​Health care reform will have a dramatic impact on the long term care industry, not the least of which is new requirements for nursing facility pharmacies, which will be required to adopt dispensing techniques, “such as weekly, daily, or automated dose dispensing” by Jan. 1, 2012, according to the Patient Protection and Affordable Care Act (PPACA), signed into law by President Obama last March.

According to PPACA, sponsors of prescription drug plans will be required to utilize “specific, uniform dispensing techniques, as determined by HHS [the U.S. Department of Health and Human Services], in consultation with relevant stakeholders.”

Short-Cycle Dispensing

Under this provision, weekly, daily, or automated dose dispensing will be considered when dispensing Medicare Part D drugs to nursing facility residents “in order to reduce waste associated with 30-day fills.”
According to a white paper released recently by Talyst, a Bellevue, Wash.-based technology company, this provision is “guaranteed to have a major impact on long term care pharmacies, facilities, and the industry as a whole.”

As a result, says Talyst, such pharmacies are extremely concerned about the effort and costs associated with making the transition from traditional 30-day dispensing.

The paper urges pharmacy operators to become educated about various medication dispensing models, technology, and automation “in order to prepare for when the legislation goes into effect.”

Outlined in the paper are descriptions of the two main long term care pharmacy distribution models—centralized and decentralized (facility-based). As the most common form of medication distribution used in nursing facilities today, centralized dispensing involves a local or regional pharmacy, generally located within two to four hours from the nursing facilities they service. These pharmacies dispense medications at the pharmacy and deliver to each facility twice or more per day.

Three Options For LTC Pharmacies

According to the paper, long term care pharmacies that operate using a centralized distribution model have three basic options for dispensing systems: manual dispensing, punch card automation, and multidose strip packaging.

In a decentralized model, medications are dispensed onsite, often in daily or unit-dose supplies, at the nursing facility. The typical method of distribution under this model is through the use of automated dispensing systems located at the facility, the benefits of which are the elimination of medication waste and timely access to medications, the paper asserts.

The cost of investing in automated dispensing for most long term care pharmacies is expensive, “although many nursing facilities are sharing in the costs of these systems,” the paper notes.

Since long term care pharmacies will be required to adopt dispensing techniques that will shorten the dispensing cycles, “pharmacies will need to make some decisions,” the paper advises. 

Organizations such as the American Society of Consultant Pharmacists, the National Council of Prescription Drug Plans, and the National Association of Boards of Pharmacy offer resources on dispensing models.

Source: “Impact of Healthcare Reform on LTC Pharmacy,” Talyst, Bellevue, Wash.