How to Work with Telemedicine Providers
- March 5, 2019
- / Andrew Fisher
- / Post Tags
By Andrew Fisher
Part of ORCHIDsocial Series
If you watch ESPN or some other common channels, you’ll find it hard to miss the TV commercials that air throughout the evening offering pain-relieving back braces for Medicare beneficiaries. Many of them now also talk about topicals and other types of medications. Have you ever wondered what that is all about? Direct-to-patient marketing is a big business in the U.S., and, while there are rules about what can and can’t be done, there are millions of patients who respond to these types of advertisements. It’s a real segment of healthcare, and – despite what certain cynical people might say – it’s not fraud, and it’s not illegal. At least not if it is done correctly.
Most people who are against this type of business (the PBMs included) will say that these people don’t need these therapies and it’s just a waste of money. Or they’ll say that because these patients are usually receiving the consultation from a provider via telemedicine there is no “real” patient-provider relationship. It’s very hypocritical that as they are discrediting telemedicine, their sister insurance company (Aetna, for example) is sending out mailers to their network offering telemedicine services. Which is it? Are telemedicine consultations a real, patient-doctor interaction? The simple answer is, “Yes.” The complicated answer is that states have different laws when it comes to whether the provider did enough to constitute a patient provider relationship, and those laws have not typically been on the books for very long, so they haven’t really been challenged in front of a judge or jury yet.
Okay, now that we have established that direct-to-patient advertising is a complicated space but there are opportunities within it, let’s get to the question that pharmacy owners really care about. Can you integrate direct-to-patient advertising and/or telemedicine into your pharmacy? Disclaimer: I am not an attorney, so don’t take this as legal advice, but, yes, you can. Do it consciously and carefully if you are going to do it, and the following are a few tips to help you do that:
1. Know the source of the business. Were patients solicited, or were these patients who contacted the publishers of the advertising campaign of their own volition? It matters because of telemarketing laws.
2. Understand the interaction between the patient and the provider. Did the patient have an interaction with the person who signed the RX, or did they not? You should also know your state’s rule about what constitutes a legal patient-provider relationship and make sure that is happening. An RX is not valid even if it was written by a valid prescriber if that prescriber does not have a valid relationship with the patient.
3. Check whether your pharmacy board has any public positions on telemedicine.
4. Make sure the provider and patient are located in the same state. Claims where the provider and patient are located in different states are scrutinized more heavily by the PBMs during audits.
5. Make sure you either have a face-to-face interaction with the patient or a phone call with the patient prior to issuing them their medications. It’s generally not legal to issue a medication to patients without their permission.
6. If it looks shady, it probably is. Make sure you know with whom you are doing business. The groups with whom you are working should have good attorneys and strong legal opinions. You also should not get a lot of patients who don’t know what you are talking about when you contact them about filling the prescription.
7. If you are paying a percentage of the revenue earned on this business to an outside group, you should check with an experienced healthcare attorney to make sure the arrangement does not violate any state or federal kickback laws. There are legal ways to partner with outside groups, but having an attorney review the arrangement is a good idea.
Telemedicine represents a big opportunity for independent pharmacies. Because of the nature of the patient and provider interactions pharmacies have a chance to get involved and offer a very valuable service. ORCHID has experience working with telemedicine groups and can help you evaluate whether or not accepting this kind of business is a good fit for your pharmacy. Please contact us if you are interested in learning more.