Implementing Dispensing Within Your Practice

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Implementing Dispensing Within Your Practice
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Reasons to Dispense

• Convenience to the pt.
• Often patients receive chemo treatment and are
  too sick to seek medication
• One single point of care
• Opportunity to counsel patient regarding lab
  values, assess condition for refills
• Better for outcome based medicine
• Manage the transition from IV to oral medications
• Reduction of errors
• Transcription errors in communicating new
  prescriptions and changes
• Revenue to practice
• New drug pipeline is moving to orals
• Self injectables moved to pharmacy benefit

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Do Regulations Support Dispensing?

• A physician can dispense to his own patients-
  Chapter 65 of the Lousiana Medical Professions
  Rules- Chapter 65
• http//www.lsbme.louisiana.gov/46v45MedicalProfess
  ionsSeptember2009practice.htm_Toc243144027
• Physician is required to register with the LA
  Board of Medical Examiners- 75 annual fee
• Must have 3 years of practice experience
• Record keeping and labeling requirements are
  outlined
• Retail pharmacy ownership

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Discovery Period

• Is my practice ready for this initiative?
• Do we have the space?
• Need enough room for a computer,printer
• Small area to count and pour
• Drug storage area
• Consider at your busiest location or where the
  most prescriptions are written
• Do we have the personnel?
• Consider a point person with retail drug
  experience
• Is everyone onboard?
• Physicians must be accepting of it
• Does it make financial sense?
• Are there other initiaives that are more
  important?
• Will it be profitable

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A Revenue Analysis

• Needs to be based on your practice
• Collect all prescriptions for a 1 month period
• Written, Faxed, Eprescribed, phone in
• Collect pharmacy prescription cards for 1 month
  period
• The card that they would normally give to their
  pharmacist

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Top Dispensed Drugs

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Reimbursement

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Reimbursement Self-Injectables

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Which Model is Right for You?

• Analysis should shake out whether you would
  consider a pharmacy.
• Pharmacy expenses to consider
• Pharmacy build out
• 300 square feet requirement
• 24 square feet of unobstructed counter space
• Sink with hot and cold water
• 30 inch width for aisle space between pharmacy
  counter and obstructions
• security-adequately alarmed
• Labor costs
• Pharmacist In Charge
• Minimum of 10hrs per week
• Check to see if extra insurance needed
• More access into payer networks

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Processing System

• Simplified prescription processing
• Stores Transmits Rxs for payment in Real Time
• - New Rxs
• - Refill Rxs
• Bill claim at time of dispensing in one process
• Monitors Drug Interactions
• - Drug / Drug
• - Drug / Food
• Generate Rx Labels
• Generate Required Pharmacy Reports
• Produces Business Reports on Dispensing activity
• On Line DEMO visit www.qs1.com select products,
  NRx
• Eprescribe ready
• HL7

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Start Up Costs

• Software 0-10K
• Installation fees
• PC and Printer equipment costs Varies (5000)
• Monthly maintenance fees-varies 20-500/mo
• Third Party Contract Plans-20-40/mo
• Transaction fees 5 cents-3
• NCPDP and certain third party application fees
• Supply costs- 50 cents per prescription
• Inventory

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Inventory

• Most important consideration
• How much
• Turnaround time for receiving
• Stock or after paid claim
• Access to medications
• Limited Distribution (Nexavar,Afinitor, Revlimid)
• Injectables
• Prepack program vs bulk
• Contracted Items
• Xeloda,Oforta,Sancuso,Anzemet,Fareston,Cesamet

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Your Formulary/Inventory

• Practitioners should be engaged
• Develop a starting formulary
• Antibiotics,Steroids,Anti-emetics,Anti-Cancer
  Drugs, Support meds (blood thinners,antidepressant
  s,neuropathy/pain meds
• Keep it simple
• Generics whenever possible
• 20-40 drugs
• Have a process for formulary additions
• Formulary should be fluid
• Will need to change as new drugs/generics hit
  market
• Cost/reimbursement considerations
• What will you carry vs order for next day

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Implementation

• Obtain provider number with NCPDP
• Credential with payers
• Have computer and printer available
• Schedule software installation
• Insurance plans active (90-100days)
• 4-6 hour Web-based training performed by QS/1
• ION Pharmacist to assist onsite
• 90 days from training to dispensing on all plans
• 8-12 weeks in contracts
• Inventory ordered drugs and dispensing supplies
• Support

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Keys to Success

• Motivated point person for Dispensing
• Data Entry
• Drug ordering
• Record keeping
• Process payments
• Understand your flow
• A good idea to visit another practice that is
  dispensing
• How will prescriptions get to the dispensing
  area?
• How is insurance information received
• Where are payments received
• Communicate to everyone
• Make it easy for your patients

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Questions?