Recent events suggest that the voice of community pharmacy is simply not being heard. Despite months of lobbying by our profession, the Centers for Medicare & Medicaid Services (CMS) announced Average Manufacturers Price?based Medicaid reimbursement rates that could be financially disastrous for pharmacies. A more recent CMS plan, requiring tamper-resistant prescription pads for all Medicaid prescriptions this fall, also could be highly damaging. It would put pharmacists in the position of denying patients access to drugs if their prescriber does not use a tamperresistant prescription blank?or filling the prescription and risking loss of reimbursement.
We need to continue to fight unfair plans such as these, and we still have hope that we will be able to reduce the potential damage.We also need to think about the longer-term implications, however. Our traditional model is threatened, and our protests are often ignored. Is the solution to protest even more loudly? Or, rather than expecting the world to change, do we need to change what we do? I believe that the survival of community pharmacy depends on focusing on what we can provide that is different and valuable.
Community pharmacists are uniquely placed to counsel patients about their drug therapy and to help them achieve better health. This is something that patients cannot obtain from alternative channels such as mail order. Today we provide that counseling free while dispensing drugs. If we treat it simply as a by-product of the dispensing operation, however, we provide no incentive for others to see it as a valuable service. If we are providing a unique service, we need to recognize its value and focus on it ourselves, and we need to communicate its value to patients and payers.
Signs are evident that others are beginning to agree on the need for change. The American Pharmacists Association, the National Association of Chain Drug Stores, and the National Community Pharmacists Association recently announced Project Destiny?a joint effort to develop new practice and reimbursement models, with a focus on positioning the pharmacist as the medication expert and the key provider of medication therapy management services to patients.
Of course, focusing on new services may mean delegating more routine tasks to technicians. That is something many of us still feel uneasy about.
We need new approaches. We cannot continue to do business as we have and expect others to respect and preserve our traditional model. It is up to us to find new roles if we want to be a vital part of the 21st-century health care system.