G. Joseph Norwood

Capitation Payment for Pharmacy Services: Impact on Generic Substitution

This article evaluates changes in the rate of generic substitution as well as the appropriateness of such changes in dispensing behavior when the conventional fee-for-service system for reimbursement of pharmacists is replaced by a capitation system. The fee-for-service system under Medicaid usually covers ingredient costs plus a fixed professional dispensing fee. The capitation system provides a cash payment per Medicaid eligible at the first of each month, which varies by aid category and season of the year. The dispensing behavior of pharmacists in two experimental rural counties is examined during a 1-year preperiod in which the fee-for-service form of reimbursement was employed, as well as a 2-year postperiod in which capitation was used in lieu of fee-for-service payments. The results are compared with pharmacist behavior patterns in two other rural counties which remained on the fee-for-service system over the same 3-year period. The data indicate highly significant increases in both the rate of generic substitution as well as the dollar savings per substitution in the experimental counties after the institution of capitation reimbursement. Using explicit criteria, no substantial differences in the appropriateness of generic substitution were noted between the two financing schemes.

Costs of Implementing Pharmaceutical Care in Community Pharmacies

OBJECTIVE To estimate the costs and benefits to community pharmacies of converting a traditional practice into one based on pharmaceutical care. SETTING Community-based ambulatory care pharmacies. PRACTICE DESCRIPTION Community pharmacy. PRACTICE INNOVATION Pharmaceutical care. MAIN OUTCOME MEASURES Costs incurred and revenues received. DESIGN Twenty-five community pharmacies that had made the transition from traditional practice to one based on pharmaceutical care returned a survey providing data on the costs and revenues associated with the transition. RESULTS Mean total cost of making the conversion for the 25 pharmacies was

Effects of Capitation Payment for Pharmacy Services on Pharmacist-Dispensing and Physician-Prescribing Behavior: II. Therapeutic Category Analysis, Over-the-Counter Drug Usage, and Drug Interactions

36,207. The largest cost component associated with the transition was personnel, which had a mean cost of

Pharmacist drug consultation behavior

16,512 per pharmacy. Mean revenues received for pharmaceutical care by these 25 pharmacies was

Attitudes of Rural Consumers and Physicians Toward Expanded Roles for Pharmacists

3,687, mainly for disease management services. Pharmacies that spent more on the conversions, and used brochures and physician detailing as well as consultants and franschises, tended to be more successful in generating revenues from pharmaceutical care. CONCLUSION Most pharmacies that have made the conversion to pharmaceutical care have not experienced an increase in profits as a result of that conversion. More effort needs to be directed toward improving the flow of revenues obtained from providing pharmaceutical care.

Capitation Payment for Medicaid Pharmacy Services: Impact on Non-Medicaid Prescriptions

Este articulo evalua tres efectos potenciales que tiene el uso del sistema de reembolso per-capita en el comportamiento del medico al prescribir y del farmaceutico al dispensar. Se evaluan los cambios que pueden ocurrir en (1) el tipo de medicamentos dispensado dentro de una categoria terapeutica, (2) el uso de medicamentos que no requieren prescripcion medica y, (3) la frecuencia de interacciones de droga.Los resultados indican que no todos los farmaceuticos pagados a base del sistema de reembolso per-capita aprovecharon las oportunidades disponibles para reducir costos en farmacoterapia como son la sustitucion de medicamentos dentro de la misma categoria terapeutica y la deteccion de interacciones de drogas. Se recomienda que en el futuro estos programas esten acompanados de programas educativos que enfoquen los tipos de situaciones donde los farmaceuticos pueden intervenir para mejorar la calidad y reducir los costos de la farmacoterapia.

The Public’s Attitude Toward Pharmacy *

Abstract Many studies have demonstrated that pharmacists perform inadequately when consulting with patients and physicians about drug therapy. The objective of this was to determine if this failure in drug consultation was due to a lack of knowledge or other factors. Fifty-five retail pharmacists were presented six prescriptions requiring consultation in order to ensure proper drug therapy. Three of the prescriptions required patient consultation and three necessitated physician consultation. Observation of pharmacist consultation behavior was conducted by the purchaser of the prescription at the time of dispensing. Each pharmacist was then administered a knowledge test to determine awareness of the problem area requiring consultation. The correlation between knowledge and consultation behavior was significant at the 0.01 level in the case of prescriptions requiring patient consultation. In contrast, there was not a significant correlation between knowledge and consultation behavior for prescriptions requiring physician consultation. Possible explanations for these differences are explored.