E-DRUG: RFI: Reimbursement as barriers to pharmaceutical care (2)
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Dear Funmi,
Here are several recent citations from various perspectives, both national
and cross-cultural. I hope this is helpful. Some have email addresses you
may use to contact the authors directly. I included the abstracts because I
didn't know whether you had access to them.
Regards,
Richard
Richard H. Parrish II, PhD, RPh
Assistant professor, pharmacy practice
Shenandoah University
Bernard J. Dunn School of Pharmacy
1775 North Sector Ct
Winchester, VA 22601 USA
tel: 01+540 678-4392
email: RParrish@su.edu
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1: Kuo GM, Buckley TE, Fitzsimmons DS, Steinbauer JR. Collaborative drug
therapy management services and reimbursement in a family medicine clinic.
Am J Health Syst Pharm. 2004 Feb 15;61(4):343-54.
PURPOSE: The legislative and regulatory issues surrounding the reimbursement
of pharmacists for cognitive services are reviewed and billing practices for
a pharmacist-physician collaborative drug therapy management service (DTMS)
in a family medicine clinic are examined. A case study is offered to
illustrate the real-world application of these practices. SUMMARY: As
regimens of prescription medications have become more complex and the
potential for adverse drug reactions and interactions has increased, the
need for individualized optimal drug therapy and drug-therapy experts has
grown. Pharmacists, who are professionally trained to be an integral part of
the medical team, are well prepared to ensure optimal drug therapy and
medication safety for patients. Consequently, collaboration between
physicians and pharmacists can lead to improved patient care and reduced
medication errors. The following 10 steps are recommended for establishing a
successful collaborative DTMS: (1) es!
tablish a working relationship with physician colleagues, (2) assess the
needs of your patients, (3) draft collaborative DTMS protocols and
agreements, (4) apply for credentialing status within your health
organization, (5) consult the billing office staff at the clinic, (6) design
a clinic-encounter form, (7) identify and train support personnel, (8)
allocate resources, (9) advertise the DTMS, and (10) evaluate and improve
your service. CONCLUSION: Establishing a DTMS presents many challenges and
obstacles, but they should not lead to discouragement. Rather, pharmacists
should be diligent and continue to explore ways in which they could provide
optimal medication therapy to patients through appropriate channels that
also facilitate reimbursement.
2: Farris KB, Kumbera P, Halterman T, Fang G. Outcomes-based pharmacist
reimbursement: reimbursing pharmacists for cognitive services part 1. J
Manag Care Pharm. 2002 Sep-Oct;8(5):383-9. karen-farris@uiowa.edu
OBJECTIVES: (1) Describe the structure of an outcomes-based method of
pharmacist reimbursement for cognitive services, (2) outline the structure
of an intervention program, (3) explain a mechanism to increase the
provision of pharmacists. cognitive services, and (4) summarize findings
from the first year of operations of this outcomes-based pharmacist
reimbursement program (OBPR). METHODS: A cross-sectional descriptive study
was completed using the claims submitted by pharmacists to summarize
findings from the first year of operations of this OBPR. The program
involves collaboration between pharmacy benefit managers (PBMs) and
community pharmacists to improve medication use. Pharmacists were reimbursed
for (1) converting therapeutic regimens to generic drugs or preferred
formulary medications when a prescriber contact is required; (2) conducting
patient education and follow-up after initiation of new medications, changes
in drug therapy, or following an over-the-counter (OTC!
) consultation; and (3) resolving drug-therapy problems. An efficient,
no-cost billing system was created. Pharmacies participating in this program
are located in cities throughout Iowa, ranging in population from a few
hundred to more than 100,000. The main outcome measures were descriptive
statistics of prescriptions, intervention claims, and pharmacist
participation in the program. Frequency distributions and descriptive
statistics were used to summarize the first year of claims. Comparisons of
averages were completed with t tests. Chi-square tests were used to compare
frequency distributions. RESULTS: Data analysis for the first year of
operation, July 1, 2000, through June 30, 2001, showed that 11,326 enrollees
obtained 124,768 prescriptions. The majority of individuals (n=8335, 74%)
received some intervention service. The majority (90%) of intervention
services were patient education and follow-up on new prescriptions or
changes in prescriptions. More than 200 individ!
uals had drug-related problems. There was variability in the level of
s
pharmacy as the median number of intervention services was 30, while the
mean was 113?188, among those providing any interventions. CONCLUSION: This
unique system of outcomes-based pharmacist reimbursement permits community
pharmacists to document and bill for cognitive services. It has demonstrated
that PBMs and community pharmacists can work together to improve drug
therapy, and it may reduce health care costs.
