Long-term care pharmacy: missed opportunities

DATE: May 3, 2017

Published by McKnight’s

One thing I’ve learned since joining this business years ago is that if you want a creative, persuasive thinker on your team, you could do a whole lot worse than Alan Rosenbloom. He’s now spending his days trying to raise the profile of the senior care pharmacist, lucky for them.

While frontliners might grapple with IMPACT Act provisions that need adhering to, for example, Rosenbloom wonders why more wasn’t done through the 2014 law. The president of the Senior Care Pharmacy Coalition, Rosenbloom says assigning medication reconciliation chores came up far short of what is needed.

“Congress missed what a crucial opportunity,” he told me. “What we really need from consultant pharmacists is medication therapy management. That’s quite different.”

If pharmacists were more permanent fixtures on more care-planning teams, providers would see their caregiving scores, and bottom lines, rise, Rosenbloom holds.

He goes as far as to wonder whether there’s “any actual intensive medication therapy management” being done today. Or, as he adds with an icy fork, “if pharmacy benefits managers [PBMs] are collecting money for not doing much work.” Some 86% of senior care prescriptions are placed through just three big PBMs, Rosenbloom mused.

A great test would be to have parallel demonstration projects take place, he believes. One where PBMs took the lead and another where long-term care pharmacies ran things.

“The question really is: Who does a better job of managing medication therapy — a pharmacy with consultant pharmacists or an intermediary whose primary goal is payment,” Rosenbloom said. “That’s really what we’re talking about. That’s something that should have been tested — and still could be.”

Rosenbloom and other consultant pharmacist fans, however, will not be holding their breath.

Their push for a medication management standard leads to the really big goal: proving the value of the consultant pharmacist and pharmacist — in terms of patient outcomes and Medicare dollars spent that can be uniquely tied to consultant pharmacists.”

Everyone, even Rosenbloom, says change will require long-term plans and follow-up pressure to make progress. This is especially true in an era where the “generic tsunami” has hit. Figures show that five years ago, about 65% of the meds prescribed were generic; today that number is “over 90%,” making pharmacists’ jobs all the more difficult.

Pharmacists must keep up with the changing regulatory landscape and advocate for their own rights, Rosenbloom emphasizes. It’s time to give consultant pharmacists a seat at the table, along with other care provider partners.

“We think that down the line, the concept of a long-term care pharmacy will be defined more by a patient’s characteristics than by the patient’s location,” Rosenbloom says. “That is very consistent with the IMPACT Act.”

And perhaps a path to better medication management, which in turn would lead to lower expenditures. That’s a payoff we all could live with.

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