Monday, June 11, 2012

No one said insurance was involved!

Posted by Tom Vassas at Monday, June 11, 2012

I left off in my last post with the big picture of my admin rotation...and that still does not do it justice.  Among my responsibilities with small projects and investigating data, I was given a few creative topics to work on.  First is organizing an inservice for the specialty pharmacy staff at the East Ann Arbor facility.  I will be detailing to them an overview, financial impact, and current/future states of speciality pharmacy. Just as a side note; specialty pharmacy, as it is becoming known, is fairly recent grouping together of various unique aspects of pharmacy. It includes most drugs and drug products that are biologics, expensive injectable/inhaled/oral drugs, and may require tedious monitoring or intense handling precautions. Transplant drugs are by far the most common at UofM, but the top three nationally are autoimmune/inflammatory disorders, multiple sclerosis, and cancer.

Aside from covering specialty pharmacy, I have been learning a great deal about 340B pricing. 340B is a program created to help offset the cost incurred by organizations (such as UM health system) that will treat indignant or uninsured patients. Similar to how 3rd party pricing with insurance works, 340B is yet another player in the game that drug manufacturers, distributors, primary insurance, the covered entitity (the health institution usually) and the participating pharmacy dance around. It is not vastly complex when  the covered entity only permits 340B for its own pharmacies, but in the mid 2000s, covered entities were permitted to begin contracting non associated pharmacies to serve 340B patients. That is when you really need to draw a flow chart to follow the money and medicine.

One of the nuanced parts of this rotation so far are the non-structured, non-scheduled "journal clubs". It usually consists of a good or interesting point brought up in a meeting, me reading an article about it, and more or less a long discussion of the topic with its ramifications to the profession. The most common theme has been on leadership in the profession, and Dr. Kelley and I have analyzed a lot of leadership styles and qualities.  Next time should be a joint post with fellow admin blogger Maria, so stay tuned for a LEANer style of writing. (hint: that is a foreshadow and a well placed one I might add)


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