Insurance Provider to Test Reimbursing Pharmacists for Clinical Services
(DAYTON, Ohio – August 4, 2020) – CareSource, a leading multi-state managed care plan, announced Tuesday a six-month pilot program reimbursing pharmacists for clinical services provided to Medicaid patients in Ohio. The Pharmacist Provider Status Pilot program begins today and includes two sites near Dayton, Ohio: an independent pharmacy in a rural community, Camden Village Pharmacy, and an inner-city independent pharmacy, ZIKS Pharmacy.
“The pilot program is a win-win for the Greater Dayton community because it improves health outcomes and will decrease hospitalizations and unnecessary ER visits for patients with chronic diseases,” said Nnodum Iheme, owner of ZIKS Family Pharmacy. “Pharmacists are in a position to greatly impact better health outcomes by increasing patient access to care. We are grateful to CareSource for giving us the opportunity to serve our community by promoting optimal health.”
Pharmacists involved in the pilot have collaborative practice agreements with physicians, nurse practitioners, or physicians, and the pharmacists will focus on CareSource patients that they have identified as being at high-risk or in need of care for tobacco cessation, opioid management, diabetes, and/or asthma.
For patients with diabetes, for example, the pharmacists participating in the pilot program will provide diabetes education, adjust medications, perform foot checks and blood sugar testing.
The pharmacists in the pilot will be working closely with CareSource pharmacists and with the Ohio Pharmacists Association Provider Status Task Force.
“When pharmacists are empowered to practice at the top of their licenses, patient outcomes can dramatically improve, and overall healthcare spending can be significantly reduced,” Ernest Boyd, RPh, MBA, CAE, Executive Director of the Ohio Pharmacists Association. “We salute the entire team at CareSource for their continued dedication to evolving the pharmacy benefit as a means to bring a higher level of care to patients.”
The pharmacist provider status pilot adds to the Value-Based Reimbursement (VBR) opportunity, that CareSource released in January 2020. The VBR program is the first of its kind in the state and allows for pharmacies to achieve payment for increasing the quality of patient care outside of the traditional pharmacy benefits manager reimbursement model.
“As the largest Medicaid plan in Ohio, CareSource recognizes the expertise and value pharmacists provide as an integral part of the health care team,” said Steve Ringel, Ohio Market President, CareSource. “Pharmacists are one of the most accessible and most trusted healthcare providers with the opportunity to discuss patients’ medical needs in a comfortable and familiar setting. Our long-term goal is to reimburse pharmacists, not only for dispensing medications but also for providing their expertise through clinical encounters with our members.”
In 2012, CareSource led the industry in becoming the first health plan in the country to offer Medication Therapy Management (MTM) to Medicaid patients. In 2019, CareSource’s pharmacy partners completed nearly 655,000 medication therapy management activities across the state. This January, CareSource transformed its benefits strategy launching RxInnovations to provide transparency and innovation in the way a managed care plan offers pharmacy benefits to members with accountability to stakeholders.
“We are extremely pleased that CareSource is rolling out this new initiative that expands patient access to care,” said Boyd. “CareSource has been a national leader among insurers in recognizing the value of pharmacists as providers, and bringing that value to their beneficiaries.”