PHARMACY

The World Speaks: Networking to have pharmacy’s value recognized

BY Doug Hoey

It’s complex, convoluted, confusing. And costly, to boot.

It’s the prescription payment model. Patients don’t know what they’ll pay when they walk into the pharmacy. Pharmacists don’t know how much they’ll be told to charge the patient or how much the pharmacy will be reimbursed.

Simplifying the pharmacy payment model is an enormous undertaking that will necessitate participation from all players in the prescription medication channels. It’s desperately needed, though, and is a mission that we at the National Community Pharmacists Association are focused on doing our part to see through. And we’ll be working to do that using advocacy — helping federal and state governments save money — and through market possibility like Community Pharmacy Enhanced Services Networks USA, helping to lower overall healthcare costs.

Generating Savings
Whether pushing to eliminate retroactive pharmacy fees in Medicare Part D or working with state Medicaid agencies to enact solutions in states where the broken pharmacy payment model is resulting in hundreds of millions of wasted taxpayer dollars, NCPA is committed to ensuring accountability to taxpayers, affordable costs for patients, and fair reimbursements for community pharmacies.

Lowering Costs
NCPA co-founded CPESN with Community Care of North Carolina to help pharmacies develop local care networks, demonstrating value by coordinating patient care with broader care teams to help ensure quality and control costs. It is a clinically integrated network, allowing it to approach plan sponsors to negotiate value-based programs and payment for providing enhanced services.

More than 2,000 pharmacies have caught on to CPESN’s vision to diversify the payment strategy. Participating pharmacies still will be reliant on revenue from dispensing, but that revenue must be augmented from the patient care services they provide. In other words, all their eggs aren’t in the product reimbursement basket.

Through advocacy and opportunities like CPESN, changing the pharmacy payment model will happen. Maybe not today or tomorrow, but a different type of pharmacy practice and a different pharmacy payment model are in our sights. Challenging, sure. But essential for mending health care in America.


Doug Hoey, CEO of the National Community Pharmacists Association.

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