriate medication use
    • Evaluate disease management program outcomes

    Different Pharmacist Interaction with Patients with Different Diseases

    Depression

    According to the US Preventive Services Task Force's (USPSTF), screening for depression can help reduce or eliminate depression symptoms, something that pharmacists can help with.

    As a member of a collaborative care team, a pharmacist can:

    • Carry out depression screening services.
    • Monitor patients who are predisposed to depression symptoms because of their medication regimens.
    • Educate and communicate with patients in print or verbally.
    • Identify symptoms of depression in patients who avoid seeking medical help because of the social stigma of mental health issues and then extend support.
    • Make themselves accessible for advice on health care and depression medication and adherence.

    Diabetes

    Blood glucose testing and other routine and simple tests are offered in pharmacies. For diabetes patients who do not have an established relationship with a primary care physician, this option provides a more accessible and less-expensive alternative.

    These tests are then used by pharmacists to identify those with potential diagnosis and to help them find appropriate medical attention. As the most accessible healthcare provider, pharmacists are key in the betterment of diabetes patients’ health.

    • Educate patients about the disease through educational programs often carried out in a less formal setting.
    • Educate patients on how to use blood glucose monitor equipment at home.
    • Regularly monitor glucose levels both self-tested and laboratory tested.
    • Monitor patient compliance with scheduled clinic and laboratory appointments and prescribed therapies.
    • Provide medication management and review.
    • Screen for interactions and infrastructure actions for drug/drug, drug/food, drug/lab and drug/disease.

    Asthma

    Pharmacists not only provide asthma patients with the medication they need but also valuable resources to help them understand pharmacological agents for treating and managing their disease.

    Their knowledge about the disease and recommended medication are valuable and beneficial to patients. Recent studies show that increased awareness about asthma reduced the numbers of asthma-related missed days at school and work, hospitalizations, emergency department visits, and deaths.

    • Educate patients about the proper use of inhalation devices, especially those that are overwhelmed with diagnosis and treatment plans.
    • Provide educational programs with an emphasis on warning signs of asthma attacks, triggers, and patient adherence.
    • Conduct a periodic review of the kind of inhaler technique patients’ use.
    • Regularly monitor peak-flow function tests.
    • Ensure compliance assistance and manage chronic medication use.

    Hypertension and Cholesterol

    When the American Heart Association released its new guidelines that specify 130/80 is the new high, many people found themselves with high blood pressure. This added 30 million people to the nearly half of Americans that have hypertension.

    While the new guidelines spelled bad news for patients, it offers independent community pharmacies an opportunity to further serve them and boost business at the same time.

    • Offer patients blood pressure screenings.
    • Assist with medication adherence and prescription management.
    • Assist patients with smoking cessation program.
    • Educate patients about hypertension and cholesterol, their effect on life and health, and the common comorbidities and conditions.
    • Monitor compliance with diet and exercise regimens.
    • Perform periodic blood pressure and cholesterol level checks.
    • Screen for interactions and infrastructure actions for drug/drug, drug/food, drug/lab and drug/disease.

    Conclusion

    Disease management programs are an opportunity to improve patient outcomes. But it can only be achieved with complete commitment from the members of the multidisciplinary team. In terms of collaborative development and the implementation and improvement of disease management programs, the pharmacist has the leadership role.

    Submitted by Prestige Pharmacy | Michigan 

    Sources:

    http://www.amcp.org/WorkArea/DownloadAsset.aspx?id=9295

    https://www.ncbi.nlm.nih.gov/books/NBK362935/   

    https://www.congress.gov/bill/115th-congress/house-bill/592  

    https://www.pharmacytimes.com/publications/issue/2017/august2017/pharmacists-can-play-important-role-in-depression-screening

    https://www.pharmacytimes.com/contributor/marilyn-bulloch-pharmd-bcps/2017/11/pharmacists-play-a-key-role-in-diabetes-management

    https://www.pharmacytimes.com/publications/issue/2014/april2014/managing-asthma-the-pharmacists-role  

    https://www.pbahealth.com/high-blood-pressure-guidelines/

  • 1 Feb 2019 9:00 AM | Anonymous

    Donald Trump

    How the Trump Administration’s New Proposals Will Affect PBMs

    "We're very much eliminating the middlemen. The middlemen became very rich. They won't be so rich anymore."

