Initial Assessment by a Qualified Healthcare Provider

• A licensed healthcare provider (e.g., pharmacist, physician, nurse practitioner, or other qualified clinician) must conduct an initial assessment of the patient.
• This assessment should evaluate the patient’s care needs, chronic or complex conditions, medication management requirements, and overall suitability for Long-Term Care Pharmacy at Home services.

Pharmacist Review and Attestation

• The pharmacist at the dispensing pharmacy must review the assessment to ensure it meets LTC Pharmacy at Home service standards.
• The pharmacist must attest to the accuracy of the assessment before submitting any claims under the LTC NPI for the patient.

Standardized Patient Qualification Form

• The assessment must be documented using the Standard Patient Qualification Form, ensuring consistency and compliance across patients.
• This form must be completed at the time of qualification and redone every six months to confirm the patient’s ongoing eligibility.
• The form must be securely stored in the patient’s profile, either electronically or in paper format.

Document Storage and Accessibility

• The patient qualification form must be readily accessible for audit or review by payers or regulatory entities.
• Use the Standard Patient Qualification Form to document assessments.

Please visit the page Patient Qualification Form to review how to utilize this attestation.

• Ensures Appropriate Use of Long-Term Care Pharmacy at Home Services – Conducting thorough qualifications prevents misuse of LTC Pharmacy at Home services.
• Supports Accurate Claims Submission – Reviewing and attesting to patient eligibility ensures claims are submitted correctly under the LTC NPI.
• Maintains Regulatory Compliance – Adhering to patient qualification standards aligns with payer and regulatory expectations.
• Promotes Continuity of Care – Regular reassessments ensure that patients continue to meet eligibility criteria and receive the level of care appropriate to their evolving needs.

Patient Communications

• Pre-Fill Calls: The pharmacy must contact the patient or caregiver before refilling medications to confirm:
  • Medication adherence.
  • Any changes in medication or health conditions.
  • The need for additional prescriptions or adjustments.
• All patient communications must be documented in the patient’s profile, including details of the call and any resulting actions.

Follow-up with Healthcare Providers

• Pharmacies must coordinate with the patient’s healthcare providers to address:
  • Questions or concerns raised during patient interactions.
  • Refills, medication adjustments, prior authorizations, or therapeutic alternatives.
• All follow-up efforts with providers must be documented in the patient’s profile, including outcomes and any resulting changes to the care plan.

Medication Synchronization and Medication Cycle Management

Pharmacies must manage the timing and synchronization of patient medications to ensure:

• All prescribed medications are aligned to be refilled on the same schedule, reducing the frequency of pharmacy visits or deliveries.
• Medication cycles are managed to coincide with patient reviews, healthcare provider consultations, and care plan assessments.
• All efforts related to medication synchronization and cycle management must be documented in the patient’s profile, including:
  • Dates of synchronization adjustments.
  • Correspondence with healthcare providers regarding cycle management.
  • Any changes to the patient’s medication plan as a result of synchronization efforts.

Collaboration Across the Patient’s Healthcare Team

• Document all care efforts that involve other members of the patient’s health team, such as:
  • Home health providers.
  • Specialists.
  • Case managers.
  • Ensure that documentation is easily accessible and includes timestamps for all interactions.
• Maintain a record of collaborative decisions and follow-ups to ensure continuity of care.

• Maintain consistent and detailed records of all care coordination efforts, including:
  • Communications with the patient, caregivers, and healthcare providers.
  • Notes on medication adherence, side effects, or changes in therapy.
  • Updates to the patient’s overall care plan.
  • Ensure that documentation is easily accessible and includes timestamps for all interactions.
• Document all care efforts that involve other members of the patient’s health team.

Standardize Communication Procedures

• Develop and implement standardized protocols for pre-fill calls, provider follow-ups, and other patient interactions to ensure consistency.
• Train pharmacy staff thoroughly on conducting and documenting these communications effectively.
• Document all communications in the patient’s profile within the pharmacy management system (PMS), detailing the purpose, outcomes, and any follow-up actions needed.

Use a Comprehensive Pharmacy Management System (PMS)

• Utilize a PMS to log and manage all patient interactions, provider communications, and care coordination efforts systematically.
• Ensure the system is equipped for easy data retrieval and auditing of patient profiles to support both ongoing care management and compliance requirements.
  • In addition to digital records, paper documentation may be utilized for critical patient information and care coordination efforts. This practice can serve as a fail-safe against digital data loss and facilitate accessibility for audits and reviews.

Establish Robust Documentation and Quality Assurance Processes

• Create a detailed documentation policy that mandates recording every interaction related to the patient’s care. This policy should specify what needs to be documented, including the interaction’s purpose, the outcomes, and subsequent actions taken.
• Set up regular quality assurance reviews to audit patient profiles, verifying that all communications and coordination efforts are documented accurately and comprehensively.
• Collaborate proactively with the patient’s healthcare team to align care goals and updates, ensuring that all communications are timely and documented clearly in the patient’s care record.

