Long-Term Care at Home Pharmacy Quality Commission Releases Industry First Patient Qualification Form
Quality Commission Releases Industry's First Patient Qualification Form and Sets New Standards for Long-Term Care Pharmacy in Home Settings.
Naples, FL - The Long Term Care at Home Pharmacy Quality Commission is proud to announce the release of the country's first standardized Long Term Care Pharmacy at Home Patient Qualification Form. This pivotal pharmacy-based attestation document has been adopted by hundreds of pharmacies across the nation, facilitating a uniform standard for qualifying patients for long-term care pharmacy services provided at home.
Since its implementation, the Patient Qualification Form has been utilized in multiple pharmacy audits across the United States, proving its effectiveness in identifying legitimate Long Term Care Pharmacy at Home patients. While it is not guaranteed to be audit-proof, its success in the market underscores its reliability and robustness in compliance and verification processes.
'This form is a game-changer for the industry,' said Lindsay Dymowski Constantino, President of the Long Term Care at Home Pharmacy Quality Commission. 'It not only standardizes the patient qualification process across the board but also ensures that all parties, from pharmacies to PBMs to health plans, are on the same page when it comes to compliantly identifying Long Term Care Pharmacy at Home patients.'
The Commission's release of this form marks a significant step forward in establishing a consistent framework for service provision and regulatory compliance. The document has already been used in audits conducted by Pharmacy Benefit Managers (PBM), further validating its comprehensive applicability and acceptance.
In addition, PBMs in the US market have received copies of this qualification form to include in their audit and compliance departments. This ensures that these key stakeholders are well-acquainted with the criteria used to define and confirm a true Long Term Care Pharmacy at Home patient, facilitating smoother audit processes and enhancing the overall efficiency of compliance checks.
'The introduction of the Patient Qualification Form by the Long Term Care at Home Pharmacy Quality Commission is a milestone that supports our commitment to providing transparent, standardized, and high-quality care to patients at home,' added Dymowski Constantino. 'We are delighted to see its positive impact on the industry and will continue to work towards innovations that support our pharmacies and their patients.'
In addition to the qualification attestation, the Long Term Care at Home Pharmacy Quality Commission has also released the first set of compliance standards and minimum service requirements in the market for LTC Pharmacy at home. This pioneering initiative has solidified the Commission's role in elevating industry standards. Already, the Commission has partnered with an accrediting organization to launch the country's first long-term care pharmacy at home accreditation, marking a significant advancement in ensuring consistent and quality care for patients receiving services in their homes. This collaborative effort underlines the commitment to not only setting but also maintaining high standards within the LTC Pharmacy at home sector.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Yahoo
12 hours ago
- Yahoo
Pharmacy benefit managers wield significant influence over patient care, costs
Multiple Republican-led states have sued to rescind a federal rule keeping the records of those who sought legal reproductive care private, while a federal judge in Texas is questioning the constitutionality of the federal HIPAA law in its entirety. (Photo by) As a physician, I have witnessed firsthand the inefficiencies in our health care system that make it harder for patients to access the care they need. One of these complexities patients now have to navigate is a growing industry of insurance middlemen known as pharmacy benefit managers (PBMs), whose practices meddling in our local health system increase health care costs and block access to critical medications. PBMs work between health insurance companies and drug manufacturers to negotiate lower drug prices for the health plans they represent. Their function and influence in the health care industry have evolved significantly, and today, PBMs operate with very little oversight or transparency and their decisions are often based on what is most profitable for a health plan rather than what is best for a patient. PBMs wield significant influence over what treatments patients can access and how much they will be required to pay. These middlemen receive significant rebates and discounts from pharmaceutical manufacturers for the cost of medications and treatments after negotiations, but they don't pass those savings on to patients receiving the care, increasing what patients are required to pay out of pocket when they pick up their medication at the pharmacy counter. PBMs can also require only certain drugs be covered by a health plan, impose arbitrary rules around access to provider-prescribed medications, and PBM revenue is often directly linked to the list price of a medicine, so PBMs are incentivized to recommend treatments that would yield the most profit. The three largest PBMs – CVS Caremark, Express Scripts and OptumRx – manage nearly 80% of prescription drug claims for 270 million people across the country. To make matters worse, PBMs are increasingly integrating and consolidating with other health care services, including distributors and pharmacies, making the influence PBMs hold over the health care system even larger. As these for-profit entities merge and collaborate, it's unclear if the system is actually functioning in the best interest of patients regarding quality and cost of care. PBMs have flown under the radar for far too long, but scrutiny of these middlemen and their impact on our health care system has rightfully grown in recent years, with many federal and state policymakers and regulators calling attention to the outsized role PBMs play in driving up health care costs. The Federal Trade Commission (FTC) found that PBM integration with chain pharmacies and insurers has allowed them to dominate the broader health system and that PBMs have significant control over what drugs are available to patients and how much they are required to pay. The FTC even filed suit against the three of the nation's largest PBMs, citing their anticompetitive tactics as a barrier to health care access. In addition, numerous investigations found that PBMs often act in their own financial interest, including pushing patients toward drugs with higher out-of-pocket costs because it's more profitable for the PBM. Access to consistent treatments is necessary for Louisiana patients, particularly those living with chronic health conditions or hard-to-treat illnesses such as cancer. Each year, more than 25,000 Louisianans receive a new cancer diagnosis. Alleviating access and financial barriers to care is a necessary step to improving health outcomes for patients. It is overwhelmingly clear that we must take action to reform PBM practices to improve access to care for patients and stop letting middlemen meddle in our health system. There has never been a time when we can do more for patients as doctors, but at the same time, there has never been a time when we have more complexities in the health care systems impede healthcare access and affordability. This 'profit over patients' business model is putting critical care out of reach for many Louisiana patients. Time is overdue to curb harmful PBM practices.
