CPESN looks for pharmacy strength in numbers
As independent pharmacies face more margin pressure as payers look to cut costs, there is a new way pharmacists are coming together to get paid for the enhanced services they offer patients every day.
At a panel during the Cardinal Health RBC 2017 Opening Session that featured National Community Pharmacists Association CEO, DeAnn Mullins, NCPA president, Doug Hoey, and independent pharmacist, Rob Cockman of Midtown Pharmacy in Whitsett, N.C., the three outlined the role a new pharmacist network is playing in properly compensating independent pharmacists for their role in providing healthy patient outcomes.
The Community Pharmacy Enhanced Services Network — which has launched in 14 states and is at various stages of planning in 30 others — is the solution that has been developed to help pharmacists be properly reimbursed for their services in the age of DIR fees and shrinking margins — and while pharmacists still push for provider status under Medicare Part B.
“Yes, it's another acronym to add to your vocabulary, but it’s an important one because we are taking back pharmacy one enhanced services network at a time,” Mullins said. CPESN works directly with payers, positioning pharmacies as a resource to help improve the health of their sickest patients in an effort to lower overall healthcare costs. In North Carolina, Cockman was on the ground floor of establishing a CPESN network that works with local payer Community Care of North Carolina.
“In addition to the prescription, we get paid monthly for every patient that's in the CPESN network that comes to our pharmacy,” Cockman said about the payment structure for CPESN pharmacies that receive patients from CCNC case workers who think pharmacies can help.
“It’s extended and enhanced services above putting pills in bottles — stuff we already do on a daily basis,” he said. Mullins said that working within a CPESN network is a way for pharmacists to change how payers and PBMs think about pharmacy’s role in the healthcare system.
“To think about being paid differently means that you have to think differently,” she said. “There's $3.2 trillion being spent on health care every year, and we're considered a cost center — 10% of that spend is focused on pharmacy as a cost. I would say we are not a cost, we are an investment.”
For Hoey, CPESN is emerging at a time when there is fruitful ground for a new solution to the perennial and increasingly imperative question of how to lower healthcare costs while addressing some of the most pressing problems pharmacies face in this environment.
“One of the reasons the time is now for this is the pressure on disrupting the current payment system,” he said. “Prescription drug prices going off the charts and 17% of GDP going toward healthcare are putting pressure on finding another way, and this is another way. This begins to get at the issues that are near and dear to our hearts - like limited access. It begins to get at MACs and DIR fees. They’ll still be there, but there's another way to be getting paid — in addition to the prescription side, the product side.”
Hoey and Cockman noted that even when demonstrating value, pharmacy tends to be seen as a cost center rather than a resource. If that perception changes and pharmacies can better make their value known to key stakeholders, pharmacies can begin to tap into the other 90% of healthcare spending.
“Pharmacy is only 10% of overall medical spend, and we've been stuck in that 10% ever since that model came about,” Cockman said. “Being part of a CPESN is a way for us to say 'We can't argue with PBMs over our value anymore — let's make our way into the other 90% of the total medical spend and show our worth there.’”
But it won’t happen without work — including learning more and becoming part of a network.
“There's no reason why any of you can't do any of the same things we do in North Carolina,” Cockman said. “I implore you to find out how to tap into the networks that are already there or help start your own network.”
Photos courtesy of Alabastro Photography
At a panel during the Cardinal Health RBC 2017 Opening Session that featured National Community Pharmacists Association CEO, DeAnn Mullins, NCPA president, Doug Hoey, and independent pharmacist, Rob Cockman of Midtown Pharmacy in Whitsett, N.C., the three outlined the role a new pharmacist network is playing in properly compensating independent pharmacists for their role in providing healthy patient outcomes.
The Community Pharmacy Enhanced Services Network — which has launched in 14 states and is at various stages of planning in 30 others — is the solution that has been developed to help pharmacists be properly reimbursed for their services in the age of DIR fees and shrinking margins — and while pharmacists still push for provider status under Medicare Part B.
“Yes, it's another acronym to add to your vocabulary, but it’s an important one because we are taking back pharmacy one enhanced services network at a time,” Mullins said. CPESN works directly with payers, positioning pharmacies as a resource to help improve the health of their sickest patients in an effort to lower overall healthcare costs. In North Carolina, Cockman was on the ground floor of establishing a CPESN network that works with local payer Community Care of North Carolina.
“In addition to the prescription, we get paid monthly for every patient that's in the CPESN network that comes to our pharmacy,” Cockman said about the payment structure for CPESN pharmacies that receive patients from CCNC case workers who think pharmacies can help.
“It’s extended and enhanced services above putting pills in bottles — stuff we already do on a daily basis,” he said. Mullins said that working within a CPESN network is a way for pharmacists to change how payers and PBMs think about pharmacy’s role in the healthcare system.
“To think about being paid differently means that you have to think differently,” she said. “There's $3.2 trillion being spent on health care every year, and we're considered a cost center — 10% of that spend is focused on pharmacy as a cost. I would say we are not a cost, we are an investment.”
For Hoey, CPESN is emerging at a time when there is fruitful ground for a new solution to the perennial and increasingly imperative question of how to lower healthcare costs while addressing some of the most pressing problems pharmacies face in this environment.
“One of the reasons the time is now for this is the pressure on disrupting the current payment system,” he said. “Prescription drug prices going off the charts and 17% of GDP going toward healthcare are putting pressure on finding another way, and this is another way. This begins to get at the issues that are near and dear to our hearts - like limited access. It begins to get at MACs and DIR fees. They’ll still be there, but there's another way to be getting paid — in addition to the prescription side, the product side.”
Hoey and Cockman noted that even when demonstrating value, pharmacy tends to be seen as a cost center rather than a resource. If that perception changes and pharmacies can better make their value known to key stakeholders, pharmacies can begin to tap into the other 90% of healthcare spending.
“Pharmacy is only 10% of overall medical spend, and we've been stuck in that 10% ever since that model came about,” Cockman said. “Being part of a CPESN is a way for us to say 'We can't argue with PBMs over our value anymore — let's make our way into the other 90% of the total medical spend and show our worth there.’”
But it won’t happen without work — including learning more and becoming part of a network.
“There's no reason why any of you can't do any of the same things we do in North Carolina,” Cockman said. “I implore you to find out how to tap into the networks that are already there or help start your own network.”
Photos courtesy of Alabastro Photography