A Need for Change
Mr. Eckel is professor and director of the Office of Practice Development and Education at the School of Pharmacy, University of North Carolina at Chapel Hill.
Recent events suggest that thevoice of community pharmacy issimply not being heard. Despitemonths of lobbying by our profession, theCenters for Medicare & Medicaid Services(CMS) announced Average ManufacturersPrice?based Medicaid reimbursementrates that could be financiallydisastrous for pharmacies. A more recentCMS plan, requiring tamper-resistant prescriptionpads for all Medicaid prescriptionsthis fall, also could be highly damaging.It would put pharmacists in the positionof denying patients access to drugsif their prescriber does not use a tamperresistantprescription blank?or filling theprescription and risking loss of reimbursement.
We need to continue to fight unfairplans such as these, and we still havehope that we will be able to reduce thepotential damage.We also need to thinkabout the longer-term implications, however.Our traditional model is threatened,and our protests are often ignored. Is thesolution to protest even more loudly? Or,rather than expecting the world tochange, do we need to change what wedo? I believe that the survival of communitypharmacy depends on focusing onwhat we can provide that is different andvaluable.
Community pharmacists are uniquelyplaced to counsel patients about theirdrug therapy and to help them achievebetter health. This is something thatpatients cannot obtain from alternativechannels such as mail order. Today weprovide that counseling free while dispensingdrugs. If we treat it simply as aby-product of the dispensing operation,however, we provide no incentive forothers to see it as a valuable service. Ifwe are providing a unique service, weneed to recognize its value and focus onit ourselves, and we need to communicateits value to patients and payers.
Signs are evident that others are beginningto agree on the need for change.The American Pharmacists Association,the National Association of Chain DrugStores, and the National CommunityPharmacists Association recently announcedProject Destiny?a joint effortto develop new practice and reimbursementmodels, with a focus on positioningthe pharmacist as the medication expertand the key provider of medication therapymanagement services to patients.
Of course, focusing on new servicesmay mean delegating more routine tasksto technicians. That is something many ofus still feel uneasy about.
We need new approaches. We cannotcontinue to do business as we have andexpect others to respect and preserveour traditional model. It is up to us to findnew roles if we want to be a vital part ofthe 21st-century health care system.