Pharmacists Bring In Additional Revenue By Providing Consultations To Medicare Advantage Beneficiaries Under Medicare Program

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Pharmacy / Pharmacist
Article Date: 16 Apr 2009 - 5:00 PDT


Attempts by Medicare and private insurers to control costs by limiting patients' misuse of medications have provided many pharmacists the opportunity to make additional money by providing in-depth consultations and other services, the Tennessean reports. According to the Tennessean, pharmacies' income typically comes from adding an additional fee to the price of medications. However, as profit margins decline, consultations are becoming another way for pharmacists to bring in additional revenue, the Tennessean reports.

Under existing CMS guidelines, insurers that offer Medicare Advantage plans are required to pay pharmacies for the meetings with patients, during which they discuss the importance of taking the proper medications at the appropriate times. MA beneficiaries with at least $4,000 worth of annual drug costs are eligible for the consultations at no cost. Some pharmacists now earn up to $160 for a one-hour meeting with patients.

The opportunities for pharmacists to generate additional revenue are about to expand, the Tennessean reports. In 2010, new CMS guidelines will broaden the pharmacy consultation benefit to more MA beneficiaries. Under the revised guidelines, MA plans will be required to review their member rolls on a quarterly basis to identify eligible members for the program. In addition, health plans will be prohibited from restricting access to the benefit to members with a high number of chronic health conditions and medications, and the annual drug cost limit will be reduced from $4,000 to $3,000.

Pharmacists will be paid $50 to review a beneficiary's medications and make recommendations to their physician. Pharmacists will receive additional payments if they recommend a less-costly, therapeutic equivalent to the patient. Sal Giorgianni, assistant professor at the Belmont University pharmacy school, said, "It's well documented that when you reduce the number of medications that someone's taking, it also reduces the possibility of side effects and harmful interactions between medications" (Ward, Tennessean, 4/14).

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