USP <800> Pharmacy Compliance

USP <800> Pharmacy Compliance:

Back in March of 2014 the USP (US Pharmacopeial Convention) published yet another intensive set of guidelines regarding the handling of hazardous drugs and their preparation with the release of USP <800> Pharmacy Compliance. Many Pharmacists still remember the 2008 release of the update to USP <797> and we have numerous clients who implemented the changes required for compounding hazardous medications so that the result is a sterile parenteral product. The initial attempt in 2008 was a step in the right direction, but fell short by not having non-parenteral compounding guidelines. Even so, <800> was then hotly debated, criticized and revised. Finally on February 1, 2016, USP <800> was approved. Now implementation of <800> for handling hazardous drugs in all health care settings is a must. Yet after 10 months many Pharmacies and compounding facilities are asking how.

The need for such guidelines is not in question. All prior evidence linked the handling of hazardous drugs to increasing a workers chances for cancer and reproductive issues (as well as the birth defects that have been well documented). Add to this all the media attention over the past few years regarding the FDA and hazardous drug contamination from several specialty pharmacies that resulted in meningitis and patient deaths. The risks of handling hazardous drugs have been known since the early 1980s. The problem that a Pharmacy faces is the never ending changing of these regulations. It has been documented that so far there have been over seventeen guidelines published by six separate Federal agencies and other Healthcare organizations!

Legal Issues –
USP <800> is both a State & Federal standard. What that means is that inspections by both State Boards of Pharmacy and the FDA can cite a Pharmacy for non-compliance. Although compliance is mandatory, the issue is that “current legislation governing sterile product compounding is a patchwork of state-specific regulations with wide variations between jurisdictions” according to a recent article in Pharmacy Times. As the article notes, even though USP <797> is legally enforceable and the industry standard despite state legislation, less than half of state regulations specifically reference USP <797> for sterile compounding.

So far no inspections have occurred that we are aware of regarding USP <800> compliance. However, State Pharmacy Boards have conducted inspections ensuring compliance with USP <797> standards (Florida, California, Texas and Minnesota).

Current legislation governing sterile product compounding is a patchwork of state-specific regulations with wide variations between jurisdictions” according to a recent article published in Pharmacy Times

Actual Changes That Need To Be Implemented ASAP –
Basically USP <800> deals with hazardous drug manufacturing, including such key elements as compounding, preparing the drugs, storage, transport, product storage, compounding, preparation, and administration of parenteral and non-parenteral products. Obviously compliance is mandatory and will be enforced. So the question we all face is: Where do I start?

The core of the changes may actually cause many Pharmacy operations to actually have to change their workflow patterns. Additionally, the equipment specifications may require capital expenditures that will pose a major cash flow problem to many Pharmacy businesses. Although not intended as a legal summary of the USP <800>, here are the key points to focus on:

  1. Compounding, preparing & storing hazardous drugs must occur in an designated area that is separate from areas that non-hazardous drugs are dealt with and stored. Just as an example of the costs that may be involved in being compliant, negative pressure rooms intended for hazardous drug preparation & compounding cannot be used for non-hazardous medication compounding., USP <800> requires pharmacies to utilize a totally separate negative pressure room (plus an additional primary engineering control system) to be compliant!
  2. All hazardous medications are now required to be administered with the use of a CSTD (closed-system transfer device). This is to ensure safety to both nurses who administer the drugs, as well as the patients.

A 2014 study on USP <797> found that many Pharmacies were not compliant. The primary reasons cited were:

  • Financial and budgetary: 27%
  • Physical space limitations: 21%
  • Lack of training resources: 19%
  • Time restraints: 15%
  • Lack of management & leadership support: 5%

So the time to get compliant is now! Don’t put off putting together a Compliance Plan & Strategy until legal issues force you to. As always, please contact us here at HCC if you have any questions regarding this. With over 27 years in the Pharmacy Consulting business, HCC can assist with expert advice in any area of your pharmacy business or practice. We urge you to contact us today to see how our Pharmacy Consulting services can help. With a full-time staff of in-house Pharmacy Consultant specialists, HCC can answer any questions that you may have in all Pharmacy settings. Contact us online or call us today at 800-642-1652 for a free consultation.


