Strange how you told me about my medicine!

http://www.youtube.com/watch?v=LzDx2ZyHnnA&hl=en

** SPOILER ALERT show: The first few seconds of the game a surprise ending, so do not watch this video if you have played the game already, or are not planning to play it in the near future or whatever pampered .* * Long before Pixar was first begun "Outtakes" in the credits of their animated feature films, Sierra On-Line decided to put outtakes in the credits of their comedic western adventure game, "Freddy Pharkas, Frontier Pharmacist. FPFP came in 1995, and it is not a very well known …

http://www.youtube.com/watch?v=B25hFmjWPYc&hl=en

There are benefits to working in Healthcare System as opposed to a retail environment. Stable working hours – Pharmacists in an intuitional setting will work the normal amount of hours but may be required to work evenings, nights and weekends as medications are required around the clock.

What is a Health System Pharmacist? A pharmacist is a trained individual who dispenses medications to patients. They are trained in the selection, dosing, and administration of drugs to patients.

Their training includes knowledge about basic compounds which go into a formulation for a drug, its effects, side effects and interactions with past and present medications that a patient may take. A Health System pharmacist works in various organizations such as a hospital or clinic.

Where do Health System Pharmacists work? A health system is the combination of all the organizations, institutions and resources whose purpose is to promote and improve health.

This includes hospitals, insurance companies, clinics, doctors, nursing homes, and other places where people get help when they are ill or require recuperation. The skills and experience of a pharmacist is required at many levels within the Healthcare System, for example in a hospital, clinic, or nursing home, a pharmacist is usually in charge of the medications dispensary. Each day, there are a number of medications which are dispensed to patients by nurses or other floor staff to patients.

A team of pharmacists prepare and record all medications which are dispensed to each patient. Details are recorded as to the dose and type of medication, as well as changes to the regimen by a physician.

In addition to medications other drugs are dispensed on an individual need basis for emergencies, surgery and other one time treatments. Other duties include advising the medical staff on the selection and effects of drugs, making sterile solutions to be administered intravenously or plan, monitor and evaluate drug programs or regimens.

They may counsel hospitalized patients on the use of drugs before the patients are discharged. At a large physicians practice or clinic a pharmacist may be in charge of prescribing medications for patients, advising them on patients about general health topics such as diet, exercise, and stress management, and provide information on products such as durable medical equipment or home health care supplies.

At an insurance or benefits company, a pharmacist will be counted on to monitor the requests for medication by the physician to ensure that the treatment is correct and within standards.

They will have a hand in composing and reviewing the processes and procedures for approval to reimburse for medications or what types of medications can be substituted in treatments.

Another benefits:

Income – Pharmacists are highly trained individuals, requiring testing and licensing to practice. Their income would be commensurate with those of other healthcare professionals.

Opportunity to advance – In addition to dispensing medications, pharmacists may also advance to managerial duties, supervising other pharmacists and technicians or leading a department.

They also my have the opportunity to teach or advise to staff or groups about new and upcoming medicines and treatments. Other duties include composing and establish process and procedures for the recommendation, dispensing and approval of medicines.

Author: Amy Nutt.
Source: isnare.com
Staffing Agency offering full time and part time pharmacy jobs. Visit us to learn more about the wide range of pharmacist jobs opportunities. Visit us http://www.rphonthego.com/

By Devin Stone

A comprehensive new study offers a pair of critical lessons for medication therapy. First, community pharmacists are highly trained medication experts that can help patients optimize the value of their medications, while saving money. And, second, the tangible value of such interventions plummets when delivered by distant pharmacists outside of the patient’s local community. 

Pharmacists work with physicians and patients to adjust medication regimens to boost adherence while minimizing the potential for adverse drug events.  Such quality management of medications can lead to lower health care costs by reducing the chances of more costly forms of care such as hospitalizations and emergency room visits. 

The gold standard in demonstrating the role that pharmacists can play in promoting better health through patient-centered care have been the original Asheville studies beginning from 1996, with new research projects occurring ever since.

