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Long Term Care Services


The delivery of pharmacy services in the Long Term Care (LTC) setting demands accuracy; efficiency in cost, time, and distribution, as well as a solid understanding of the range and goals of the care provided to residents. This is the foundation on which Xubex LTC Pharmacy has established its professional comprehensive pharmacy services.



At the core of our pharmacy is the expertise and direction of Xubex LTC’s resource network, a team of diverse professionals who are proficient in the delivery of long term pharmacy.

Xubex LTC Pharmacy Network provides:

  • Seamless Transition to our pharmacy services
  • Staff Education Programs
  • Tailored Medical Records
  • Computerized Reporting and Analysis
  • Cost-Containment Programs
  • Quality Improvement Programs
  • State and Federal Regulation Compliance
  • Clinical Pharmacists
  • Nurse Consultants
  • State of the art technology: Web Access Portal


Understanding the diverse needs of a provider, we offer: A comprehensive list of pharmaceutical products

  • Competitive prices
  • Timely delivery
  • Specialized medication packaging
  • Emergency Medication Support 7 Days a Week, 24 Hours a Day
  • Clinical Consulting Services
  • Medical Supplies and Equipment
To assist in cost reduction, Xubex LTC Pharmacy uses a variety of pharmaceutical strategies including:

  • Therapeutic drug substitution
  • Generic substitution
  • Clinical screening to prevent drug misadventures
  • Optimization of drug utilization to decrease the need for hospitalization
  • Geriatric specific formulary management
  • Co-pay assistance Program (CAP)
  • Free Medication Program
  • Patient Assistance Program (PAP)
  • Discount Drug Program

What is a consultant pharmacist, and what does he/she do?

A consultant pharmacist is a clinical pharmacist specially trained in the areas of geriatrics and long-term care. Consultant pharmacists review medication regimens for each resident in the nursing facility monthly. Reviews are done every other month or quarterly for some residents in assisted living facilities (by facility request and state requirements). They work closely with the facility staff, physicians/nurse practitioners and other interdisciplinary team members to ensure optimal patient care. Our goal is maximizing patient function and quality of life while minimizing the number of medications needed. Currently, we average over six requests for medication discontinuations for every one request for medication addition. We also make recommendations regarding medication dose reduction, duration of therapy, medication monitoring (lab work, vital signs, etc.), drug interactions, potential adverse drug reactions and medication substitutions for greater efficacy, reduction in nursing med-pass time and decrease in costs. Our consultant pharmacists enjoy an excellent working relationship with our physicians and average a 93% positive response rate to recommendations.

Xubex Care Pharmacy Consultant Pharmacists are also available for clinical questions, drug information, survey support, medication bill reviews and for participation on various committees such as QA/CQI Committees, Fall Prevention, Weight Management and Psychotropic Medication Committees.

Why is reducing the number of medications important?

Medication misadventures are the #1 reason for hospital admissions from the nursing facility. The more medications a patient takes, the greater the risk for drug-drug interactions and adverse drug reactions. Decreasing the number of medications also decreases drug costs. Besides the obvious costs of drug dispensing, passing fewer medications reduces nursing time and frees the nurses up to perform other duties. Xubex Care Pharmacy believes in the goal of minimizing medication therapy while still providing optimal care for our patients

How does Xubex Care Pharmacy protect the residents from drug-related problems?

Xubex Care Pharmacy Consultant Pharmacists review each resident’s medications on a monthly basis to screen for drug-related problems. We also track any adverse drug reactions reported to us by facility or Xubex Care Pharmacy staff. These are tracked and reviewed each quarter by our Regulatory Committee. Any trends can be identified and an action plan put into place.

What is the Xubex Care Pharmacy Formulary, and how is it developed?

Xubex Care Pharmacy has a Formulary Committee that is charged with developing and maintaining our Medication Formulary. This committee comprises clinical pharmacists, from the academic arena, dispensing pharmacists and senior management from purchasing personnel. Each drug class is reviewed for the most appropriate medication selection for our patients. Cost is certainly considered along with 10 criteria such as third-party coverage, efficacy, side-effect profile, dosage forms and ease of administration. Resident quality of care is the most important consideration in this process. The resultant formulary is presented to the facilities for approval annually. This process provides incredibly significant cost savings to the facility. Formulary cost savings is presented at the quarterly QA/CQI Meetings.

What information is provided by Xubex Care Pharmacy at our QA/CQI Meetings?

Our Consultant Pharmacists and Customer Care Account Managers are active participants in your QA/CQI Process. We attend and provide a report including, but not limited to the following:

1.      Average medication count per patient, broken down by station, if requested, and compared to a Xubex Care Pharmacy average for like-sized facilities

2.      Average psychotropic mediation use by category and compared to State and National averages

3.      Savings realized by our Medication Formulary, as well as any updates to the formulary made during the quarter

4.      Consultant pharmacists’ recommendations by category and the physician response rate to these recommendations

5.      Customer Care activity during the quarter

6.      Clinical Education activity during the quarter

7.      Any other consultant pharmacist services performed, including the results of any QA surveys performed

8.      Medication errors for the quarter

9.      Stat delivery report including numbers, which medications and “on-time” percentages

10.  Clinical packet: developed by the Consulting and Clinical Education department and including information on new medications, drug warnings, indications, new regulations, new guidelines and new clinical studies pertinent to long-term care.

