Service Criteria for LTC Pharmacies

CMS has developed service and performance criteria for pharmacies providing services to long-term care residents under Medicare Part D. The criteria were based on widely used best practices in the market today and were designed to provide guidance to Part D plans as they establish LTC pharmacy networks.*

All Omnicare pharmacies meet and exceed CMS' service and performance criteria.

Minimum Performance and Service Criteria for LTC Pharmacies

1. Comprehensive Inventory and Inventory Capacity — a comprehensive inventory of Plan formulary drugs commonly used in the long-term care setting. The pharmacy must provide a secured area for physical storage of drugs, with necessary added security as required by the federal and state law for controlled substances.
2. Pharmacy Operations and Prescription Orders — a dispensing pharmacist to meet the requirements for dispensing prescription drugs to LTC residents.

   The pharmacy must:

   • conduct drug utilization review (DUR) to routinely screen for allergies and drug interactions, to identify potential adverse drug reactions, to identify inappropriate drug usage in the LTC population, and to promote cost effective therapy.
   • be equipped with pharmacy software and systems sufficient to meet the needs of prescription drug ordering and distributing to an LTC facility.
   • provide written copies of the pharmacy procedures manual, which must be available at each LTC facility nurses' unit.
   • provide ongoing in-service training to assure that LTC facility staff are proficient in the pharmacy's processes for ordering and receiving of medications.
   • be responsible for return and/or disposal of unused medications following discontinuance, transfer, discharge, or death as permitted by State Boards of Pharmacy. Controlled substances and out-of-date substances must be disposed of within State and Federal guidelines.

3. Special Packaging — the capacity to provide specific drugs in Unit of Use Packaging, Bingo Cards, Cassettes, Unit Dose, or other special packaging commonly required by LTC facilities. The pharmacy must have access to or arrangements with vendors to furnish supplies and equipment.
4. IV Medications — the capacity to provide IV medications, with access to specialized facilities for the preparation of IV prescriptions. The pharmacy must have access to or arrangements with vendors to furnish special equipment and supplies as well as IV trained pharmacists and technicians as required to safely provide IV medications.
5. Compounding/Alternative Forms of Drug Composition — the capacity to provide specialized drug delivery formulations to facilitate effective drug delivery (i.e., via suspensions, gels, split pills or crushed pills) to LTC residents who may be unable to swallow or ingest medications through normal means.
6. Pharmacist On-Call Service — provide an on-call pharmacist 24 hours a day, seven days a week to handle calls after hours and to provide medication dispensing during an emergency, holidays, and after hours of normal operations.
7. Delivery Service — delivery of medications to the LTC facility up to seven days each week (up to three times per day). Emergency delivery service must be available 24 hours a day, seven days a week. Specific delivery arrangements will be determined through an agreement between the pharmacy and the LTC facility.

   The pharmacy must:

   • provide safe and secure exchange systems for delivery of medication.
   • provide medication cassettes, or other standard delivery systems, that may be exchanged on a routine basis for automatic restocking. The delivery of medication to carts is a part of routine "dispensing."

8. Emergency Boxes — provide an "emergency" supply of medications as required by the facility in compliance with State requirements.
9. Emergency Log Books — provide a system for logging and charging medication used from emergency/first dose stock. The pharmacy must maintain a comprehensive record of a resident's medication order and drug administration.
10. Miscellaneous Reports, Forms and Prescription Ordering Supplies — provide reports, forms, and prescription ordering supplies necessary for the delivery of quality pharmaceutical care. Such reports, forms, and prescription ordering supplies may include, but will not necessarily be limited to: provider order forms, monthly management reports to assist the LTC facility in managing orders, medication administration records, treatment administration records, interim order forms for new prescription orders, and boxes/folders for order storage and reconciliation in the facility.

* PDP plans are required to demonstrate to CMS that they have contracted with a network of long-term care pharmacies that meet the minimum criteria and provide convenient access to pharmacy services for Part D enrollees who are long-term care residents.