New Decade, New Pharmacy Model

by David Pope, PharmD, CDE, Chief Innovation Officer

More pharmacists are scheduling patient appointments and providing billable clinical services with patients than ever before. Immunizations have been an effective and profitable entry into clinical services for pharmacies, with 90 percent of pharmacies today providing an immunization service. The list of additional medical services, such as diabetes education and tobacco cessation, has grown exponentially in recent years but there’s still a lot of room to grow. Retail pharmacy is becoming a health hub for the community, and as we start a new decade, now is the time to engage in the ‘primary care pharmacist’ model.

So why are medical services such a significant area of growth in pharmacy? Pharmacists are demonstrating value by delivering education, accountability and diagnostic screenings that improve outcomes and lower overall healthcare costs. And the industry taking note.

A great example is chronic disease management. A study published in The Annals of Pharmacotherapy showed that patients who received care that included pharmacist involvement had adjusted A1c levels reduced by an average of 1.38 percentage points compared to those without pharmacist involvement. This is a clinically meaningful improvement, making it three times as likely for patients to achieve an A1c level of less than 7 percent when a pharmacist is engaged in care.

As a result of this and other studies that have demonstrated the value of pharmacists engaging in clinical care, multiple states have passed landmark laws that allow pharmacists to prescribe birth control, cholesterol medications, administer flu tests and more. Additionally, payers are noticing and are increasingly allowing pharmacists as medical providers into their preferred networks, even in states where provider status laws have yet to be passed.

The pharmacy landscape is rapidly changing to include service-based approaches that are proving to be a major factor in healthcare reform. Pharmacists face a unique opportunity to embrace the role of a ‘primary-care pharmacist’ while maintaining their role as the purveyors of medicine.

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Running a retail pharmacy is hard. First and foremost, you serve the needs of your patients: dispensing drugs, ensuring safety, improving medication adherence and providing clinical care.  Then there is the operating side of your business: marketing, pricing, inventory management, vendor relations, finance and accounting, reporting… the list goes on.  And all of this must be done during a period of transformation as the industry evolves from a traditional dispensing model to that of a provider of care.

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Will the MBI Transition Impact Your Reimbursement?

by Shelley Hansell, SVP, Client Relations & Revenue Cycle Product Management

January 1, 2020 is an important date for pharmacies that process medical claims under Medicare Part B. If you administer immunizations, dispense diabetic supplies or provide DME items to Medicare beneficiaries, your reimbursement may be at risk. Starting on January 1, all claims submitted to Medicare will require a MBI for claim reimbursement, even if the date of service is prior to January 1. Claims sent without a MBI will be rejected.