A recent study published in the Journal of the American Pharmacists Association, demonstrated that MTM interventions performed by community pharmacists were able to reduce prescription drug costs on average by $35 per month, providing annual savings of $420 per patient.

The study was conducted by the Mirixa Corporation, created by NCPA in 2006 to help pharmacists better provide medication therapy management (MTM) programs for their patients.  Mirixa has been a success, as already pharmacists using the MirixaPro Platform have performed interventions for over half a million patients.  Even more amazing are the quantified savings that have occurred from these MTM interventions. 

These pharmacists were able to help patients reduce their prescription drug costs by working with physicians and patients to end duplicative therapies, promote the use of less expensive generic drugs, and make other changes to the patient’s medication regimen for safety and cost reasons. 

The study is limited in that it only compares changes in prescription drug spending due to MTM programs, even through previous studies have demonstrated that MTM programs not only improve the health of patients but can also help to lower non-drug medical expenses. 

It is important to note that not all MTM programs are equal.  Although it is financially cheaper for pharmacy benefit managers (PBMs) to do a mass educational mailing to their covered lives, such a practice is less effective.  As the authors of the Mirixa study note,

“Educational mailings do not meet the profession wide definition of MTM.  Although an educational mailing met Centers for Medicare & Medicaid Services requirements for an MTM service in 2007, results from the current work suggest that it is not effective at improving patient medication use.”

Many PBMs are promoting the use of pharmacists specialized in specific disease states that can perform MTM over the phone and through educational mailings to at-risk patients.  Despite many of these PBM led initiatives, the Mirixa study demonstrates that interventions performed by pharmacists through call centers are only half as effective in creating prescription drug savings as interventions performed by community pharmacists via telephone or in person.  Educational mailings were the least effective leading to average monthly prescription drug savings of $1 per patient per month. 

The disparities in the potential for savings should cause alarm for health plans that are mandating and/or incentivizing their patients to use a mail order pharmacy.  Community pharmacists are health care professionals that provide a service that is of value to their patients.  Mandating that a patient abandon that relationship in order to receive their prescriptions from a pharmacy owned by the PBM stifles competition to the detriment of patients and health plans.  Freedom of the patient to choose their preferred pharmacy must be preserved so that these patients can continue to use the pharmacy that best meets their individual circumstances, so that patients can make the most of their medications.

By Kevin Schweers

Since the 2007 merger of pharmacy retail giant CVS and pharmacy benefit manager (PBM) Caremark, community pharmacists have heard a drumbeat of complaints from patients accusing the combined company of deceptive practices, privacy violations and conduct resulting in higher health care costs. The problems led NCPA, the National Legislative Association on Prescription Drug Prices and the union-backed Change to Win coalition to seek a Federal Trade Commission investigation earlier this year.

Last month, CVS Caremark disclosed that it is currently the subject of an FTC inquiry. That same day, analysts separately expressed renewed skepticism about the viability of the combined PBM-retail pharmacy model.

NCPA recently shared with the FTC the following new, unfortunate patient stories. They are consistent with problems identified in a remarkable Houston TV news report that aired last month. Summarized below, these cases make clearer that these problems are no anomaly and remain a current concern.

Mailed medication arrives late; costly complications ensue; but you “save” $2!

A patient reports having to use CVS Caremark mail order for monthly deliveries of Enbrel, a pain medication.  Enbrel must be refrigerated immediately upon receipt.

Despite the patient’s best efforts, including taking time off from work to wait for deliveries, sometimes the deliveries are so late as to result in missed doses. When that happens the bills really start piling up for the patient’s insurance plan: $70 to visit the pain management doctor; $400 to receive a spinal injection and $1,200 for an MRI.

Previously, through the local community pharmacy, the patient paid a $164 co-payment and could conveniently refrigerate the drug. Through CVS Caremark mail order the co-payment is $162. That’s $2 of “savings” in exchange for a stressful monthly ritual, a mountain of medical bills to treat resulting complications and untold hours of lost time and productivity at work. In addition to the obvious health concerns, it’s some “deal” for the patient and taxpayers.

