We can learn many lessons from the challenges of the past year. Key among these is the importance of remaining adaptable. For pharmacy owners and operators, the concept of adaptability can mean reimagining current delivery models in an effort to address shrinking margins. Adaptability can also take the form of adopting a best-practice solution, adding a new service, and becoming agile in order to enhance efficiency.
The COVID-19 pandemic has highlighted how interconnected our communities are and as a result, many business owners are emerging from the experience with a renewed focus on how to make a greater contribution to society. An owner or operator of a viable and profitable pharmacy business can make a significant contribution by actively pursuing programs and services that help address healthcare disparities in the community. Many pharmacy services administrative organizations (PSAOs) offer a range of programs that go beyond contracting. Make a note to inquire about your PSAO’s program offerings to learn how they can help offset shrinking margins while you break down barriers of access to quality healthcare.
Here are 3 programs that can serve as revenue streams while enabling a pharmacy owner or operator to contribute to the greater good.
Cash Discount Card
According to a survey conducted by the Commonwealth Fund, 43.4 percent of U.S. adults between the ages of 19 and 64 were inadequately insured in the first half of 2020. It is likely that your pharmacy serves patients who belong to this segment of the population. Patients whose current insurance plans carry high copays for brand name or generic drugs or have no prescription drug coverage because they are either uninsured or underinsured, will typically pay cash for filled prescriptions. When implemented correctly, a cash discount card program can help you maximize your pharmacy’s cash business. Hidden administrative fees from a cash discount card program can significantly reduce its benefit to your pharmacy—transparency is key.
In addition to transaction fees, most cash discount card programs offer features such as covered discounts, MAC lists, and an online pricing tool. As with any program or service, it is helpful to do some research and read the fine print! The right cash discount card program will offer a) cost savings through administrative and transaction fees that are on the lower end of the spectrum; b) pricing that factors available wholesaler pricing into determining MAC pricing; and c) protection from audit recoupment based on effective procedures designed to prevent prescription claim pricing that is below what is usual and customary (submitting prescription claims priced below what is usual and customary could trigger an audit).
The pandemic has brought the discussion on healthcare disparities in underserved communities to the fore. Today, there is an increased awareness of the role that businesses, community organizations, state and federal agencies, and individuals can play in reducing these disparities. An independent pharmacy can play a role in addressing healthcare disparities as a contracted pharmacy for a 340B covered entity. Health Resources and Services Administration (HRSA) describes the 340B program as contract pharmacy services delivered to 340B covered entities to help them expand health services to vulnerable and underserved populations in the communities they serve. 340B opportunities in your service area as well as guidelines for contracted pharmacies on responsibilities, audit requirements, and registration are outlined on HRSA.gov. Your PSAO may have a partnership with a third-party that can help reduce the administrative burden and maximize existing 340B relationships.
Point-of-care testing has gained new ground in recent times and especially so with the COVID-19 pandemic. Under this model of testing, patients are given a simple rapid test in the pharmacy for conditions such as influenza, Strep A, A1C or other ailment. Once the test is successfully administered, a prescription is written for treatment, where appropriate. According to the National Community Pharmacists Association (NCPA), tests of this nature that are administered outside a laboratory are waived under the Clinical Laboratory Improvement Amendments (CLIA) Act and can be billed to the patient or third-party payer. Point-of-care testing can be one more reason for patients to come through the doors of your pharmacy. Additionally, you can help reduce gaps in both access and quality of care. Learn more about CLIA and how to obtain a waiver at CMS.gov.
Centers for Medicare and Medicaid Services. (March, 2021). Clinical Laboratory Improvement Amendments. https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA
Health Resources and Resources Administration. (2021). Office of Pharmacy Affairs 340B OPAIS. https://340bopais.hrsa.gov/CoveredEntitySearch/000132134
Health Resources and Resources Administration. (October, 2018). Contract pharmacy services. https://www.hrsa.gov/opa/implementation/contract/index.html
National Community Pharmacists Association. (2020). Point-of-care testing. https://ncpa.org/point-care-poc-testing
The Commonwealth Fund. (2020, August). U.S. Health insurance coverage in 2020: A looming crisis in affordability. https://www.commonwealthfund.org/publications/issue-briefs/2020/aug/looming-crisis-health-coverage-2020-biennial