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Ringing in the New Year – Top 5 Pharmacy Observations of 2013

2013 was quite the year in Pharmacy! To sum up, pharmacists are becoming more critical to America’s healthcare. This can be seen with pharmacists pushing for provider status in California, the priority of patient adherence, and individuals becoming more familiar with spend on pharmaceuticals thanks to high deductible insurance plans. So, let’s celebrate the role of pharmacists by looking back on some of the highlights (or lowlights, depending on your perspective) in 2013!

5. D.0 a Reality

What was the bane of many industry veterans’ existence in 2012 finally was put in the rear-view mirror in 2013. It seems much of the world is compliant with D.0, thus pharmacy can begin to realize the benefits of the new telecommunications standard.

4. Individual (type I) NPI Required for Billing

CMS’ requirement for the individual practitioner’s NPI to be used for billing instead of an organization’s NPI (type II) created some worry in the industry as there were (and still are) many individuals that do not have their own NPI. Whether they are using their supervisor’s or a fraudulent NPI is questionable, but at least the majority of organization NPIs have ceased being used for billing.

3. Affordable Care Act (Obamacare)

What to say about this? This story has yet to play out in full, and will forever change the landscape of healthcare in the United States.

2. DEA

Via several high profile settlements and fines, the DEA put the industry on notice regulations would be enforced. From the various prescriber impacts (status, schedule, authority) to the ordering via distributors, it was all in play. Look for more on this in 2014 as the DEA tightens their grip on diversion control.

1. Medicare Part D and Medicaid Expansion

As our prescriptions become more closely tied to government payments, the rules stipulated by the government become adopted by commercial plans. As you can see in this chart from Pembroke Consulting, the trend towards an increasing percentage paid by the government continues to move higher, causing CMS’ regulatory rules to become the pharmacy standard.

Pembroke Consulting shows the trend towards an increasing percentage paid by the government continues to move higher, causing CMS’ regulatory rules to become the pharmacy standard.

What are your thoughts about the role of the pharmacist in 2014?