1. Michael Dutton, R.Ph., MBA, SSBB PIC Evergreen Pharmaceutical

2. Outline • Introduction • Omnicare • Medicaid • Medicare • Challenges • Summary • Questions

3. Long Term Care Pharmacy • Omnicare, Inc., is the nation’s largest provider of pharmacy services to long-term care facilities • Omnicare serves residents in long-term care facilities comprising approximately 1,003,000 beds in 47 • Omnicare's corporate headquarters is in Covington, Kentucky.

4. Long Term Care Pharmacy • Evergreen Pharmaceutical • Seven locations in the northwest • Servicing 20,000 residents • 65% Medicaid • 12% Medicare

5. The Changing Environment of Reimbursement • Medicaid • Preferred Drug List • What are the effects of the new program • To early to tell? • Why is the pharmacists not reimbursed for the clinical intervention? • What is the liability of the pharmacists?

6. The Changing Environment of Reimbursement • Medicaid • Clinical reimbursement opportunities • Clozaril • Provider number • No billing codes

7. The Changing Environment of Reimbursement • Medicare • Part D (2006) • How will this effect Long Term Care? • Not sure • Current landscape • Partner with facilities to control costs • Facilities bill Medicare-pay pharmacy

8. The Changing Environment of Reimbursement • Challenges • Dual eligible • Medicaid residents in facilities do not have Medicare coverage. • Washington State requires Medicare be billed and denied prior to billing Medicaid. • Part D will end this (in one year)

9. The Changing Environment of Reimbursement • Challenges (con’t) • Arenesp • Medicare will cover only with hemoglobin < than 12 • Diabetic supplies • Albuterol/Atrovent SVN

10. Summary • How will Part D impact Medicaid • How will Part D impact Pharmacy • What is the impact on Long Term Care • To early to judge the effects

11. Questions?