Issue link: http://osercommunicationsgroup.uberflip.com/i/709458
AN INDEPENDENT PUBLICATION NOT AFFILIATED WITH NACDS Lee M. Oser CEO and Editor-in-Chief Jules Denton Kim Forrester Delaney Oser Carlos Velasquez Associate Publishers Lorrie Baumann Editorial Director Jeanie Catron JoEllen Lowry Karrie Welborn Associate Editors Yasmine Brown Jonathan Schieffer Graphic Designers Caitlyn McGrath Sarah Glenn Heather Canale Customer Service Managers Stacy Davis Show Logistics & Distribution James Gennette Mark Romero Sarah Robinson Account Managers Enrico Cecchi European Sales Chain Drugstore Daily is published by Oser Communications Group ©2016 All rights reserved. Executive and editorial offices at: 1877 N. Kolb Road, Tucson, AZ 85715 520.721.1300/Fax: 520.721.6300 www.osercommunicationsgroup.com European offices located at Lungarno Benvenuto Cellini, 11, 50125 Florence, Italy C h a i n D r u g s t o r e D a i l y Tu e s d a y, A u g u s t 9 , 2 0 1 6 4 HOW QUALITY IS CHANGING THE PHARMACY BUSINESS MODEL By Jeff Pepperworth, President, Inmar Healthcare Network The shift in healthcare from the fee-for- service business model to value based reimbursement is being implemented in pharmacy in 2016, and will continue to evolve. Retail pharmacies face signifi- cant implications as a result of this shift. There are different contracting mod- els for Medicare, HIX/Marketplace plans, Medicaid. CMS is adding new measures and adjusting thresholds on others. Plans are responding by aligning formularies, clinical strategies, network contracts and promotions with Star Ratings measures; and by moving towards pay for performance and nar- rowing their preferred networks based on quality and value criteria. It can be over- whelming, and there is still much evolu- tion to come. In a fee-for-service model, calculat- ing pharmacy revenue is relatively sim- ple. In 2016, there are five flavors of value based/quality contracting: "Pure Incentive" – payout based on achieving measures; "Pay In and Earn Back" – an upfront fee per claim is paid with the abili- ty to earn back funds; "DIR Penalty Scale" – claim deductions are based on per- formance; "Heavy Weighting to High Risk Medications" modifier – the percentage of HRM impacts the per claim fee; and "Weighted Averages plus MTM" modifier – fee is based on ranked averages of specified adherence metrics combined with MTM participation volume. The average retail pharmacy has $50,000 to $100,000 in reimbursements at risk in 2016 for quality, and this will MYCRATINE: CUSTOMER TESTIMONIAL By Elaine Harter, Mycratine Customer I grew up in a family that had migraines. I started having migraines when I was around 13. They would last between two and three days, and noth- ing I took touched them. Nothing worked for me; I would lie on the couch with the drapes drawn and suffer through. When newer medications came out, I took the self-administered shots. I thought they would help, but they always made me feel terrible in other ways. My heart would pound, my head would feel like there were tiny explo- sions going off in there, and it would feel like a tight band was around my heart for about an hour. Then the pain would finally let up, but I would still feel foggy and exhausted afterward. Over time, those types of drugs lost their effectiveness, as well. The problem became so severe that in my mid-thirties I started waking up with a "screaming" migraine every day. I am in my mid-sixties now, and still wake up almost daily with a migraine. I tried natural remedies, things that other people swore by. None helped. Finally, I remembered seeing an ad for Mycratine, and read about the homeopathic method of extracting the beneficial molecule from nicotine, and it sounded convinc- ing. The first time I took the Mycratine, I had a horrible migraine. I drank the lit- tle blue bottle down and went back to what I was doing. Fifteen minutes later, I suddenly realized that the migraine was completely gone, and I hadn't even C o ntinued o n P age 8 5 C o ntinued o n P age 8 5