    This is what President Donald Trump said during a speech back in May, regarding prescription drug prices. His administration is focused on four key strategies that will help consumers save from their trips to the pharmacy.

    His proposals are in sharp contrast to his campaign promise of allowing Medicare to directly negotiate with drug makers because it is designed to give private health plans more flexibility to negotiate discounts for Medicare-covered seniors and to increase competition.

    The Department of Health and Human Services are also given the following directives:

    • To allow more substitution through part D four single-source generics
    • For health plans to share with patients a minimal portion of drug rebates
    • For Part B price increases to be limited above the inflation rate.

    Although President Donald Trump blamed everyone involved in the broken system—from the drug makers to the government, his harshest comments are focused on the middlemen, specifically the pharmacy benefit managers (PBMs).

    How the New Proposal Will Affect PBMs

    Potential restriction of the use of rebates

    When it comes to rebates, drug makers and PBMs are blaming each other.

    Manufacturers blame PBMs of profiting off higher list prices because they have the power to negotiate for bigger discounts. Pharmacy Benefit Managers, on the other hand, blame drug makers for setting the drug prices high in the first place.

    This led the administration to question the entire system of rebates as a means for the pharmacy channel to negotiate discounts.

    According to Health and Human Services Secretary Alex Azar, "Because right now, every incentive is for the drug company to have a very high list price and to negotiate list price down, often in a very nontransparent way."

    This increases the possibility of restricting the use of rebates. The same is true with discounts of drug prices that PBMs negotiated with manufacturers.

    Push for transparency

    Aznar has directed Food and Drug Administration Commissioner Scott Gottlieb to look into the possibility to publish list prices in job advertisements, making it a requirement from drug manufacturers.

    "Think about all the time everybody spends watching drug company ads, and how much information companies are required to put in them. If we want to have a real market for drugs, why not have them disclose their prices in the ads, too?" Azar said.

    PBM transparency has been one of the areas that many legislators want established and passed as law. Currently, pharmacies are bound by the gag clauses in the contract with PBMs not to disclose the actual price of a drug or to inform consumers of a cheaper alternative for their prescription drugs. But with drug prices listed in an advertisement, nothing could be clearer.

    Trump's policy may lead to more price transparency. It will also give everyone a better understanding of the role of a PBM.

    Passing along pharmacy discounts

    The Trump administration proposes that the pharmacy discounts that the government gets from drug manufacturer rebates should be passed along to beneficiaries with Medicare at the point of prescription sale.

    According to the Pharmaceutical Care Management Association, “We also support the patient always paying the lowest cost at the pharmacy counter, whether it's the cash price or the copay.” Something that is already standard in the commercial sector and Medicare.

    Last month UnitedHealth Group said they will pass along pharmacy discounts from drug manufacturer rebates to their fully-insured customers at the point of a sale.

    Express Scripts and CVS Health praised the administration for their efforts in tackling the costs of prescription drugs.

    What do the PBMs think about the Trump administration's new proposals?


    References/Sources:

    https://www.cnbc.com/2018/05/11/president-trump-unveils-prescription-drug-price-plan.html

    https://www.healthleadersmedia.com/finance/eliminating-middlemen-trump-takes-aim-pbms-drug-pricing-speech

    https://www.forbes.com/sites/brucejapsen/2018/05/11/trump-doesnt-know-who-middlemen-are-but-pbms-okay-with-his-drug-price-proposal/#5e1f31c53295


  • 4 Jan 2019 6:32 PM | Anonymous

    Ways to Prevent and Protect Your Pharmacy from Internal Theft!

