Have you ever wondered which pharmacy networks are the largest? CVS and Walgreens might be at the top of your list, but there is a relatively unknown network of over 3,000 community-based pharmacies that have quickly moved into the top five. That is over 3000 local community pharmacies across that nation in a newly created network called CPESN® USA. CPESN® USA is not an ordinary network but rather the country’s first and only Accountable Pharmacy Organization – a group of forward-thinking community pharmacy owners focused on both providing critical clinical services to the patients they serve and on working directly with payers who value the benefits of a patient-focused approach. In other words, CPESN® USA is focused on creating opportunities to provide value-based care in community pharmacies.
This original network was able to create local opportunities where pharmacies/pharmacists would contract with employer groups and bill for clinical services rendered under the medical benefits of health plans. This is revolutionary as most reimbursement for pharmacies is tied to a product, despite the many other clinical tasks that are performed by pharmacists including but not limited to extensive counseling, blood pressure screenings, monitoring of lab values and ensuring patient adherence to medications with a variety of adherence tools. However, pharmacists are typically not able to charge pharmacy benefits managers for these services and although medication therapy management programs have propelled pharmacists to showcase our significant impact on managing chronic disease the reimbursement is low and related to dispensing adherence not outcomes. Those are the key tenets of every new CPESN network in operation today or every new CPESN network going forward.
With this shared mindset, pharmacists across the nation recognize the role local, community-based pharmacies have in keeping patients healthy. This has led to an explosion of CPESN networks being established, the creation of minimum service standards that are shared across the networks, and importantly, education, training, and best practices sharing centered around working directly with health plans and other medical side payers who are focused on improving the overall health of their patients (members).
As we go into 2021, CPESN® USA is positioned to excel in three areas.
First, CPESN® USA is a federal vaccine partner helping independent pharmacies prepare to deliver the COVID 19 vaccinations to their communities. They want to help getting America back to normal, especially in the underserved rural and inner city areas where CPESN pharmacies have a strong presence.
Second, CPESN® USA has educated and trained pharmacists in each network to have the skill set to approach health plans and other medical side payer to confidently share the CPESN model and its documented success in improving outcomes and surpassing performance metrics.
Third, CPESN® USA is actively recruiting new pharmacies, partners, and payors to expand the reach local networks have to serve communities in need.
About the Authors
Kerry Kribbs, BBA, MHA, is a Network Liaison with CPESN USA.
Kerri Okamura, RPh, is a Network Liaison with CPESN as well as a Luminary for CPESN Hawaii. She is also Director of Pharmacy for KTA Super Stores who have been members of CPESN since 2018.
Jay Williams has been working directly with independent, community-based pharmacy owners for more than twenty years. As the Director of Marketing & Communications for CPESN USA, Jay continues that journey. Prior to joining CPESN USA, Jay served as the VP of Marketing for PrescribeWellness, VP of Marketing for Cardinal Health, and Director of Marketing for AmerisourceBergen. In each of these leadership positions, he was responsible for the marketing strategy and communications deliverables impacting community-based pharmacies.
Sonya Frausto, PharmD, MAG, FCPhA, FCCS, FACC, is the CPESN CA Network Facilitator, Flip the Pharmacy Coach, and owns Ten Acres Pharmacy. Dr. Frausto is the CPESN Editor for the Journal of Contemporary Pharmacy Practice.