Retailers Can Tap Medicare Incentives

IF ROBOTICS and other pharmacy automation allow retail pharmacists to interact more with patients, they may have a new opportunity next year to generate some extra revenues for their stores. That's because of two changes taking place in the Medicare Part D prescription program overseen by the Centers for Medicare and Medicaid Services (CMS). CMS has started rating private-sector insurance companies

IF ROBOTICS and other pharmacy automation allow retail pharmacists to interact more with patients, they may have a new opportunity next year to generate some extra revenues for their stores.

That's because of two changes taking place in the Medicare Part D prescription program overseen by the Centers for Medicare and Medicaid Services (CMS).

CMS has started rating private-sector insurance companies on their level of compliance with a series of 19 standards related to medication quality, such as drug-drug interactions, high-risk medications in the elderly and appropriate treatment of high-blood pressure in patients in diabetes. Providers are rated with stars, from one to five. Starting this fall, patients can get a look at these ratings online to help in selecting a plan for 2012.

Next year, the ratings will include the “proportion of days covered” (PDC) measure of a patient's medication adherence — how consistently they are taking their meds — which is a metric that retail pharmacists are in a position to influence. In addition, insurance companies will begin receiving quality bonus payments (QBPs) from CMS based on their star rating, beginning with a three-star rating.

The QBPs can amount to “millions of dollars,” said Laura Cranston, executive director, Pharmacy Quality Alliance (PQA), Fairfax Station, Va., which developed some of the metrics used by the CMS in rating insurance companies.

Retailers, said Cranston, should be asking themselves what they can do to help insurance companies drive up patients' adherence levels, and therefore their CMS scores, so that the companies can earn more QBPs. Then, in negotiating a contract with the providers, retailers can attempt to secure a share of the incentives. “Retailers should be saying, ‘I want a cut of that,’” she said, adding that retailers currently receive no part of the QBPs. “That's what we're trying to educate retailers about.”