Groups Announce New Collaboration to Measure and Improve Quality at the
Pharmacy Level
WASHINGTON, April 19 /PRNewswire/ -- In an unprecedented joint effort,
America's Health Insurance Plans (AHIP), the National Community Pharmacists
Association (NCPA), and the National Association of Chain Drug Stores
(NACDS) have collaborated to simplify and standardize the steps that most
affect service for Medicare beneficiaries filling prescriptions at
pharmacies.
(Logo: http://www.newscom.com/cgi-bin/prnh/20040830/AHIPLOGO )
NACDS, NCPA, and AHIP have worked together over the past six weeks,
along with the American Pharmacists Association (APhA) and the
Pharmaceutical Care Management Association, to simplify and standardize the
electronic claims processing messages going from Medicare Part D drug
sponsors to independent pharmacies and retail chains. The initial step in
this effort was to provide pharmacists electronic message clarity regarding
the coverage status of certain drugs.
Coverage denials can be grouped into two categories: drugs that are
denied because they are excluded from Part D coverage as mandated by the
Medicare Modernization Act, and drugs that are denied because they are
covered under Medicare Part B.
AHIP, NACDS, and NCPA developed and presented joint recommendations to
a Work Group of the National Council for Prescription Drug Programs
(NCPDP), the organization that creates and promotes standards for
transferring data to and from pharmacies. NCPDP has approved a process for
using standardized coding and electronic messages notifying pharmacists of
claims rejections in these two situations.
Today, NACDS, AHIP, and NCPA are transmitting to the Centers for
Medicare & Medicaid Services (CMS) and NCPDP a second set of
recommendations to further improve service to Medicare beneficiaries
filling prescriptions at community pharmacies. The new proposal for
additional standardized electronic claims processing messages to
pharmacists addresses prior authorization requirements, daily dose
limitations, quantities that may be dispensed for a given prescription, and
age and gender contraindications.
"The result of the work between our groups is that everyone wins," said
Bob Hannan, Interim CEO of NACDS. "Medicare recipients will benefit from
this important collaboration through less confusion, less time at the
pharmacy counter, and faster access to the medications they need.
Pharmacists will also be assisted through improved communication concerning
the status of drugs covered under Medicare."
The success of this unprecedented collaboration among AHIP, NCPA, and
NACDS has led to discussions of how to build on these cooperative efforts.
"I think we have a unique opportunity to build on this collaboration
between prescription drug plans and pharmacists to identify additional
efforts to improve the Medicare Part D benefit and build a new model that
results in enhanced patient care," said NCPA Executive Vice President and
CEO Bruce Roberts, RPh.
At a news briefing today, CMS Administrator Mark B. McClellan, MD, PhD,
also announced the formation of the Pharmacy Quality Alliance (PQA). PQA
will aim to improve pharmacy care and outcomes through a collaboration of
the pharmacy community, health plans, government, employers, physicians,
and consumers. The goal of PQA will be to agree on a strategy for measuring
and reporting data that will help consumers make informed choices and
appropriate healthcare decisions.
"Pharmacists and pharmacies have demonstrated how important they are to
the implementation of the Medicare drug benefit, and we're pleased to
support these collaborative efforts," said Dr. McClellan. "The PQA is an
important next step in supporting pharmacists' efforts to improve quality
and reduce costs in our health care system," he said.
The founding members of PQA will include APhA, NACDS, NCPA, and AHIP
along with other leading consumer groups, pharmacy organizations, employer
groups, physician organizations, and health plans.
"Today's health care challenges require that we as stakeholders roll up
our sleeves, remove ourselves from silos, and work together with new
partners and in new ways," said AHIP President and CEO Karen Ignagni. "No
one stakeholder alone can achieve the system-wide improvements in quality
that we hope to achieve together," she said.
The National Community Pharmacists Association, founded in 1898,
represents the nation's community pharmacists, including the owners of more
than 24,000 pharmacies. The nation's independent pharmacies, independent
pharmacy franchises, and independent chains represent an $84 billion
marketplace, dispensing nearly half of the nation's retail prescription
medicines.
The National Association of Chain Drug Stores (NACDS) represents the
nation's leading retail chain pharmacies and suppliers, helping them better
meet the changing needs of their patients and customers. Chain pharmacies
operate more than 37,000 pharmacies, employ 114,000 pharmacists, fill more
than 2.3 billion prescriptions yearly, and have annual sales of nearly $700
billion. Other members include more than 1,000 suppliers of products and
services to the chain drug industry. NACDS international membership has
grown to include 93 members from 30 countries. For more information about
NACDS, visit http://www.nacds.org.
America's Health Insurance Plans - Providing Health Benefits to More
Than 200 Million Americans
SOURCE America's Health Insurance Plans; National Community
Pharmacists
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Related links:
http://www.ahip.org
http://www.nacds.org/
Photo Notes:http://www.newscom.com/cgi-bin/prnh/20040830/AHIPLOGO
AP Archive: http://photoarchive.ap.org PRN Photo Desk
photodesk@prnewswire.com
CONTACT:
Susan Pisano of AHIP, +1-202-778-3245; Lance
Lemmonds of NACDS, +1-703-837-4607; Carol Cooke of NCPA,
+1-703-838-2686; or Peter Ashkenaz of CMS, +1-202-690-6145
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