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Medicare D Reform for Independent Retail Pharmacies

Medicare D Reform for Independent Retail Pharmacies:

Pharmacy Benefit Manager (PBM) companies have become a major concern for the independent Pharmacy businesses and owners that we have as clients. We at HCC fully support independent retail Pharmacies and everyone can agree that they are a vital part of every community. However, some recent policies and rules generated by several PBMs are seen as a threat to the operation and survival of independent community Pharmacies throughout the country.

The PBM essentially acts as a third-party administrator (TPA) regarding prescription drug programs. These plans include Medicare Part D, as well as many commercial corporate health plans, self insured plans, and for many government employee plans (on both the State and Federal levels). According to APhA’s (The American Pharmacists Association) description: “PBMs are primarily responsible for developing and maintaining the formulary, contracting with pharmacies, negotiating discounts and rebates with drug manufacturers, and processing and paying prescription drug claims. For the most part, they work with self-insured companies and government programs striving to maintain or reduce the pharmacy expenditures of the plan while concurrently trying to improve health care outcomes.” It is estimated that nearly 300 million people in the United States are currently affected by a PBM managing their pharmacy benefits. It must also be noted that there are currently about two dozen existing “major” PBMs (although a total as high as 60 has been referenced several times), but that the 3 “Super PBMs” account for roughly 80% of the entire market  and have almost 200 million patients enrolled.
The 3 “Super PBMs” are:

1. Express Scripts
2. CVS Health (formerly CVS Caremark)
3. United Health (also referred to as OptumRx & Catamaran)

The intent of this post is not to build a case against PBMs, but to point out that perhaps some reform is necessary for independent community Pharmacies to be able to make a profit and continue to thrive in our communities. The intent of PBMs is to maximize the purchasing power for large groups of patients, resulting in a reduction in their prescription drug prices. This is accomplished through volume buying, pharmaceutical manufacturer rebates and pricing discounts at participating retail pharmacies and drug stores. So far no independent study has shown this to be happening. A study often cited by PBMs in 2015 by CVS claimed a reduction of 6.8% for its members, but so far this has not been independently substantiated. The fact that in 2015 there were seven lawsuits filed against PBMs (for antitrust violations, fraud and criminal negligence) has not helped the situation. Additionally, at a 2014 ERISA hearing (Employee Retirement Income Security Act) it was clearly pointed out that PBMs in many instances pose “conflicts of interest” regarding providing consumers reductions in their prescription drug spending.

Now a Pharmacist is taking some action by initiating a Medicare D Reform Petition. Jae K. Shin, the managing pharmacist of Jays Drug and director of Jays Diabetes Education Center in the greater Los Angeles is asking all Pharmacists to officially go on record and support his petition. Although his email in it’s entirety is too long to include, here are the foundation points that Mr. Shin provided:
*Please see http://www.ckapha.org/174105 where his entire email is posted.

1. PBM companies reimburse rate are extremely low, be reflected fair pharmacist dispensing fee.
2. Pharmacy dispensing fee should calculate by AWP, not Direct Price(partial items are not returnable and there are many medication need special care with cost)
3. Pharmacy does not need unreasonable accreditation or attestation.
4. PBM should not take any amount of fund from pharmacy account, such as Dir or other weird rank order.
5. PBM company should not treat differently with independent pharmacy, such as preferred plan which is no copay if they go their own chain pharmacy.
6. Pharmacy are no need accreditation for special drugs.
7. Pharmacy wants eliminate abusive pharmacy audit from PBM companies
8. Pharmacy want to return the high cost of old generic drugs which raise the price recent years.(one of old generic drug Colchicine 0.6mg was $5.00 for 100 tablet, not name changed same medication are $200.00 for 30 tablet.)
9. Pharmacy want to reform Medicare D plan more simple and better understanding module. The coverage should apply equally to individual recipient.
10. How pharmacy chain can have PBM company. (If chain pharmacy doesn’t own PBM company, then chain pharmacy fight for low reimbursement and also this PBM company no need to treat differently for their patient to go their own chain pharmacy.)
If you support this petition, Mr. Shin asks that you fill out the following information and send it to him via e-mail (jaysrx@gmail.com) or fax it to him at (805) 388-5889. He also provided his phone number for contacting him: (323) 810-3360.

Name of Pharmacist:
Name of Pharmacy:
Address:
Telephone No:
Fax No:
E-mail address, if available:

As always, please contact us here at HCC if you have any questions regarding this. With over 27 years in the Pharmacy Consulting business, HCC can assist with expert advice in any area of your pharmacy business or practice. We urge you to contact us today to see how our Pharmacy Consulting services can help. With a full-time staff of in-house Pharmacy Consultant specialists, HCC can answer any questions that you may have in all Pharmacy settings. Contact us online or call us today at 800-642-1652 for a free consultation.


