Start 2023 Strong Knowing These Star Ratings Changes

The COVID-19 pandemic shifted the way the world views health care. In response, the Center for Medicare & Medicaid Services (CMS) has adopted several changes to the idea that patients should face minimal hurdles to receiving care and treatment during COVID-19.

New & Notable in 2023

The following measures have distinct exclusions that indicate how the measurements were conducted.

Medication Adherence Measures

For MAPD thresholds, all thresholds see an increase across all measures.

For PDP thresholds, all thresholds see an increase as well.

For pharmacies: The medication adherence measures the percentage of eligible members with a proportion of days covered (PDC) rate of 80% or over for the specific drug classes (e.g., diabetes, hypertension, and cholesterol medications).

Statin Use in Persons with Diabetes (SUPD)

The average performance for the SUPD measure was up 2% for MAPD, to a new average of 83%, and 3% for PDPs, to a new average of 81%.

For pharmacies: The SUPD measures the percentage of beneficiaries 40-75 years old who were dispensed at least two diabetes medications during the measurement period. Exclusions include members with Early State Renal Disease (ESRD).

Statin Therapy for Patients with Cardiovascular Disease (SPC) – Part C

The average performance for the SPC measure was up 3% to 84%.

For pharmacies: The percentage of males 21–75 years of age and females 40–75 years of age during the measurement year identified as having clinical atherosclerotic cardiovascular disease (ASCVD) and who were dispensed at least one high or moderate-intensity statin medication during the measurement year. Several exclusions exist with other conditions including ESRD and Hospice.

MTM Program Completion Rate for Comprehensive Medication Review (CMR)

In addition to the increase in measure-level Star Ratings, the measure averages also increased significantly with MAPDs now having an average score of 83%, up 7% from the year prior, and PDPs have an average score of 54%, which is an increase of 9%.

For pharmacies: This measures the percent of MTM eligible members that received a CMR during the measurement period of at least 61 days or more of continuous enrollment. However, members that did not receive a CMR during the same period would be excluded from the measure.

What Should I Do?

You can view more information and an organized look at MAPD and PDP thresholds here.

The Clinical Performance Dashboard was developed exclusively for EPIC Pharmacy Network, Inc. (EPN) members. It is designed to provide pharmacies quick and easy access to essential performance information. Pharmacies can view their performance at a glance for PrescribeWellness, EQuIPP, OutcomesMTM, and Mirixa; and, most importantly, are provided support on how to improve.

Interested in learning more about this exciting performance tool or viewing a demo? Contact the EPIC Rx Clinical Programs Team online or at 800-965-EPIC (3742).

Brittany LaPorta named Director of Government Affairs for EPIC Pharmacies


EPIC Pharmacies has announced the appointment of Brittany LaPorta as its Director of Government Affairs. LaPorta will manage and coordinate state legislative and regulatory advocacy efforts for EPIC Pharmacies that protect the interests of community pharmacies.

“It’s impossible for community pharmacists and owners to monitor the hundreds of legislative actions and bills that directly impact their business and patients,” said Brian Hose, EPIC Pharmacies Board of Directors chairperson and Sharpsburg Pharmacy owner. “We are excited to bring this new position to expand our advocacy for community pharmacy.”

LaPorta brings a demonstrated history of working in government affairs, specifically public policy, and government relations. She was most recently government affairs and community relations manager at TC Energy, where she led the company’s government affairs and community relations efforts for the Mid-Atlantic Region. LaPorta earned her master’s degree in public administration from West Virginia University.

“As a partner to independent pharmacies across the country, EPIC Pharmacies has a lengthy and robust history of protecting the interest of our member pharmacies,” says Joey McLaughlin, Jr., R.Ph., CEO of EPIC Pharmacies. “We are excited to have Brittany join our team and continue expanding our advocacy of these valuable community health resources.”

EPIC Pharmacies protects the interests of community pharmacies by supporting legislation that encourages consumer access to community pharmacies, ensures the collective voice of independent pharmacy is heard at the state level, and fights against those opposed to issues vital to independent pharmacy.

