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2013: Pharmacy Trends to Consider
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n 2012, there was a myriad of changes affecting pharmacy. Over a dozen popular brand-name medications have become available as generics, including Actos, Singulair, Plavix, and Tricor. Walgreens rejoined the Express Scripts network, and the biologics market exploded with the addition of medications to treat a host of conditions, including rheumatoid arthritis, multiple sclerosis, and various types of cancer. While still adapting to the changes of 2012, it may be hard to begin thinking about the developments that 2013 promises to bring. It is important, however, to begin planning for the shifting environment, so as not to be caught off guard. Some of the trends that may be seen in 2013 include continued pressure on prescription reimbursement rates, an increase in the use of technology in pharmacies to help offset reimbursement reductions, and an expansion in pharmacy services with a changing healthcare business model. Understanding these changes now will help pharmacists to better prepare for the dynamic environment of the future.
Reimbursement Rates With the passage of the Affordable
Care Act in 2010, there has been an increased push to reduce prescription reimbursement rates. In 2013, we could begin seeing the results of this new reimbursement focus. The CMS efforts to create new pricing metrics have prompted the creation of the national average retail price (NARP), the national drug acquisition cost (NADAC), and the average manufacturer’s price (AMP) federal upper limit (FUL). While the NARP is a compilation of average drug prices self-reported by retail pharmacies, the NADAC provides an average of pharmacy purchasing prices. Although we do not anticipate commercial payers adopting these metrics for reimbursement in 2013, we will see these metrics used by payers as a way to compare where their pricing currently stands in relationship to the marketplace. If their pricing is above market price, they will lower their reimbursement rates, which would place increased pressure on pharmacy margins in 2013. The AMP-based FUL is calculated by taking no less than 175% of the monthly weighted average of the AMP. In mid-2012, the development of
Tom Kosty, R.Ph.
Ann Johnson, Pharm.D.
three-month rolling averages of the AMPbased FUL helped to minimize fluctuations in price from month to month. A report released in October 2012 by the OIG recommended that CMS continue to publish these prices and complete the implementation of the AMP-based FUL program in the near future. CMS agreed with the OIG’s recommendations, and if CMS uses this report as justification, AMP-based FUL pricing may be implemented in 2013 for most generically available products. Like the NADAC and NARP pricing, this change will place additional pressure on pharmacies to maintain profit margins.
Use of Technology In order to
help offset some of these reductions in reimbursement rates, the use of technology in pharmacies will be more important now than ever. E-prescribing lowers pharmacy costs by speeding up prescription entry and verification times. In 2010, the government legalized the e-prescribing of controlled substances. With technology now available to handle the security demands of e-prescribing controlled substances, big advancements in this area can be expected in 2013. According to Surescripts, only 36% of prescriptions dispensed were eprescribed in 2011, despite the fact that continued on next page November/December 2012
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