Managed Care - June 2008 - (Page 6)

LETTERS PBM contracting Linda Cahn makes some salient points in her article on decreasing prescription costs [“How to Dramatically Decrease Your MCO’s Rx Coverage Costs,” April.] First and foremost, every MCO should understand what motivates its PBM. How does your PBM make money? Does it own and sell drugs through a mail order, retail, or specialty pharmacy? Utilization is the driver of any MCO’s drug spend. If the PBM’s bottom line is enhanced by selling more drugs, will it really be motivated to lower this trend? Just some other points to consider. Dawn Anderson Vice President MedImpact Healthcare Systems San Diego, Calif. Now Part of the Corporate Dashboard Wellness Care M A N A G E D FEBRUARY 2008 Will Health Plans Get Their Share of the Business? PACKAGE INCLUDES: An Opportunity for Health Plans 24 You Will Live Healthily! 30 Major Employers Lead the Way 35 Legislators Urged to Reward Wellness 39 WWW.MANAGEDCAREMAG.COM Unfair to pharmacies The article on e-prescribing in the February 2008 edition [“Why Is It So Tough to Deliver on E-Prescribing’s Promise?] completely overlooked an important fact. E-prescribing costs the receiving pharmacy for each and every prescription received. Physicians will have onetime costs for software and training. They will not be charged for transmitting prescriptions. Pharmacies will pay for each prescription received. Medicare Part D has already forced the closure of many independent pharmacies because of inadequate and delayed payments. How can an independent pharmacy afford to pay for each prescription received in addition to paying for the transmission of each claim to an insurer? Many more pharmacies will be forced out of business or forced to stop serving Medicare Part D patients by the mandate of e-prescribing without funding and sustaining implementation. If there are proposals for incentives and rewards for physicians to implement e-prescribing, why not to the pharmacies that have to have software changed to accept the prescriptions? This cost should not have to be borne by pharmacy alone. Pharmacists will still be on the phone to physicians’ offices with questions about prescriptions. The electronic prescribing systems in place now leave plenty of room for inaccuracies and problems. We won’t be calling about the handwriting, but inadvertent changes in strength or directions, quantities that don’t make sense, product description that doesn’t match prescribed size, even choice of wrong medication all take place. I see a great potential for e-prescribing, but also a great unfairness in placing the cost burden on physician practices and pharmacies. Julie Schrantz, RPh Director of Pharmacy Services Clinton Memorial Hospital Saint Johns, Mich. programs are reducing health care costs but want to make you aware that there is a program out there that is actually documenting cost savings by companies when they set up programs using pharmacists as “coaches.” The American Pharmacists Association Foundation (www. aphafoundation.org) started the Diabetes Ten Cities Challenge in 2005. There are published papers about the actual cost savings involved in the Asheville Project, a diabetes self-management program started 10 years ago by the APhA Foundation that has proven to improve overall health, reduce absenteeism, shorten hospital stays, and reduce health care costs. I hope that you will consider doing an article about this progressive program. I am a provider pharmacist in the Maryland P3 program, which is part of the Ten Cities Challenge. I am learning first hand what a difference we can make in people’s lives. Linda M. Smith, RPh, Pharmacy consultant Silver Spring, Md. (Editor’s note: I guess you missed our cover story, “Asheville’s Legacy,” in the October 2007 issue. Go to www.managedcaremag.com and search for “Asheville.”) e s th ith 42 at’ W ? Wh blem bing Pro scri re E-P Where are the data? I read your article in the February 2008 magazine called “What’s the ROI on Wellness?” What was interesting is that the companies that are providing the wellness programs had no data to support their claim of positive results. I do not doubt that their No more patches It is interesting that WellPoint cannot afford to pay providers more, inasmuch as their 2006 annual report stated a profit of over $3 billion [“How Doctors Are Paid Now, and Why It Has to Change,” December 2007]. Yes, $3 billion with a “B.” United’s “scandal” continued on page 13 6 MANAGED CARE / JUNE 2008 http://www.aphafoundation.org http://www.aphafoundation.org http://WWW.MANAGEDCAREMAG.COM http://www.managedcaremag.com

Table of Contents Feed for the Digital Edition of Managed Care - June 2008

Managed Care - June 2008 Editor’s Memo Contents Viewpoint Letters News and Commentary Legislation & Regulation Medication Management Compensation Monitor Plans Chart Course in Rough Waters A Conversation With Barbara Starfield, MD Smoke Signals from Payers Slow Going for Clinical Decision Support Back Pain and Physical Therapy Formulary Files PlanWatch Outlook

Managed Care - June 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.