Transcript How Pharmacy Computer Systems Work

Pharmacy as a Business
• Explain third-party administration.
• Explain the terms prescription benefits manager and tiered copay.
• Discuss drug coverage for Medicaid and Medicare patients.
• Identify procedures for inventory management, including
purchasing, receiving, and storage.
• Identify procedures for the purchasing, receiving, storage, and
inventory control of controlled-drug substances.
MANAGING COMPUTER SYSTEMS
• Parts of a Computer System: Some of the more
important parts of a typical computer system
include: input devices, central processing unit,
storage devices, random-access memory, readonly memory, monitor, printer, scanner, modem,
operating system, and applications.
• How Pharmacy Computer Systems Work:
Pharmacy computer systems differ dramatically
from one another. Most systems often allow the
operator to call up patient profiles onscreen and to
enter new prescription information.
Community Pharmacy
Business Issues
Safety Note!
• Many pharmacy computer systems contain
features that will warn, automatically, of
possible allergic reactions or adverse food
or drug interactions based on information in
the patient profile and on a database of
known contraindications for given
medications.
BILLING AND THIRD-PARTY
ADMINISTRATION
• Processing Prescription Drug Claims: When a
new prescription is received, the pharmacy technician must
obtain all necessary insurance information from the
customer, including deductibles plus any copay or
coinsurance percent amount.
• Medicaid Prescription Billing: Medicaid subsidizes
the cost of healthcare, including drugs, for indigent and
disabled citizens of its state who meet age and income
eligibility requirements. Most community pharmacies sign
a contract to agree to provide prescription benefits to this
disadvantaged population according to the terms of that
state.
BILLING AND THIRD-PARTY
ADMINISTRATION
• Medicare Prescription Drug, Improvement,
and Modernization Act of 2003: This act offers
eligible patients the option to add drug insurance
to their health coverage. Starting in January 2006,
patients who qualified for Medicare coverage were
eligible to add drug benefit coverage for an
additional monthly charge to their current
premium.
INVENTORY MANAGEMENT
• Purchasing: Purchasing is usually carried out by
either an independent or group process. The
Controlled Substances Act (CSA) defines
procedures for purchasing.
• Receiving: The pharmaceutical products received
must be carefully checked against the purchase
order or requisition. The shipment should be
compared for name of product, quantity, product
strength, and product package size.
INVENTORY MANAGEMENT
• Inventory Management Processes: Inventory
management includes knowledge of the
importance of turnover ratios. Several important
issues include how much inventory should be
maintained, when inventory levels should be
adjusted, and where inventory should be stored.
Factors that bear on decisions regarding these
issues include floor space allocation, design and
arrangement of shelves, and demands on available
refrigerator or freezer space.
INVENTORY MANAGEMENT
• Inventory Management Requirements for
Controlled Substances: The DEA requires that a
complete inventory of all controlled substances
must be taken every 2 years. Some states have
more stringent requirements such as a yearly
inventory. The complete inventory must include
an inventory record and an extemporaneous
compounding record.
Figure 7.3
BUSINESS MATH USED IN PHARMACY
PRACTICE
• Markup: Prescription pricing is subject to
governmental laws and regulations, as well as
competition within the marketplace. Markup
plays an important part in the pricing system.
• Discount: A pharmacy may offer a consumer a
discount, or a deduction from what is normally
charged, as an incentive to purchase an item.
BUSINESS MATH USED IN PHARMACY
PRACTICE
• Average Wholesale Price Applications: Usually
a third parties reimburse a pharmacy based on the
AWP less an agreed on discount. Therefore the
pharmacy has an incentive to purchase a drug as
far below its AWP as possible.
• Capitation Fee: This reimbursement plan is
infrequently used because it places all risk on the
pharmacy without adequate controls in place to
control prescribing.
Discussion
A pharmacy technician working in a retail environment should be
familiar with various terms related to heath insurance. Patients
often have a difficult time understanding how their insurance
works, and the technician can often act as an intermediary and
advocate for the patient with regards to prescription drug benefits.
Research the following insurance terms and define them in words
that would be easily understood by a customer of the pharmacy.
a.
b.
c.
d.
e.
f.
major medical insurance
Medicare, Parts A, B, and D
Medicaid
deductible
copay
coinsurance
g. preferred formulary
h. prescription benefits
manager (PBM)
i. usual and customary
j. dual and tiered copays