The Medical Home and Pharmacy Services
Friday, May 13, 2011
Posted by: Joy Ingram
Could this addition give us the home of our dreams?by Patrick Riley, Regional Director, SUNRx
Across the country, the “medical home” is proving to be an effective way to provide affordable, high quality care to uninsured and underinsured families. By coordinating primary, specialty, and hospital care, the medical home promotes routine and preventive care and allows problems to be addressed early and monitored closely by a primary care doctor.
The Other Drug Problem
Having one physician coordinate care is an important first step. But at home, after the office visit, patients still need to take their medications as prescribed. Too often, this is where things break down.
To paraphrase C. Everett Koop, “Medications only work when they are taken.” But nearly half of all Americans can’t afford to take them as prescribed. According to a recent Kaiser Family Foundation poll, three in 10 Americans did not fill a prescription due to cost. Another two in 10 cut pills or skipped doses.
Because poor medication compliance has reached epidemic proportions, it is now commonly referred to as America’s other drug problem.
A Prescription for Compliance
But there is a solution: The federal 340B drug discount program. This program, enacted nearly 20 years ago -- visionary for its time, incorporates pharmacy services into the medical home model.
Under 340B, federally qualified health centers, disproportionate share hospitals and certain other entities may purchase medications at steep discounts and partner with local retail pharmacies to dispense them to eligible patients.
To be eligible for 340B medications, a patient must rely on the 340B-covered entity for their medical home. When a provider at a covered entity refers a patient to a specialist, the prescriptions written by specialist are also eligible for 340B discounts.
Coordinating pharmacy services within the medical home model also allows the primary care doctor to keep track of whether a patient is having his prescriptions filled and refilled. Now the doctor can follow up with patients and urge them to take their medications. Over the long run, this will improve outcomes, reduce ER visits and reduce the cost of healthcare for all of us.
340B also contributes to the medical home model in other important ways. For example, covered entities may purchase medications at 340B prices and then bill third party payors. This generates revenue -- millions of dollars annually for some entities -- that can be reinvested in facilities, operations, staff and care or to subsidize medications for other patients.
Over the next few years, as the population ages, deficits balloon, and medical inflation continues to rise, our entire nation will be focused on ways to improve healthcare quality, access and value. The medical home is emerging as one of the most effective ways to accomplish these goals. And, by incorporating pharmacy services in this model, it may just be the prescription policymakers, payors, providers and patients have all been seeking.