More independent pharmacies offer patient services in challenging healthcare environment

Approximately half of independents are helping patients to improve health outcomes through medication adherence counseling services. They are also recommending generic drug use to patients and their physicians, and achieving a high acceptance rate (83%), said B. Douglas Hoey, RPh, MBA, CEO of the National Community Pharmacists Association (NCPA), speaking in October at the association’s 115th annual convention in Orlando, Fla.

“Forty-eight percent of independent community pharmacists are offering medication adherence counseling services. It was 39% last year. NCPA has encouraged that strongly, because we believe adherence is the building block for pharmacists to develop clinical services. In addition, pharmacists’ recommendations to physicians about generic drug use are accepted 83% of the time,” said Hoey during a media call discussing the results of the recently released 2013 NCPA Digest, sponsored by Cardinal Health. The Digest is a comprehensive analysis of 2012 financial and practice data of independent NCPA members.

 “There is an urgency around the advancement of pharmacy practice, and now is our time to act. Because of poor medication adherence, the rampant prescription drug abuse problem, and the worsening primary care shortage, pharmacists are ideally situated,” Hoey noted.

More independent community pharmacists now offer medication therapy management (69% in 2012 vs. 67% in 2011), compliance packaging (41% in 2012 vs. 38% in 2011), phone calls and text reminders (39% in 2012 vs. 22% in 2011), and medication synchronization (39% in 2012 vs. 35% in 2011).

“There is also excitement about the program Simplify My Meds, which allows patients to have their prescription medications synchronized” for easy monthly pickup, Hoey said. “This also allows the pharmacist to have a comprehensive medication overview with the patient.” More than 30,000 patients are enrolled in the medication synchronization program through 1,000 independent pharmacies.

Financials

There has been a slight decline in the number of independent community pharmacies - from 23,106 in 2011 to 20,029 in 2012. Prescription sales volume has also decreased from a mean of 62,969 in 2011 to 62,583 in 2012. This may be attributed to a decline in refill rates because of mandatory mail-order policies. Refill rates were 53% in 2012, 54% in 2011, and 55% in 2010, the Digest noted.

This decline in sales volume has translated into a 3% pre-tax net profit on average for independents in 2012, which is approximately on par with 2011’s figure of 2.9%. However, according to the Digest, 10 years ago the pre-tax net profit for independents averaged 4%.

Generic price spikes

Independent community pharmacists are also struggling with the large increase in generic drug prices and the fact that some pharmacy benefit managers (PBMs) are not updating the maximum allowable cost (MAC) drug reimbursement lists quickly enough, said NCPA President-elect Mark Riley, RPh, who spoke during the media call.

“We are seeing large increases in generic drug prices. The middlemen in pharmacy - PBMs - are not keeping up with the price increases. Pharmacists are put in the position that they have to dispense some drugs at a loss in order to continue treating these patients. They may lose $10, $20, or $30 for a prescription, and this puts them in a terrible situation,” Riley said. “Pharmacists cannot continue to fill prescriptions where they are consistently losing money.”

Generic prices have risen dramatically for a number of reasons. Some generic suppliers have been sanctioned or restricted by FDA for problems in their facilities. In addition, there has been consolidation within the generic industry, as well as a limited number of suppliers of the raw ingredients, according to Hoey.

“There is a fine line between market forces and price-gouging,” Riley added.

NCPA is making it a legislative priority to address this alleged misuse by PBMs of MAC drug reimbursement caps. “We foresee MAC bills being introduced in a number of states in 2014,” Hoey said.

Compounding legislation

NCPA endorsed H.R. 3024, The Drug Quality and Security Act, which passed in the House of Representatives by a voice vote at the end of September and is awaiting Senate review after the government shutdown ends, said Steve Pfister, NCPA’s senior vice president of government affairs.

This legislation preserves the practice of traditional pharmacy compounding within the community, Pfister noted, and requires FDA to work with state regulators to help prevent another compounding disaster like the one that occurred last year at the New England Compounding Center.  In addition, pharmacies that compound sterile drugs for distribution can voluntarily register with FDA as “outsourcing facilities,” and will be subject to FDA inspections. In FY 2015, these outsourcing facilities will pay $15,000 for registration and another $15,000 for inspections.

The bill also includes a provision for securing the drug supply chain with federal registration of manufacturers, wholesale distributors, repackagers, and third-party logistics providers. In January 2015, drugs will be labeled and tracked at the lot level, and in 10 years from enactment, drugs will be tracked electronically at the unit level.