Has owned a high volume pharmacy for 19 years, recently opened a consultation office, Center for Life and Health Education to provide his cognitive services.

Diabetic education, nutritional education, disease education, alternative therapy, and third party payer consult;

Provides diabetic education, including nutrition and disease management based on ADA guide lines. Previously, 25% of claims were reimbursed. Recently however, New Jersey has mandated reimbusrement for diabetes education for pharmacists that are C.D.E. certified. So, 100% reimbursement;

Asthma disease management is not currently reimbursed by insurance companies, but is being highly reimbursed by patients. He is working on documentation of how management of asthma is keeping people out of hospitals and doctors offices, to present to insurers;

For diabetes, he is providing nutritional education that works with the patients. He asks them what foods they like to eat, and them supplies them a print out of a diet that allows them to eat what they want, adjusted to how they should eat these foods as they are incorporated into a diabetic diet;

Provides clinical cognitive reviews of drug therapy and disease management. Is being highly reimbursed solely by patients;

Is currently working with state associations of pharmacy to educated pharmacists on how to employ his diabetic education into their pharmacies and receive reimbursement. Also how they can become certified. (lecturing to Georgia Association Feb. 17). He feels that other states will follow what New Jersey has already employed and is making an effort to help that processes along;

Asthma and Clinical Cognitive review documentation for insurance companies is being helped funded by drug companies.

His fee is basically $1.00/ minute; a two hour consult is $75 and is based of NIH standards for purposes of documentation.

Currently considering Care Point software....

Mr. Panarcello is also working through Temple Univ. training pharmacists in his state on asthma management.

Upon noticing a problem with a patient (eye lesion, drug interaction, improper drug treatment, high blood pressure, etc.) he will utilize a physician if applicable and accepted, or write a letter to the patient stating what he has noticed and will recommend an appropriate action plan for the patient, stating that he has charged the patient $10 for his recommendation and appraisal if that is acceptable to them.

He feels that pharmacists in his state have been reduced to a vending machine. He encourages cognitive services, but pleads that pharmacists will not sell him out by not charging for these, or charging too little. He states that our six years of education is being under utilized by the public and other health care professionals, but it is up to the teaching institutions and pharmacists to change this. He is tired of being told he must provide cognitive services and watching insurance companies slowly eliminate reimbursement.

He works closely with physicians, often having a two way recommendation system accepted and utilized. He is not however discouraged by unyielding physicians and will go behind them to provide his services, because it is the patient that has the need and is paying to have it met.