California Pharmacists Association Supports State Pharmacists in Serving Medicare Beneficiaries

California Pharmacists Association Supports State Pharmacists in Serving Medicare Beneficiaries

Pharmacists and pharmacies play an increasingly important role in assuring people’s access to and safety with their medications. As the trade organization for pharmacists throughout the state, the California Pharmacists Association (CPhA) supports this role through providing: regional trainings statewide on new legislation/programs affecting drug access; educational information on their website; and regular newsletters and bulletins to CPhA members. They actively introduce and respond to existing legislation that affects pharmacists and medication access and safety as well. Over the past year, California Health Advocates has also enjoyed working with the CPhA in California Medicare Coalition regional educational events and other statewide meetings addressing Medicare Part D issues.

Similar to last edition’s article on the California Board of Pharmacy, this article provides an overview of the CPhA and their role in working with pharmacists in regards to Medicare Part D. It is written in a simple question and answer format based on questions submitted to and answered by the former CPhA General Counsel, John Cronin, who had worked with the CPhA for 15 years. Note that
while Mr. Cronin was made available for the interview,
he was not speaking in an official capacity for the
Association.

What role does the CPhA play in educating pharmacies/pharmacists about Medicare Part D and helping them navigate glitches in the system?

In the months before Part D began, the CPhA coordinated trainings with local and national pharmacy organizations to educate their pharmacist members about Medicare Part D, how the program ‘should’ work, and resources of where to go for help. They included the Health Insurance Counseling & Advocacy Program’s (HICAP) number in their materials as well as information on Consumer Reports Best Buy Drugs program. They also provided a telephone ‘help-desk’ for the first two-three months of Part D’s commencement. The CPhA, however, does not provide ongoing training on Part D. As Part D issues come up, CPhA will notify their members on how to deal with these issues mostly through emails, faxes, and their quarterly newsletter. CPhA also works with the existing legislature and takes complaints, problems and feedback from their member pharmacists regarding Part D to the Department of Health Services (DHS) and the Centers for Medicare and Medicaid Services (CMS) for resolution.

What tools do pharmacists use to help patients make good choices in selecting a Part D plan? Does the CPhA recommend or provide any tools?

CPhA does not provide specific tools to assist pharmacists in helping patients make good choices in selecting a Part D plan. While they encourage pharmacists to help beneficiaries, they also recognize that this service is neither the pharmacist’s area of expertise nor a paid service. CPhA encourages their members to refer patients to HICAP or 1-800-Medicare.

In regards to Medicare Part D, do you know if the responsibility for processing and requesting Part D plan info/exceptions for denied drugs is placed on the pharmacist in most pharmacies? Or, on their clerks or someone else?

In general pharmacists become involved in requesting information or exceptions for denied drugs, especially if it entails a formulary problem. For other reasons, such as needing prior authorization from the plan, the pharmacist may or may not become involved. Although they often work with client’s physicians, they are not required to. They may refer the client to resolve the issue with their plan and physician themselves.

Why do some ‘non-network’ pharmacies refuse to process prescription drug purchases for Medicare beneficiaries? –Even if a beneficiary wants to do business with them? HICAP has had pharmacists say “we don’t accept xyz plan…” and turn away the beneficiary.

Pharmacists who refuse to process some drug purchases do so for many business reasons. Some plans do not pay pharmacists enough for it to be profitable or even affordable to work with them. And other plans are particularly difficult to work with leading pharmacists to refuse to do business with beneficiaries enrolled in those plans.

Does the CPhA provide tips/education for pharmacists to bill Medi-Cal for dual eligible drugs covered only by Medi-Cal?

Yes, as part of the general trainings CPhA organized before Part D began, they let pharmacists know how and for which drugs to continue to bill Medi-Cal. Again, CPhA does not provide ongoing trainings for Part D, but does educate pharmacists on current issues through emails, faxes and newsletters.

Does the CPhA do any education with pharmacists on how to use the Point-of-Sale as a back up for dual eligibles who are not in Part D plans due to a lag in auto-assignment? Advocates are finding some pharmacists refuse to use this Point-of-Sale system. Has the CPhA heard from pharmacists about this issue?

Yes, CPhA does review this eleven point check-list of tasks for using Point-of-Sales system with pharmacists, yet they do not encourage its use. Pharmacists are not given any reimbursement/compensation for the time and effort to complete these tasks and receive no guarantee of payment for medications after completing the POS process. Many times pharmacists do give out medications to people in need, complete this process, and still do not get paid.

What are some examples of legislation advocacy the CPhA is involved in?

CPhA both introduces and responds to legislation. One example is CPhA sponsored the Senate Concurrent Resolution 49 (SCR 49) authored by Senator Jackie Speier which convened a Medication Errors Panel to study the causes of medication errors in the outpatient setting and to produce a report recommending changes to the health care system that would reduce errors associated with prescription and over-the-counter medication use. This year CPhA is also encouraging the authors of four pieces of legislation concerning prescription labeling issues to work together in response to implementing some of the Medication Errors Panel’s recommendations.

For more information on the California Pharmacists Association and the services and resources they provide, visit their website at www.cpha.com.

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.