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Michael Dutton, R.Ph., MBA, SSBB

Michael Dutton, R.Ph., MBA, SSBB. PIC Evergreen Pharmaceutical. Outline. Introduction Omnicare Medicaid Medicare Challenges Summary Questions. Long Term Care Pharmacy. Omnicare, Inc., is the nation’s largest provider of pharmacy services to long-term care facilities

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Michael Dutton, R.Ph., MBA, SSBB

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  1. Michael Dutton, R.Ph., MBA, SSBB PIC Evergreen Pharmaceutical

  2. Outline • Introduction • Omnicare • Medicaid • Medicare • Challenges • Summary • Questions

  3. Long Term Care Pharmacy • Omnicare, Inc., is the nation’s largest provider of pharmacy services to long-term care facilities • Omnicare serves residents in long-term care facilities comprising approximately 1,003,000 beds in 47 • Omnicare's corporate headquarters is in Covington, Kentucky.

  4. Long Term Care Pharmacy • Evergreen Pharmaceutical • Seven locations in the northwest • Servicing 20,000 residents • 65% Medicaid • 12% Medicare

  5. The Changing Environment of Reimbursement • Medicaid • Preferred Drug List • What are the effects of the new program • To early to tell? • Why is the pharmacists not reimbursed for the clinical intervention? • What is the liability of the pharmacists?

  6. The Changing Environment of Reimbursement • Medicaid • Clinical reimbursement opportunities • Clozaril • Provider number • No billing codes

  7. The Changing Environment of Reimbursement • Medicare • Part D (2006) • How will this effect Long Term Care? • Not sure • Current landscape • Partner with facilities to control costs • Facilities bill Medicare-pay pharmacy

  8. The Changing Environment of Reimbursement • Challenges • Dual eligible • Medicaid residents in facilities do not have Medicare coverage. • Washington State requires Medicare be billed and denied prior to billing Medicaid. • Part D will end this (in one year)

  9. The Changing Environment of Reimbursement • Challenges (con’t) • Arenesp • Medicare will cover only with hemoglobin < than 12 • Diabetic supplies • Albuterol/Atrovent SVN

  10. Summary • How will Part D impact Medicaid • How will Part D impact Pharmacy • What is the impact on Long Term Care • To early to judge the effects

  11. Questions?

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