    In Volusia County, Florida a newly hired pharmacy tech was arrested for stealing more than a dozen bottles of prescription drugs. This is the second drug arrest in three weeks, with the first arrest made on May 25, 2018.

    Last January 12, 2018, a Houston man was convicted by a Fort Bend County jury of felony misapplication of fiduciary property. Jorge Alberto Perez was caught stealing from the pharmacy when an internal audit showed a shortage of prescription drugs in the period of 2009 to 2010.

    These cases of theft cost pharmacies major losses. In 2011, the cases of employee theft total an average of $996.

    But with the outrageous prices of prescription drugs and the lure of controlled substances, pharmacy theft is a potential risk in a pharmaceutical business.

    Pharmacy personal steal because of:

    • Personal use or personal gain
    • High-street values of some control prescription substances
    • Opportunities due to a pharmacy’s lack of understanding about drug diversion and prevention practices

    According to a study conducted by the Auburn University's Harrison School of Pharmacy, approximately 10% of pharmacists become chemically impaired at some point in their career.

    A survey conducted by the University of Georgia also showed that:

    • 40% of the pharmacists take regulated prescription substance without a prescription.
    • 20% admitted to repeated use.

    These numbers show that the issue of internal theft should be addressed once and for all. It is the best way to prevent business loss and ensure theft doesn't go unchecked.

    How to Prevent Pharmacy Internal Theft

    Vet employees thoroughly

    Didn't they say that prevention is better than cure? Before you take anyone on board, it is important to conduct thorough reference and background checks. Due to lack of prosecution, embezzlers and thieves often move from one practice to the next. Don't be the next victim.

    Treat your staff well

    They will think twice about stealing from you if they have competitive salaries, benefits, and other perks. Combine that with consistent coaching and feedback and your staff would feel as much a part and accountable with your pharmacy as you are.

    Implement accounting controls

    Financial transactions should be carried out by trusted individuals.

    Different people should handle different financial transactions—review of electronic transfers, prepare checks, sign checks, and regular EHR reconciliation.

    In addition, appoint partners to conduct periodic spot checks and hire an independent accountant to review the financial records of your pharmacy.

    Implement point-of-sale (POS) solutions

    • All POS systems today have a biometric fingerprint that helps ensure employees don't steal or share passwords. Through the use of a fingerprint sensor to access the system and run the register, you can beef up security and trace theft easily.
    • Limit the discounted amounts that a cashier can give at a register. A robust POS system will allow you to pre-program amount limits.
    • Better cash management, what with a full-featured POS solution equipped with tools that help manage cashier activities, allow an additional level of employee auditing, and thorough reporting.
    • Automatic discounting can be pre-programmed for certain groups of customers, such as loyal customers, senior citizens, and employees. Since the machine, automatically give discounts, the discounting decisions are taken off the hands of cashiers, some of which may struggle to give the correct change or identify whether a customer is due a discount or not.

    Verify vendors

    This is one way to ensure that there is no conflict of interest to your practice. Thieves and embezzlers are capable of many things, including fabricating vendors. So make sure that you verified vendors and run a thorough check.

    Conclusion

    Theft of any kind is often a combination of motive and opportunity. So make sure that your pharmacy leaves no opportunity for employees to steal from you. Set up the security measures listed above to deter and prevent internal theft.

    Sources:

    https://www.wftv.com/news/local/newly-hired-pharmacy-employee-caught-on-camera-stealing-drugs-deputies-say/770376412

    http://fbindependent.com/cvs-pharmacy-employee-convicted-for-theft-of-drugs-p11822-106.htm#puzzle,1422,1533684530504

    https://losspreventionmedia.com/insider/employee-theft/drug-diversion-preventing-retail-pharmacy-theft/

    https://www.healthcarefinancenews.com/news/medical-practices-can-make-it-harder-employees-embezzle-money-these-basic-steps

    https://www.rm-solutions.com/blog/bid/199131/Top-5-Ways-to-reduce-employee-theft-in-your-pharmacy

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