CMS chief needs you to help make Medicare law succeed

The administrator of the Centers for Medicare & Medicaid Services, Mark McClellan, is in a big hurry. A telltale sign is the rapid-fire way in which he spoke before pharmacists at the American Pharmacists Association annual meeting in Orlando last month. McClellan knows there are still many plans to be laid in the remaining months before Medicare Part D can be rolled out next January. But on schedule it will be, he vowed repeatedly at APhA's opening general session.

Mindful of the lukewarm results the Medicare discount cards have received, McClellan is well aware that the new drug benefit can't meet with the same fate. He's also cognizant that it's not enough just to offer seniors a drug benefit. To succeed, he will need the help of pharmacists to explain the prescription drug plans (PDPs) to patients. Supporting this is a recent Kaiser Family Foundation survey, which found that almost one-third of seniors said they would "very likely turn" to their pharmacists for help when choosing a Medicare drug plan.

To secure pharmacists' cooperation, McClellan told the audience that CMS is doing a number of things to help them. First, to increase the voice of pharmacy in the agency, CMS has hired more pharmacists than ever before. "Of all the health professionals we've brought into CMS to help make sure we implement all of the changes in the new Medicare law effectively, pharmacists have been at the top of the list," he declared. CMS has recruited at least one pharmacist in each of its 10 regional offices and 10 in its central office. In addition, it will be working with at least 125 pharmacists who will help the agency review the formularies proposed by PDPs.

Another way to save pharmacists' time is to require electronic prescriptions. While the Medicare law has provisions that mandate the implementation of e-prescribing no later than 2009, McClellan said CMS would accelerate this schedule. CMS will be finalizing standards for e-Rxs before the drug benefit begins in 2006. He added that the agency plans to set up some e-prescribing pilot projects and urged companies that are now engaged in the practice to participate.

In addition to time, pharmacists will need solid information about the new law to share with their patients. McClellan said CMS would be working with APhA to provide a nationwide continuing education program for pharmacists so they can, in turn, train other R.Ph.s on how to implement the law. Ideally this "train the trainer" program will include both federal-and state-specific materials for participants.

What's in it for R.Ph.s to get involved? McClellan claimed that pharmacies would see a net increase in their revenues of 0.6% to 1.9%. There could also be additional payment for medication therapy management (MTM) services. However, he cautioned that only "high-quality" MTM services would be rewarded and, at present, quality does vary from pharmacy to pharmacy. CMS is now measuring the quality of hospitals, nursing homes, and other providers; it wants to do the same with pharmacies.

In an interview with the press following his presentation, McClellan said the agency is implementing a Medicare Health Support program to pilot MTM services. Pharmacies that improve outcomes and lower costs will be rewarded. "We need pharmacists to work with us to come up with measures to identify and reward high-quality pharmacy services," he said.