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Medication Dispensing Errors – Policies & Procedures – Pharmacy Consulting

Medication Dispensing Errors – Policies & Procedures:

Medication dispensing errors are a Pharmacy “fact of life” and we all deal with them. Having Policies and Procedures in place to assure that your Pharmacy adheres to current best practices is a must. This pertains to both preventing medication dispensing errors, as well as dealing with the documentation and reporting of errors that do occur.

A study performed over a 7 month period at a major hospital revealed the following regarding medication dispensing errors:

-A total of 140,755 drug dosages were prepared by Pharmacy technicians and 3.6% contained an error.
– 0.75% of the medications prepared left the Pharmacy with an error after verified by the Hospital Pharmacist. The Pharmacist “caught” only 79% of the medication errors using the hospital’s “routine verification” procedures.
– 23.5% of the medication errors that left the Pharmacy undetected could have resulted in an adverse effect if given to the patient. Of these, 28% were considered “serious” and 0.8% were classified as “life threatening”.
– The results of the study then revealed that the dispensing errors were:
Incorrect Medication: 36%
Incorrect Dosage or Strength: 35%
Incorrect Dosage Form: 21%

Many medical professionals found these numbers to be “scary” and “unacceptable”. It was noted that had the Hospital Pharmacy instituted up to date policies and procedures with better documentation, that a majority of the medication dispensing errors would have been “easily avoided”. This study directly ties in to the latest data released recently by The Institute for Safe Medication Practices (ISMP). ISMP diligently works to identify major medication safety issues, plus promoting the sharing of procedures and strategies that would lead to a reduction & prevention of medication dispensing errors in order to protect patients and consumers.

At ASHP Midyear, ISMP revealed the classes of drugs most frequently documented for errors and suggested that safety strategies were the key factor that we all must develop and adhere to going forward.

Darryl S. Rich, PharmD, MBA, FASHP, medication safety specialist for ISMP, presented the top 5 high-alert medication classes based on data from 2016. Opioids, antithrombotics, and insulins topped the list, followed by antipsychotics and antibiotics. Rich noted that data pegged wrong dosage as the top reason for adverse events in most cases, except in the use of antibiotics, for which wrong drug was the top reason.

The point is that it is now critical that all Pharmacies develop Policies and Procedures that both minimize the occurrence and potential for medication dispensing errors, plus have a plan in place to deal with the errors that inevitably will occur. This is being called “the Age of Documentation” by many and everyone must show that they have “best practices” in place, PLUS follow these “best practices” to the best of the their ability. Without doing this crucial documentation, not only will the occurrence of medication dispensing errors increase, but liability will exponentially increase as well.

We at HCC strongly advise that you develop Policies and Procedures that ensure “best practices” are implemented at your Pharmacy operation immediately. In addition, document and report all medication dispensing errors that occur (and we all know that they will). Another instance of the old cliche that “an ounce of prevention is worth a pound of cure” that we here at HCC have been advising our clients to adhere to for over 27 years now.

As always, please contact us here at HCC if you have any questions regarding development of policies and procedures related to medication dispensing errors. If you already have them in place, perhaps a review by an objective (and experienced) third party is a good idea? With over 27 years in the Pharmacy Consulting business, HCC can assist with expert advice in any area of your pharmacy business or practice. We urge you to contact us today to see how our Pharmacy Consulting services can help. With a full-time staff of in-house Pharmacy Consultant specialists, HCC can answer any questions that you may have in all Pharmacy settings. Contact us online or call us today at 800-642-1652 for a free consultation.


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Pharmacogenetic Testing In Community Pharmacies Best Practices – Pharmacy Consulting

Pharmacogenetic Testing In Community Pharmacies Best Practices:

Pharmacogenetics is getting a lot of media attention and becoming a new term that patients are asking their Pharmacists about (plus performing a lot of research on their own). In a recent article in Pharmacy Times, the author states that over the past several years “Pharmacogenetic testing in community pharmacies has become more mainstream”. It has also been stated numerous times recently that Pharmacogenetics is becoming the primary basis or foundation for the shift towards personalized medicine and medication prescribing.

So what really is Pharmacogenetics? As Pharmacists, what do we need to do to help it be effective in helping our customers and patients?

