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Michael Dutton, R.Ph., MBA, SSBB

PIC

Evergreen Pharmaceutical

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Outline

• Introduction

• Omnicare

• Medicaid

• Medicare

• Challenges

• Summary

• Questions

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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.

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Long Term Care Pharmacy

• Evergreen Pharmaceutical– Seven locations in the northwest– Servicing 20,000 residents– 65% Medicaid– 12% Medicare

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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?

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The Changing Environment of Reimbursement

• Medicaid– Clinical reimbursement opportunities

• Clozaril • Provider number

– No billing codes

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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

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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)

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The Changing Environment of Reimbursement

• Challenges (con’t)– Arenesp

• Medicare will cover only with hemoglobin < than 12

– Diabetic supplies– Albuterol/Atrovent SVN

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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

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• Questions?