NRHA Mission

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HCR 1010 Core Health Benefit Task Force Report
and Recommendations
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• Task Force Report
• Nearly 100 of participants selected coverage in
• Hospital Care
• Pharmacy
• Primary Care
• Scans and X-rays

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Average Rx Prices
Still sold under the original brand name, but
patent has expired and is available generically.
SOURCE NACDS, based on Medicaid drug utilization
data from CMS.
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Double-Edged Sword
Fact 82 percent of the U.S. population reported
using at least one prescription medication,
over-the-counter medication, or dietary
supplement in the previous week, and 30 percent
reported using five or more of these drugs.
2004, D. Budnitz et al.
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The Good News Fact A prescription drug
benefit (drug card) increases access to
medications among the insured vs the
uninsured. Fact A prescription drug benefit
(drug card) increases utilization of
medications among the insured vs the
uninsured.
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The Bad News Adverse drug events among
outpatients will likely increase with increased
use of medications unless prevention strategies
are implemented.
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In fact. for every dollar spent on ambulatory
medications, another dollar is spent to treat new
health problems caused by the medication. The
1999 Institute of Medicine (IOM) Report To Err
is Human
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Prescription Drug Benefit
The issue is not just access to drugs. The
issue in Oklahoma is access to Pharmaceutical
Services.
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Defining the Need for Pharmacists

• Prescription drug therapy
• is growing at an
• exponential rate.
• The cost of drug-related
• problems is increasing at
• a rate similar to the use of
• medications.

1995 76.6 Billion Johnson and
Bootman 2001 177.4 Billion Ernst and Grizzle
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Meeting the Drug-related Need

• Pharmacists can reduce the incidence of
  drug-related problems and improve
  medication-related outcomes.
• Pharmacists are well prepared to provide
  pharmaceutical care and no other healthcare
  provider is better prepared to identify, prevent
  or resolve drug-related problems.

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Meeting the Drug-related Need Especially in
Rural Oklahoma where there are even higher
rates of un-insured and
under-insured. and lower pharmacist/population
ratio.
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Oklahoma Communities with only one Pharmacy
74 Communities with only one Pharmacy 10 miles
from any other pharmacy 43 2000
Population in Communities with only one Pharmacy
10 miles from any other pharmacy
67,170 Reliance on Independently Owned
Pharmacies in Rural America RUPRI Center for
Rural Health Policy Analysis Policy Brief No.
2007-6 November 2007 www.unmc.edu/ruprihealth Mich
ael D. Shambaugh-Miller, Ph.D., Nicole Vanosdel,
B.S., and Keith J. Mueller, Ph.D.
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Healthcare Value of a Pharmacist in a Rural Town

• Broad/Comprehensive Medication Delivery
• Medication Information (OTC and Rx)
• Product selection
• Dosing
• Adverse Effects
• Triage (first-contact care)
• Evaluation
• Therapeutic Plan
• Therapeutic Assessment
• Health Promotion/Disease Prevention
• Consumer Protection

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The Economic Impact of a Typical Rural Community
Pharmacy
For every 1 in income in a typical rural
community pharmacy, an additional 0.19 in income
is generated in other businesses and industries
in the local economy.
Study prepared by Cheryl F. St. Clair, Associate
State Extension Specialist, Gerald A. Doeksen,
OSU Regents Professor/Health Economist, National
Center for Rural Health Works, December 2007.
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My Opinion

• A prescription drug benefit should encourage the
  use of generic medications.
• Through incentives to the patient (smaller or
  zero co-pays)
• Through incentives to the pharmacist to increase
  utilization of generics (larger dispensing fee)

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Generic Drugs Cost Less than Brand Name Drugs
Average generic reimbursement is 1/6 the average
amount for patented brand name drugs.
Still sold under the original brand name, but
patent has expired and is available generically.
SOURCE NACDS, based on Medicaid drug utilization
data from CMS.
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Prescription Payment Components 1980 to 2002
(current dollars)
SOURCE Compiled by Stephen W. Schondelmeyer,
PRIME Institute, University of Minnesota from
data found in CMS/HCFA-2082 Reports (adjudicated
paid claims), CMS/HCFA-64 Reports (budgeted and
expended funds), CMS/HCFA Medicaid Drug
Utilization public use files, and the annual
volumes of Pharmaceutical Benefits Under State
Medical Assistance Programs (Reston, VA National
Pharmaceutical Council, 1967 to 2002).
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My Opinion

• A prescription drug benefit should include
  prevention strategies to decrease the incidence
  of medication injuries and adverse events.
• Clinical pharmacy services
• Chronic Disease Management programs.
• Medication Therapy Management (MTM)
• Reimbursement pharmacists for services.

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for every dollar spent on ambulatory
medications, another dollar is spent to treat new
health problems caused by the medication.
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My Opinion

• A prescription drug benefit should not adversely
  affect access to pharmacists in rural Oklahoma.
• Negotiable Contracts
• Consistent Co-pays and Days Supply ( with mail
  order pharmacies)
• Reasonable Reimbursement
• Enforce Prompt-Pay regulations

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Thank you.