About EPIC Pharmacies
Member-owned and operated, EPIC Pharmacies provides flexible solutions and hands-on resources so pharmacy members can preserve their independence while providing top-quality patient care for their communities and remaining competitive in the marketplace. EPIC Rx is a valuable service for independent pharmacies across the country, offering group purchasing value, compliance assistance, and much more.

Next Level Patient Care Begins with a Successful Clinical Program

The COVID-19 pandemic greatly influenced the scope of community pharmacies. What was once considered just a place to pick up medication has expanded to a location providing health screenings and treatments.

Clinical programs are an excellent way for independent pharmacies to create additional revenue while maintaining patient relationships.

“The right PSAO partner can enhance your pharmacy’s clinical performance,” said Tracy Tran, PharmD, MBA, EPIC Rx director of pharmacy clinical operations. “Here at EPIC Rx, we provide the tools and solutions you need to drive better patient outcomes and improve reimbursement at the pharmacy and network level. Our dedicated team is committed to your success and the health of your patients.”

Remote Patient Monitoring (RPM) is one great way to build a clinical program within your pharmacy. RPM allows patients to keep track of essential medical records, such as blood pressure measurements and blood sugar levels. When the patient records these vitals, pharmacists can regularly monitor the stats to ensure that the patient is receiving the best care possible.

Pharmacy students and technicians are great resources for establishing a robust clinical program and developing relationships with patients. Students and technicians are eager to learn more and experience personalized care that is often unavailable at the chain store level. Allowing pharmacy students and staff to work with patients enable pharmacists to focus on reviewing and verifying prescriptions for optimal therapy.

The following resources are provided to EPIC Pharmacy Network members. With one-on-one support, our clinical programs team strives to support your pharmacy through these programs.

OutcomesMTM is a resource that allows local pharmacists to help with Medication Therapy Management (MTM) for patients. With MTM, pharmacy staff can help patients improve medication adherence and provide health screenings and tests.

Comprehensive Medication Review (CMRs) is a great way to build one-on-one relationship with patients while promoting chronic care management, medication adherence, and overall health.

EQuIPP® provides standardized, benchmarked data to help shape strategies and guide medication-related performance improvement.

PrescribeWellness is a web-based platform to provide pharmacies with real-time performance data to improve performance, medication adherence, and increase your bottom line with minimum impact on workflow.

Independent pharmacies offer so much more than pills in a bottle. What sets community pharmacies apart from the chains is extent and level of care. What was once a place to pick up medication is now a health care destination.

Learn more about how your pharmacy can establish a strong clinical program with the help of EPIC Rx here.

Community Pharmacy Definitions

The independent pharmacy industry is full of terminology that is important to understand. Here are some common pharmacy terms and definitions that will be helpful to know.

Medicare Part D: The part of Medicare that covers most outpatient prescription drugs, Medicare Part D was implemented on January 1, 2006, under the “Medicare Prescription Drug, Improvement, and Modernization Act of 2003.”

Medicare Prescription Drug Plans (PDP) do not offer hospital or medical coverage. This drug coverage is offered by stand-alone companies. These plan sponsors have a four-digit identifier beginning with the letter “S.” The four-digit identifier indicates which Medicare plan the insurance is under.

Medicare Advantage Prescription Drug (MAPD) offers hospital, medical, and prescription drug coverage under a single policy. There are four MA-PDs: Health Maintenance Organization (HMO), Preferred Provider Organizations (PPO), Private Fee for Service Plan (PFFS), and Special Needs Plan (SNP). MAPD plan sponsors have a four-digit identifier beginning with the letter “H.”

Employer/Union Sponsored Part D Retiree Plans may be offered by employers to eligible employees/retirees. These plans’ sponsors have a four-digit identifier beginning with the letter “E.”

Standard (Non-Preferred) In-Network Pharmacy prescriptions may have a higher cost-sharing amount for the patient. Preferred In-Network Pharmacy prescriptions may have a lower cost-sharing amount for the patient. Pharmacies agree to give plans a large discount.