The definition of Pharmacogenetics is basically centered around the fact that an individual patient’s genetic makeup can lead to different individual responses to certain medications. These genetic differences can lead to increased or decreased effectiveness of the drugs, plus also have an influence on the adverse side effects associated with certain medications. Pharmacogenetics is just one aspect of what is being called “Personalized Medicine” (where medications are tailored to each patient based on a model that places the patient into groups that result in a predicted response regarding response, dosage and risks).

The key to success we believe here at HealthCare Consultants is education and communication. This education and communication includes everyone: Ourselves as Pharmacists, the physicians prescribing the medications and, of course, the patients themselves. For the best results in a community Pharmacy setting, this translates into increased counseling with our patients and increased communication with the prescribing doctors regarding pharmacogenetic test results. Studies are already showing that without proper counseling by a Pharmacist, patients who receive their genetic test results showed a tendency to self-adjust or discontinue their medications due to misinterpretation of the test results.

Those who choose to be participants in the success of Pharmacogenetic testing in community pharmacies need to ask themselves the following questions:

-How will I communicate to my patients the basics of Pharmacogenetic science and drug metabolism in a way that the average patient can comprehend?
– Where will I find the most up to date Pharmacogenetic guidelines?
– How will I get started and keep myself educated on Pharmacogenetic testing?

HealthCare Consultants can help you establish the guidelines, strategies and procedures required for a community Pharmacy to be a success in the emergence of Pharmacogenetic testing.  Although this is not intended to be a comprehensive list of guidelines, the basic strategies include:

1. Communication with the patient’s Physician – Collaborate with the patient’s primary care provider in order to personalize the patient’s medication and become part of the “team”.
2. Assessing the patient’s knowledge on genetics and communicating to each patient individually on their level.
3. Providing the patient adequate disclaimers so that they comprehend that taking medications based on a Pharmacogenetic test does not mean that they are free of adverse effects or that they will be 100% effective.
4. Training the patient on how to use the test results (as basically these results can be reused by the patient throughout their life).

If you are interested in getting more information regarding Pharmacogenetic testing for your pharmacy, please contact us on line or call us today for a Free Consultation at 800-642-1652 to discuss how we can help you. Healthcare Consultants is a nationally renowned full service Pharmacy staffing and consulting firm that has been in business for over 27 years. Owned, managed and staffed by full-time in-house Pharmacists, HCC offers a full range of Pharmacy Consulting Services that other firms simply cannot offer.


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Pharmacy Home Delivery Services (Continued)

Pharmacy Home Delivery Services:

In a recent blog post we discussed the fact that Pharmacy Home Delivery services were on the rise nationally. We all know that Pharmacy Home Delivery is really not anything new, but has been a service primarily utilized by the major Pharmacy Mail Order Houses and several of the large Pharmacy Chains for well over a decade or more. As we always urge our clients to explore additional revenue streams for their business, the addition of Pharmacy Home Delivery services has been proven to be a “value added service” that has vastly increased customer retention, acquisition of new patients and led to increased profits.

In our recent post we alluded to a consumer survey that was conducted by the nationally renowned firm JD Powers on the subject of Pharmacy deliveries and how patients and customers viewed the trend. The survey showed that without a doubt the majority of consumers nationally viewed Pharmacy Home Delivery as a positive, plus overwhelmingly agreed that in the future this would be the norm for the industry. However, the JD Powers study also revealed what has kept many patients & consumers from utilizing Pharmacy Home Delivery Services at all (and prevented customers from using them more frequently). Consumer resistance to Pharmacy Home Delivery of their medications becoming the standard basically centered on three areas:

1. Patients stated clearly that they have justified fear regarding delivery dates. Most of the vendors were not local, but spread “far away” and basically shipping the patient’s medications and supplies from “out of the state”. This was backed up by the fact that studies have shown that up to 5% of deliveries nationally do not actually occur as scheduled. Add into the equation the fact that both FedEx and UPS are affected by the weather and seasonal considerations, and one can understand the hesitancy expressed by consumers. Especially those that are on medications that cannot have dosages missed. As we all sometimes joke, who really believes the date we get at the post office regarding deliveries around Christmas time?
2. Not only were the vendors located elsewhere and “out of state”, patients expressed fear that the vendors were “too large”. Many asked the same question: “Can you imagine trying to get an actual person on the phone to discuss a problem with or talk to?”. Many shared from previous personal experience that the mail order houses and major Pharmacy chains were too large and that as a customer they felt they were just another “number’ to them. In contrast, their local Pharmacy “promotes a personal touch” and treats them as neighbors and community members.
3. Only a local Pharmacy could respond quickly enough to certain situations that arise: providing such medications like antibiotics & pain killers quickly (as that they are obviously not things that you can wait on), plus making dosage adjustments in a timely manner which is critical in many instances. Tying into this is the fact that the local Pharmacists are familiar with the local physician community (which again is impossible for Mail Order houses and large chains which are centralized in various parts of the country or in some cases actually located in another country!).