Medicine by Help Desk, part II

This next case is reminiscent of an earlier problem that The Dose covered here – Medicine by Help Desk.

In this case, a resident of a long-term care facility needed a refill from the community pharmacy servicing them, but the claim was rejected. The state requires that the resident’s medications come in unit-dosed blister packaging.  When the pharmacist called CVS Caremark to ask why the claim was rejected a phone representative explained that the patient had reached their third refill. Because there were no CVS locations nearby, mail order was suggested. But CVS Caremark mail order did not prepare unit-dose medications.

The phone rep suggested two solutions. Pay out-of-pocket and submit a receipt to get 50% of the cost reimbursed. Or ask the prescribing physician to change the dose of the drug every third refill!

Ultimately, the patient paid cash.

Taxpayers Pay Emergency Room Price for Routine Insulin Dose

After running out of Lantus (insulin), a Medicare Part D patient went to the community pharmacy for a refill. CVS Caremark refused to pay for it, saying the plan limitations were exceeded. 

After refusing an override, a company phone rep told the community pharmacist that the patient would need to use mail order. Obviously, that wasn’t an option, so CVS Caremark advised the patient to pay cash to get the drug now.

Because the patient could not afford the $95 out-of-pocket cost, the patient was forced to go to the emergency room to get the insulin in time.

This is just a sampling of the patient complaints that keep rolling in.

By Devin Stone

As the financial editor of the 2009 NCPA Digest, sponsored by Cardinal Health, I was responsible for calculating the statistics used in the report.  So I was disappointed to read a blog posting on Drug Channels that exaggerated the owner discretionary income for independent community pharmacy, estimating the figure to be $300,000.  

Opening any small business will entail very real financial risks, which means that a defined minimal expected rate of return is necessary as an incentive to encourage an entrepreneur to open a pharmacy rather than to work for an already existing retail establishment.   Reflecting that risk, the 2009 Digest data documented a net reduction in the overall number of independent community pharmacies – 590 fewer than the previous year.

It’s highly unlikely that a pharmacy owner will ever make a fraction of the kind of money PBM chiefs David Snow, George Paz, or Thomas Ryan. But through hard work these pharmacists can continue to keep their profession alive and relevant, with locally owned pharmacies that are staples of the community.

On a side note, it was particularly surprising for Drug Channels to criticize NCPA over transparency when Drug Channels/Pembroke Consulting does not disclose a meaningful list of paying clientele.   Given the opinions expressed on Drug Channels, advising readers of possible conflicts of interest would appear to be a prudent step.

Nevertheless, on the issue of transparency, the Digest is provided free of charge to all NCPA members and an electronic copy is sent to every pharmacy school in the country.  This makes it widely accessible and commonly used by academics and students, at no cost.  Like most trade associations, members receive certain additional benefits that non-members don’t have access too.

 By Kevin Schweers

Two years ago this week something significant and positive happened for Medicaid patients and their community pharmacists. This December, we’re working for more of the same. 

Under current law, delayed by court injunction, Medicaid would reimburse pharmacies for generic drugs based on the medicine’s average manufacturer price, or AMP.  Doing so would force pharmacies to accept losses so great that many would likely have to leave the Medicaid program or close their doors altogether. 

The impact on independent community pharmacies would be particularly dire. They’re often in underserved urban and rural areas where they care for many Medicaid recipients. Nearly all independent pharmacy revenue (93% on average) comes from prescription sales and, on average, Medicaid makes up 15% of those sales. For some independents, that figure is much higher.

That’s the point of a new ad NCPA is running in Capitol Hill publications.  You can see the ad here.

Both Democrats and Republicans in Congress understand this. One of the issues buried in the health care reform proposals are revisions of the AMP formula. We prefer the Senate’s AMP fix as a more workable way to ensure pharmacies remain viable Medicaid providers.

