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Implementing Dispensing Within Your Practice

Implementing Dispensing Within Your Practice. 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

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Implementing Dispensing Within Your Practice

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  1. Implementing Dispensing Within Your Practice

  2. 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

  3. 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/46v45MedicalProfessionsSeptember2009practice.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

  4. 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

  5. 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

  6. Top Dispensed Drugs

  7. Reimbursement

  8. Reimbursement Self-Injectables

  9. 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

  10. 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.comselect products, NRx Eprescribe ready HL7

  11. 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

  12. 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

  13. Your Formulary/Inventory Practitioners should be engaged Develop a starting formulary Antibiotics,Steroids,Anti-emetics,Anti-Cancer Drugs, Support meds (blood thinners,antidepressants,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

  14. 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

  15. 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

  16. Questions?

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