Jerry Sauter, R.Ph., has recently opened a new pharmacy in Bradenton, Fla., called ApricusRx. Sauter is building this new pharmacy specifically to cater to what he calls “medical-at-home” patients. These are patients living at home who require the same level of service as those who are residents in a facility.
Dispensing Fees for LTC Services
Sauter began developing this new pharmacy model after reading the Dec. 15, 2021, letter from the Centers for Medicare & Medicaid Services (CMS) titled “Part D Dispensing Fees and Enrollees with Institutionalized Level of Care Needs.” In that letter CMS states “Part D dispensing fees can include additional costs for specialized services typically provided in the institutional care setting, such as delivery and special packaging, for enrollees residing in their homes with institutionalized level of care needs.”
“I am building ApricusRx to provide a full LTC level of care for patients who are returning to their homes after being discharged, for example, from skilled nursing or a long-term care facility after rehabilitation,” says Sauter, “or who just don’t want to be in an LTC facility.”
LTC Services Criteria
Patients eligible for these services do have to meet specific criteria, notes Sauter. “One requirement is that they aren’t able to perform two of the major activities of daily living,” he says. “A physician then has to approve that the patients can receive skilled care at home.”
There are minimum criteria for the pharmacy as well, according to Sauter, although it is not required to be a closed-door LTC pharmacy. In fact, ApriusRx is a community pharmacy. “There’s a list of 10 baseline requirements,” says Sauter. “For example, the pharmacy must be available 24/7 to the patient. And it has to offer adherence packaging, IV services, and delivery.” These are logical requirements, but the big takeaway is CMS’ provision for billing for these in the dispensing fee.
“Our motto is ‘all service, no excuses,’” says Sauter. “After I moved down here to Florida I worked in a chain pharmacy where elderly patients came in and all they heard was ‘We don’t have this’ or ‘We can’t do this.’ When I read CMS’ letter, I knew that this is the opportunity for a community pharmacy to provide patients with the full array of LTC services at home.” CT
Read more about the current trends in the LTC pharmacy market in the September/October 2022 cover story.
Unlock The Dec. 15, 2021, CMS Letter, “Part D Dispensing Fees and Enrollees with Institutionalized Level of Care Needs”
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