But the legislative process takes time, so relief was sought from the courts to prevent these devastating cuts from taking effect.

Two years ago today, on Dec. 14, 2007, a hearing was held on a motion filed jointly by NCPA and the National Association of Chain Drug Stores. On Dec. 19, 2007, U.S. District Court Judge Royce Lamberth granted the injunction to prevent the Centers for Medicare and Medicaid Services from implementing the proposed AMP cuts.

 During these past two years, with the injunction in place, community pharmacies have saved approximately $4 billion due to the efforts of NCPA and NACDS. That amounts to $5.5 million every day nationwide or a savings, on average, of $70,438 for every retail pharmacy outlet in the U.S. Every patient, whether covered by Medicaid or not, has benefitted from having convenient, local access to pharmacies and their highly trained personnel.

Even with the injunction, one does not have to look far to be reminded that pharmacy profit margins can be razor-thin.  Just a few days ago the Tidewater News of Franklin, Va., reported on the closing of Parker Drug, a longtime local fixture.

“Independent pharmacies are really up against it because third-party insurance companies aren’t reimbursing us enough to make ends meet,” co-owner Ed Canada told the paper. “One thing compounds the other, and it’s finally gotten to the point where we just can’t stay there. I’m losing money.”

NCPA officials will continue working with Members of Congress from both parties to ensure an equitable formula is enacted for Medicaid generic drug reimbursement.

S1E2

http://www.youtube.com/watch?v=CUIkp4Lxyko&hl=en

By Kevin Schweers

 For more than 30 years Gallup has conducted an annual survey gauging Americans’ level of trust, or distrust, of various professions.  This week the 2009 results were announced and, if you’re a pharmacist, take a bow. 

Pharmacists ranked 2^nd out of 22 professions featured in the survey.  About two out of every three respondents (66%) rated pharmacists “very high” or “high” when asked about their honesty and ethical standards. Only nurses scored higher. At the lower end of the spectrum were politicians and car salesmen.

The public’s high regard for pharmacists is a longstanding trend.  The poll found pharmacists to be the second most trusted profession four out of the past five years (finishing third in 2007).  Since 1995, pharmacists have scored between 64% and 72% in this survey.  It’s a point former Senate Majority Leaders Tom Daschle and Bill Frist also touched on at NCPA’s recent annual convention.

Health care professionals continued to score well overall.  Physicians joined pharmacists and nurses in the top three most trusted professions. Conversely, “HMO managers” ranked next to last.

For a look behind the numbers, check out this article in today’s Winston-Salem Journal. The paper profiles three area independent pharmacies and the sterling patient service and niche services they provide to stand out from the competition. The story recounts the work of Foster Drug in Mocksville, NC; truly live-saving efforts that resulted in the pharmacy’s recognition by Drug Topics as one of its “Top Independent Pharmacists.”  Marley Drug and Jonestown Pharmacy of Winston-Salem are also featured, among others.

Millions more Americans could soon gain a new appreciation for community pharmacies. Today the Department of Defense changed its policy to cover some common pharmacist-administered immunizations for its TRICARE beneficiaries.  Previously, they had to visit doctors’ offices or hospitals to get vaccinated against H1N1, seasonal flu or pneumonia.  Now, all 9.5 million TRICARE eligible patients can get vaccinated against these diseases at local community pharmacies with a co-payment that can’t be beat: $0.  Yet taxpayers and the Pentagon should still save money.

Department officials tell us this should be fully implemented later this month. NCPA long supported this concept and you can read our statement here.

By Kevin Schweers

Dispensing fees paid to Ohio pharmacies under the Medicaid program are currently among the lowest in the nation and well below the actual cost of dispensing. This fall the state filed a state plan amendment with the U.S. Centers for Medicare and Medicaid Services (CMS) in an effort to further cut dispensing fees in 2010 – from $3.70 to $1.80.

By contrast, the average Medicaid dispensing fee is $5.02, an NCPA analysis found, and the average cost of dispensing is $11.01, according to the 2009 NCPA Digest, sponsored by Cardinal Health.

