Our Profession's Own Pharmacy Care Administrator (PCA): Can a Dream Become Reality?

Recent events and accusations

Our own pharmacy care administrator (PCA)

1. The mere mention of the designations "pharmacy benefit manager" and "PBM" has such negative and deceptive connotations that a different designation such as "pharmacy care administrator (PCA)" must be used. The use of the word "administrator" instead of "manager" must not be interpreted to mean that the proposed program will only be addressing the financial parameters of prescription claims. Rather, the program will include and provide incentives for high standards of pharmacy practice, positive therapeutic outcomes, and strategies to negotiate costs of medications in a manner that is cost-effective and consistent with quality standards.
   
   
2. A task force should be convened that would include individuals who have a commitment to the provision of the highest quality of pharmacist services and the advancement of the professional roles of pharmacists, and who have expertise with respect to pharmacist services and/or the legal, financial, organizational, management, and other areas that are critical for the success of the new program. I recommend that the leadership of the American Pharmacists Association (APhA) and the National Community Pharmacists Association (NCPA) identify individuals who have the needed expertise and convene this task force as quickly as possible.
   
   
3. Unless there are legal or other considerations that would preclude doing so, I recommend that APhA and NCPA develop, with appropriate collaboration and contracts with others as needed, and own the proposed program. An alternative possibility would be to have the pharmacists who participate in the program have ownership involvement in a manner similar to the structure of current pharmaceutical wholesaler/independent pharmacist collaborative organizations.
   
   I anticipate that the proposed program would be a very attractive opportunity for potential investors. However, it is essential that the ownership and other influences within the program reside and remain in the profession of pharmacy. There have been some previous initiatives that were developed with good intentions for patients and pharmacists that, when they reached a certain level of size and success, were acquired by a large PBM or otherwise moved in a direction with very different priorities. Safeguards must be put in place for the continued assurance of positive therapeutic outcomes for patients and advocacy for the advancement of the professional roles of pharmacists.
   
   
4. A network of pharmacies can be quickly established. Specifically, independent community pharmacies provide the opportunity for establishing the largest network of participating pharmacies with the broadest geographical distribution. Provision would also be made for the participation of selected chain pharmacies that are willing to meet the standards of the proposed program and provide the expected counseling, monitoring, and other professional services.
   
   Many independent pharmacies, as well as some chain pharmacies, are currently struggling to financially survive. The proposed program would provide an opportunity to not only survive, but thrive, both professionally and financially, and also encourage entrepreneurism that would result in the establishment of new independent pharmacies. We must recognize, however, that there are community pharmacists who have not remained current with respect to the advances and other changes in drug therapy, and who are not in a position to now acquire that expertise, or hire another pharmacist who has the expertise to implement programs such as medication therapy management that would be included in the proposed program. For these situations, the professional organizations that own and administer the program, in collaboration with colleges of pharmacy, could establish a network of pharmacists and student pharmacists with expertise in providing such services who could be retained on a part-time or consultant basis by the pharmacies having these needs.
   
   
5. The proposed program will provide equitable compensation for pharmacists and be administered in a transparent manner. The latter feature alone will be very attractive to potential clients for whom the secrecy regarding the financial provisions of current programs has been cause for frustration and litigation.
   

A bold goal