Public Policy Forum: Healthcare reform means opportunity for community pharmacy owners, experts say

LAS VEGAS — McKesson ideaShare 2013 concluded with a bang, as healthcare and policy experts discussed the implementation of healthcare reform and the impact it will have on community pharmacy during a special Public Policy Forum session held on June 29, the final day of the conference.

“For pharmacy, healthcare reform can mean new scripts and new business. Hopefully it also means front-end business in addition to the pharmacy side,” Ann Richardson Berkey, SVP public affairs at McKesson, told attendees. “One of the most important things you can also look at is the coordination of care. The pharmacy community is the link between all of these settings of care. We have talked about this at McKesson, and we have written about it in comment letters that we have sent to CMS and HHS about how important the pharmacist is in maintaining that care continuum.”

Berkey kicked off the session with a discussion of how the implementation of healthcare reform includes state health insurance marketplaces and the expansion of Medicaid. The creation of the state health insurance marketplaces — more commonly referred to as exchanges — is likely to introduce significant opportunities for community pharmacy owners to serve as an additional educational resource for patients, Berkey told attendees.

The Patient Protection and Affordable Care Act provides premium and cost-sharing assistance to some individuals to make purchasing coverage through the exchanges more affordable. Individuals and small employers will be able to comparison-shop for health insurance coverage through the exchanges, which is open for enrollment on Oct. 1 for coverage beginning Jan. 1, 2014.

All 50 states will have health insurance coverage through the exchanges, Berkey explained, and each state has decided how it will operate: create and manage their own marketplace, have HHS administer the marketplace, or partner with HHS to run some functions of their marketplace. Some states have already received “conditional approval” to start a marketplace in October, she said.

“There will be a lot of publicity starting this summer. Enrollment starts Oct. 1 and goes until the end of March. It may become the longest enrollment period of any insurance plan you’ve ever seen, with the goal of bringing people — especially young ‘invincibles’ — into the program,” Berkey said. “There will be a lot more people at the pharmacy counters wanting to know, “What do I do?, Is my medicine covered?, How do I manage this?”

Berkey noted that there are several ways in which pharmacies can participate in the process. Practical tips the pharmacist should consider include the following:

  • Train employees to provide in-person assistance;
  • Assist with marketing, education and referral activities; and
  • Hang posters, distribute flyers and include messages about coverage on store bags and/or cash register receipts.

Berkey also discussed the expansion of Medicaid and its implication on pharmacy.

“Medicaid expansion is something state legislators and governors have to understand in terms of budget issues,” Berkey said. “Those of you in community pharmacy have a unique role because of the relationships that you have with the customers who come into your stores. Remember that the prescription drug benefits within the increased coverage plan will, fortunately, present an opportunity with more people coming into your stores looking for guidance. Hopefully you’ll be that linchpin in the care continuum,” Berkey said.

Twenty-two states have currently decided to expand Medicaid; however, 10 states currently remain undecided as they grapple with the fact that, eventually, some of the cost will revert to the states.

Following Berkey, Jon Kingsdale, a key architect of Massachusetts’ universal healthcare plan, took to the stage to share his experience as a leader in the 2006 implementation of the state’s healthcare program, which essentially serves as a living lab for universal health coverage for the rest of the country.

Reflecting on healthcare reform in Massachusetts, Kingsdale noted that 67% to 75% of likely-to-vote adults surveyed said they were in favor of the state’s healthcare plan and viewed it positively. The program met two of the key goals of healthcare reform — to lower cost and improve access for patients. Massachusetts currently has the lowest rate of uninsured in the country. Fewer residents have unmet healthcare needs because of cost, and preventative and other services have increased among adults within the state, he said.

Perhaps one of the most profound inventions of Massachusetts’ healthcare plan is the concept that state residents have the option to choose the health coverage plan that best meets their needs. The Affordable Care Act adopts this approach with the new exchanges, Kingsdale explained, and he recommended that pharmacists go online to the Massachusetts Health Connector website to familiarize themselves with the resource. The web portal, serves individuals, families, employees, employers, young adults and brokers, matching each with the coverage options available to them in the state. Echoing Berkey’s comments, Kingsdale noted that all of this activity will create an opportunity for retail pharmacy — and that can mean community pharmacy owners or their competitors.

“Starting in August and September, [the Marketplaces are] going to be out there; they are going to be in the community, and your customers are going to come to you with questions … and it is an opportunity for you or your competitors [to serve as an educational resource for patients],” Kingsdale said.

In anticipation of the throngs of patients that will look to their pharmacists for answers in the months ahead, as implementation of the Affordable Care Act draws closer, Kingsdale noted that the important thing is to have a resource set up to handle these inquiries.

For example, pharmacies could set up in store a computer where patients could access www.HealthCare.gov or other appropriate online resources or a telephone kiosk with phone numbers patients could call for additional information on new coverage options. Pharmacists may also want to consider keeping a log of all of the questions they receive from patients to ensure they have accurate answers readily available.

He also said that each state is going to have well-informed assistors and navigators — individuals and organizations to help educate individuals on enrollment — and he advised pharmacists to establish a relationship with these groups, perhaps inviting them to the store for weekly educational workshops with patients.

“You don’t have to master all of the intricacies,” he said.

Indeed, it is clear that healthcare reform will create as many questions for patients as it will present opportunities for community pharmacy — the key for independent pharmacy owners is to seize the opportunity to be a resource for customers and a destination for answers.

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