The point to all of this is that the addition of Pharmacy Home Delivery services to YOUR Pharmacy business will lead to increased customer retention, acquisition of new patients and increased profits. BUT customers are informed and aware of the negatives. So HCC urges you to do it right! Call today and one of our experienced Pharmacy consultants will discuss how to overcome these challenges AND plan, execute and maintain a “First Class” Pharmacy Home Delivery Service for your patients and Pharmacy business!

Healthcare Consultants is a nationally renowned full service Pharmacy staffing and consulting firm that has been in business for over 27 years. Owned, managed and staffed by full-time in-house Pharmacists, HCC offers a full range of Pharmacy Consulting Services that other firms simply cannot offer. Contact us on line or call us today for a Free Consultation at 800-642-1652 to discuss how we can help you.


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Pharmacy Professions and Pharmacy Careers

Pharmacy Profession and Pharmacy Careers:

As we all enjoy the Holiday Season, I was thinking that this is a great time to reflect on our chosen profession as Pharmacists and to realize what being a pharmacist and having a pharmacy job means to each of us. Pharmacy is truly a profession that all of us should be grateful to be a part of and be proud of the jobs that we do in making pharmacy an integral part of our communities. We see a lot of negative publicity lately regarding pharmacy professions, but here are some reasons that we all should reflect on when reviewing our choice of a career in Pharmacy:

– Expanding Number of Pharmacy Jobs
In a recent article in Forbes magazine, pharmacy jobs are expected to have a 14% increase by the year 2022. Pharmacists not only have tremendous job security, we all have the ability to advance in our careers.

– Career Options and Opportunities
There are such diverse career opportunities for Pharmacists today that we can all choose a pharmacy job that we find satisfying. From not only choices in retail and hospital settings, but to specialty, clinical, consulting, nuclear and compounding pharmacy jobs as examples….. pharmacists have the ability to work in an arena that best fits their area of interest.

– Salary
Although money should not always be our primary goal in a job, pharmacy is a well paid profession. Again, according to Forbes magazine, the average pharmacist salary exceeds $110,000. There are few degrees one can obtain that can match this salary for someone just graduating with a degree from college.

– Work Schedule Flexibility
In addition to the diversity of career options mentioned above, pharmacists have the ability to choose just about any work schedule that suits their life style. Pharmacists in both retail and hospital settings are in demand “around the clock” and pharmacy is one of the few professions that allows us to choose our work schedule to accommodate our personal needs and life styles.

– A Profession That Is Trusted and Respected
Pharmacy consistently makes the top of all “Most Trusted Professions” lists. This is a fact that all of us as pharmacists should be extremely proud of! The public views pharmacists as well educated professionals……. and we are.

– A Profession That Helps
We truly are blessed as pharmacists to be involved in a profession that helps others on a daily basis. The basis of being a pharmacist is that we look out for the public’s’ welfare on a daily basis, no matter what setting we practice in. This is huge responsibility, but the payoff is that we can all feel really good about the impact we make on helping others stay healthy and happy in their lives.

The only person who really determines whether you have a great job is you. You determine what kind of career, life, and day you will have. Keep in mind that Healthcare Pharmacy Staffing has been known as a leader in helping pharmacists find the right job since 1989. For over 27 year now, HCC has been helping outstanding individuals connect with great companies to find satisfaction in their careers while being vital members of their communities. If you are not satisfied with your current job, or simply want to explore your career options, we encourage you to us today to see if we can help you.  Contact us on line or call us today for a Free Consultation at 800-642-1652 to discuss what new opportunities are waiting for you in your path as a Pharmacist!