Independent community pharmacies are often in underserved urban and rural areas, where they care for a high rate of Medicaid recipients. Many people are surprised to learn that independents derive, on average, 15.5% of their total revenue from Medicaid and the vast majority of overall revenue from prescription claims generally. So cuts such as these would hit the 607 independents in Ohio disproportionately hard.

Today NCPA wrote to CMS to urge the agency to reject Ohio’s state plan amendment. Our letter, available here, articulates three critiques of the state’s approach:

• First, the cuts would force some independent community pharmacies with a high volume of Medicaid patients to close their doors.
• Second, the resulting pharmacy closures would compromise beneficiary access to care to levels that could trigger a violation of the Medicaid Act under 42 U.S.C. 1396a(30)(A).
• Third, this could lead to an increased need for other more costly health care services, such as emergency room admissions, at significant cost to the state.

Clearly, economic and budgetary times are tough, particularly in Ohio. And a similar debate is playing out in Washington and in state capitals around the country.

But, as we wrote in today’s letter, “independent community pharmacies can help reduce health care costs by promoting the optimal use of prescription drugs and counseling beneficiaries to remain adherent to their drug regimens. These actions alone can reduce the number of hospitalizations and emergency room visits that are ultimately more costly to the Medicaid system than pharmacy reimbursement.”

An economic analysis of the impact of independent community pharmacy has in Ohio is available here.

By Kevin Schweers

Recent health reform activity in the U.S. Senate could have new implications for community pharmacy.  Three new amendments, in particular, have been offered and were endorsed today by NCPA.

Perhaps most notably, Sen. Sherrod Brown (D-OH) wants to exempt community pharmacies from DMEPOS surety bond requirements.  The other amendments, respectively, would advance medication therapy management in Medicare and produce the first federal cost of dispensing study for Medicaid in more than a decade.

In addition, Senators are reportedly contemplating asking the U.S. Office of Personnel Management (OPM) to administer health coverage in the so-called public option.  OPM currently oversees the Federal Employees Health Benefits Program and relies primarily on CVS Caremark to administer the drug benefit. 

That contract arrangement has been the subject of pointed questions from OPM’s own inspector general and U.S. Rep. Stephen Lynch (D-MA), Chairman of the House Oversight and Government Reform’s Subcommittee on the federal workforce, the U.S. Postal Service and the District of Columbia.  NCPA’s Bruce Roberts recently wrote about this Federal Times.

NCPA officials are urging Congress to ensure that the drug benefit of any such program is administered by a pharmacy benefit administrator, rather than a PBM, and to retain PBM transparency language in the legislation.

More details can be found in today’s NCPA statement pasted below and also available here.

NEWS RELEASE

NCPA Backs New Amendments to Senate Health Reform Bill;

Expresses Concern over Revised Public Option’s Pharmacy Benefit

Alexandria, Va. (Dec. 8, 2009) – The National Community Pharmacists Association (NCPA) today endorsed three amendments recently proposed to the Patient Protection and Affordable Care Act and raised questions about an emerging public insurance option that would be administered by the federal Office of Personnel Management (OPM). NCPA Executive Vice President and CEO Bruce T. Roberts, RPh, issued the following statement:

“NCPA strongly supports an amendment by Sen. Sherrod Brown (D-OH) that allows pharmacies to continue providing Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and Part B drugs to Medicare beneficiaries without purchasing a surety bond. Like the 14 other types of medical professionals that Medicare exempted from the surety bond requirement, pharmacists are licensed and regulated by the states. Requiring surety bonds is duplicative and may lead to loss of patient access to valuable health care services, such as diabetes testing supplies, canes and crutches.

“We continue to work with Congress on both a permanent pharmacy exemption from DMEPOS accreditation requirements, as well as an extension of the current moratorium, which is scheduled to expire on Dec. 31, 2009.

