Shortly before Congress adjourned for the run-up to the November elections, NCPA staff joined two representatives of the pharmacy community in the basement of the U.S. Capitol to educate Congressional staffers about pharmacists’ expanding role in health care as a means of improving outcomes and lowering costs.
Pharmacists are among most trusted professionals, NCPA’s John Coster, RPh noted. And pharmacists play a critical role in reducing health care costs by promoting generic drug use.
NCPA greatly appreciates the tremendous job that Tim Weippert, RPh, Thrifty White Pharmacy’s Executive Vice President of Pharmacy and Fred Burke, President and CEO of Guardian Pharmacy, did during the briefing to give Congressional staffers a view of the critical role and opportunities for community pharmacists.
America has a real problem with the $290 billion in estimated health care costs due to medication non-adherence, Weippert stated. According to him, too many patients don’t have their prescriptions filled in the first place.
Many independent community pharmacies are implementing new programs, such as Simplify My Meds, to better help patients stick with their prescribed medication regimen. Weippert articulated the three-tiered approach that Thrifty White has adopted, noting that having all of a patient’s maintenance medications ready for them on one day each month helps pharmacists really work with patients to improve their health and medication adherence. Seeing the patient and being able to review all of their medications at one time each month makes the difference and helps avert larger problems such as hospital re-admissions, he noted.
Among the challenges that community pharmacists face, Weippert listed ensuring patient access to medication therapy management consultations with pharmacists and gaining greater transparency into how health plans set generic drug reimbursement caps known as “maximum allowable costs” or MACs.
It’s hard to run a business when you don’t know what you will be reimbursed for 80 percent of your prescriptions filled, he said in reference to generics’ large makeup of their drug mix.
Health plan decisions to require the use of mail order pharmacies have patients back in his home state of Minnesota in an uproar, Weippert added. “They are being literally pushed and shoved into mandatory mail order.”
Guardian Pharmacy’s Burke gave Congressional staff a step-by-step walkthrough of how long-term care (LTC) pharmacists help ensure safe medication dispensing and positive health outcomes.
Burke then expanded on the challenge that MACs present to his pharmacies’ ability to continue serving patients. Guardian Pharmacy loses money on about half of the drugs it dispenses, according to Burke, due to the MAC limits.
“Visualize the Wizard of Oz behind the curtain with the buttons and the levers,” Burke said. “It’s the PBM [pharmacy benefit manager] pushing the buttons and pulling the levers setting the MACs. We’re not asking to control MAC or to impose any restrictions on how PBMs set MACS. Just tell me where you are finding these prices because I’d like to buy at that price.”