Prescription incentives: Concern for patient safety

MTM Pearls


I recently saw an ad in our local newspaper from one of our regional grocery/pharmacy chains that offered patients a savings on gas ($1.00 per gallon) for each prescription they transferred from another pharmacy. As a profession, we keep talking about the value of pharmacists, the need for pharmacists to be recognized as providers by CMS and other payers, and the importance of pharmacists in the health care system to ensure that patients are receiving safe and effective medications. Yet we continue to see prescription transfer incentives that not only cheapen our profession but also have the potential to negatively affect the care of our patients.

Key points

Although I may not agree with this practice, I thought I’d better review the primary literature and the Iowa Pharmacy Association’s (IPA) policy statement. I discovered that IPA opposes the use of financial incentives to influence a patient’s choice of pharmacy services.1 In addition, an article on community pharmacists’ perceptions about prescription transfer incentives made the following points:2

  • Pharmacists perceived that patients who transferred prescriptions based on incentive coupons do not receive thorough drug interaction screenings.
  • Pharmacists perceived that patients who use these incentives may be at an increased risk of medication-related problems (e.g., wrong drug, dosing errors, drug interactions).
  • Some patients may fill prescriptions unnecessarily to qualify for the promotion.
  • Pharmacists felt that these incentives devalued the profession.
  • Pharmacists did not believe the incentives were effective in attracting and maintaining patients.
  • One pharmacist wrote a letter to the editor of a pharmacy journal indicating that the health of patients can be adversely affected by prescription transfer incentives because patients lose their pharmacy home.3

MTM pearls

As I researched this topic, I was encouraged to see that I was not alone in my belief that prescription transfer incentives are potentially detrimental to patient care and devalue our profession. Pharmacists who practice in environments that use prescription transfer incentives may be put into a difficult professional situation. They strive to provide good patient care while being asked to promote a business practice that potentially puts their patients at risk of a medication-related problem.

Also, I am sure that Iowa is not the only state to have its state pharmacy association broach this topic and have policy in place that opposes the practice. Yet I still see these incentives being promoted regularly. I hope that at some point this business practice is challenged and goes away. It is not consistent with the quality health care movement, it is not good for pharmacy, and most importantly, it is not good for patients!

As health care moves toward a value-based system in which health care providers are reimbursed based on patients achieving positive outcomes, it is important that pharmacists step up their efforts to ensure quality patient care. This means that we need to review our own practices and determine if our actions and the actions of our employers are consistent with good patient care. Our patients’ safety should be paramount, and our practices should put in place processes that emphasize optimal patient outcomes and restrict business practices that do not.

Perhaps we will see a change in this type of promotion when pharmacy networks are developed that restrict patient access to only quality pharmacy providers. At that point, payers may direct patients to a pharmacy based on the ability of pharmacists to provide quality patient care. We are closer to this model of health care and reimbursement than many people may believe. Now is the time to create the changes in practice to promote patient care!

References

  1. Iowa Pharmacy Association policy 95-U1
  2. J Am Pharm Assoc. 2012;52(5):e53–58
  3. Am J Health Syst Pharm. 2011;68(9):787