Reimbursement for Pharmacy Cognitive Services: Pharmacists' Assessment

Abstract

OBJECTIVE: To assess the willingness of insurance carriers to reimburse for pharmaceutical care and to determine the extent and success of the Pharmacist Care Claim Form (PCCF) used in obtaining reimbursement. DESIGN: A nine-item survey addressing the PCCF (compiled by the National Community Pharmacists Association, formerly the National Association of Retail druggists. Reimbursement was sent to a random sample of insurance carriers including Blue Cross/Blue Shield, health maintenance organizations (HMOs), preferred provider organizations (PPOs), and commercial insurance companies. RESULT: Overall, 116 of 311 (37.3%) surveys were returned (Blue Cross, 57.4%; HMOs, 41.6%; PPOs, 30.7%; and commercial carriers, 27.0%). Of insurance carriers, 6.9% of 116 respondents reported they had reimbursed pharmacists for nondispensing activities. Two carriers reported reimbursement for "monitoring of drug therapy" and "prescription counseling." Only two health insurance carriers reported reimbursement to pharmacists usi...