Magazine article Drug Topics

APhA Endorses PAID Plan and Draws Heavy Flak

Magazine article Drug Topics

APhA Endorses PAID Plan and Draws Heavy Flak

Article excerpt

Playing with political fire, the American pharmaceuticall Association has taken the unusual step of endorsing a pharmacy network sponsored by a subsidiary of Medco Containment Services Inc. Medco, which Merck & Co. recently announced plans to purchase for $6 billion, has long been the target of many traditional pharmacists because of its giant mail-order pharmacy operation.

Officials of APhA believe that pharmacy's future has arrived with the unveiling of the Coordinated Care Network. The PATD Prescriptions Inc. program will directly involve community pharmacists in monitoring and managing patient compliance and will pay them for those cognitive services. The provider network is the result of six months of cooperation between APhA and PAID to find a way to reimburse community R.Ph.s for pharmaceutical care and lower costs. Its introduction was held up to be sure it meshed with the Clinton Administration's healthcare reform package.

"It creates a new paradigm," John Gans, APhA's executive v.p., told Drug Topics. "For the first time, pharmacists will be recognized for the value they add to the system. We did it because he death spiral of reimbursement for product is driving pharmacies out of business. APhA's No. 1 priorty is to change the reimbursement system. We found a partner willing to do that."


While PAID is already presenting the concept to all its plan sponsors, the Coordinated Care Network will be jmplemented in two stages, beginning in January. At first, participating phannacists will be reimbursed for keeping tabs on the drug mix by using more generics and a brand-drug formulary. In April, the second phase will kick in, paying for case management and compliance monitoring. An added incentive is that the pharmacy filling the initial Rx will continue to be reimbursed for as long as the patient is on the therapy, regardless of where refills are dispensed.

The network will also provide R.Ph.s with online data, training, and other resources. Gans said it will give them purchasing opportunities that will help even out the playing field. Payers will reap 80% of the anticipated savings, and 20% is earmarked for pharmacies. He added that APhA's endorsement is not exclusive to PAID and that he's willing to work with other benefit managers to rreate similar networks.

"We've very excited because it puts payment behind the message of pharmaceutical care," said Gans. "It's put up or shut up time [on pharmaceutical care], but I have no doubt that pharmacists want to do this. …

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