A new model for gout: pharmacy-based care



“I think pharmacy is really excited about providing these types of services. Pharmacists managing gout patients is perfectly in line with what is going on now” in the field. “I can’t imagine how” outcomes “are not going to be positive,” said pharmacist Jan Hirsch, PhD, a professor of clinical pharmacy at the University of California, San Diego, where pharmacists are also on primary care teams.

Who’s going to pay?

No one wants a zero-sum game; physicians and pharmacists both need to be paid fairly for their services. The goal is collaborative care, not stealing patients.

Even so, the issue for a lot of primary care providers “will be who pays for this, and who doesn’t get paid when other people do this,” Dr. Blackwelder said.

Dr. Jan Hirsch

Dr. Jan Hirsch

One option outside of large health systems is for primary care practices to contract with a trusted local pharmacist to come in every few weeks to help with gout and other chronic problems.

Since they would be in the same office as the physician, family doctors could bill under their own name and split the payment with the pharmacist. “I would just contract with [pharmacists] personally,” Dr. Blackwelder said. “That way you don’t have to worry if the pharmacist” is considered “a provider or not” under Medicare Part B.

Meanwhile, Medicare Part D and some commercial plans reimburse for medication management, which is another option for pharmacist payments.

Additional options are likely to emerge, as well. “Payment models are evolving for pharmacists,” Dr. Hirsch said.

Dr. Mikuls disclosed pending research funding from AstraZeneca. Dr. Terkeltaub is a consultant for AstraZeneca, CymaBay, Revive, Relburn, and other companies.

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