Yahoo
17 hours ago
- Yahoo
Pa. pharmacists demand state action to regulate PBMs, curb pharmacy closures
A shuttered independent pharmacy in Harrisburg. (Capital-Star photo by Vincent DiFonzo) Last month, pharmacists from across the state travelled to Harrisburg for an urgent meeting with lawmakers. Their goal was to communicate a simple message — pharmacies are closing at an alarming rate, eliminating one of the few places customers can receive free, unscheduled consultations with medical professionals. They warned they're being driven out of business by middlemen in the pharmaceutical supply chain called pharmacy benefit managers, or PBMs. Lawmakers took aim at this problem last year by passing the Pharmacy Benefit Reform Act, which sought to decrease the costs of prescription drugs and regulate PBMs. The legislation was touted by Gov. Josh Shapiro as an example of successful bipartisan reform while he was being considered for the vice presidential nomination. Nearly a year after the law's passage, pharmacists say it has failed to prevent closures. Since January 2024, at least 200 pharmacies have closed across the state. Now, they're asking lawmakers to act again. 'The current PBM system is aptly harming our local pharmacies, jeopardizing patient access to care and threatening the very fabric of our community health infrastructure,' Victoria Elliot, CEO of the Pennsylvania Pharmacist Association, told lawmakers during the meeting last month. Pharmacy benefit managers are companies hired by insurance providers to administer prescription drug benefits of a health plan. They negotiate drug prices, decide what drugs are covered under insurance plans and reimburse pharmacies for drugs dispensed. Theoretically, PBMs secure lower drug prices for patients by streamlining communication between insurance companies, drug manufacturers and pharmacies. Pharmacy advocates insist the opposite is true — that PBMs are raising drug costs and driving them out of business through anticompetitive practices that force them to dispense prescriptions at a loss. Prescription for trouble: Pennsylvania pharmacists say PBMs are driving pharmacy closures The three largest PBMs — CVS Caremark, OptumRx and ExpressScripts — control about 80% of the market and are owned by companies that also own national pharmacy chains and insurance companies. That means pharmacies that don't agree to accept the reimbursement rates they set are likely to lose customers whose insurance plans rely on them. E. Michael Murphy, senior advisor for state government affairs at the American Pharmacists Association and assistant professor of clinical pharmacy at Ohio State University, says low dispensing and reimbursement fees paid to pharmacies by PBMs are a leading cause of closures. 'Oftentimes, when pharmacies dispense a medication for a patient, they're taking a loss on that medication, either in the reimbursement for acquiring that medication from a wholesaler or in the professional dispensing fee,' Murphy said. 'And unfortunately you can only do that for so long before the business model crumbles. That's one of the big reasons that we've seen community pharmacies closing across the country.' Murphy said community pharmacy closures not only hurt small business owners, but also impact the ability of patients to access medications as they have to travel further to pick up prescriptions. 'When a community pharmacy closes, it can have a pretty dramatic impact on the health outcomes of that community,' he said. 'There's concern that can disproportionately affect patients in more marginalized or socioeconomicly vulnerable communities.' Murphy voiced support for ensuring state agencies have the resources to enforce existing laws and regulate 'anticompetitive' PBM practices. Greg Lopes, a spokesperson for the Pharmaceutical Care Management Association, a D.C.-based trade group that represents the country's largest PBMs, says PBMs help, not harm, Pennsylvania pharmacies. 'PBMs recognize that pharmacies provide access for patients to get drugs, so it makes no sense to blame PBMs for pharmacy closures in Pennsylvania,' said Lopes. 'PBMs aren't trying to put pharmacies out of business, in fact, PBMs are supporting community pharmacies in Pennsylvania through programs that increase reimbursement and advocating to allow them to expand the additional clinical services they can offer.' SUPPORT: YOU MAKE OUR WORK POSSIBLE He pointed to 'customer preferences for online options and changing demographics,' as factors driving pharmacy closures. PBM reforms passed with bipartisan support in last year's Act 77, which expanded the Pennsylvania Insurance Department's regulatory power and created new transparency requirements for PBMs operating in the state. But pharmacy advocates say the law didn't go far enough, and pharmacies are still closing at an alarming rate. Rob Frankil, executive director of the Philadelphia Association of Retail Druggists told the Capital-Star that out of approximately 225 pharmacies represented by his organization, 12 have closed since January and 25 closed in 2024. He pointed to low reimbursement as the primary cause. 