Pharmacy benefit management is a reality in healthcare and has developed into a critical component of hospice care during the last 15 to 20 years. Hospices must pay for all patient prescriptions linked with a hospice diagnosis, emphasizing the importance of a PBM's negotiation and purchasing power.
Along with their purchasing power, PBMs provide hospice agencies with the pharmaceutical expertise they require. Hospice regulations require that a pharmacist oversee each patient's prescription regimen, which is typically unavailable through a local pharmacy provider and might be challenging without a PBM's interface capabilities (see Your EMR-PBM Interface, below). Additionally, hospice agencies can analyze and report prescription data by patient, diagnosis, or day when using a PBM.
Hospice PBMs also provide critical support and education services, such as 24-hour support (essential for hospice clinicians), hospice Emergency or Comfort Kits, nurse-specific online portals, and even nursing CEUs (Continuing Education Units).
Of course, the cost is a significant aspect in selecting a PBM, but many of the largest hospice PBM players will be pretty similar financially. Consider the PBM's per-diem vs. per-drug rate possibilities.
Another critical factor to consider when picking a PBM for hospices is ensuring that your EMR system communicates with the chosen PBM. Ascertain that the PBM and EMR vendor is willing and capable of integrating their systems. A continuous data flow from your EMR system to your PBM eliminates double entry of patient data and contributes to the reduction of drug errors. It can save nurses numerous hours.
Hospice care focuses on ensuring patients' comfort by addressing pain and other symptoms associated with terminal illnesses. Given the centrality of medication therapy to that purpose, it's unsurprising that pharmacists play a significant role in inpatient care. Likewise, the hospice pharmacy benefit manager, or PBM, does the same thing.
A PBM's primary function in the broader healthcare market is to handle claims and reimburse pharmacies for prescription distribution. Additionally, they assist in cost management by managing formularies and negotiating pricing with pharmaceutical firms.
Due to hospices' specialized demands, they frequently rely on PBMs and other pharmacy providers that specialize in hospice care. Our origins date back to some of the first pharmacies and PBM providers to specialize in hospice care. It now serves over 450 hospices and over 90,000 daily patients.
As a 51-year-old business, Pharmacy Benefit Managers (PBMs) have seen a significant shift since their inception in Scottsdale, Arizona. PBMs are a four-letter word for many because of their Scrooge-like reputation, particularly among pharmacists.
The first modern hospice in the United States opened in 1974, following Dame Cicely Saunders' groundbreaking presentation to American healthcare professionals on the hospice movement's success in the United Kingdom. When hospice became a covered benefit under Medicare in the 1980s, palliative medication therapy became a covered benefit. Newly eligible hospices teamed with PBMs to adjudicate claims. Because both businesses were new to healthcare, partnership opportunities were restricted.
In the 2000s, a hybrid rival emerged: the hospice pharmacy-PBM, which was in charge of prescription ordering/fulfillment and pharmacy benefit claims. They attracted hospices by passing on huge discounts obtained through rebates from wealthy and influential parent corporations. Hospices benefited, but savings did not reach patients, who, like others, saw their out-of-pocket drug expenses increase by 169 percent between 1994 and 2015. Without a doubt, this percentage has now risen. Atropine exhibits hospice drug price increase. Atropine, frequently used to dilate pupils during eye tests, has the odd side effect of quieting death rasps. Despite unchanging components and manufacturing costs, a $10 drug is now priced at $50.
Hospice care has distinct goals from curative health care. There is insufficient data on the efficacy of specific medications in terminally ill patients. The dying process poses numerous complications with the metabolization of drugs. As patients' health deteriorates, they may require alternate administration methods.
Hospice PMBs should provide specialized clinical services in hospice and palliative care and fast access to medication information and education. This includes providing evidence-based alternatives for administering medicine to address availability difficulties or better meet patient needs.
Our clinical support program includes strategic use management and training opportunities, and pharmacists available 24 hours a day to assist with drug therapy management, hence boosting the interdisciplinary team's effectiveness. They assist nurses and prescribers with a variety of issues, including the following: