On Skid Row, where the down-on-their-luck come for food, shelter and a second chance, pharmacist Steven Chen bustles into a small examining room at a community clinic. He sits down next to Floyd McLucas, who has diabetes.
The two talk for more than 25 minutes about McLucas’ medication, his diet and his recent blood sugar test results. Chen then suggests that McLucas, 58, a former truck driver who lives at a nearby charity mission, begin taking a drug to lower his cholesterol.
What’s unusual about the encounter is not only the amount of time Chen is able to spend with McLucas, but also that Chen is a pharmacist with the authority to order lab tests, add or change medications and otherwise help oversee patient care.
Both men are part of a program under way at a handful of federally funded health centers across the country, which aim to show that more directly involving pharmacists with patients can improve care and lower the cost of treating patients with chronic illnesses such as diabetes, asthma and heart disease.
Measurable Results
During more than two years, patients with diabetes referred to the pharmacist program at the JWCH Medical Clinic showed an average drop in blood sugar levels of 3.7 percentage points, a significant drop. Lowering blood sugar levels can help patients avoid some of the serious complications of diabetes. Blood pressure levels for the participants also fell significantly to near-normal range.
At another community clinic, a group of diabetes patients referred to its pharmacist-overseen program had lower blood sugar levels after six months than counterparts getting standard care.
Results like these could help lead to more such efforts as both government health programs and private insurers look for ways to control some of the most costly diseases. Preventing the complications of diabetes, including blindness, limb amputations, heart disease and stroke, could not only save lives but also reduce hospitalization and other medical costs for insurers, program proponents say.
“This is the future of the practice of pharmacy,” says Jimmy Mitchell, director of the office of pharmacy affairs at the federal Health Resources and Services Administration (HRSA), which granted start-up money for 18 such programs.
More than 40 states allow such collaborations between pharmacists and doctors. But because many insurers don’t directly pay pharmacists for patient care, such programs are mainly found in programs run by a few state Medicaid programs, as well as the Department of Veterans Affairs, the Indian Health Service and federally funded community clinics, which accept all patients, regardless of whether they have insurance or money.
Insurance Roadblocks
“We’ve been fortunate in that we’ve combined some profits from the pharmacy department to pay for this, and we have a foundation that seeks private donations to our program,” said pharmacy director Tony Felix.
A big change came when Congress passed the Medicare Modernization Act of 2003, which created a drug benefit for Medicare patients and said for the first time pharmacists can be paid by insurers for counseling certain chronically ill Medicare patients who spend at least $4,000 a year on drugs.
“That was a turning point for community pharmacists to be recognized as health care providers,” says Edith Rosato, senior vice president of pharmacy for the National Association of Chain Drug Stores.
The new rules come as retail pharmacies are expanding services — one way to boost foot traffic in their stores — to include more medical services, going beyond offering flu shots to offering other types of vaccinations or having specially trained pharmacists fit patients for medical equipment, such as wheelchairs.
Still, most pharmacists in busy drugstores don’t have the time or the space for longer disease-management sessions.
“Retail pharmacies are not usually conducive to this type of thing,” says Bridget Eber, national practice leader for pharmacy benefits at benefits consulting firm Towers Perrin.
Humana, like some other insurers, runs disease-management programs for members with chronic conditions, such as diabetes. Because the insurer does not have its own medical clinics, it has asked its network of 60,000 retail pharmacies if they would provide such counseling and get paid for it.
Independent Action
So far, just short of 7,000 pharmacies have signed on, many of them independent pharmacies rather than the large chain drugstores, says William Fleming, Humana’s vice president of pharmacy. He attributes the low sign-up rate to a reluctance of pharmacies to set aside retail space for private counseling areas.