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Independent Pharmacy Home Delivery Services On the Rise

Independent Pharmacy Home Delivery Services On the Rise:

A local independent Pharmacy displays a large new sign: “Need your prescriptions delivered to your home or office? Delivery service available at no additional charge (with a guarantee!)”. Made me reminisce about growing up in an era when Doctors actually made house-calls. We here at HCC Pharmacy Consulting constantly tell our clients that offering new services to patients and customers is the key to both retention of your existing client base, as well as growing your business by attracting new revenue streams. Pharmacy home delivery services on a local level seems to be a viable and economic service to accomplish both goals.

So I decided to research this trend and can share with you what I found:
1. Although no dependable studies were found to cite actual numbers, our best on-line resource (Wikipedia) estimates that currently about 10% of independent Pharmacies are offering this service. Plus this number has steadily been growing on a national level for over 6 straight years. The largest growth has been occurring in rural and less densely populated areas. The smallest growth seen is in large cities and metropolitan areas throughout the USA.
2. Independent Pharmacies were on average seeing an increase in total revenues of roughly 6 to 8% after about 3 to 4 months from initiating a Pharmacy Home Delivery service. An interesting side note on this is that the 6 – 8% sales volume increase was NOT attributed to an increased prescription volume, but to an increase in OTC medications and “ancillary” items requested by customers to be delivered along with their prescription medications! In fact in certain areas it was noted that patients requested Home Delivery of goods and items from a Pharmacy even though their “order” actually did not contain a single prescription at all.
3. A consumer survey that was conducted by the nationally renowned firm JD Powers on the subject revealed  three very interesting facts:
– By far the largest “payoff” after initiating a Pharmacy Home Delivery Service was attributed to patient/customer/client retention! The common feedback centered around the fact that patients that utilized local Independent Pharmacies were more interested in service than in price. Several patients made statements that reflected the following theme according to JD Powers in its final report: “Patients are a name, even family, at these pharmacies—not a number”. Aren’t these the type of customers that everyone wants to attract to their Pharmacy businesses?
– Most patients interviewed by JD Powers who have their prescriptions delivered stated that they were more likely to use them better as directed by their doctors. In  other words, patients were saying that they were actually more compliant in regards to taking their medications as prescribed, thus leading to better management of chronic conditions. It has been proven via numerous studies over the years that patient compliance is the number one reason that prescription medications don’t work as they should. An increase in prescription compliance by patients would benefit everyone (including the insurance companies who have been spending billions on patient education to improve patient compliance). The end results would of course, be both an increase in patients’ health and improved profitability for both the manufacturers and the Pharmacies.

Take a moment to review an excellent example of the non-compliance problem supplied to HCC by the American Heart Association. Their estimates are that failing to take medications as prescribed leads to 125,000 patient deaths and costs $300 billion annually in additional emergency room trips, doctors’ office visits and hospitalizations.
4. Consumers stated that Pharmacy Home Delivery has led to increased consulting with their Pharmacy/Pharmacist regarding drug usage and prescription information, Either too busy to take the time at the Drug Store when picking up their medications, embarrassment regarding their questions at the time of pickup, or simply that the “Pharmacist looked to busy to interrupt with questions”  do not “come into play” with Pharmacy Home Delivery services. The patient is more likely to feel comfortable in their own home, not need to worry about other customers being present, plus have given JD Powers feedback that the employee making the delivery can concentrate on them as a specific individual (and not as just another person to get in & out of the store as quickly as possible.

Now we all know that  Pharmacy Home Delivery is really not anything new, but has been a service primarily utilized by the major Pharmacy Mail Order Houses and  several of the large Pharmacy Chains for well over a decade or more. What has kept many patients & consumers from utilizing Pharmacy Home Delivery Services at all (and prevented customers from using them more frequently) was also revealed by the JD Powers survey. In our next Blog post, HCC will share these with you. Plus we will discuss both how to overcome these challenges AND plan, execute and maintain a “First Class” Pharmacy Home Delivery Service for your patients and Pharmacy business!

As we tell everyone who will listen, Healthcare Consulting is a nationally renowned full service Pharmacy staffing and consulting firm that has been in business for over 27 years. Owned, managed and staffed by full-time in-house Pharmacists, HCC offers a full range of Pharmacy Consulting Services that other firms simply cannot offer. Contact us on line or call us today for a Free Consultation at 800-642-1652 to discuss how we can help you.