'Eleven of the 12 pharmacies that my association lost this year are in Philadelphia,' he said. 'They all went out of business because they're not being paid enough for the prescriptions they're filling.' He wants legislation that addresses reimbursement rates directly. One proposal is to require PBMs to reimburse pharmacies based on the average national cost of the medication they're dispensing, plus a fee set by the state that accounts for a pharmacist's time and materials used. Neighboring West Virginia passed a similar law in 2021. A spokesperson for Shapiro, asked if the governor would support further PBM reforms, responded with a quote from the governor's February budget address, highlighting last year's PBM reform law. 'We knew it was a problem that shady middlemen could jack up the cost of prescription drugs while driving our community pharmacies out of business,' the statement said. 'So we came together to pass landmark reforms that bring transparency to how pharmacy benefit managers operate, keep more money in Pennsylvanians' pockets, and protect the small and independent pharmacies we rely on in our communities.' The primary sponsor of that PBM reform law, Rep. Jessica Benham (D-Allegheny), told the Capital-Star that further PBM reform is necessary, but said, 'We are somewhat limited on the state level with what we are able to do.' Benham added that understanding the full impact of Act 77 will take time. She noted the bill required the state Insurance Department to conduct a study on the impact on consumers and pharmacies of future legislation to set a standard dispensing fee of $10.49. They will also study the impact of patient steering and spread pricing on prescription drug costs and pharmacy access. Patient steering is a practice in which PBMs drive customers to their preferred pharmacies, often owned by the same parent company as the PBM. Spread pricing occurs when a PBM pays one price for a drug and reimburses a pharmacy less, profiting off the difference. An Insurance Department spokesperson said the study requires 'specialized expertise.' The department will procure a vendor 'to assist with the development and implementation of the study,' but have not begun this process yet. 'We will have to wait for the results to then move forward on further legislation,' Benham said. As it stands, a number of PBMs are contracted by individual Medicaid providers, and are allowed to set their own reimbursement policies. Frankil told lawmakers last month that dispensing fees can be as low as a dollar. A 2020 study commissioned by a community pharmacy advocacy group found the average cost of dispensing a prescription for a pharmacy is $12.40. One proposal Benham said she supports would have the Department of Human Services, which oversees state Medicaid, use a single PBM to administer Medicaid benefits, an action pharmacy advocates are demanding that has precedent in other states. In 2022, the Ohio Medicaid Department moved to a single PBM to administer Medicaid, with one entity overseeing prescriptions covered by Medicaid. This forced Medicaid managed care organizations to work with a single PBM contracted through the state's Medicaid Department, rather than procuring their own. A 2025 study found this move saved Ohio's Medicaid Department $140 million, saved the state $333 million in administrative costs and allowed $700 million dispensing fees to be paid to pharmacies in the two years since its implementation. Murphy, an Ohio resident, praised this move. 'Oftentimes, when I talk to pharmacists in Ohio, they'll say that Ohio Medicaid is the best and most stable source of revenue for their businesses, which is just indicative of how positive this program has rolled out,' he said. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
Yahoo
2 days ago
- Yahoo
Ovid Therapeutics to Host Investor and Media Event Thursday, June 12, 2025
Emerging Biomarkers in the Clinical Development of Epilepsy Medicines and OV329 Program Highlights NEW YORK, June 05, 2025 (GLOBE NEWSWIRE) -- Ovid Therapeutics Inc. (NASDAQ: OVID), a biopharmaceutical company dedicated to developing medicines for brain conditions with significant unmet need, will host an investor and media event on Thursday, June 12, 2025, on the topic of applying Biomarkers in Epilepsy, including their strategic use to demonstrate the pharmacodynamic activity of the Company's OV329 clinical development program. World-leading expert, Dr. Alexander Rotenberg will join company management to discuss the emerging use of a wide range of biomarkers for the study of anti-seizure medicines. The event will take place at Ovid's headquarters in New York's Hudson Yards from 9:30 to 10:30 am ET and will be webcast simultaneously. Sophisticated imaging and radiological tools are increasingly enabling medicines developers