PHARMACISTS EXPANDING ROLE IN DIABETES CARE

DAVID VACZEK

Supermarket pharmacists with training in diabetes care are making a difference.

Pharmacists with elevated skills are meeting a large demand for diabetes patient education while furthering food store chains' repositioning of pharmacy for patient care services.

A burst of new state legislation mandating insurers to reimburse providers of diabetes products and services will motivate pharmacists' retraining and enhances the potential for community pharmacy to establish niches in disease management, it was noted.

New Jersey, West Virginia and Oklahoma have passed legislation, which has gone into effect this year, that mandates reimbursement to pharmacists for "cognitive services" given to diabetes patients, as well as payment for diabetes products.

Six other states since the late 1980s have passed laws requiring private insurers to pay for some of patients' diabetes costs. But these three are the first states specifically mandating compensation to pharmacists for their care, said Allen Nichol, chief executive officer of the New Jersey Pharmacists Association, Trenton, N.J. "We were the first state to recognize pharmacists under a mandate for compensation for diabetes care services," said Nichol.

In New Jersey, pharmacists may be paid from $30 to $140 for diabetes education and management services, which will range from "a telephone call of five minutes to full-blown intervention," under a law effective Jan. 5, 1996. The law requires pharmacists to become certified by completing a course of education approved by the state Board of Pharmacy that will include an experiential component of intervention with diabetic patients.

"We will have trained close to 200 people by the end of this year," said Nichol. He predicts that 5% of the state's pharmacists per year will make the switch to providing clinical services for compensation, with 20% offering services in four years. Pending at the state capital, meanwhile, is a similar measure calling for payment for asthma care.

"I view this as the first big step in the right direction of pharmacists securing reimbursement for services they have traditionally been providing to their patients," said Richard Stevens, executive director of the West Virginia Pharmacists Association, Charleston, W.Va., of that state's law, which took effect June 7.

The mandated insurance reimbursement for diabetes -- which will drive patients' purchases and use of products and services alike -- will prompt more pharmacists to meet the requirements for diabetes educator status and will support chain commitments to pharmacy care, it was said.

According to an industry source, one major supermarket chain, which operates in New Jersey, is now considering launching diabetes health care centers in some stores. The centers would capture new revenues, attract new customers and help set stores apart from competitors, noted a source.

In selective markets, including West Virginia, Kroger is unveiling in all new stores 70-square-foot glass-enclosed counseling areas adjacent to the pharmacy for disease state management services.

With or without the immediate prospect of reimbursement for diabetes services, food store chains have been proactive in reorienting pharmacies toward patient care activities, at least to the extent of encouraging pharmacists to advance their disease state skills.

Pharmacists are retraining in diabetes care and expanding services to aid diabetics who are not receiving the hands-on care they often need in managing a complex and potentially high-cost disease.

"Management is showing an interest and allowing me to go that extra mile. They know it's a great idea to provide any added service that we can," said one pharmacist at an East Coast grocery chain, who has completed the New Jersey certification and begun billing for services from the store.

The pharmacist, in a high-volume chain store setting doing 1,700 scripts per week, advises his patients that he has taken the course, and offers, where needed, to set up a time for private counseling. "We don't have any more time to spend with them than we ever did, but I try to make time," he said.

Patients will take better care of themselves and make more purchases knowing they are getting reimbursed for devices such as test strips, which cost $35 for a 25-day supply. "It has been cost-prohibitive for many patients to stay on top of their disease. Patients are not testing blood glucose daily because of the expense. This is a boon for the pharmacy business," he said.

"Diabetes patients are starved for information. You know their disease hasn't been managed well, and they have not received the education they need to take care of it," said Diane McDaniel-Mah, a pharmacist at Albertson's. McDaniel-Mah is coordinating Albertson's second annual Diabetes Fair, to be held Oct. 12 at the Brea Community Center, Orange County, Calif.