McKesson : The Business of Health Care September 2017

Retail and hospital pharmacies are playing an increasingly important role in the success of value-based care models. Pharmacies' ability to optimize patients' medication use reduces the need for more costly care from physicians and hospitals. Yet, pharmacies simultaneously are facing business challenges that threaten their ability to perform that role. Eight industry developments illustrate how pharmacies can succeed on both tracks in this complex environment.

Pharmacy Business

Nearly 80 percent of rural pharmacies cite DIR fees as their top operational challenge

That's according to a survey of 118 rural pharmacies conducted by the Rural Policy Research Institute at the University of Iowa. Pharmacies pay direct and indirect remuneration (DIR) fees to health insurance plans and pharmacy benefit managers to compensate them for their share of rebates and other discounts the pharmacies receive from drug makers. Some 79.8 percent of the surveyed rural pharmacies cited DIR fees as a 'very large' challenge. Three other challenges cited as 'very large' by more than half of the pharmacies were: maximum allowable costs not being updated quickly enough to reflect changes in wholesale drug costs (78 percent); greater competition from mail-order pharmacies (60.7 percent); and not being a preferred Medicare Part D pharmacy (58.8 percent). 'The major challenges facing rural pharmacies…affect their ability to generate net revenue from the sale of prescription medications,' the survey report said.

Pharmacies dispensed nearly 4.5 billion prescriptions in 2016

Pharmacies of all types and sizes dispensed 4.45 billion prescriptions last year, according to the latest annual report on U.S. medication use and spending from the QuintilesIMS Institute. That's up about 2 percent from the 4.37 billion prescriptions dispensed by pharmacies in 2015. Some 91.3 percent of the prescriptions were dispensed in retail pharmacy settings last year; 8.7 percent were dispensed by non-retail pharmacies. Most of the prescriptions dispensed in 2016 were paid for at least in part by a commercial third-payer-51.3 percent. The rest were covered by Medicare Part D plans (26.9 percent); Medicaid (14.1 percent); and cash payments from customers and patients (7.7 percent).

Clinical Programs

64% of ACOs say they effectively manage the quality of medication use by patients

But only 31 percent of ACOs say they effectively manage the cost of their patients' medication. That's according to a survey of 49 ACOs by the National Pharmaceutical Council and Leavitt Partners. The organizations reported the survey results in the Journal of Managed Care & Specialty Pharmacy. They asked the ACOs to rate their performance on 38 different medication capabilities in six areas. Of the 38 capabilities, the ACOs rated themselves the highest on transmitting prescriptions electronically, notifying providers of known drug allergies and listing medications in visit summaries prior to discharge. They rated themselves the lowest on notifying pharmacies when a prescription is canceled, notifying providers when a prescription is discontinued and notifying providers when a prescription is changed. 'Integrating pharmacists into care, giving both pharmacist and physicians access to clinical data, obtaining physician buy-in and measuring the impact of practices to optimize medication use may improve these practices,' the researchers concluded.

Expanding clinical services offered by community pharmacies in Canada could save $25.7 billion

That's according to a report released by the Conference Board of Canada that offers lessons for health care systems in any country, including the U.S. The report said expanding three specific services-smoking cessation, advanced medication review and management for cardiovascular disease and vaccines for pneumonia-could reduce health care spending in Canada from $2.5 billion to as much as $25.7 billion over 20 years. The savings would be generated by reducing chronic disease and premature death rates from lung cancer, heart disease, pneumonia and other related ailments. Pharmacists 'could play an even greater role in ensuring the sustainability of the health care system, if we can further capitalize on their expertise as medication experts and expand the services they provide,' the report said.

Medication Adherence

40% of patients miss one or more doses of their prescription medication

That's according to a survey of 1,215 adults age 18 or older by Excellus BlueCross BlueShield, the Blues plan serving upstate New York. A subset of respondents take medications to manage one or more chronic medical conditions, including high blood pressure, high cholesterol, depression, diabetes, asthma and cancer. Some 90 percent of the respondents agreed that taking their medications as prescribed was 'very important' or 'extremely important.' Yet, 20 percent said they missed one dose of medication, and another 20 percent said they missed more than one dose. The top three reasons cited for their lack of adherence were: they forgot (43 percent); side effects (20 percent); and cost (14 percent). The top three methods cited to aid with adherence were: a daily routine (46 percent); a pill box (30 percent); and participation in a pharmacy refill program (17 percent).

Meta review says appointment-based medication synchronization improves drug adherence

Appointment-based medication synchronization improve patients' adherence to their prescription medications and reduces overall health care spending. That's the conclusion of researchers from the University of Connecticut School of Pharmacy who conducted a meta review of five research studies on the clinical and financial impact of the appointment-based model (ABM) for medication synchronization. Under the ABM model, patients make appointments with their pharmacies to pick up and discuss their multiple prescription medications at one time each month. The researchers published their in the Journal of Clinical Pharmacy and Therapeutics meta review. The studies found that appointment-based med sync is associated with a two- to six-fold increase in adherence rates. 'Data suggest that the ABM is associated with improvements in objective measures of medication taking behavior and is associated with costs savings,' the researchers said.

Medication Reconciliation

75% of hospital executives concerned that patients' medication history is incomplete or inaccurate

That's according to a survey of 120 hospital executives by the College of Healthcare Information Management Executives (CHIME) Foundation. The respondents included CIOs, CMIOs and informatics directors. Some 83 percent of the respondents said medication reconciliation is a multidisciplinary effort across their entire operation. The causes of subpar medication histories cited by the executives were: inconsistent practices across departments, disciplines and shifts (60 percent); patients discharged with an incorrect medication list (48 percent); difficulty importing external medication histories, including home meds (46 percent); lengthy phone interviews with families, pharmacies and providers (43 percent); and outdated medication workflows (30 percent). The respondents cited three best practices to remedy the situation: enhanced drug data stewardship through technology; patient engagement and accountability through technology; and mitigation of medication history gaps through additional data feeds.

Study links e-prescribing to lower risk of diabetes-related emergency room visit or hospitalization

A study in the journal Medical Care reported a strong correlation between physicians who electronically prescribe diabetes medications for Medicare patients and a substantially lower risk of the same patients experiencing an emergency room visit or hospital stay caused by hypoglycemia or a diabetes-related adverse drug event (ADE). Of the Medicare patients who had 75 percent or more of their diabetes medications prescribed electronically by their doctors, the ADE rate was 21 per 1,000 beneficiaries. The rate increased to: 36 per 1,000 when 50 percent to 74.9 percent of medications were e-prescribed; 41 per 1,000 when 25 percent to 49.9 percent of medications were e-prescribed; and 44 per 1,000 when 0.1 percent to 24.9 percent of medications were e-prescribed. 'E-prescribing helps providers to send accurate and legible prescriptions directly to pharmacies,' the study said.