Long-term-care (LTC) consultant pharmacists will not be required to be independent from dispensing pharmacies, pharmaceutical manufacturers, or distributors, according to the final ruling of the Centers for Medicare and Medicaid Services (CMS). "From comments received on this issue, we now believe a more targeted and less disruptive approach is warranted," CMS stated in a fact sheet summarizing the rule.
However, CMS would like the LTC industry to increase transparency and reduce drug overuse by adopting the following: Separation of LTC consultant contracting for dispensing and other pharmacy services; disclosure to the LTC facility of potential conflict of interest by the consultant pharmacist, or execution of a consultant pharmacist integrity agreement; and payment of fair market rates for consultant pharmacist services.
"In reaction to CMS' response, some are saying that we dodged a bullet," said Penny Shelton, PharmD, CGP, FASCP, president of the American Society of Consultant Pharmacists. "I don't see CMS' response in this light, and I believe their response is a warning to turn things around or face more regulations down the road."
In the rule proposed last October, CMS raised the possibility of a mandatory independent status for consultant pharmacists, noting concerns about conflict of interest, kickbacks, financial incentives, and impact on drug utilization.
According to Gene A. Memoli, RPh, FASCP, immediate past president of the Connecticut chapter of ASCP and a member of Drug Topics' editorial advisory board, the CMS ruling provides an excellent platform for consultant pharmacists to showcase their role in providing optimal patient care and medication management education in LTC facilities. He pointed out that access to electronic patient information, bidirectional communication, and continuum of care may be enhanced if the LTC consultant pharmacist is employed by the dispensing pharmacy.