Pharmacy techs eye larger role in health reform era

Health reform will stand. So what’s next for the pharmacy technician?

In late June, the U.S. Supreme Court, by a 5-4 vote, ruled that the Patient Protection and Affordable Care Act of 2010 did not violate the U.S. Constitution and could not be overturned on legal grounds. With the approval of the nation’s highest court behind it — and assuming that Republicans in the U.S. House and Senate fail in their repeated bids to repeal the law in Congress — the Affordable Care Act has resumed its gradual but steady rollout under the Department of Health and Human Services. When the law is fully implemented in 2014, it will have profound effects on the way pharmacists and pharmacy technicians do their jobs.

Among other major effects, the law makes it illegal for insurance companies to deny coverage based on preexisting conditions or to cap lifetime benefits for patients. It also allows children to remain covered under their parents’ policies until they’re 26 years old, and, importantly, requires Americans to obtain health insurance or face fines, while providing offsetting tax benefits to those who would face economic hardship buying coverage.

Health reform also will have more direct implications for pharmacists and pharmacy technicians. For one thing, they’re likely to begin serving a larger number of patients as the law extends coverage to millions of the uninsured by its full implementation date of 2014. Also, the Affordable Care Act already has begun ushering in a new era of innovation and experimentation in health delivery with concepts like accountable care organizations and medical homes that serve as a base for a more integrated care model for patients. The new model also is aimed at fostering a more team-oriented approach to health care, driven by electronic health records and digital record-keeping, and drawing on a partnership of physicians, health centers, testing labs, pharmacists and other providers.

That opens “a plethora of opportunities for pharmacists to optimize their patient-care services,” in the words of one pharmacy leader. And that, it goes without saying, means an expansion of the role played by pharmacy techs as they fill the void in duties related to dispensing, prescription claims adjudication and other administrative tasks.

As the reform law transforms parts of the nation’s healthcare system and builds toward full implementation in 2014, “pharmacy technicians at CVS/pharmacy will continue to provide the critical support that allows our pharmacists to focus on their licensed professional duties, including quality assurance, one-on-one patient counseling, and medication and disease management services,” CVS/pharmacy chief spokesman Mike DeAngelis told DSN Collaborative Care. “Among the most important support duties our technicians provide is advanced support of the prescription-filling process, third-party payment resolution and pharmacy inventory management.”

Nevertheless, the full impact of health reform will take time to assess, said Megan Coder, PharmD, director of professional affairs for the Pharmacy Technician Certification Board. “The difficult thing is that every state is going to look a little different in implementing this, so technicians are going to need to be flexible and proactive in working with pharmacists to best serve patients and reduce overall costs,” Coder told DSN Collaborative Care.

One clear outcome of health reform for pharmacists and support staff in all states, however, will be an increasing emphasis on prevention and wellness by Medicare, Medicaid and the military’s Tricare health program. The law directs HHS to begin a massive shift in the way the federal health reimbursement system pays for health services — including pharmaceuticals and pharmacy-based patient care — from a flat-fee-for-services model to one that rewards teams of health providers in both the hospital and ambulatory care setting for improving patients’ overall health outcomes.

In general, that means pharmacists and pharmacy techs will focus more time on direct, face-to-face contacts with patients. Pharmacists will provide more in-depth counseling on both the conditions and treatments patients are dealing with. Medication therapy management will assume a greater role, particularly for seniors, as will clinical and preventive-health services like immunizations, public health education programs and the management and monitoring of patients by pharmacists.

In all cases, that means “an increased role for techs as pharmacists take on more patient care opportunities out of the Affordable Care Act,” noted Ronna Hauser, VP policy and regulatory affairs for the National Community Pharmacists Association. With the health-reform law’s “funding of new care models,” she added, “pharmacists will be part of a larger, integrated healthcare team. And that means more opportunities for pharmacy technicians in assisting pharmacists in caring for the patient.”

HHS and the Centers for Medicare and Medicaid Services now are aggressively pursuing these new care models. Coder cited one federally funded program that sprang from the Obama administration’s campaign to overhaul the healthcare system in 2010: the so-called Innovation Center operated by CMS at Innovations.cms.gov. The goal of the center, she told DSN Collaborative Care, “is to find new ways to pay for and deliver care that improves care and health while lowering costs.”

To that end, HHS, through the CMS Innovation Center, has “funded a ... number of projects that will highlight innovative ways to save costs and improve the quality of care,” Coder said. Indeed, since May, HHS has awarded grants to 107 projects in all 50 states to “support innovative projects nationwide designed to deliver high-quality medical care, enhance the healthcare workforce and save money,” according to the agency, which predicted the projects will save the healthcare system $1.9 billion over the next three years.

The innovation awards, said HHS Secretary Kathleen Sebelius, were “made possible by the Affordable Care Act” and will fund a host of new, more cost-effective and more integrated models of community health care involving teams of pharmacists and pharmacy staff together with doctors, hospitals, clinics and other health providers. “Thanks to the healthcare law, we are giving people in local communities the resources they need to make our healthcare system stronger,” Sebelius said.

One of the biggest changes ushered in by the health-reform law will be a ramping up of the prescription coverage roles as an estimated 32 million Americans currently uninsured become eligible for health and pharmacy benefits under an expanded Medicaid program and more affordable coverage, culminating with the full implementation of the law by 2014. The expansion in insurance eligibility to millions more patients, coupled with new federal reimbursement policies and caps on out-of-pocket liabilities for insured Americans under Obamacare, “will gradually make prescription drugs more affordable, increasing access to pharmaceutical services,” according to the AFL-CIO report.

Added author John Rossheim in a report on the jobs outlook from Monster.com, “When 32 million people get insurance in 2014, there will be a boost in demand, and we’ll need more pharmacists and pharmacy technicians.”