3: Ito MK. Role of the pharmacist in establishing lipid intervention
programs. Pharmacotherapy. 2003 Sep;23(9 Pt 2):41S-47S.
Despite the availability of the National Cholesterol Education Program Adult
Treatment Panel (ATP) guidelines for the management of hyperlipidemia since
1988, most patients do not achieve their target low-density lipoprotein
cholesterol (LDL) goals. With the publication of the most recent guidelines
(ATP III), which contain more aggressive treatment recommendations, the
cholesterol treatment gap is likely to widen further. Factors responsible
for patients not receiving adequate treatment include a lack of focus on
asymptomatic diseases, time and reimbursement constraints, inadequate
training, a reluctance to prescribe aggressive treatment regimens, and poor
communication among health care professionals. Results of several studies
evaluating intervention programs indicate that pharmacists can play a key
role in improving cholesterol management whether in lipid clinics, community
pharmacies, or hospitals. In these intervention programs, pharmacists
provided a wide range of fun!
ctions that included reviewing the medical history, monitoring laboratory
values, selecting lipid-lowering therapies, and educating patients regarding
drug therapies and the importance of compliance. These interventions
produced significant improvements in lipid parameters and in the number of
patients who achieved LDL treatment goals. Most important, these
interventions were associated with decreases in clinical events. Pharmacist
intervention also was highly cost-effective and time efficient. These
results suggest that pharmacists are in a unique position and possess the
requisite skills to improve the treatment of patients with hyperlipidemia.
4: Akaho E, MacLaughlin EJ, Takeuchi Y. Comparison of prescription
reimbursement methodologies in Japan and the United States. J Am Pharm Assoc
(Wash DC). 2003 Jul-Aug;43(4):519-26.
OBJECTIVES: To compare methods of prescription reimbursement in Japan and
the United States. DATA SOURCES: Data were obtained through interviews and a
search of the pharmacy literature using MEDLINE, International
Pharmaceutical Abstracts, the Iowa Drug Information Service, and the
Internet. Search terms were pharmacy, dispensing fee, reimbursement,
prescriptions, Japan, United States, and average wholesale price (AWP). A
comprehensive search was done (i.e., no year limits were observed). STUDY
SELECTION AND DATA EXTRACTION: Performed manually by the authors. DATA
SYNTHESIS: The reimbursement systems for prescriptions differ widely between
Japan and the United States. The reimbursement system in the United States
is fairly straightforward and easy to understand; it is generally based on
product cost (e.g., AWP minus a percentage) plus a small dispensing fee. The
system in Japan is extremely complex. Reimbursement formulae have four
components, including fees for professional!
dispensing, drug cost, counseling and administration, and medication
supplies and devices. Additionally, various adjustments to the final amount
are made based on dosage form, length of therapy, number of prescriptions
dispensed by the pharmacy per month, and when the prescription is filled
(e.g., after hours, on Sundays or holidays). In Japan, each pharmacist is
limited to filling 40 prescriptions per day, but each "prescription" can
involve several medication orders, making it difficult to compare Japanese
pharmacists' workloads with those of their counterparts in the United
States. In addition, Japanese pharmacists are provided remuneration for
providing various cognitive services, such as taking a patient history,
counseling a patient, consulting with a physician, and identifying
drug-related problems. CONCLUSION: Japan and the United States have very
different methods of reimbursing pharmacists for dispensing prescriptions,
each with positive and negative features. Ba!
sed on the features of pharmacy reimbursement systems in each country,
practice system would have workload limits that reflect safety standards and
amount of support staff available, provide a fair and standardized method
for determining drug cost, are relatively straightforward, pay for cognitive
services, and provide care for all of citizens through of some type of
national health care system.
5: Law S, Wu W. Cost-savings from subsidized pro-active pharmacist
interventions. J Pharm Pharm Sci. 2003 Jan-Apr;6(1):84-94. slaw@mta.ca
PURPOSE: This paper evaluates a pilot project to determine the desirability
of implementing a reimbursement model for pro-active interventions. A drug
plan administration conducted an experiment in which a pharmacist could
recommend to physicians the substitution of lower-cost therapies with
equivalent health outcomes. The pharmacist shared any cost savings with the
insurer. METHODS: Drug plan costs without the intervention were estimated
using time-series forecasting models and compared to actual costs with the
intervention. RESULTS: Over the course of this experiment, there were some
cost savings generated by reactive pharmacist interventions but pro-active
interventions, intended to influence subsequent physician behaviour, appear
to have had no significant effect on the profile of drug expenditures.
CONCLUSIONS: The evidence does not lend extensive support for full
implementation of this type of reimbursement model.
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