Bold fee-for-service diabetes initiatives on trial in Texas pharmacies

Drug Store News, Feb 21, 2000 by Kim Roller

AMARILLO, Texas -- Texas pharmacists are poised to begin a two-year diabetes demonstration project under which pharmacists will be reimbursed through a state Medicaid program for diabetes care.

The program, from Texas Tech University Health Science Center's Pharmacy and Medical School here, will collect data from about 3,000 patients across the state over 24 months. It will be the first controlled study of a fee-for-service patient care initiative implemented on such a large scale in community pharmacies, said Arthur Nelson, dean of the Pharmacy School at Texas Tech and the original author of the proposal. Nelson said program coordinators are hopeful pharmacists will be seeing patients by summer.

"The Medicaid Agency says that if this works, they'll put the program in statewide," Nelson added. "We'll just go on to asthma and probably half a dozen to a dozen different chronic disease states if we demonstrate that the pharmacists, when they're appropriately trained and have the appropriate set-up of their practice, can be very effective."

The Texas Medicaid Agency submitted a request at the end of December for a waiver from the federal Healthcare Financing Administration, which is required to begin the program. Although the proposal was originally submitted last summer, the Texas State Medical Society "got nervous, I guess," Nelson noted. "They asked us to sit down and go through it. We didn't really make any changes, just rewording, and we resubmitted it."

Nelson said the "only sticking point we're having any trouble with" stems from the proposal providing for pharmacists to do CLIA-waved monitoring tests, which, he said, "some physicians are up in arms about. They're concerned about loss of revenues from these types of tests. That's the last little controversy in terms of the Medical Society signing off and getting the program out of the starting gate."

The program will be run exclusively in community pharmacies, both chain and independent, throughout Texas and will include between 100 and 150 pharmacists who have passed an advanced "credentialing" exam.

The program will be announced across the state and invite pharmacists to participate. Pharmacists from Texas Tech's School of Pharmacy faculty already participate in programs with Eckerd and United Supermarkets.

"These are Pharm.D., residency-trained people who practice in the pharmacy doing disease management now for private-pay patients mostly and some managed care contracts," Nelson said, noting these programs include one in Dallas with Eckerd and one with United Supermarkets in Amarillo and in Lubbock, Texas. "We've been working with chains for quite some time," he said.