PHARMACY

NCPDP conference preview: D.0, PBMs and HIE, oh my!

BY Paul Hooper

The Emdeon team always looks forward to the NCPDP Annual Conference. The 2012 version is coming up in early May at the Arizona Biltmore. As expected, NCPDP has done an excellent job in scheduling a large number of important and interesting topics. Emdeon’s Lathe Bigler will be discussing the impact of  health information exchanges (HIEs) and accountable care organizations (ACOs) on our industry, and I am scheduled to talk about the industry’s observations and lessons learned regarding the implementation of D.0.

Additionally there will be other great subjects covered:

  • What is “ePrior Authorization” all about? How does this emerging standard affect the interaction between pharmacy, physicians and plans? This is a timely topic as several states have introduced legislation that specifies “point of care” prior authorization language.
  • How will the new pricing benchmarks taking place in the pharmaceutical industry, such as AAC and NADAC, impact AMP and the pharmacy industry?
  • How can the industry adapt to the changing landscape within the PBM marketplace? A legal viewpoint will be delivered helping us understand what laws were passed in 2011 and where we may be headed for 2012.
  • How is the industry adapting to Electronic Prescribing of Controlled Substances (EPCS)? As we continue to implement these new protocols, a real world perspective will be given. How are we doing in moving to the DEA’s Interim Final Rule passed in 2010?
  • What potential benefits exist for the pharmacy industry in the emerging state-HIE marketplace across the United States? As a whole, how will the pharmacy industry adapt as healthcare sectors across the marketplace continue to automate as a result of HITECH?
  • How will meaningful use impact pharmacy? CMS has issued $3.8 billion in incentive payments to eligible prescribers and hospitals. But how does meaningful use relate to HIE? And what does HIE have to do with pharmacy? We know for instance that pharmacy is not eligible for meaningful use incentive payments. However, this doesn’t mean pharmacy has no role to play within HIE or meaningful use. There will be a webinar bringing all of this together and helping pharmacy better understand its important role in supporting interoperability and access to information across the healthcare system.  

The above examples are only a sampling of the important topics being covered next month at the annual NCPDP conference. This is both an exciting and challenging time within our industry. Stay tuned as we look forward to the reviews and commentary from this event which takes place May 6 to 12. Better yet, I encourage you to attend this important industry event. It is an informational, fun and important conference attended by pharmacy leaders throughout the industry. Social events, such as receptions and especially the closing night theme party, are scattered throughout the schedule, giving you time to network and unwind all at the same time.

We continue to advocate for membership and active participation in NCPDP as it affects our business in so very many positive ways. We believe that through collaboration and commitment to a quality healthcare system,  it has and will continue to live up to its mission, which in part states “provides a forum wherein our diverse membership can develop business solutions” that effect our industry. For more information on the conference, click here.

 


Paul Hooper
VP of pharmacy network services
Paul Hooper directs Emdeon'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 Pennsylvania State University.

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Has anybody seen the fifth guy?

BY Michael Johnsen

WHAT IT MEANS AND WHY IT’S IMPORTANT — If you were to tell me that 4-out-of-every-5 people would choose 90-day prescriptions available by pickup at the pharmacy versus 90-day prescriptions delivered through mail order — and for about the same cost — I would tell you that we need to find the fifth person and make sure that they’re OK. They might be suffering from a medical emergency and could need our help. The publication of this study in a peer-reviewed journal, however, serves as proof of concept addressing two concerns — choice and plan cost. In other words, giving patients choice of 90-day at retail doesn’t have a material impact on plan cost.

(THE NEWS: Walgreens study finds patients prefer to fill Rxs at community pharmacies. For the full story, click here.)

That cost-neutral aspect is an important distinction to make, given what’s happening in the marketplace — namely the Express Scripts-Medco merger, and at an important time, during the PBM selling season. The fact is that a lot of the healthcare debate today really comes down to that one critical consideration — how much is this going to cost at the end of the day? If "this" is 90-day at retail and the answer is, "Not any more than mail order," then increasing patient choice by including 90-day at retail becomes an easy choice to make for health plan administrators.

Because the four patients that do go to the pharmacy have a living, breathing pharmacist who can counsel them on their medications when they come in; they have a pharmacist who, with multiple intercept opportunities, can help improve medication adherence and compliance through any number of programs; and they have a retail pharmacy operator that is engaging them online, through their emails and on their smartphones, or just about any venue that those 4-in-5 patients choose. And, chances are, those 4-in-5 patients who avail themselves of that kind of personal attentional from their pharmacist don’t find themselves in a medical emergency nearly as often.

So 90-day at retail is cost-neutral and helps increase compliance through better choice. That leaves just one question left for health plan coordinators: Has anybody seen the fifth guy?

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Lilly chief executive John Lechleiter appointed as PhRMA chairman

BY Alaric DeArment

BOSTON — The Pharmaceutical Research and Manufacturers of America announced Friday the appointment of Eli Lilly chairman, president and CEO John Lechleiter as PhRMA chairman at its annual meeting. The group also elected Celgene president and CEO Robert Hugin as chairman-elect of its board of directors and Pfizer president and CEO Ian Read as board treasurer. Lechleiter replaces Sanofi CEO Christopher Viehbacher as chairman.

"Chris has been indispensable to PhRMA on many fronts, providing invaluable leadership as the industry navigates the evolving policy and regulatory landscapes essential to continued innovation while always putting patients first," PhRMA president and CEO John Castellani said. "As Dr. Lechleiter assumes the chairman role, we can all feel comfort knowing that the patient-centered approaches we utilize in all our advocacy efforts will continue to be central to our mission of advancing innovation in the [United States] and worldwide."


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