December 2013, Vol 1, No 2 - The First Word
Donald J. Dietz, RPh, MS

Retail pharmacists will find 2014 to be a very interesting and challenging year. In the face of declining third-party reimbursement rates, we expect more of our customers to have prescription benefit coverage through the new insurance exchanges. In addition to those who are new to healthcare insurance coverage, millions more with existing coverage will switch healthcare providers or will have their employer select a new prescription benefit provider. These changes will impact pharmacists as these new prescription benefit coverage designs will expand patient consumerism in ways we have not seen before.

Deductibles, coinsurance, and therapeutic interchange (alternatives) will be 3 areas where pharmacists have the opportunity to engage patients and help them to maximize the benefits of their prescription coverage. The new exchange plans offer high deductibles and coinsurance that may very well create sticker shock as patients are exposed to the “actual cost” of the medication. Coinsurance will become more frequently seen with the more expensive specialty medications.

Expect your patients to ask about the price of the medications they have been prescribed before you fill the prescription, and be prepared for the patients who will elect to abandon the prescription at pickup because of the high price. High deductibles and coinsurance will prompt your patients to ask questions about formulary options, generic alternatives, partial quantities, and other ways to manage their out-of-pocket medication expenditures. Aside from generic substitution, these issues will result in additional prescriber calls to discuss therapeutic alternatives that may be covered, in a preferred tier, or that have a lower out-of-pocket cost to the patient.

Although this is yet another nonreimbursed activity, consider it a chance to bond with a new pharmacy visitor or cement a relationship with an existing patient. Similar to the introduction of Medicare Part D 8 years ago, retail pharmacists will be called upon to smooth out the rough spots at the program’s introduction and help patients to make the most of their new prescription drug benefit coverage.

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Last modified: February 12, 2014
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