Medicare’s new Star Rating system for Part D insurance companies and Pharmacies is focusing on PT’S ADHERENCE to their chronic medications.
Help these pharmacies that are HEALTHCARE DENIERS to “feel your pain”.. Keep in mind.. without filing complaints with www.cms.gov about denied Rxs.. there will be NO DATA collected on your NON-ADHERENCE.. The denial of Rxs will be INVISIBLE to the Medicare’s database that will be the determining if your are compliant with your medications.
This is another incident of if you DO NOTHING… YOU GET NOTHING….
You know the statistics about the estimated $290 billion cost of medication non-adherence, but some people willingly say they will pay the ultimate price if they could avoid taking their prescription daily.
Any good team has both a strong offense and a strong defense. NCPA’s advocacy work fixes and protects community pharmacies from legislation and policies harmful to pharmacy small business owners and the communities we serve. On offense, NCPA helps community pharmacies know what to expect in order to stay ahead of the market. Simplify My Meds® is an example of such a program.
Medicare’s star ratings are driving how health plans contract for pharmacies. About half of a health plan’s star ratings come from pharmacy-related quality measures. And, most of the pharmacy’s quality measures are related to medication adherence. Simplify My Meds is a program NCPA promotes to pharmacies to use to synchronize patient medications, which leads to increased medication adherence.
This isn’t some touchy, feely concept program with no relevance to the real world. Next year some Part D Plans are saying they will pay pharmacies with high quality scores that boost health plan star ratings more than those with low quality scores that pull the star ratings down. Eventually, some health plans will exclude pharmacies from being in their network based on their drag on the plan’s star rating.
Almost 2,500 community pharmacies have enrolled in Simplify My Meds and they have enrolled more than 100,000 patients taking chronic medications!
Plus, medication adherence is a bridge between today’s payment model and future value-based payment models. You know the reasons for medication adherence already—lower overall health care costs, better quality of life for patients, pharmacist expertise in action, and increased pharmacy revenue. Despite everyone in the health system having aligned interests motivating patients to take their medications is not easy.
Filed under: General Problems
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