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    Medicaid Expansions Mean New Roles for Pharmacists

    Pharmacists will be the most frequent point of contact for new Medicaid patients.


    The Role for Pharmacists

    Medicaid users, including those who entered under expansion, often require more touch points and more assistance navigating the health-care system. Many of these individuals had little or no experience with health care before and may have complex needs or disease states that were not properly addressed before they had coverage. They need education and counseling and both health-system and community pharmacist are situated to supply it.

    “I think it’s incumbent on the pharmacy provider, the pharmacist, to reach out and make sure that a patient understands the benefit as well as the risk,” said Tom Bizzaro, Vice President of Health Policy and Industry Relations for First Databank. “We’re always counseling about adverse events, that’s something that we do,” he added. “I’d like to see us also change that counseling to be one that reinforces the reasons and benefits of taking those drugs to a patient.”

    Brad Arthur, RPh, co-owner of two independent pharmacies in Buffalo, NY, said the Medicaid patient population his pharmacies serve are typically some of his most complex patients, with multiple disease states and multiple health-care providers.

    Related article: The Future of Independent Pharmacy

    “In my community, there is not a single private-practice physician, they are all clinic-based, so the population typically is going to multiple places to receive care,” he said. “There’s very little coordination of their care, so the pharmacy has a unique opportunity to be that point of coordination and contact.”

    Compliance and adherence issues are also typically issues with these patients, many of whom may live alone or have a disability that could make them more susceptible to gaps in care or treatment, Arthur said. In urban areas, “the patient is left on their own in having to do these things, so there’s a lot of opportunity for us to interact with them.”

    His pharmacies offer medication synchronization services and adherence programs, along with free delivery. “A lot of my folks are shut-in and if I can’t get the prescriptions to them, they are just not going to take them,” he said.

    Pharmacists’ frequent access to Medicaid patients has positioned them to play a more central role in care for them.

    “I think [pharmacists] can be a great source of preventative care services, so everything from testing for certain conditions, A1c levels, blood pressure, bone density, things of that nature to providing immunizations, being that front-line preventative health-care provider,” Hill said.

    Most Medicaid health plans do not use mail-order pharmacies for traditional medications due to eligibility issues, which means that the majority of Medicaid patients will be regularly visiting a pharmacy for their medications. Plans tend not to not use mail order because a patient’s eligibility for Medicaid may change from one month to the next, Shin explained. The exception is for specialty medications which may have to come through the mail because of their high cost of inventory at traditional pharmacies.

    Jill Sederstrom
    Jill Sederstrom is a Contributing Editor

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