December 22, 2004

Resident Choice of Pharmacy vs. Facility Choice of Medication Distribution System

Do you use a pharmacy that has adopted the Opus system or a similar system? Have you specified that any pharmacy who does business with your facility must use the Opus system including the part where the pharmacist generates the MARS and physician order forms and provides other services?

If so, you may run afoul of DADS. Recently, a facility was cited for having such requirements on the basis that this is a violation of resident rights. As you know Rule 19.1502, Choice of Pharmacy states:

A Medicaid-certified facility must have written agreements with its provider pharmacies that define required services. These agreements will not be considered to abridge the resident's freedom of choice of pharmacy services when they require labeling, packaging, and a drug-distribution system according to facility policy. The drug-distribution system must be accessible to all pharmacies willing to meet the distribution system requirements. The agreements must require the following:

(1) that the resident's pharmacy services be provided by a pharmacy on a 24-hour basis for emergency medications; and

(2) that the resident's medications be delivered to the facility on a timely and reasonable basis.

(c) The resident's choice of pharmacy provider must be in accordance with ยง19.406(c) of this title (relating to Free Choice).
(emphasis added)

According to a source, the legal department at DADS reads this to mean that requiring pharmacies to have the ability to generate the MARS and physician order forms is too expensive a requirement for many "Mom and Pop" pharmacies. DADS , thus, takes the position that you can't require that pharmacies go over and above what the standards require or you are unduly restricting the resident's choice of pharmacies.

I have a few questions for DADS about this. How are you defining a labeling, packaging and drug distribution system? Are you saying that any pharmacy system that does more than providing services on a 24 hour basis and delivering on a timely basis to be over an above the standards? I'll try to find this out and will report back.

Word of warning: If any of you have changed to this system and have, as a result, made a local pharmacist mad--beware.