How to Improve Your Independent Pharmacy's Performance in 5 Steps


Independent pharmacies can affect how well plans and pharmacy advantage managers (PBMs) rating on their overall performance metrics. In turn, PBMs examine their pharmacy partner's usage of clinical and operational metrics that directly affect payer reimbursement.


One of the most important challenges for independent pharmacies is knowing how they’re being evaluated, then taking suitable actions to enhance in the areas of highest interest to payers. 


Improved overall performance, pharmacies can:


  • Gain access to preferred pharmacy networks

  • Improve take care of patients and customers

  • Create new revenue possibilities

  • More effectively control working expenses

  • To receive those benefits, your independent pharmacy should take the following 5 steps.



1. Review and recognize overall performance requirements:


Your independent pharmacy must understand how it’s being measured if you need to understand which areas to focus on. PBMs normally specify in each reimbursement contract with a pharmacy the measures that they'll use to evaluate the pharmacy’s overall performance.


Your pharmacy also can seek help from your pharmacy services administrative organization (PSAO). PSAOs have information in user-friendly formats and break down metrics through type and weighted percentage. 


Common medical measures are


  • Medication adherence fees for disease states like diabetes, hypertension, and hyperlipidemia,

  • Gaps in recommended care like annual statin use in sufferers with diabetes.

  • Completion charges for comprehensive medication reviews (CMRs).

 

Some examples of common operational measures are


  • Generic efficiency, that's filling with a generic choice when a generic drug is available.

  • Compliance with an approved drug formulary, that's the ability to fill prescriptions and the usage of medicines preferred by the PBM.


2. Measure and monitor your own overall performance against payer requirements:


Once your independent pharmacy knows the criteria on which it’s being judged, the next step is monitoring how well it is doing against the criteria. Pharmacies can use technology to assist them with self-evaluation.


The majority of PBMs use a system called the Electronic Quality Improvement Platform for Plans and Pharmacies, or EQuIPP, to track their overall performance. EQuIPP has a dashboard that displays scores on the different health plans, PBM, and pharmacy overall performance measures. 


Some players don’t use EQuIPP. In those instances, the PBMs can send their own reports to your pharmacy to let you know how well it is doing against the criteria.


3. Use technology to discover sufferers who're negatively affecting performance ratings:


Your independent pharmacy can leverage EQuIPP to discover individual sufferers who're having a negative impact on performance measures for a specific health plan or PBM.


Utilizing the technology, pharmacies can pinpoint patient “outliers” in each plan or PBM. For example, outliers could be sufferers who are recognized as being non-adherent to prescription medications or at risk of becoming nonadherent.




4. Engage patients who're outliers to help alternate their medication behaviors:


After your independent pharmacy identifies sufferers who're affecting its performance on numerous clinical and operational metrics, it’s time to act. The information creates opportunities for your pharmacy to engage outlier sufferers in each plan or PBM about their medication behaviors and preferences.


Clinical measures include:


  • Work with sufferers to discover precise boundaries preventing them from taking medications as prescribed

  • Use motivational interviewing to ask sufferers open-ended questions to identify adherence issues

  • Once a problem is recognized, your pharmacy can tailor solutions to overcome the specific issue. If price is a problem, an alternative, less-expensive drug or co-price assistance from a drug manufacturer could help.


Operational measures include:


  • Increasing generic efficiency by instructing patients on the availability of generic versions of brand-name capsules and presenting the generic alternative.

  • Improve 90-day fill costs by explaining to sufferers that they could have one co-pay rather than three—one for each 30-day supply.

  • Improve formulary compliance by ensuring pharmacy staff is aware of drug formulary changes for each PBM, which includes updates and alerts from pharmacy management systems and ongoing staff education.


5. Use advanced clinical and operational scores to reduce charges and increase revenue:


Your independent pharmacy should see enhancements in its performance scores on clinical and operational measures after following the first 4 steps. Your pharmacy can leverage those improved scores to reduce charges, create new revenue possibilities and enhance patient care.


On the revenue side, enhancing medication adherence prices will boom your pharmacy’s revenue because more prescriptions are being filled. Some plans and PBMs are starting to reimburse pharmacies for achieving medication adherence goals as part of pay-for-performance reimbursement contracts.


If your independent pharmacy could make those commitments, the 5 steps provide a path to sustainable clinical and enterprise success. It is recommended to join AAPA, With AAPA, you gain access to unbeatable pricing and a great network of support through their AdvantEdge Portal.

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