Viewpoints: May/June 2014
Pharmacy interns may interact with many computer systems within the prescription fulfillment workflow, with the most obvious being the pharmacy computer system. Interns who are educated on the different systems have the ability to impact the profitability of the pharmacy and improve customer service, while providing a head start on having a successful career as a pharmacist. Here we will focus on five areas where understanding the pharmacy computer system can benefit the intern.
Brand Versus Generic
Future pharmacists should understand how drugs are classified. Sometimes a product has a generic name, but the patient co-pay is based on a brand tier; this can be explained in just seconds without much effort. Interns should understand that factors such as the drug type, single or multiple source identifier, and the reference listed drug identifier influence brand or generic classification.
How does the computer system determine and display product substitution options? Depending on state laws and the specific mention of the Orange Book, the pharmacist should be confident that only therapeutically equivalent products are displayed as substitution options. For example, when the FDA changed the rating for Budeprion XL 300 mg from AB to BX, pharmacists should have clearly understood why that product was no longer an available dispensing option after selecting Wellbutrin XL 300 mg as the prescribed product. When pharmacy interns understand the attributes that the system uses to display product selection options, they can confidently make product selection choices that benefit the patient and the pharmacy.
Until interns are introduced to third- party contracts, they have no idea that a cash price for a drug may impact the prescription business. The third-party reimbursement calculation includes usual and customary (U&C) prices, and lowering the U&C price can drastically reduce reimbursement to the pharmacy. This is a teaching opportunity where the computer system can be used to illustrate the reimbursement differences when a claim has a U&C greater than the contracted rate. Instructing interns on average wholesale price (AWP) discounts, maximum allowable cost (MAC) prices (including federal upper limit [FUL]), dispensing fees, and other reimbursement metrics provides a framework for the intern to gain a basic understanding and build on that foundation.
Insurance Plan Messages
The pharmacy system contains every data point regarding a prescription. While it may be overwhelming to display all of the data, the ability to find specific details at the right time helps pharmacists fully understand the situation. When a response is received from the third party with a large patient payment required, can the intern use the system to determine the reason? Often the details are in a payment details screen beyond the main processing screen. Is this product not covered and therefore requires 100% patient payment? Is this the first fill of the year, and the patient has a deductible? The pharmacy system contains the details sent from the third- party payer system and identifies what portion of the payment, if any, applies to the deductible.
Interns will also be managing rejections from third parties. The reject message spectrum encompasses basic messages to detailed, instantly actionable messages. Explaining these reject messages to interns helps spread the responsibility across multiple team members. Quick, appropriate actions, whether via phone calls or by initiating electronic prior authorization requests, will reduce the time to complete a prescription. Another aspect of rejects is communicating with patients to manage expectations.
Inventory management is an area where interns can make a contribution. Start with basic tasks like returning expired products. As their knowledge grows, they can become involved with organizing stocking levels and performing cycle counts to verify that inventory volumes match the levels specified in the computer system. Showing interns how to read usage reports will allow them to assist with managing stocking levels. Pharmacies with perpetual inventory can task interns with updating and maintaining the drug order points to balance out-ofstock occurrences and maximize inventory turns.
Improving medication adherence can involve the intern and the pharmacy system. At the very least, the intern can be asked to analyze the prescription fill history to assess medication adherence. Interns can also be tasked with identifying patients who could benefit from education on their treatments and disease to encourage adherence. Another way to potentially increase adherence is medication synchronization. Interns can be used to identify anchor drugs and come up with a plan to limit trips to the pharmacy for the patient. Patients may benefit with improved outcomes, and pharmacies may have increased prescriptions from these activities.
Pharmacists should look to expand the proficiencies of pharmacy interns by introducing the pharmacy computer system functionality and explaining areas where interns can benefit from understanding the processes that are used on a regular basis. Knowledge about brands and generics, reimbursement, third-party rejections, inventory, and adherence will help launch the successful career for the intern. CT
Don Dietz, R.Ph., M.S., is vice president at PHSI and an adjunct faculty member at Duquesne University School of Pharmacy. His focus is on solutions that enable clients to effectively manage the appropriate use of both prescription and OTC products. Alan Sekula, Pharm.D., is a consultant at PHSI. His areas of focus include MAC pricing, generic drug launch analysis and forecasting, data and process analysis, prescription claim adjudication and reimbursement, rebate analysis, pharmacy practice management systems, and pharmacy business processes. The authors can be reached at firstname.lastname@example.org and email@example.com.