Improves Continuity of Care

• Documenting all interactions ensures that all members of the care team have a clear understanding of the patient’s health status and care plan.

Supports Medication Adherence

• Regular pre-fill calls, medication synchronization, and follow-ups help identify barriers to adherence, such as side effects or confusion about medications, and address them proactively.

Enhances Patient Safety

• Detailed documentation helps prevent errors by ensuring that all aspects of the patient’s care are recorded and communicated across the health team.

Facilitates Compliance and Accountability

• Comprehensive records demonstrate the pharmacy’s commitment to compliance with payer and regulatory requirements, reducing the risk of audits or disputes.

Builds Trust with Patients and Providers

• Clear, documented care coordination fosters trust among patients, caregivers, and healthcare providers by ensuring a seamless and collaborative approach to health management.

Drives Better Outcomes

• Coordinated and documented care efforts result in more personalized and effective treatment, improving overall patient health outcomes and quality of life.

• Combination of DUR and Medication Reconciliation: The MDR integrates the screening and evaluation of DUR with the verification and clarification of medication reconciliation.
• Qualified Pharmacist: A licensed and qualified pharmacist must complete the MDR to ensure clinical expertise is applied.

• How an MDR is Performed: A licensed pharmacist conducts a comprehensive evaluation combining Drug Utilization Review (DUR) and medication reconciliation to assess and verify the appropriateness of all medications for a patient. This review is completed monthly and whenever medications are dispensed to ensure accuracy and safety in medication management. The review includes checking for drug interactions, appropriate dosages, therapy duplications, and ensuring that the medication regimen aligns with current health conditions and treatment objectives.
• Information within the MDR Template: The template includes sections for recording the pharmacist’s name, review date, patient details, a checklist for medication verification, DUR aspects (like interaction screening and dosage verification), medication reconciliation processes, patient consultation details, provider communication logs, and a summary of findings. Documentation sections ensure all changes, interactions with healthcare providers, and patient education efforts are meticulously recorded, providing a clear audit trail and supporting continuous quality improvement in patient care.

Medication Dispensing Review Template

• Frequency of MDR
  • Monthly Review: An MDR must be conducted for every patient at least once a month to evaluate the ongoing appropriateness of the medication regimen.
  • Upon Dispensing: An MDR may be completed each time the pharmacy dispenses medication to the patient, including new prescriptions, refills, or changes in therapy.

• Documentation in the Patient Profile:
  • MDR Documentation Process: The findings and actions taken during the Medication Dispensing Review (MDR) must be thoroughly documented in the patient’s profile within the pharmacy management system (PMS). Many PMS platforms offer built-in modules for Drug Utilization Review (DUR) and medication reconciliation, which can streamline the MDR process. These modules typically allow for real-time data entry and integration, ensuring that all relevant medication information is updated and accessible.
  • Details to Include in Documentation:
    • Changes in Medication Therapy: Record any additions, discontinuations, or dosage adjustments made to the patient’s medication regimen.
    • Identified Drug Interactions, Duplications, or Contraindications: Document any potential or actual drug interactions, unnecessary duplications, or contraindications identified during the review.
    • Communication with Healthcare Providers: Log all interactions with healthcare providers concerning the MDR findings. This should include the date of communication, the nature of the discussion, and any decisions or recommendations made as a result.
  • Using PMS for MDR Documentation: Utilize the DUR and medication reconciliation modules within the PMS to capture and store this information efficiently. These modules help ensure that all necessary data is collected, maintained, and easily retrievable for audits or reviews, enhancing the accuracy and reliability of the medication management process.
  • MDR Template Usage: In addition to the PMS, a downloadable MDR template is available to help guide pharmacists through the documentation process. This template provides a structured format for recording all pertinent information and can be used as a supplementary tool to ensure thoroughness.

The template can be downloaded HERE

• Enhances Patient Safety
  • Combines two critical safety processes—DUR and medication reconciliation—to identify and address potential medication risks.
• Improves Medication Management
  • Regular MDRs ensure that medication regimens remain appropriate and effective as patient conditions and care plans evolve.
• Reduces Errors and Adverse Events
  • Identifying and resolving issues such as duplications, contraindications, or incorrect dosages minimizes the risk of adverse drug events.
• Supports Coordination of Care
  • Clear documentation and communication with healthcare providers ensure that all members of the care team are aligned, improving the patient’s overall treatment outcomes.
• Fulfills Compliance and Quality Standards
  • Conducting and documenting MDRs aligns with regulatory requirements and payer expectations, ensuring compliance and supporting the pharmacy’s credibility.