The medical at home model has represented a shifting population of patients preferring to receive the same care they would receive in a long-term care (LTC) facility in their homes, which is a lower cost environment.
LTC pharmacists are providing the services they are providing to skilled nursing patients, but the services are being delivered in the patient’s home. In November 2015, NCPDP passed DERF 1306,1 which approved one new level of service referencing medical at home services with special pharmacy services identical to those provided LTC nursing facility beneficiaries (not including emergency kits).
In order to participate in Medicare Part D sponsor LTC pharmacy networks, Chapter 5 of the Prescription Drug Benefit Manual requires that the pharmacy have the capacity to provide the following minimum performance and service criteria:
- Comprehensive Inventory and Inventory Capacity
- Pharmacy Operations and Prescription Orders
- Special Packaging
- IV Medications
- Compounding/Alternative Forms of Drug Composition
- Pharmacist On-call Service
- Delivery Service
- Miscellaneous Reports, Forms and Prescription Ordering Supplies
LTC pharmacies may additionally provide the below services to a patient in their home: Medication management services
- Transition of care management – pharmacists and healthcare professionals collaborate to evaluate hospitalizations and aim to decrease readmissions
- Physician, caregiver, and family engagement and education
- Nursing home services (in concert with other healthcare providers)
A recent article in the Pharmacy Times indicated that although the coronavirus disease 2019 (COVID-19) pandemic has caused a sharp increase in at-home care, long-term care (LTC) pharmacies caring for this population face a myriad of unique obstacles, especially the regulatory framework surrounding them.
This population is often medically complex, with 8 or more prescriptions and 3 or more chronic diseases. They could also be transferred between a hospital and a skilled nursing facility before going home. Therefore, they require medication management assistance throughout the care continuum and for the rest of their life to avoid gaps in care. Although this type of care is common in inpatient facilities, not all patients require institutionalization and need this type of care at home.
Defining these LTC pharmacies presents a major challenge, however. The various definitions result in a major problem for these pharmacies, including how they get paid. A payer’s first inclination is often to treat long-term care pharmacies that deliver to the home as a mail-order pharmacy, but this ignores the high-touch, complex services that they provide and that are required by patients.
Takeaway: COVID-19 has accelerated the number of patients receiving at-home care, and LTC pharmacies will increasingly become more important in providing care