CMS Regulations For Specialized Pharmacy Services
The Medicare Modernization Act of 2003 recognizes that beneficiaries who reside in long term care facilities have needs for specialized pharmacy services, have access to a pharmacist 24 hours per day, seven days per week, and emergency deliveries of medication to assure residents receive timely access to appropriate medication therapies (CMS, 2014). To meet this type of service, many long term care facilities have contract with long-term care pharmacies (LTCP).
Standards of practice for LTCP have evolved over several decades in response to a complex set of Federal and state regulations governing the provision of prescription drugs in ...view middle of the document...
Prescription orders are transmitted to the LTCP via facsimile. After the LTCP receives medication orders, they are reviewed and processed (CMS, 2014).
Pharmacists and technicians subsequently update an existing patient record or create a new one. In some circumstances, the pharmacy may need to clarify this orders with nursing personnel or the physician to complete a medication record. The computerized recording of prescriptions track actual and potential drug interactions prior to drug dispensing. A pharmacist consultant will also review the chart for any other potential problems that could exist with the prescription.
Most state Medicaid programs require on-line Drug Utilization Review for all recipients. Pharmacists also perform a formulary check prior to filling the order to verify whether the prescribed drug is covered by the insurance(CMS, 2014). If a prescription is dispensed for a non-covered drug, either the LTCP or the LTC is at risk for the cost of the drug. To prevent this from happening, the pharmacist will contact the physician to suggest a change to the prescription (CMS, 2014). The process of formulary review promotes cost saving, however, this would further delays medication dispensing await for the pharmacist or nursing personnel to contact the physician.
LTCPs must be equipped to dispense emergency prescription medications to a resident 24 hours a day. Emergency prescription orders include controlled substance pain medications and specially prepared intravenous antibiotics (CMS, 2014). LTCPs have a pharmacist and pharmacy technician staff on call 24 hours day to handle such urgent requests. State regulations generally do not specify a timeframe in which delivery must take place, calling for “timely” delivery of medications. The industry practice for the emergency delivery time is approximately two to four hours (CMS, 2014).
LTCP are required by law to provide LTC with emergency back-up systems. Most nursing facilities maintain a stock of medications at the facility for emergency...