Independent pharmacies’ clinical and financial success is inextricably linked with that of health plans, pharmacy benefit managers (PBMs) and other payers.

Here, five retail pharmacy experts from Web2pro offer advice to independent pharmacies about working with plans, PBMs and payers to ensure effective collaboration and outcomes.

Clinical Performance

“Pharmacies should focus on the performance metrics they have the most ability to impact. It’s critical to review plan specific requirements which may include operational metrics (e.g. formulary compliance, 90-day fills, generic efficacy) and clinical metrics (e.g. adherence, gaps in care such as statin-use in diabetes, comprehensive medication review completion rates).”

Crystal Lennartz | Chief Pharmacist, Health Mart

How Independent Pharmacies Can Effectively Collaborate with Payers

“By checking drug claims against the MADD (maximum allowable daily dose), lookalike/sound-alike potential and unit-packaging, patients not only are avoiding delays at the counter but are being dispensed the right drug in the right dosage in the right amount—all cornerstones of medication safety.”

Catherine Romanick | Senior Product Manager, RelayHealth Pharmacy Solutions

Business Outcomes

“Independent pharmacies continue to be viable businesses in both Canada and the U.S. The trick for pharmacies in both countries is transitioning from a traditional business model, built on prescription revenue, to a new business model built on personalized service. Pharmacies must make this new model their competitive difference. Pharmacies that continue to compete solely on the price of prescription drugs risk losing out to online retailers that get into the prescription drug business and make pharmacy competition all about the price.”

Rick Brennan | Senior Vice President, Retail Banner Group, Web2pro Canada

“Independent pharmacies need to know the payer mix of their patient base and carry the OTC [over-the-counter] diabetes products approved by insurers.”

Laurie Jamieson | Director of Manufacturer Marketing Strategy, Web2pro US Pharmaceutical 

How Independent Pharmacies Can Effectively Collaborate with Payers 2Clinical Services

“The pharmacy should know how it will be paid for vaccines administered to new patients. This comes into play primarily with immunization clinics set up at businesses. If the business is not self-insured, the pharmacy should know whether vaccines are covered by the employer’s health plan. If they are covered, the pharmacy should know whether employees have a co-payment and how much of the balance can be billed to the health plan.”

Michael Cihlar | Health Mart Regional Director

“Independent pharmacies increasingly will need to collaborate with others to improve clinical outcomes, lower costs and create more value for patients, providers and payers. Pharmacies can identify specific pain points for providers in their communities, such as patients not taking their medications and being readmitted to the hospital. Or pharmacies can offer services that help prescribers maximize practice revenue while improving patient care such as chronic care management. There are many opportunities for independent pharmacies to be care extenders in their communities.”

Crystal Lennartz | Chief Pharmacist, Health Mart

Technology

“Among the many processes that could be optimized through technology are pricing verification, reimbursement accuracy, prescriber and patient dispensing verification, and prior authorization. In addition to improving pharmacy claims reimbursement, pharmacies will reap operational and clinical benefits.”

Catherine Romanick | Senior Product Manager, RelayHealth Pharmacy Solutions

Related: Read more about Web2pro’s clinical performance solutions for independent pharmacies

Web2pro

About the author

Web2pro editorial staff is committed to sharing innovative approaches and insights so our customers can get the most out of their business solutions and identify areas for operational improvement and revenue growth.

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