CMS considers requiring independence of LTC consultant pharmacists

Medicare rule depicts conflicting interests; ASCP says profession puts patients first.

Depicting the potential for a conflict of interest,  that considers requiring the independence of LTC consultant pharmacists from LTC pharmacies and drug manufacturers and distributors.

As considered, nursing homes also would be prohibited from contracting for consultant pharmacy services with an LTC pharmacy subsidiary created to provide reorganized services.

Financial arrangements
Appearing in the Federal Register on October 11, the proposed rule noted that LTC consultant pharmacists perform monthly drug regimen reviews for all residents, described payments from drug companies to LTC pharmacies and consultant pharmacists for encouraging physicians to prescribe the manufacturer’s drugs for residents, and added that state laws or state pharmacy boards may allow signed agreements under which consultant pharmacists can make medication switches.

“These types of arrangements may result in incentives for the LTC consultant pharmacist to make recommendations that conflict with the best interests of nursing home residents,” CMS said.

Three LTC pharmacy organizations have 90% of the market.

The agency anticipates that consultant pharmacists may reorganize by becoming directly employed by the nursing homes or “banding together” with other consultant pharmacists in professional corporations, and aims for the changes to take effect in January 2013.

ASCP reacts
The American Society of Consultant Pharmacists (ASCP) was aware that the agency was concerned about some areas of conflict of interest, but was not expecting the discussion in the proposed rule, Lynne Batshon, ASCP Director of Policy & Advocacy, told

While the agency’s examples of how there could be a potential for conflict of interest are accurate, Batshon said, “We’re concerned that the setting has not been portrayed accurately.”

In a  that predates the new proposed rule, ASCP recommended that LTC consultant pharmacists should be independent of the LTC pharmacy providing medications to residents because of the potential for, or appearance of, conflicts of interest.

In the absence of separation, the position statement suggested separate contracts for dispensing and consultant pharmacist services, payment for consultant pharmacist services at market-based rates, and the empowerment of consultant pharmacists by their employers to make independent judgments about the appropriateness of medication use for each patient.

“I am deeply troubled that CMS has mischaracterized our profession by suggesting that consultant pharmacists don’t serve patients’ best interests as a primary goal of our practice,” ASCP President Albert Barber, PharmD, CGP, FASCP, said in an  on the group’s website. The , he noted, “clearly defines professional conduct that places patients’ needs at the center of care.”

Evaluating the impact
To gather information, ASCP is conducting a survey and also is reaching out to member experts in a variety of settings with good data.

Asked about the impact on consultant pharmacists, as considered, Batshon responded, “We are still in the process of evaluating that.” The day the survey came out, within 30 minutes, ASCP had received 50 responses. As of October 13, ASCP had received nearly 1,200 responses. Also, nonmembers have responded in overwhelming numbers. The reactions continue to pour in.

CMS requested comments be received by December 12, 2011. ASCP will submit comments to CMS based on the feedback. Twlug will continue dialogue with ASCP and other pharmacy stakeholders as it analyzes and prepares comments on this issue and other provisions in the proposal.

“We do believe that no matter what comes out on the other end of this,” Batshon said, “it clearly has shined a spotlight on this particular issue. It is certainly something that we will be following for some time to come.”