CMS Separation Rule
CMS Rule: Separation of consultant pharmacist from provider pharmacy
In late 2011 CMS proposed separation of consultant pharmacist from provider pharmacy:
- Rationale for separation: Reduce source(s) of conflict (Consultant Pharmacist with Provider Pharmacy with Drug Manufacturers and Rebates)
- Goal of separation: Increased quality of service, increased patient safety, decreased healthcare costs.
CMS published this view of the Consultant Pharmacist and Provider Pharmacy relationship:
“We have been informed that LTC pharmacies typically provide the consultant pharmacists to nursing homes at rates that are well below the LTC pharmacy’s cost and below fair market value. We are concerned that these arrangements may be used to entice nursing homes to enter into contracts with the LTC pharmacy for pharmacy dispensing services and the purchase of prescription drugs.”
CMS expectations of separation:
- More appropriate prescribing
- Decreased medications prescribed
- Decreased high cost medications (Brand) prescribed
- Reduced Antipsychotic prescribing
- Decreased use of inappropriately prescribed medications (drugs to avoid in the elderly)
- Medicare A savings, direct savings to facilities
- Medicaid savings, potential savings to facilities
- Medicare D savings, direct savings to the sponsors
- Savings to the resident and their families
CMS is asking LTC industry to voluntarily adopt the following changes to increase transparency:
- Separate contracting for LTC consulting services from dispensing and other pharmacy services;
- Payment by LTC facilities of a fair market rate for consultant pharmacist services;
- Disclosure by the consultant pharmacists to the LTC facility of any affiliations that would pose potential conflicts of interest; or the execution by the consultant pharmacists of an integrity agreement.
So what are your options?
Because of these CMS recommendations, most Provider Pharmacy contracts have the Consultant Pharmacist and the Dispensary Services in two separate contracts. So, renew the Dispensary and not the Consultant Pharmacist contract with the Pharmacy. Then seek an outside, Independent Consultant Pharmacist, to complete the clinical roles within the facility. Take control of the level of care you are offering your residents and ensure you stay compliant with state/federal regulations by choosing an independent.
Call your Provider Pharmacy and ask permission to obtain your own Consultant Pharmacist.
Most Provider Pharmacies are still under contract with Nursing Facilities for reimbursement well below fair market value. This is a significant loss leader for the Provider Pharmacy. Most will graciously allow the Nursing Facility to contract their own Independent Consultant Pharmacist to improve their bottom line.
Call your Provider Pharmacy and tell them you want the Consultant Pharmacists from CTS.
To keep their Nursing Facilities happy, many Pharmacies will gladly make that call for you. The Provider Pharmacy does not want to lose your business and often contract out Consultant Pharmacist services during times of growth or for other temporary coverage needs.
Switch Pharmacy Provider and get the clinical services you demand and your residents deserve!
If your Provider Pharmacy is not putting the needs of you and your residents first, why are they still a business partner of yours?
Give us a call (317-507-8193) and we'll gladly discuss your options and answer any of your questions.
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