Will My IHS Pharmacy Have to offer mail-order services?
Last month you read about how using the VA Consolidated Mail Outpatient Pharmacy (CMOP) for mail-order prescription services in IHS may affect pharmacy staff size. From what we learned during our interview with CAPT Pam Schweitzer, IHS-VA National CMOP Coordinator, the plan is for most sites to stay at the same staff size or to even increase. We asked you what you thought in our poll, and 70% thought that it wouldn’t increase.
Phoenix Indian Medical Center staff visiting the VA CMOP Leavenworth
Another frequently asked question about the program is “Will my pharmacy HAVE to offer mail-order services & use CMOP?” We discussed this with CAPT Schweitzer, and she took the time to address some of thse important and valid concerns:
Q: Will IHS require every site to get on board with CMOP?
Q: Will the tribes have an opportunity to get on board with CMOP?
Ken Siehr, National CMOP Director snapped this photo of the staff when he stopped by Phoenix Indian Medical Center
Q: Which IHS sites are already implementing CMOP services?
IHS Pharmacy Directors: Pharmacy staff to decrease with CMOP implementation?
I promised you an update on concerns about IHS pharmacies starting to offer central fill mail-order prescription refills through the Veteran’s Affairs Consolidated Mail Outpatient Pharmacy (CMOP) in Leavenworth, KS.
Some concerns I heard from IHS/tribal pharmacy directors were: How would mailing prescriptions impact the current pharmacy staff? Will mailing prescriptions really be in the interest of patient care, and will every site be required to provide mail service? What about tribal pharmacies-can they get involved? Click here to find out the answers
I spoke to CAPT Pam Schweitzer, IHS-VA National CMOP Coordinator, to ask her these and other common questions about IHS mailing prescriptions and using the VA CMOP.
Read on to find out answers to some FAQs about the program and how the goals above will be met:
Q: Is pharmacy staff expected to increase, decrease, or stay the same?
A: The IHS sites where CMOP has been implemented so far have kept their pharmacy staff, and in some cases have increased pharmacy staff. These sites are fortunate to have good CEO support of the pharmacy department. The pharmacists will be able to spend more time reviewing a patient’s records when processing refills, performing medication reconciliation, and/or fulfilling Improving Patient Care (IPC) objectives that allow pharmacists more time to do clinical work.
Q. Wouldn’t mail-order services be worse off for patient care because the patients don’t get as frequent personal interaction, and our work may become less clinical?
A: Mailing prescriptions can increase patient compliance, especially for patients who live in remote areas and may have transportation barriers that prevent access to the pharmacy. Studies have shown that mailing prescriptions can increase patient adherence. Yet if a patient chooses to go to your pharmacy to pick up medications instead, he/she can still choose to do so. The pharmacists’ time will likely be freed up to provide more clinical services for patients, because pharmacists won’t need to be involved with filling nor verifying the prescriptions.
Q: What are the less known features of VA CMOP that will be beneficial to patient care?
A: 
Patients can be provided with a 30-day supply of medications at each fill, increasing the possibility for billing and reimbursement for drug costs (especially if a site is currently dispensing 90 day supplies).
Patients are able to request their medication early (before the next fill is due) using a new feature in RPMS called Suspense.
Example: patient picked up medication today. He/she can request refill right now for their next fill.
Q: How will staff pharmacists’ & pharmacy technicians’ roles change due to CMOP implementation?
Staff pharmacists will still be involved with processing the refill prescriptions and will likely have more time to review the patient’s electronic record and manage medication therapy.
The pharmacy technicians’ workload of filling prescriptions will decrease, allowing more time for monitoring point-of-sale billing and inventory management. One additional duty the technicians have with CMOP is answering the phone and looking up tracking information if the patient didn’t receive their medication.
Stay tuned in a future issue to find out the rest of the answers to FAQs like whether every site will be required to use VA CMOP and what may be in store for tribal facilities. You’ll also see how CMOP would work if integrated with your pharmacy services.
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Mail-Order Pharmacy for IHS?
Last year, someone I know who works at the VA told me that as a pilot program, a VA mail-order facility started filling prescriptions for an IHS site around June/July in South Dakota. And that a site in Oklahoma was thinking about coming on board too. The idea, my friend said, was to get IHS on board with the VA filling their prescriptions through mail-order. My first reaction was that of being completely surprised. Then I tucked the thought away to revisit it after hearing more. Now we are beyond Valentine’s Day in 2012 and to my understanding, this idea may be further along than a pilot idea.
Mail-order for the IHS—what do you think?
My first reaction was wow–this new implementation feels opposite to what the praised IHS pharmacy model of patient care stands for. If mail-order were implemented, patients may miss out on an important opportunity for a timely medication intervention or to get their medication-related questions answered by a pharmacist.
There have been many times while working at an IHS/tribal pharmacy, I remember sharing something important with a patient that had an impact on their medication adherence & health (translating to healthcare cost savings), which would never have come up if I had not interacted with them in person. It’s like talking to your personal trainer on the phone and getting some basic tips vs. seeing your personal trainer through a full workout. He or she gets to hold you accountable in a more impactful way in person. The level of personalized care jumps exponentially.
Then I wondered what the plus side would be. Perhaps there would be easier access to medication for patients. Workload can be taken off current pharmacists’ plate for more clinical work.
But is it realistic to hope that budgets would allow pharmacists to do more clinical work, or will sites end up having a reason to cut the budgets even more when mail-order is implemented?
Comment below (and feel free to post anonymously) about what you think the pros & cons are. Share your opinion and be heard. You’ll get updates in an upcoming issue about the status of this concept and its implementation in IHS, what IHS/tribal pharmacy directors throughout the country think about its impact on our patients & practice, and ideas on how best to make it work.
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