Pharmacists, insurers, Medicare align to promote qualityprescribing

June 1, 2006

Washington, D.C.-Insurers, pharmacists and Medicare officialshave established a formal partnership called the Pharmacy QualityAlliance (PQA) to improve measurement of pharmacy performance. Amajor function of the alliance will be to develop quality measures,new payment models and information systems to promote appropriatedrug treatment and to compensate pharmacists for supporting theseefforts.

WASHINGTON, D.C.-Insurers, pharmacists and Medicare officials have established a formal partnership called the Pharmacy Quality Alliance (PQA) to improve measurement of pharmacy performance. A major function of the alliance will be to develop quality measures, new payment models and information systems to promote appropriate drug treatment and to compensate pharmacists for supporting these efforts.

PQA members, including America's Health Insurance Plans (AHIP), the National Association of Chain Drug Stores (NACDS) and the National Community Pharmacists Assn. (NCPA), already have agreed on standardized electronic messages that will make it easier for Medicare Part D plan sponsors to explain why a certain prescription is not covered. Such "reject codes" received by retail pharmacies may result from a need for prior authorization, quantity limitations, coverage under Part B and pharmacy network status under the system developed by PQA leaders.

The next initiative aims to make greater use of pharmacists to promote generic drug utilization, with expanded e-prescribing being another area where pharmacists may seek to collaborate.