Each year, we say good-bye to the current year and welcome in the New Year full of hope and aspirations for a successful year ahead. Customers turn out in droves for “New Year, New You” specials and when they reach the register, the retail pharmacy world knows the scenario quite well. In a few short weeks’ time, you and your staff will be asking these all too familiar questions, “Did you have any insurance changes? Did you have a change in benefits? Did you know your brand drug is now available in generic?” and so on. Here are a couple of things to keep in mind as we approach 2013 with new opportunities:
Drug pricing changes
- January continues to be the month with the most price increases as published by the drug compendiums. Make sure that you utilize some of the tools out in the marketplace to help you manage these changes.
- Plan reimbursement schemes change bringing new profitability challenges at the drug level.
Health plan changes
- New plans are published with new design parameters.
- Members have new plans. Many times members don’t have their new cards yet. Again, this is another opportunity to use tools to improve your patient interaction to make sure everything goes smoothly.
- Deductibles are reset (including Medicare Part B!).
Drugs scheduled to come off patent in 2013
- Opana ER
In addition to these changes at the beginning of the year, there are some additional activities, particularly in regards to government regulations, which are anticipated to occur in 2013 as well:
Track and trace – attempts by the Prescription Drug Security Alliance in 2012 to create a national, uniform solution did not make it through Congress, but watch Congress for another try in 2013.
Prescription drug monitoring program (PDMP) – Legislation was recently introduced to the House with intents to create an efficient, cost-effective system for states to share information from their respective PDMPs. Forty-eight states have authorized PDMPs to facilitate the exchange of information among doctors, pharmacists and authorized law enforcement, but currently, there is no national standard for the exchange of such information across state lines. This legislation, if approved, would address the standardization of interstate data sharing.
Medicare Part D – changes in the Medicare program continue to be an ever evolving situation. Premium and deductible changes along with cost-sharing changes in the coverage gap are scheduled to take effect in 2013.
Quality programs – The delivery of care via retail pharmacy continues to grow. And as these programs grow, expanded services are expected as well.
- Medication Therapy Management (MTM) programs will feature more pharmacists consulting with patients on the medications they are prescribed.
- AHRQ has released two assessment tool kits:
- Patient Safety Culture Assessment Tool
- MATCH Resource to Improve Medication Reconciliation
With the New Year, you have even more reason to stay diligent, be prepared and know what is happening in the marketplace. More and more of the pharmacy business is impacted by external events. Tools exist to help you manage many of these changes. Contact your vendors, stay active in the community. There are numerous opportunities for you to be ready and have a great 2013.
Emdeon VP of pharmacy network services
As VP of pharmacy network services at Emdeon, Paul Hooper directs the company’s pharmacy network services initiatives with a focus on developing programs, standards and partnerships that increase pharmacy efficiency and reduce healthcare costs. Paul has spent more than 25 years in the healthcare industry with a predominant focus in pharmacy. During this time, he has held roles in product development, systems, finance and operations at various recognized industry leaders: BASF, Abbott Laboratories, Cardinal Health, ArcLight and Emdeon. He holds a master's degree in business administration from Ohio University and a bachelor of science in food science from The Pennsylvania State University.
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