“Sen. Kay Hagan (D-NC) added important language to the Senate ‘Freshmen Value and Innovation Package’ amendment to codify Medicare’s medication therapy management (MTM) program. MTM utilizes community pharmacists to help patients adhere to, and maximize the benefits of, their medicine. The programs have been shown to improve outcomes while lowering health care costs.

“An amendment by Sen. Michael Bennet (D-CO) would require the Government Accountability Office (GAO) to conduct the first detailed study in more than 10 years of pharmacists’ cost of dispensing in the Medicaid program. Private studies have shown community pharmacists to be compensated well below their cost of dispensing and a GAO study could give Congress and the states needed information for measuring the adequacy of the dispensing fees they pay and the impact upon patient access to pharmacy services.

“Various news reports indicate Senators are considering an OPM-administered health plan for the uninsured.  Under such a model, we urge lawmakers to utilize a pharmacy benefit administrator (PBA) to manage drug coverage, rather than a pharmacy benefit manager (PBM).

“PBMs have a history of inflating health care costs through bloated administrative fees and questionable practices that are hidden from patients and plan sponsors. OPM’s inspector general told a House subcommittee investigating the PBMs’ effect on the federal employee health plan that ‘there’s a good chance we’re not getting a good deal because of the lack of transparency.’

“A PBA, such as those employed by Medicaid and the Pentagon, would give patients and taxpayers the best bang for their buck by passing through all rebates, discounts, and price concessions. PBM transparency requirements in the current bill should continue to apply to any plan that operates within the exchange, including the public option.

“NCPA is grateful for Congress’ bipartisan support of community pharmacy in health care reform and we will continue to work with lawmakers as the legislative process continues.”

###

The National Community Pharmacists Association (NCPA®) represents America’s community pharmacists, including the owners of more than 22,700 independent community pharmacies, pharmacy franchises, and chains. Together they represent an $88 billion health-care marketplace, employ over 65,000 pharmacists, and dispense over 40% of all retail prescriptions. To learn more go to www.ncpanet.org or read NCPA’s blog, The Dose, at http://ncpanet.wordpress.com.

By Kevin Schweers

Senator Michael Bennet (D-CO) today filed an amendment to the health care reform bill that would require the Government Accountability Office to conduct a Medicaid cost of dispensing survey. It’s been more than a decade since the feds last examined this issue in detail. Since that previous study there have been a variety of federal and state pushes to cut pharmacy reimbursement again and again without government data to fully know the impact of such reductions.

NCPA strongly supports such a study. Right now Congress is in the midst of determining the fix it will apply to the court-delayed, average manufacturer price based reimbursement. If reimbursements are set too low they would force many community pharmacies out of the Medicaid program or to close altogether. While NCPA believes the current Senate language of “no less than 175%” is preferable to the lower House level, it still may not be sufficient to recover from low state dispensing fees.

NCPA wrote to Sen. Bennet thanking him for requesting the study.  Excerpts of that letter follow below. We’re urging all Senators to support the amendment:

“We strongly support passage of your provision requiring the GAO to conduct a state-specific Medicaid pharmacy cost of dispensing study as part of health care reform. This study can help determine the true costs to pharmacies to provide needed Medicaid prescription drugs and pharmacy services to their patients.

“It is important for GAO to study and determine an appropriate level of state-specific dispensing fees under Medicaid because there is a significant discrepancy between average state dispensing fees and recent measures of the actual cost to dispense. For example, the 2009 NCPA Digest [sponsored by Cardinal Health] found that the cost of dispensing in 2008 was $11.01 per prescription. Similarly, the 2007 Grant Thorton study found that figure to be $10.50 in 2006. In contrast, the aggregate average dispensing fee paid by the states under Medicaid has been estimated to be between $4.75 and $5.02 per prescription.

“The proposed study is particularly important for rural states like Colorado, where a pharmacy may be the only accessible health care provider for many miles. In fact, over half of all pharmacies that serve rural areas of America are independent pharmacies. We appreciate your recognition of the importance of rural pharmacies to the nation’s health care infrastructure. A GAO study could give Congress and the States needed information by which to measure the adequacy of the dispensing fees they pay and the impact upon patient access to pharmacy services. We appreciate your leadership on this issue and look forward to working with you on this important study.”

