LTC Pharmacy at Home Services

The evolution of LTC Pharmacy at Home services are continuing through this year.   The need for better pharmacy care for people who are homebound or need assistance with activities of daily living (ADLs) is a reality with the increasing elderly population. According to projections in a new report from the Population Reference Bureau (PRB), the aging of the baby boom generation (those born between 1946 and 1964) could fuel a 75 percent increase in the number of Americans ages 65 and older requiring nursing home care, to about 2.3 million in 2030 from 1.3 million in 2010. New facilities are not being built today to accommodate people with institutional needs.   

Those numbers stress the need to find new ways to administer care and pharmacy services to aging adults with medical conditions and impairments limiting their ability to care for themselves. Long term care (LTC) pharmacy at home is a new way for LTC pharmacies to care for people needing institutional care but who desire to stay in their home or are financially unable to be admitted into a facility. Many of these people are participating in a home and community-based waiver (HCBS) program from their state where Medicaid pays for institutional care in their home, or they are homebound and need assistance with two or more ADLs (activities of daily living) or IADLs (instrumental activities of daily living). While the definition of pharmacy services required to be provided to people qualifying for LTC pharmacy services, a new coalition and others in the industry are providing clarity on these needed services.   The independent community LTC pharmacy, whether in closed door pharmacy or in a combination pharmacy (retail and LTC), is the best solution in providing pharmacy care to these patients and to assist in decreasing hospitalizations and emergency department visits. We know that people who do not take their medications correctly – too much, too little, wrong time, wrong dose – frequently have complications that result in ER visits and hospitalizations.  A new coalition, the Alliance for LTC Pharmacy at Home is developing strategies to define, promote and get these services paid by insurers. The coalition has been working with CMS and Congress to implement access to LTC pharmacy services  in Medicare Part D based on the need for LTC services not where the patient lives.  (https://www.pharmacyathome.org/). 

While not all home health agency patients would qualify for medical at home pharmacy services, many of them would. This is a terrific opportunity for community pharmacies to provide LTC services to homebound patients requiring institutional services. When determining if these types of patients can qualify for LTC pharmacy services, it is always important to determine that patients truly need these enhanced services, and that medications are not dispensed in special packaging with delivery simply as a convenience to the patient.  The bottom line is that both the patient and the pharmacy need to be qualified to be able to participate in this new service.  Pharmacies should be able to provide services such as syncing medications, medication management, care coordination, medication drug reviews, and other pharmacy services as needed to assist the patient in adherence and compliance with their medication.  Recently, CPESN has created a division to support pharmacies with education and accreditation to ensure the needed pharmacy services are provided to these patients. Visit their website for more information https://www.ltcah.com/ .

What required services must be provided qualify as an LTC pharmacy?

In order to participate in the Medicare Part D program as a long-term care pharmacy, CMS requires a LTC pharmacy network to adhere to the following criteria:

  1. Comprehensive inventory and inventory capacity
  2. Pharmacy operations and prescription orders
  3. Special compliance packaging
  4. IV medications
  5. Compounding/alternative forms of drug composition
  6. Pharmacist on-call service 24/7
  7. Delivery service
  8. Emergency boxes
  9. Emergency logbooks
  10. Miscellaneous reports, forms, and prescription ordering supplies

The pharmacy must have the capability to either do or supply all 10 of these products or services. According to the Medicare Part D manual, Chapter 5, “To qualify as an LTC pharmacy for Part D sponsor’s LTC pharmacy network, a pharmacy must currently have the capacity – either by itself or through subcontracts with other entities- to meet all of thesLTCe performance and service criteria, even if an LTC facility that a pharmacy serves does not need a particular service subsumed under those performance and service criteria.”

However, as quoted above, CMS says that subcontracting with other suppliers such as having a subcontract with a local hospital to mix and provide IV medications meets the needs of being an LTC pharmacy. In addition, NCPDP

Are you providing LTC services to assisted living facilities (ALF), nursing homes, group homes for the elderly or intellectually developmentally disable (IID) patients?  Are you able to provide other services beyond compliance packaging and delivery such as medication management, coordination of care, etc for people requiring an institutional level of care in their home?  There are resources at NCPA, podcasts on LTC Pharmacy at Home, and GeriMed.  GeriMed can assist you to see if the patients you service qualify for LTC Pharmacy at Home and that your pharmacy is capable of all the dispensing services and pharmacy services necessary to be considered an LTC pharmacy.  Please visit www.gerimedgso.com