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Pharmacy Robberies and Burglaries on the Rise – Develop Emergency Policies & Procedures

Pharmacy Robberies and Burglaries on the Rise:

Pharmacies have always been a target for robberies and now, pharmacy robberies and burglaries on the rise. As Pharmacists ourselves we have realized that this is a possibility and a risk that everyone in our profession constantly faces. We may all do our best to put it out of our focus and concentrate on our day-to-day daily routines while at work. We sometimes think that although the possibility exists, this is something that happens frequently but not to us!

However many robberies and burglaries we hear about, sometimes there are particular ones that grab our attention. In Illinois last week there were two related robberies that can only be described as “bizarre”. In both cases the Pharmacy robberies involved a man and woman wielding hypodermic needles that they claimed were contaminated with HIV.

The initial robbery took place at a CVS Pharmacy in Niles, Illinois last Monday morning (11/14). The second case took place the following morning at a CVS store in Naperville, Illinois according to separate press releases issued by the police.

In the initial incident a man and woman entered the Niles pharmacy and stole OTC medications, concealing them inside backpacks. When a CVS employee approached them, the man threatened the employee with a syringe he claimed was contaminated with HIV. The suspects left the pharmacy and fled with about $600 worth of medications.

The next case occurred at the Naperville CVS Pharmacy. Once again a man and woman brandishing an HIV-contaminated syringe threatened store employees and stole numerous medications before fleeing.

Recently it seems that all the Pharmacy news we read is filled with an increase of stories regarding burglaries and robberies of Pharmacies. In the past month alone we all have seen almost daily reports of Pharmacy break-ins and burglaries. This dramatic increase of robbery and burglaries always seems to cycle come Holiday season!

Are you and your Pharmacy prepared to deal with situations like these? As I stated earlier, no-one thinks that these situations will happen to us or our Pharmacy businesses, but these are truly examples of the old cliche “an ounce of prevention is worth a pound of cure” being applicable. Do you have policies and procedures written for your business and employees to act on if such a crisis arises? Do you have inventory policies in place to help determine what was taken during a burglary? Do you have training in place to help your employees in these situations that will minimize your possible liabilities? If the answers are no, then contact HCC Pharmacy Staffing to see how we can help you.

Healthcare Consulting has been a full service Pharmacy staffing and consulting firm that has been in business for over 27 years. HCC has been helping Pharmacies plan, prepare and deal with such crisis situations since 1989. Just a few examples of our services include:

– Development of Policies and Procedures
– Employee Crisis Training
– Inventory Management
– Pharmacy Management Consultation

Although we all hope that we will never personally deal with such situations, I strongly urge you to be prepared. Contact us on line or call us today for a Free Consultation at 800-642-1652 to discuss how we can help you.


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Pharmacy and DIR Fees for Medicare Part-D Plans

Pharmacy & DIR Fees for Medicare Part-D Plans:

Pharmacy and DIR fees are raising questions that most Pharmacy owners cannot answer. HCC has been receiving numerous questions regarding DIR fees and we have been intensely studying the issues regarding these fees on behalf of our clients. DIR fees stand for “Direct and Indirect Remuneration (DIR)” fees collected by a Pharmacy for Medicare Part D plans. The reason that DIR fees are such a hot topic of current discussions is how they relate to the recent “crash” of Diplomat Pharmacy stock prices. A little over two weeks ago, Diplomat Pharmacy’s stock dropped by almost 50%. The major reason for the specialty pharmacy’s stock actually dropping below its IPO offering price was attributed by the company’s management to DIR reimbursements. Diplomat’s Chairman & CEO (Phil Hagerman) cited that the way the DIR contracts now work is basically an example of PBMs versus Pharmacies with the PBMs having an unfair advantage.

Without time to go into the entire regulations (see Code of Federal Regulations Section 423.100 if you are interested in the legal specifics), Pharmacies involved in Medicare Part D must offer “covered Part D drugs at negotiated prices to Part D enrollees at lower levels of cost-sharing than apply at a non-preferred pharmacy under its pharmacy network contract”. The complexity associated with the fees is staggering!! Some plans have flat per-prescription DIR fees that range from $2.00 to $7.00 per prescription claim. Other plans require DIR fees that are a percentage of a prescription’s ingredient cost. To really complicate matters, DIR fees for many Part D plans are based on such performance criteria as generic dispensing rates and adherence metrics related to star ratings. Now pharmacy performance is becoming a key criterion for inclusion as a preferred pharmacy in a plan’s network. Many Part D plans now incorporate quantitative performance metrics into the computation of the DIR fee. For example, a pharmacy’s DIR fee could be reduced if the pharmacy: achieved better performance on the three adherence metrics used in the plan’s star rating, had better compliance with the plan’s formulary, dispensed a greater share of generic prescriptions, and/or dispensed more 90-day prescriptions. The specific criteria and thresholds are different for every plan and not publicly available. Note that these metrics are typically not relevant to a specialty pharmacy, which does not dispense the traditional drug classes with Part D adherence measures and dispenses few generic prescriptions.