By Kevin Schweers

With the year’s end fast approaching, it’s a natural time for reflection. In that spirit, here are some noteworthy pharmacy topics that you might have missed, but were covered at NCPA’s annual convention. A link to these presentations and others can be found at the end of this post.

Finances

You wouldn’t miss an annual physical, but are you as diligent in reviewing your pharmacy’s finances? That was the message of Dr. Richard A. Jackson of Mercer University’s College of Pharmacy and Health Sciences. He walked pharmacists through how they can use their balance sheets and the NCPA Digest, sponsored by Cardinal Health, to read between the tea leaves. Done right, his methodology enables pharmacists to identify trends and head off problems before they occur. Strive for a synergistic relationship to have a pharmacy that’s both a clinical and business success, he advised.

Retail Advice

“Presentation is everything,” Gabe Trahan told a packed roomful of pharmacists attending NCPA’s “How to Become an Exceptional Merchandiser” continuing education program.

In-store or window signs, for example, are an underutilized way to inform patients about a community pharmacy’s offerings or a product’s capabilities. “They don’t talk back. They’re not late. And they don’t need a ride home,” he quipped.

Trahan discussed dozens of strategies that independent community pharmacies are using to improve their business and compete against competition from big box stores. End cap arrangements, category positioning, price sticker placement, and seasonal merchandise were just some of the topics Trahan advised members about.

Take good notes and pictures of what works, he advised, so successful strategies can be recalled easily.

Technology: Pharmacy Robots, Phone Systems and More

Staff apprehension about new pharmacy technologies is often quickly overcome. That and other lessons emerged from a discussion led by Bill Osborn, RPh, of Miami, Oklahoma’s Osborn Drugs and Tim Davis, RPh, of Beaver Health Mart in Beaver, Pa.

While every pharmacy is different, robots are a valuable part of Osborn Drugs. Initially, the pharmacy’s employees were reluctant. When Bill considered naming the addition “Fred,” a staff member let him in on a secret. Robot opponents also referred to them as “F.R.E.D.,” only it stood for “Freaking Robot Everybody Despises.” Today, Bill suspects that same staff member would “probably try to tackle you if you tried to take [the robot] out.”

Davis said it’s not unusual for 10-15% of the day’s business to come in through a pharmacy’s interactive voice response (IVR) phone system. Patients appreciate the opportunity to order refills when it’s on their mind, even in the middle of the night. Osborn gives callers the option to “press one” for the automated system or to hold for a pharmacy staff member.

NCPA members have access to these and other great presentations by clicking here. Just look for the section marked 2009 Annual Convention CE Programming.

This post is part of NCPA’s expanded convention coverage. Longtime readers of The Dose may recall that we previously highlighted prescription drug disposal programs, niche services and offerings, and a health care reform discussion with former Senate Majority Leaders Tom Daschle and Bill Frist, among other topics. We’ll have one more post soon to conclude the 2009 convention series.

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oiPharmacs

So …, I have been at several different pharmacies so far, all of them having different dispensing software. What is the common thread between them?

1. None of them have a place to record a patient’s tobacco use status:

Pharmacists are in a perfect position to record a patient’s tobacco use status and routinely follow-up with them on it using motivational interviewing skills. What other health care provider sees their patients as regularly as we do? Thats right, no one! However, when I decided I wanted to start making these interventions for patients I ran into a dilemma. I have no where to easily flag someone as a tobacco user. So how am I going to allow pharmacists to follow-up on subsequent visits without annoying the patient by asking them about their status every time?

This is quite a simple fix. The developers of these programs should put one more field in, then that field can be populated upon intake for new patients. In the absence of this happening, how can we pro actively, effectively screen and assist our patients?

