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    Medicaid Expansions Mean New Roles for Pharmacists

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


    Lowering Drug Spending

    More people having health insurance coverage has meant higher health-care costs to the system. Now more than ever, the health-care industry is looking for new strategies to limit costs. Pharmacists can help lower health-care costs and further demonstrate their value on the health-care team. In community and hospital settings, pharmacists can achieve this by dispensing generics and calling the prescribing physician if a high-cost medication has a lower-cost alternative, Cohen said.

    “These regional Medicaid programs, we’ll call them managed Medicaid, need the help of the pharmacist who is there on the streets,” he said.

    Related article: Keep prescription drug benefits in ACA, NCPA urges

    For health-system pharmacists, this also means taking a more active role in cost management. Perez believes pharmacists can reduce drug spending costs by working with health-system chief financial officers to evaluate physician prescribing habits and medication use within the system to identify areas to reduce costs.

    One area of particular value from pharmacists is in opioid prescriptions. Three out of every 10 nonelderly adults who have an opioid addiction are covered by Medicaid, according to the Kaiser Family Foundation.

    “Increases in inpatient volumes, rapidly rising drug prices, and the opioid abuse epidemic constitute challenges as well as opportunities for pharmacy to contribute positively to patient care, hospital finances, and public health,” Omnicell’s Perez said.

    Reimbursement for Services

    Pharmacists can provide tremendous value for Medicaid patients, but one of the biggest challenges to assuming a greater role for these patients is reimbursement.

    With Medicare, pharmacists can be reimbursed for providing medication therapy management services, but Medicaid programs are run at the state level, so there is no comprehensive national program that provides similar reimbursement.

    Related article: Is the ACA treating America without informed consent?

    Shin says that this doesn’t mean that a health plan can’t develop its own reimbursement plan; plans are looking for a good partner who can help address gaps in care, Shin said. They have to consider the value a pharmacist can provide and the health plan’s own financial limits before these type of reimbursement programs can be launched, but pharmacists need to begin to demonstrate their value.

    Cohen said health care is entering a new era where “no outcomes, no incomes” reigns supreme. If pharmacists want to be reimbursed for the services they provide, they’ll have to demonstrate that they improve outcomes.

    “I just think the future is very bright for the practice of pharmacy but we need to have different models on how to provide pharmacy services and manage patient care,” Cohen said. 

    Jill Sederstrom
    Jill Sederstrom is a Contributing Editor

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