"Re-establishing the pharmacist as the consumer’s best advocate and information source on their medications– in the consumer’s mind – is critical to developing a grass-roots, consumer-driven revival of how clinical services at the neighborhood pharmacy are critical to their health and well-being."
I want to thank Val Kalnins, RPh and registered lobbyist for being on the blog today in order to shed some light on the provider status issues and other issues that pharmacy advocates face.
How does ValuePharmacists help advocate for pharmacists and pharmacies?
After retiring, I decided to focus my efforts on pharmacy advocacy, so my wife and I started ValuePharmacists.com. As a registered lobbyist, I have spent many hours “taking point” on a bill to speak with the legislators, Department of Regulatory Agencies, Centers for Medicare and Medicaid Services, Colorado State Board of Pharmacy, FDA, DEA and other constituent groups affected by a given bill then hones language to assure passage or defeat.
At Value Pharmacists, we also perform research for pharmacists’ organizations as well as producing “fact sheets” on a contractual basis. Testimony services are also available. The Value Pharmacists webpage includes blogs that provide insight on pharmacy topics such as provider status and collaborative drug therapy management in addition to behind the scenes information about legislation introduced in Colorado that might be helpful when a similar bill appears in your state.
What advice would you give to pharmacists who are constantly fighting with insurance companies (audits, back billing, MAC pricing, etc.)?
Stay informed of ANY and ALL insurance and regulatory changes affecting practice in your jurisdiction. You must be able to show that you are ready, willing and able to work with them. Look for safety in numbers through buying groups, local organizations where members are all dealing with the same issues. Drive the organizations to develop “best practice” documents with what you’ve found works in specific situations and companies in your jurisdiction.
Remember to support your state and local pharmacy organizations in their efforts to support fairness and transparency in dealing with insurance companies and pharmacy benefit managers (PBMs). Forty state pharmacy associations have endorsed Pharmacy Audit Assistant Services International (PAAS). PAAS is a pharmacist owned, pharmacist operated company that specializes in helping pharmacies get optimum outcomes on audits and chargebacks.
Do you see clinical services as being the next step for the community pharmacist?
Yes, Value Pharmacists agrees clinical services are the next step for community pharmacists. We also feel that the primary challenge to the profession is receiving payment for these clinical services.
Re-establishing the pharmacist as the consumer’s best advocate and information source on their medications– in the consumer’s mind – is critical to developing a grass-roots, consumer-driven revival of how clinical services at the neighborhood pharmacy are critical to their health and well-being. Margins in 2016 dictate that “these days” clinical services must be paid by the consumer and not absorbed by the pharmacy as part of doing business. So it’s a chicken or egg dilemma – convince and then ask for payment? Or ask for payment and then convince of the value?
Who else do we need to convince of the value of pharmacist services?
Legislators and insurance companies. So much of the savings that pharmacists can provide through their clinical services come from cost avoidance (reduced hospitalizations, ER visits, nursing home admissions). Unfortunately, both legislators and insurance companies are looking for actual reductions in prescription costs.
The government has long recognized the value of pharmacist services. The Office of the Inspector General issued a report in 1990 entitled The Clinical Role of the Community Pharmacist with the finding “There is strong evidence that clinical pharmacy services add value to patient care and reduce health care utilization costs.”
The 2011 Report to the Surgeon General entitled Improving Patient and Health System Outcomes Through Advanced Pharmacy Practice included 26 pages of examples how benefits from clinical pharmacy services “translate into improved consumer outcomes that support many tenets of health reform ‐ enhanced access and quality of care, cost‐effectiveness and patient safety.”
Although the government recognizes the value, pharmacists are still not recognized as health care providers in federal statute.
How can your individual voice best be heard by legislators (email, phone, snail mail, organizations, lobbyists)?
In person! If you seriously want “your individual voice” heard, volunteer to testify at hearings, work health fairs at your state house, you need to get in front of your legislators. Get to know your legislator at neighborhood events. Make sure you repeat - so they will know - your face, your name and your profession every time you meet them.
Email, phone calls and letters are all lost in the plethora of similar items. Your organization or your pharmacist lobbyist is your best choice to have your agenda or issue heard when you can’t be there live and in person.
I want to thank Val for sharing his insights into the multi-faceted battle to gain provider status.
Some key takeaways I got from this interview:
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ABOUT THE AUTHOR:
Blair Green Thielemier, PharmD is an independent consultant pharmacist living in Arkansas with her husband and daughter. She is the founder of Pharmapreneur Academy, an online teaching platform where she guides pharmacist-entrepreneurs through the process and barriers of building a pharmacy consulting business. She is the author of How to Build a Pharmacy Consulting Business: Your Rx for Finding Freedom and Loving Your Career, a contributing author for Pharmacy Times and guest host on the Pharmacy Podcast. More information about Dr. Thielemier can be found on her website BTPharmacyConsulting.com
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