By Jack McClurg, CEO, HealthTrans, a national healthcare management solutions company in Greenwood Village, Colo.
When consumers were asked by the Kaiser Family Foundation, who do they rely on to get accurate information about their medications, 72 percent said they relied "a lot" on their physicians, but 51percent also said they named their pharmacist as their second choice. Conversely, when consumers wanted to talk about the cost of drugs and less expensive alternatives, 61 percent were more likely to talk to their pharmacist than their doctor.
It is apparent that relationship with a pharmacist is highly valued by most consumers. Employers and union groups can leverage this valued relationship as they work to keep drug expenditures manageable and achieve high levels of adherence.
The advent of mail-order options has diluted that valued relationship. Given an industry trend to move more and more consumers to mail services--an increase in market share from 10 percent to 15 percent from 1999 to 2005, according to Federal Trade Commission in its report "Pharmacy Benefit Managers: Ownership of Mail-Order Pharmacies"--it is time that we look more closely at the value that can be gained through existing relationships with local pharmacists.
The community pharmacist serves a vital role as a trusted confidant who helps a patient adhere to a medication regimen. It is especially valuable to take advantage of these long-term, trusted relationships when the individual has a chronic condition that requires careful monitoring of the maintenance medications he or she is taking.
The employer or union can further benefit from a relationship with community pharmacies because a local-based pharmacy plan offers a more patient-centric program tailored to their employee or member populations.
Let's say the population to be served has a significant number of individuals with high blood pressure, the plan can include a medication therapy management program linking the local physicians with the pharmacists, who together work with patients to manage the disease better and thus lower medical costs.
For example, healthcare service provider KDI Health Solutions and community pharmacy chain Kerr Drug Stores offer community-based preventative and chronic-illness management programs to optimize healthcare outcomes.
To deliver services, KDI created a network of Centers of Excellence, located in approximately 15 percent of Kerr Drug Stores throughout North Carolina and South Carolina. These centers are innovative practice settings equipped with private patient care offices, where patients can meet by appointment with their community pharmacist. In addition to these locations, the KDI team also provides care at employer worksites and within medical practices.
KDI pharmacists specialize and continually advance their training in such conditions and treatments as diabetes, hyperlipidemia, hypertension, asthma, chronic obstructive pulmonary disease, smoking cessation, osteoporosis, medication therapy management and vaccination delivery.
These qualifications and certifications, among others, allow the team to participate in a mix of activities, including disease prevention through education, awareness and immunization; detection through screening services and health fairs; monitoring via point-of-care testing and medication adherence efforts; and management by collaboration with other healthcare providers.
Pharmacy benefit plans tailored to specific populations and their localized markets maximize choices for those covered and provide more control for the plan sponsors. The net result is powerful savings with enhanced quality care because it gives an employer or union direct control of their cost-containment strategies. At the same time, their employees or members have a broad spectrum of choices in medications, often combined with additional incentives that are difficult to offer in a "one size fits all" national plan.
The key to an effective pharmacy benefits program is to provide meaningful incentives that motivate employees to make more cost-effective decisions. A plan tailored to serve a specific population in a select geographic region is ideally positioned to achieve appropriately discounted copays for medications filled at preferred pharmacies.
The plan can build in copay incentives for the member to choose generic or over-the-counter drugs and other lower cost options from a preferred drug list or formulary. For individuals taking maintenance medications, the plan also can offer 90-day at retail fills, enabling the pharmacy bulk buying efficiencies beneficial to the pharmacy, the plan sponsor and the patient.
A plan that provides lower copays, exceptional services and convenient options for filling prescriptions also increases the opportunity for medication adherence.
Beyond the patient-centric approach to pharmacy care, there also are benefits to the community at large because the bulk of the pharmacy business remains local. At the same time, as this boosts the local economy, participants in such plans still have cost savings comparable to national mail discount services, often with the added benefit of preferred pricing at point-of-sale on nonpharmacy items. Tailoring a network with a targeted group of pharmacies is an effective way to manage costs.
For example, an employer who engaged a local network with about 200 pharmacies, offering a copay incentive for employees to choose a network pharmacy over a pharmacy out of the network, has moved compliance from 49 percent the first quarter of the program in 2006 to 74 percent in 2007. Savings to the employers was about $435,500 in 2007, or about a 21 percent savings.
The key is to offer a benefit plan that is robust enough to elicit employee support while maintaining premiums and out-of-pocket costs at levels that encourage adherence to healthcare regimens. To reach this goal, employers could begin by engaging their employees in discussions about possible options and the related financial impact that will enable them to be better informed partners in the management of a healthcare program.
Employees who have a vested interest in the final plan will have in a higher level of acceptance of the ultimate plan while becoming better consumers of healthcare services themselves.
June 1, 2009
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