2. There is no reliable way to input any documentation. What happens when I discover the patient uses tobacco and I want to note that in the system, also note the patient gets half of their prescriptions from Walmart for $4, uses 3 herbal products, and uses aspirin OTC? Well, lets document it in the notes field of our dispensing software. But wait, I only get 2 lines to document this in. How can I possibly get all of this necessary patient information in a legible manner in 2 lines of text?

Pharmacy computer systems need to advance. I believe there are some pharmacists out there who would expand their roles and provide even better patient care if the technology provided to them were to allow them these functions to make it easier. We should not need to keep extra paper charts, index card systems, or similar method if we have a database already which could be expanded to include the totality of relevant data for patient care.

Will pharmacy dispensing system providers ever realize this need and help pharmacies implement pharmaceutical care by making these changes?

By Kevin Schweers

Flexible spending account (FSA) transactions are in high gear as patients seek to spend any remaining funds before year’s end. But it appears that the transactions are being unfairly denied at many independent community pharmacies as the negative fallout from confusing Internal Revenue Service (IRS) guidance continues.

Since July 1, an IRS regulation has required that pharmacies use an expensive inventory information approval system (IIAS) to process FSA debit card transactions. It’s cost-prohibitive for some independent pharmacies, so an exemption, known as the “90% rule”, was included for pharmacies whose sales are comprised of at least 90 percent prescription drugs and other qualifying medical supplies.

However, many health insurance plan administrators have refused to honor the 90 percent rule. That leaves community pharmacies having to refer loyal customers to Big Box rivals to use their FSA debit cards.

NCPA has met with IRS, Treasury Department, and Small Business Administration officials, proposing that the feds help restore a level playing field for FSA purchases. Existing guidance should be clarified or new guidance issued stating that the agency:

• Considers purchases from 90% rule pharmacies substantiated in the same way IIAS-compliant purchases are substantiated, which means that all purchases are automatically substantiated and no further documentation is required; and
• Agrees that, in the event of an IRS audit, electronic records tracing the merchant code back to 90% rule pharmacies registered with SIGIS are sufficient to meet the burden of proof and show that the purchases are completely substantiated.

On Monday, U.S. Senator Mary Landrieu, D-La., stepped in. She heads the Senate Committee on Small Business and Entrepreneurship and wrote to the IRS, asking them to clarify “under what circumstances the IRS considers qualified medical purchases by consumers from ’90 Percent Rule’ Pharmacies using FSA debit cards as substantiated under the current applicable guidance.”

The Senator’s letter follows an NCPA missive to the Small Business Administration’s ombudsman, who flagged the issue for the IRS. The hope is that such guidance could lead health plan administrators and employers to soften their inflexible approach and allow patients to shop at their community pharmacy of choice.

It remains uncertain what action the IRS takes and how plan administrators and employers respond. Regardless, NCPA will continue seeking congressional allies and urging the IRS to take these modest steps to provide some relief without undermining the purpose of the regulation.

I know I have to be motivated by my work,  but I can’t.

When I was young, I had to study three times harder than the others because I had no brains. My parents were not pleased at my grind. But I continued swotting for an entrance examination for university, I can’t understand what made me a hard worker though. Nobody expected I would pass the exam but finally I could. After I became a pharmacist, I noticed I had to continue studying pharmaceutical knowledge  for life and I needed medical knowledge too. I take training courses every year as the other pharmacists. The charge for courses bear severely on my budget. I am not capable as a pharmacist even if I study hard. I am a third-class pharmacist. When I realise it, I have completely lost interest in everything.

I like myself when I do my best. I don’t like dull myself. Now I wish I retire early and live in a small town in a foreign country. But it might be a fine excuse for avoiding work.

By John Norton

LA Times reporter Karen Ravn has written three articles about pharmacists who because of their accessibility can play a vital role improving the health of patients in ways that physicians often can’t, that have the clinical training to help patients maximize the health benefits of their medications, and offer medication therapy management services which helps Medicare Part D patients taking multiple medications for multiple ailments. NCPA has consistently been emphasizing these points as was the case in a op-ed written by our executive vice president and CEO, Bruce Roberts.