It is becoming so complicated that some Pharmacy chains such as Walgreens have already opted out of participating. Is it worth participating for your Pharmacy business? As a Pharmacy owner it is crucial that you understand how this works. Most owners need help regarding DIR fee computations and estimating their financial impact.

In today’s environment of a constantly changing landscape in the pharmacy business, let an experienced, proven Pharmacy Consulting company provide you with the assistance you may need. We have a professional full-time staff of pharmacists with a proven track record in every area of pharmacy operations. Just a few of the services that we offer include:

– Pharmacy Performance and Efficiency Enhancements
– Pharmacy Business Management Consulting
– Pharmacy Business Planning
– Pharmacy Start-up Consulting and Implementation
– Interim Pharmacy Management
– Policy and Procedure Development and Review
– Compliance Review
– Pharmacy Exit Strategies

If you have questions regarding virtually any area of your pharmacy business or practice, we urge you to contact us today to see how our Pharmacy Consulting services can help. With a full-time staff of in-house Pharmacy Consultant specialists, HCC can answer any questions that you may have in all areas of your business. Call us today at 800-642-1652 for a free consultation.


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Additional Pharmacy Services Leads To Increased Profits

Additional Pharmacy Services Leads To Increased Profits:

Pharmacies today that are growing and showing increased profits are all doing one thing in common: they are providing additional pharmacy services to patients and customers. In today’s Pharmacy environment it is a must to expand what your business is doing! Not only to keep your existing customer base coming back, but to attract additional business and increase your profitability.  With such realities as the ACA (Affordable Care Act), the Medicare Prescription Drug Coverage (Medicare Part D), and decreasing reimbursements across all areas, it is imperative that all Pharmacies evaluate what they currently provide to their customers and to make adjustments as needed.

A decade old study from 2004 showed that less than 10% provided any type of MTM (Medication Therapy Management) to their customers. HCC has been consulting with Pharmacies for over 27 years now and although this percentage has definitely increased, we continually find that a majority of Pharmacists are resistant to changing their practices. We hear that “if it ain’t broke, don’t fix it”, but that will not work in today’s changing Pharmacy business practice. Areas of opportunity such as vaccinations by Pharmacists, on-site testing, patient education and even a reemergence of home prescription deliveries are becoming the norm rather than the exception.

A new article to be published in the Journal of the American Pharmacists Association takes the need for change even further. A couple of points from the article are worth pointing out:
– Back 10 years ago it was proven in a study that independent community Pharmacies accounted for providing the vast majority of specialized Pharmacy services. But this new article makes it clear that the large chains and grocery store pharmacies are catching up! This study revealed that the large chains and supermarkets are providing a larger share of “novel” services than the independents. In other words, the chains are taking customers and patients away from the independent community based Pharmacies by the delivery of community-based clinical services.
– An interesting side note of the article was that Pharmacies with 3+ Pharmacists on staff were much more likely to expand services and provide their customer base value added reasons to come back. Their services provided included vaccinations, prescription/medication adjustments and reconciliation, disease state management, disease state coaching and education, patient consultation & screening, specialty compounding, and point-of-care testing performed at their location, just for some examples.

In today’s environment of a constantly changing landscape in the pharmacy business, let an experienced, proven Pharmacy Consulting company provide you with the assistance you may need. We have a professional full-time staff of pharmacists with a proven track record in every area of pharmacy operations. Just a few of the services that we offer include:

– Pharmacy Performance and Efficiency Enhancements
– Pharmacy Business Management Consulting
– Pharmacy Business Planning
– Pharmacy Start-up Consulting and Implementation
– Interim Pharmacy Management
– Policy and Procedure Development and Review
– Compliance Review
– Pharmacy Exit Strategies

If you have questions regarding virtually any area of your pharmacy business or practice, we urge you to contact us today to see how our Pharmacy Consulting services can help. With a full-time staff of in-house Pharmacy Consultant specialists, HCC can answer any questions that you may have in all areas of your business. Call us today at 800-642-1652 for a free consultation.


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