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PHARMACISTS: MANAGING THERAPY IS CRITICAL

Pharmacy has been weathering a tough storm over the past few years. Though scripts are up, gross profits are being squeezed due to the growing third-party payment system.There's no question that managed care will be a driving factor in the evolving health care system. What concerns pharmacies is whether they'll get sufficient reimbursement and whether patients will have free access to their pharmacies

Pharmacy has been weathering a tough storm over the past few years. Though scripts are up, gross profits are being squeezed due to the growing third-party payment system.

There's no question that managed care will be a driving factor in the evolving health care system. What concerns pharmacies is whether they'll get sufficient reimbursement and whether patients will have free access to their pharmacies of choice. Pharmacies have been aggressively working to demonstrate that they're fully able to manage a patient's therapy program. "Chain pharmacy has long advocated that it can manage care as well as a managed-care plan," said Phil Schneider, director of public relations at the National Association of Chain Drug Stores, Alexandria, Va.

Pharmacies need to continue developing ways to hold onto their patients. Five states -- Delaware, Maine, Nebraska, Texas and West Virginia -- have adopted "Medicaid Pharmacy Carve-Out" legislation, which enables Medicaid recipients to choose their own pharmacy. New Jersey, New York, New Mexico, Pennsylvania and Georgia have proposed similar resolutions. There are other issues associated with managed care. One of the most pressing concerns is discriminatory pricing. Retail pharmacies claim drug manufacturers offer discounts to bulk buyers, such as health maintenance organizations and mail-order firms. Discounts vary, but reportedly average 15%.

The subject has been controversial for over a decade, and recently was brought to the public's attention due to a proposed $408 million class action settlement by 13 large drug manufacturers, negotiated on behalf of almost 40,000 pharmacies. Most retail pharmacy organizations, including NACDS and NARD, Alexandria, Va., representing independent retail pharmacy, opposed the proposal, saying that while it would give them some financial relief, it would not prevent the two-tiered practice from continuing. A federal judge last month turned down the tentative settlement and, as a result, the case is going to court tomorrow.

"Discriminatory pricing is one of the most critical issues for us," said Louis Mitchell, president of NARD. "We're delighted that the judge turned it down, because it didn't cover important issues, mainly a cease-and-desist order." Another important issue in today's pharmaceuticals environment is disease state management, which is when pharmacists get more actively involved in a patient's therapy. At a time when profits are in jeopardy, pharmacies need to look for other ways to get revenues. NARD is helping pharmacists provide such services through the National Institute for Pharmacy Care Outcomes, an organization it created last year. NIPCO creates educational modules that show pharmacists how to institute drug therapy programs. NIPCO provides information on data collection and drug therapy. At present, it has developed modules for diabetes, asthma and cardiovascular disease programs. "Third-party reimbursements are being ratcheted down. We believe there will come a time when reimbursements will be made through disease state management, rather than fee-for-service," Mitchell said. But pharmacists cannot provide adequate patient therapy if they don't have assistance. To help in this area, pharmacies need to develop and define a greater role for the technician.

Equally as important is obtaining more responsibility for pharmacists. Efforts currently are under way to obtain "prescriptive authority," which would allow pharmacists to prescribe certain drugs for certain indications if there's a written agreement with a physician or physicians' network.