to leverage biomarkers earlier in clinical development to identify signals of biological target engagement and pharmacodynamic activity. Discussion will focus on how these tools drive evidence informed approaches in drug development and provide insight into potential clinical outcomes. Ovid management will describe the exploratory biomarkers in use to measure its next-generation GABA-aminotransferase (GABA-AT) inhibitor program, OV329, which is anticipated to have a topline readout in Q3 2025. Keynote speaker: Leading pediatric neurologist and epileptologist Alexander Rotenberg, M.D., Ph.D. Professor of Neurology at Boston Children's Hospital and Harvard Medical School, and Director of the Epilepsy Monitoring Unit at Boston Children's Hospital, and the Experimental Neurophysiology Core at F.M. Kirby Center of Neurobiology Unfortunately, nearly 40 percent of people living with epilepsy continue to experience seizures despite existing medicines. OV329 is a next-generation GABA-AT inhibitor, that was rationally designed to work differently from current medicines and may offer a novel approach for patients with treatment-resistant seizures. OV329 seeks to endogenously deliver optimal levels of GABA to reduce seizures and provide a preferable safety and tolerability profile relative to the first-generation, GABA-AT inhibitor, vigabatrin. OV329 is currently completing a Phase 1 study that is evaluating its effects on multiple pharmacodynamic biomarkers, safety, tolerability, and pharmacokinetics. Interested in attending or participating remotely: To register, please visit: Registration Link A live webcast of the presentation can be accessed through the Events & Presentations section of Ovid's website at About Ovid Therapeutics Ovid Therapeutics Inc. is a New York-based biopharmaceutical company dedicated to developing small molecule medicines for brain conditions with significant unmet need. The Company is advancing a pipeline of novel, targeted small molecule candidates that modulate the intrinsic and extrinsic factors involved in neuronal hyperexcitability causative of multiple neurological and neuropsychiatric disorders. Ovid is developing: OV329, a next-generation GABA-aminotransferase inhibitor, as a potential therapy for treatment-resistant seizures and other undisclosed indications; OV350, OV4071 and others within a library of compounds that directly activate the KCC2 transporter, for multiple CNS disorders. For more information about these and other Ovid research programs, please visit Forward-Looking Statements This press release includes certain disclosures by Ovid that contain 'forward-looking statements' including, without limitation: statements regarding the expected timing of initiation, completion, and results and data of Ovid's clinical studies; the potential use and development of OV329, OV350, OV4071 and other compounds from Ovid's library of direct activators of KCC2; and other statements that are not historical fact. You can identify forward-looking statements because they contain words such as 'anticipates,' 'believes,' 'expects,' 'intends,' 'may,' 'plan,' 'potentially,' and 'will,' and similar expressions (as well as other words or expressions referencing future events, conditions or circumstances). Forward-looking statements are based on Ovid's current expectations and assumptions. Because forward-looking statements relate to the future, they are subject to inherent uncertainties, risks and changes in circumstances that may differ materially from those contemplated by the forward-looking statements, which are neither statements of historical fact nor guarantees or assurances of future performance. Important factors that could cause actual results to differ materially from those in the forward-looking statements include, without limitation, uncertainties inherent in the preclinical and clinical development and regulatory approval processes, risks related to Ovid's ability to achieve its financial objectives, the risk that Ovid may not be able to realize the intended benefits of its business strategy or unanticipated or greater than anticipated impacts or delays due to macroeconomic and geopolitical conditions. Additional risks that could cause actual results to differ materially from those in the forward-looking statements are set forth under the caption 'Risk Factors' in Ovid's most recently filed Annual Report on Form 10-K and Quarterly Report on Form 10-Q filed with the Securities and Exchange Commission ('SEC'), and in subsequent and future filings Ovid makes with the SEC. Any forward-looking statements contained in this press release speak only as of the date hereof, and Ovid assumes no obligation to update any forward-looking statements contained herein, whether because of any new information, future events, changed circumstances or otherwise, except as otherwise required by law. Media and Investor Relations:Victoria Fort vfort@ in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
