Magazine article Drug Topics

Billing for Dollars

Magazine article Drug Topics

Billing for Dollars

Article excerpt

Independent pharmacy owners pick up some ideas and clues on getting paid for nondispensing services

Are you getting paid for nondispensing services yet? Here's hoping you are. But if you're not, don't despair. Reimbursement for interventions, drug monitoring, disease management, and so on is popping up around the country, and it should continue to expand as more payers find proven value in such services and pharmacists create a critical mass of providers offering them.

That's one conclusion that could be drawn from a panel session on "Successful Billing Techniques for Pharmacist Care Services," held during the National Community Pharmacists Association's annual meeting last month in St. Louis.

Few large national payers reimburse for pharmacist/pharmaceutical care as a routine part of their drug benefits, reported Doug Stephens, v.p.-network administration for PCS Health Systems, Scottsdale, Ariz. But many payers are willing to pay for what he calls "event-based, nondispensing services that provide measurable value through reduced drug costs or reduced medical costs."

Stephens, a pharmacist, said payers are watching with interest the numerous pilot programs going on around the country that demonstrate the effectiveness of pharmacist care in reducing costs. Those programs are having "a very positive impact on their willingness to pay."

However, what payers are showing a strong interest in supporting now is "performance" programs that demonstrate the pharmacist's willingness and ability to perform nondispensing services for them. Stephens said PCS has enrolled nearly 80% of its membership (42 million members) in some type of performance program. He noted that, so far, pharmacies have received more than $18 million in performance incentive fees and clients have saved more that $50 million.

For next year, PCS plans to launch two major pilot programs-a drug therapy management program and a disease management program. According to Stephens, DTM programs are "very acceptable to payers" because they are concentrated on detecting and correcting drug therapy issues, they fit easily into any practice of pharmacy, and they provide significant dollar savings opportunities.

DTM programs, he said, should be considered the next step in the pharmacist care movement; they are easier to sell to payers because they are more clearly something the pharmacist would handle, with "no smoke and mirrors. …

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