Medication Management Process

First Step of Medication Management Process

selection

selection

determining what products to carry in inventory

what is a formulary and how does it apply to community pharmacy?

list of generic and brand-name prescription drugs approved by a health care entity for use and/or coverage by a health care provider or patient
formularies don’t exist in a community pharmacy, but preferred drug lists (PDLs) do

Second Step of Medication Management Process

procurement

procurement

processes involved in obtaining inventory
purchasing, shipping, receiving, processing
how to obtain products for inventory

what is typically the largest operating expense for most pharmacies/organizations?

pharmaceuticals

Pharmacy Supply Chain

various events in a pharmacy company, from manufacturing to distribution to delivering medicines to consumers

*the patient is included in, and is key component of, the supply chain

when should purchasing be delegated to non-pharmacist staff?

technical functions:
placing, receiving, and processing orders, and managing inventory levels

when is pharmacist oversight of purchasing required by law?

need to evaluate drug substitutions (e.g., drug shortages)

need to determine reasonable stock quantities to meet patient care needs

involvement of controlled substances

involvement of restricted distribution medications

involvement of investigational drugs

wholesalers are also known as

distributors

what do wholesalers do, generally?

purchase drugs from manufacturers, stores those drugs, and then sells and distributes them to chain pharmacies, independent pharmacies, hospitals, clinics, nursing homes, and mail-order pharmacies

what are additional services provided by wholesalers?

pharmacy services administrative organizations, group-purchasing organizations that negotiate discounts with pharmaceutical benefit managers on behalf of chain and independent pharmacies

drug distribution data provided to manufacturers and pharmacies

drug repackaging of large volumes of generic drugs into smaller quantities, often sold to providers

buy-back programs that facilitate manufacturer buy-backs of nearly expired drugs from pharmacies

just-in-time deliveries that give pharmacies flexibility in inventory management

medical products and equipment, along with software ordering platforms

information technology platforms that facilitate interoperability of data exchange and digital solutions across software programs

operational, financial, and regulatory support and assistance to pharmacies and pharmacists

top three major players in the Pharmaceutical Wholesaler business

McKesson, Amerisource Bergen, Cardinal Health

indirect versus direct purchasing

drugs purchased directly from manufacturer versus through an intermediary

primary vendor

entity from which a majority of products are purchased

what is a GPO?

Group Purchasing Organization
companies that negotiate prices for drugs, devices, and other medical products and services on behalf of healthcare providers, including hospitals, ambulatory care facilities, physician practices, nursing homes, home health agencies, and community pharmacies

what is a PBM?

Pharmacy Benefit Manager

they administer prescription drug plans on behalf of health insurance plans, employer groups, and others

Prime Vendor Agreement provides discount based on:

quantity, bundling/bulk-buy, cash/payment terms

what do GPOs do? what don’t they do?

leverages combined buying power of member pharmacies to negotiate discounts with manufacturers, wholesalers, and other vendors; negotiate contracts with drug manufacturers and other vendors on behalf of member hospitals or pharmacies

they do NOT purchase

Third Step of Medication Management Process

storage

storage

physical means and procedural processes involved in storing, securing, and protecting inventory

processes involved in Purchasing and Inventory Management

selection, procurement, storage

Fourth Step of Medication Management Process

ordering or prescribing

ordering or prescribing

Fifth Step of Medication Management Process

transcribing and verifying

transcribing and verifying

Sixth Step of Medication Management Process

dispensing and delivering

dispensing and delivering

Seventh Step of Medication Management Process

administering/taking

administering/taking

Eighth Step of Medication Management Process

monitoring and reporting

monitoring and reporting

Seven Rights of Medication Administration

patient

drug

dose

route

time (frequency)

indication (reason)

documentation

reconciliation

process of comparing medications history with newly ordered medications with focus on resolving discrepancies and/or potential problems

CPT codes for medication therapy management

99605
99606
99607

99605: for first-time MTM consultation, up to 15 minutes

99606: for follow-up MTM consultation, up to 15 minutes

99607: for each additional 15 minutes of an existing consultation; used in conjunction with 99605 or 99606

what is MedWatch?

FDA's medical product safety reporting program for health professionals, patients, and consumers

information and adverse event reporting program

plays critical role in the FDA’s post marketing surveillance program

receives reports and publishes safety alerts for any FDA-regulated product

what information should be reported to MedWatch?

unexpected side affects or adverse effects

quality-related problems

errors associated with use of product/medication that can be prevented

therapeutic failure/reduced benefit

is reporting to MedWatch mandatory or voluntary?

voluntary

what is VAERS?

Vaccine Adverse Event Reporting System
early warning system to identify potential safety issues related to only vaccines

who is able and/or required to report what to VAERS?

healthcare professionals: required to report certain adverse events

vaccine manufacturers: required to report all adverse events that come to their attention

anyone is able to report

what agency developed/manages VAERS?

CDC and FDA

what’s the utility of VAERS?

detect unusual or unexpected patterns of adverse events that may indicate a possible safety issue with a vaccine

what is a VIS and who produces it?

Vaccine Information Statement

CDC

informs vaccine recipients/parents/legal representatives about benefits and risks of vaccine they’re receiving

must be given prior to each dose of a vaccine

date of administration

vaccine manufacturer

vaccine lot number

name and title of the person who administered the vaccine
address of the facility where the permanent record will reside

date printed on the VIS

date the VIS was given to the patient or parent/guardian

what is an IIS?

immunization information system

what is FL’s IIS?

Florida Shots