COORDINATED CARE NET ENTERS PHASE II

JANICE ZOELLER

SEATTLE -- Phase II of Merck-Medco's plan for its Coordinated Care Network was unveiled here at the 141st annual meeting of the American Pharmaceutical Association to mixed reviews. The plan, which began this month, will pay pharmacists to perform certain services.

Supermarket pharmacists expressed reservations about Coordinated Care, which has received the endorsement of APhA.

One supermarket pharmacy director who attended the APhA convention said his company has joined the network but he is not happy about many aspects of the program. "They are using the pharmacist to move market share," he said. "That's not my job. My job is to take care of patients. We should be choosing for the patient."

However, this pharmacist was supportive of APhA's endorsement. "They are trying," he said of APhA. "They stepped up to the plate. It's a start. Maybe something good will come of it."

Phase I of Coordinated Care, started in January, pays pharmacists slightly higher dispensing fees for increasing use of generic drugs in participating plans and increasing the use of "preferred drugs," those for which the network has secured rebates from manufacturers.

Lowell Anderson, president of APhA, and owner of an independent pharmacy, addressed some of the concerns in his opening speech titled, "Reality as a Way of Life."

"I don't know if I liked it or not when Merck bought Medco. I am not sure, either, whether I would like it if Merck-Medco were to buy my drug wholesaler. And, when they, in turn, buy the chain pharmacy that operates in my town. And, when they buy the hospital that owns the doctors' office that I practice with.

"In reality, it doesn't matter whether or not I like it. It doesn't matter if you like it. Because it is a reality. Our challenge is to be a part of it. If we are not a part of it, we are a part of nothing. We

are out of business.

"Being on the outside isn't fun," he said. "Just ask some of our colleagues who can no longer service their patients who are in the Federal Employees Program or who work for General Motors. These patients disappeared just as surely from many of our practices as if they had been whisked to another planet. They didn't leave because of bad services or bad location. They left, overnight, because a network of corporate drug stores agreed to provide prescriptions for these groups, at fees that most reasonable people could not accept."

Anderson described Coordinated Care as "the first managed care initiative that appears to recognize that pharmacists can positively affect drug costs and would pay us for our efforts."

With Phase II, the network will also pay for "a very rudimentary form of case management." He acknowledged that the program falls short of paying pharmacists for providing pharmaceutical care. "In the context of the current managed care environment, however, it is a significant first step."

Enrollment in the Coordinated Care Network now exceeds 46,000 pharmacies nationwide, according to Wayne Gattinella, executive vice president of marketing at Medco Containment Services. Some 42 plans are contracted on Coordinated Care Network, representing over 1.5 million lives, with more expected to be added in July, said Gattinella. Merck-Medco has invested between $3 million and $4 million in the Coordinated Care program, he said.

"We have made a decision to reinforce our relationships with community pharmacists," said Gattinella. "We are trying to increase their participation," he said. "We are pitching this to every client." "We are not going to seek to convert people [enrolled in the Coordinated Care Network] to mail-order," said Gattinella. However, he said the company will continue to offer the option of mail-order to plan sponsors.

The Phase II programs consist of patient monitoring and counseling, "purchasing assistance" and a pilot study. Coordinated Care reimburses pharmacists for three types of patient monitoring: affecting senior citizens, prescription screening and disease management.

Under the seniors counseling program, to start May 1, pharmacies that conduct drug regimen reviews for patients taking eight or more medications concurrently will be paid an annual fee of $10 per patient counseled.

The prescription screening program pays the pharmacist a dispensing fee even if a product is not dispensed because of a drug-drug interaction.

The disease management program is said to provide the "clinical framework" to involve pharmacists in patient-physician consultation, intervention and patient compliance management.

The first therapy area to be included under disease management is asthma. Pharmacists are encouraged to identify asthma patients who may not be realizing the full benefit of drug therapy. They then counsel patients about the importance of compliance and proper use of their medications, and recommend changes in drug therapy regimens in conformance with accepted medical guidelines.

For performing these disease management functions related to asthma, pharmacists could receive up to $15 per patient.

Smoking cessation, diabetes and osteoporosis will be added in the third quarter, with allergic rhinitis and gastrointestinal disease care modules to follow in the fourth quarter. Under the "purchasing assistance" portion of the plan, to begin later this week, pharmacies can purchase generic drugs through West Point Pharma at a reported savings of 10% to 20% over comparable generic source programs. Rebates are earned on all drugs purchased from West Point Pharma. Finally, Merck-Medco is funding a pharmacy pilot program, in conjunction with APhA, "to identify how community pharmacy practice can be 're-engineered' to accomplish these patient care goals. "APhA has made a lot of promises, too," said Anderson. "These promises are about what pharmacists can do to lower health care costs and to improve patients' quality of life. Now it is time to make good on those promises, and that's going to require the efforts of all of us -- the pharmacists of America."