Third-Party Payments: Organizations that reimburse a pharmacy or patient for a portion of the patient prescription drug costs are referred to as third parties.

National Council for Prescription Drug Programs (NCPDP) is a unique seven-digit national identification number that assists pharmacies in interacting with federal agencies and third-party providers. NCPDP sets the adjudication standards for all pharmacies.

Processor Bank Identification Number: A six-digit primary identifier that indicates the insurance provider. This number is issued and maintained by NCPDP.

Processor Control Number: A second identifier used for routing claims.

Group Number: assigned by a health insurance company to identify a member’s group health plan.

Reimbursed Below Cost: PBMs use multiple options for claim reimbursement.

Maximum Allowable Cost (MAC): this list includes the upper limit or maximum amount a plan will pay for generic drugs and brand name drugs with generic versions available.

Contracted Rates: this list is based on Average Wholesale Price (AWP) or Wholesale Acquisition Cost (WAC). The National Average Drug Acquisition Cost (NADAC) reflects monthly purchasing trends across participating retail pharmacies in the United States.

AWP refers to the average value at which wholesalers sell drugs to physicians, pharmacies, and other customers. AWP is accepted as the standard measure for calculating the cost of a particular medication.

WAC is the estimated list price paid by a wholesaler, distributor, and other direct purchasers. Generally, it is the price put out by the manufacturer of the drug before any rebates, discounts, allowances, or other price concessions are offered by the supplier of the product.

NADAC (National Average Drug Acquisition Cost) is based on the retail price survey and focuses on the retail community pharmacy acquisition costs. Not all drugs have a NADAC price. The Centers for Medicare and Medicaid Services (CMS) define a process to survey chain and independent pharmacies to obtain invoice copies.

Usual and Customary (U&C): average cash price paid at a retail pharmacy. Part of every claim is submitted for reimbursement. The reimbursement is based on AWP plus a set fee/percentage.              

Effective Rates: Based on AWP, these rates are set at the network level for brands, generics, and dispense fees. There are three plan/claim types: commercial, Medicaid MCO (Managed Care Organizations), and Medicare D.

Knowing these pharmacy industry terms can help make running your independent pharmacy operations run more smoothly. For more information and to learn more about a better way of doing business, contact EPIC Rx.

2022 Annual Meeting Canceled Due to Growing Concerns over COVID-19 Virus

In the face of increasing and overwhelming concerns about the COVID-19 virus, EPIC Rx has decided to cancel the annual meeting scheduled for March 4-6, 2022, in National Harbor, MD.

We have given the situation deep consideration and want to provide all attendees with ample opportunity to manage air travel and personal schedules. We also want to respect our pharmacists’ need to be available to their patients and communities at this time.

EPIC Pharmacies Announces 2021 Student Grant Award Recipients

EPIC Pharmacies, Inc., a national network of independently owned pharmacies, announced the winners of its 2021 student grant program. Grants were awarded to six pharmacy students who plan to practice in an independent pharmacy upon graduation.  

“EPIC Pharmacies upholds a long-standing legacy of providing the tools and resources for young pharmacists to grow and learn,” says EPIC Rx Chief Executive Officer Joey McLaughlin. “We are proud to encourage and support the 2021 annual grant recipients as they continue to show their dedication to the profession.”

The 2021 recipients include:

  • Lane Callahan, Harding University College of Pharmacy
  • Hannah Howard, University of Arkansas for Medical Sciences College of Pharmacy
  • Lindsey Simmerman, University of Mississippi School of Pharmacy
  • Hayden Wooldridge, University of Mississippi School of Pharmacy
  • Judy Noh, University of Maryland School of Pharmacy
  • Noah Nussbaum, Medical University of South Carolina

Applications for the 2022 program will be available on January 1, 2022, at any EPIC Pharmacies member location. To find a location near you or for more information about EPIC Pharmacies, visit www.epicrx.com.