PHARMACY

NCPA and three Oregon legislators push for greater oversight, transparency of PBMs

BY Michael Johnsen

ALEXANDRIA, Va. — The National Community Pharmacists Association on Wednesday urged Oregon state lawmakers to pass a series of bills that would "collectively reduce red tape for pharmacists caring for patients, give consumers greater pharmacy choice at no extra cost, and keep more revenue within the state."

NCPA has identified four issues of import:

  • The first is setting reasonable standards for pharmacy audits to protect against fraud without abusing the system. According to NCPA, audits claim thousands of dollars from Oregon pharmacists and small business owners even when the correct medication is dispensed to the correct customer for the correct price. Recently, 22 different states have passed audit reform legislation, the association noted;
  • Second, legislation that would focus on freeing patients from requirements that use out-of-state mail order pharmacies by allowing them to transfer their prescription to a local pharmacy that agrees to accept the same terms and conditions, including reimbursement rates. This legislation is similar to that adopted in the last legislative sessions in both New York and Pennsylvania. National consumer surveys conducted by J.D. Power and Associates, Consumer Reports and others have documented patients’ preference and higher satisfaction rates with local pharmacies, NCPA noted;
  • Third, maximum allowable costs are the system PBMs use to determine how much they will reimburse pharmacies, mostly for generic prescription drugs that comprise 80% of what is dispensed to patients. Unfortunately, pharmacies are kept in the dark about the pricing changes for these products, NCPA stated. "Thus, these small business providers are ‘flying blind’ in terms of taking into account the operating costs of their prescription drug inventory. The legislative remedy would allow pharmacists simply to know how the MACs are determined and make sure that timely updates are made to reflect market prices."; and
  • Fourth, NCPA is addressing the lack of transparency in PBM contracting practices. "Health plan sponsors and patients are left in the dark about the validity and soundness of how their prescription drug benefits are being administered. Greater transparency into this often secretive and byzantine sector can facilitate better evaluation of PBM performance."

Spear-heading the effort is State Rep. Jules Bailey, D-Portland, who has organized a bipartisan working group with State Reps. Jim Thompson, R-Dallas, and Margaret Doherty, D-Tigard, to generate consensus solutions. 

“My interests in this legislation come from listening to my constituents,” Bailey stated. “Patients tell me about their maddening experiences navigating the PBM bureaucracy to get vital prescription drugs at a reasonable price and in a timely fashion. Pharmacists tell me about how PBMs squeeze them to the breaking point as a result of the onerous, take-it-or-leave-it contracts they must sign to have access to patients and about abusive PBM audit practices. The universal complaint is that the current system is broken," he said. "When people learn about all the questionable business tactics PBMs are allowed to employ on a daily basis without any accountability they are amazed. … While regulation for regulation’s sake is not a panacea, the utter lack of regulation when it comes to the PBM industry must end. I hope my fellow legislators, the governor and people of Oregon will join us in demanding reform. Without these proactive steps patients, health plan sponsors and pharmacies will continue to get the short end of the stick.”


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PHARMACY

Hamacher, HDMA report analyzes front end as profit driver for independent pharmacy

BY Michael Johnsen

WAUKESHA, Wis. — Over-the-counter products across the front-end are becoming a more and more important profit driver for independent pharmacy operators, Hamacher Resource Group and the Healthcare Distribution Management Association revealed Wednesday as part of new research titled "Independent Pharmacy Shoppers: Who, What, and Why?" The report places a spotlight on the independent pharmacy front-end customer and helps identify shopper behaviors, purchase preferences and potential barriers that stand in the way of further engagement with independents.

According to the 48-page report, as many as 73% of pharmacists surveyed reported their front-end businesses were either growing or holding steady. And according to the research, as the frequency of shopping trips increased, so did the corresponding percentages of OTC and personal care purchases. In other words, the more often an independent pharmacy patient visited the store, the more likely they were to walk out with an OTC or beauty-care item in their shopping bag each trip. "The average independent [made] 10 recommendations per day for OTCs," Dave Wendland, VP, told attendants to a webinar hosted by Hamacher and HDMA Wednesday afternoon.

To help maximize productivity of an OTC set within the independent setting, set planograms and point-of-purchase materials are a good starting point, Wendland suggested.

"Among all shoppers interviewed, those who spent approximately 15 minutes in the store made the most OTC purchases," the report noted. "Those who spent less than 15 minutes in the store made the most purchases of personal care products. The lesson to independent pharmacies is to ensure those 15 minutes are ‘productive’ time. For example, they could train staff to interact with customers by recommending companion purchases. The goal is to match the speed of front-end service with the speed of prescription transactions."

Even as OTC grows in importance for independent operators, the greater incursion of the dollar channel into health and beauty items has emerged as a direct competitive threat to independent pharmacies.

In addition to HDMA, "Independent Pharmacy Shoppers: Who, What, and Why?" was made possible through the sponsorships of AmerisourceBergen, Cardinal Health, H. D. Smith, Johnson & Johnson Sales and Logistics Company, McKesson, Mutual Wholesale Drug Company, Novartis Consumer Health, Smith Drug Company and Value Drug Company.


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Study: Thrifty White’s Medication Synchronization Program improves Rx adherence

BY Antoinette Alexander

PLYMOUTH, Minn. — Regional player Thrifty White Pharmacy, which operates 90 pharmacies in the upper Midwest, is working to enroll patients in its Medication Synchronization Program as a recent study conducted by Virginia Commonwealth University found that those patients taking their medications correctly with the program are more likely to stay well, make fewer clinic visits and require fewer hospitalizations, thus reducing overall healthcare spending.

“The number one problem of treating illness today is a patient’s failure to take prescription medications correctly, regardless of patient age.” stated Dave Rueter, EVP of human resources. “By synchronizing all your prescriptions patients are more adherent and compliant leading to healthier outcomes and healthier patients.”

Through the program, the pharmacy team works with the patient to synchronize all their maintenance medications so that all their prescriptions can be picked up at the pharmacy one time a month verses making multiple trips to the pharmacy. Ten days prior to their prescriptions being filled, the customer receives a call from the pharmacy to confirm the prescriptions to be filled and review any possible medication changes. On the prescription pickup day (appointment day) the pharmacist will review the prescription regimen, monitor changes from any doctor or hospital visits and check for any possible drug interactions.

For the study, data was collected over a 12-month period between 2011 and 2012. There were two arms of the study (Medication Synchronization and control group). Study patients were selected having at least two fills for one of six chronic medication classes.

The analysis indicated significant improvements in adherence and persistence for the Medication Synchronization patients when compared with the control patients for all the chronic medication classes. Depending on the drug class, patients enrolled in the program had 3.4 to 6.1 times greater odds of adherence as controls during the evaluation period, the study found.

Studies from The New England Health Institute estimate that non-adherence, along with improper medication management, results in $290 billion a year in avoidable medical spending on the healthcare system. Poor adherence often leads to preventable worsening of disease, posing serious and unnecessary health risks, particularly for patients with chronic diseases. An estimated one-third to one-half of all patients in the United States do not take their medications as prescribed by their doctors.


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