How does Xubex Care Pharmacy control your medication costs?

Acceptance of the Xubex Care Pharmacy Medication Formulary has a huge impact on drug costs. Xubex Care Pharmacy also has a stock OTC program that allows you to purchase over-the-counter medication at extremely competitive pricing. This helps combat the recent problem of Medicaid non-coverage for OTC products, as well as allows convenient daily delivery of stock items. Consultant pharmacists, as mentioned above, work to decrease the number of medications used and also strive for less frequent, or daily dosing whenever possible.

 

 

How does Xubex Care Pharmacy educate nursing facility staff on new developments pertinent to long-term care?

Xubex Care Pharmacy’s clinical education department provides a monthly “clinical packet” with updates on regulations, care guidelines, suggested protocols, new policies and any other timely topics. An extensive clinical packet is also distributed at all QA/CQI Meetings. Individualized in-facility in-service programs are available on request from our consultant pharmacists and clinical nurses. Additionally, we sponsor as well as co-sponsor various all-day and half-day educational events that focus on topics of importance to the long-term professionals within our communities.

Can assisted living patients receive 90-day supplies of medications?

In some but not all cases, three-month supplies of medications are available to residents who are self-medicating. Contact your dedicated pharmacist in each specific case.

What if a resident needs infusion therapy?

We offer a full range of IV and other infusion therapy services, including nursing care, training and devices, such as infusion pumps.

How often does a pharmacist review medication regimens in long-term care facilities?

Our consultant pharmacists review medications monthly for residents in long term care facilities. Assisted living and other types of facilities also have the option of using consulting pharmacy services. Assisted living and ICF/MR facilities usually have their residents reviewed on a quarterly basis. Our consultant pharmacists are also available for extra reviews upon request for situations such a frequent falls, adverse effects, concern with cost of meds/insurance coverage or any other medication concern.

What does the pharmacist do when a problem/issue arises with a medication?

When issues arise, Xubex Care Consultant Pharmacists contact the prescribers to make recommendations in written, faxed or direct form. Our pharmacists also offer to meet with prescribers at the facility to discuss medication concerns as well as perform clinical consults upon the request of any practitioner. The internal staff pharmacists generally contact the facility to notify them of medication concerns such as drug contraindications, drug to drug interactions, allergy profile and other dispensing issues or when necessary, communicate these problems directly to the physician.

 

 

 

How does the pharmacist ensure that recommendations are the most cost-effective?

Our Formulary Committee evaluates safety, efficacy and costs of medications. Our consultant pharmacists help to ensure that the formulary selection is used whenever possible, to keep costs low. The consultant pharmacists also have many other cost-saving recommendations they make above and beyond formulary adherence. We strive to maintain the patients functional well being while using the least number of medications possible, always striving to discontinue unneeded medications, and only requesting medications be added when the benefit clearly outweighs the medication cost.

Why is less better than more when it comes to resident medication profiles?

Additional medications can equal unnecessary costs while creating risk for drug interaction potential, disease interaction potential, a sense of dependency in making day-to-day healthy lifestyle choices and a lack of proper drug monitoring.

Medication misadventures are the #1 reason for hospital admissions. With each medication added, the risk increases for an adverse drug reaction or a drug-drug interaction. Sometimes, a drug is added to the patient’s regimen to combat a side effect of a previously added medication. It can be quite difficult to make sense of this when the average patient now takes over 10 routine mediations. Our consultant pharmacists are highly trained and experienced in sorting out these issues.

Why should we choose Xubex Care Pharmacy over another local or national pharmacy?

It’s called old-fashioned “hometown” service with “uptown” expertise. As a mid-size provider, we have the capabilities to be responsive to your pharmacy requests by assigning designated personnel with intimate knowledge of your staff and operational expectations. In other words, we offer the personal touch.

Conversely, smaller does not necessarily mean leaner in the realm of knowledge or experience. Xubex Care professionals are the best in their field with extensive backgrounds in geriatric and long-term care. They work tirelessly to ensure your residents receive the minimal amount of medication necessary to improve or maintain their medical conditions with the least amount of risk. Consultants are generous with their knowledge, sharing best practices as well as pharmaceutical and clinical information with facility staff and residents in order to expedite quality care and promote wellness understanding.

Xubex Care also prides itself on its innovative practices, something the local pharmacy may not be able to match. Our state-of-the-art operations allow us to minimize costs to facilities and residents while providing us leverage to offer many unique products and services that no longer exist from national competitors and are considered unaffordable by smaller pharmacies.

What packaging options does Xubex Care Pharmacy offer?

Packaging is customized to facility request. Xubex Care offers unit dose, bubble or blister pack/cards dispensed on either a calendar or cycle fill basis, or multi-dose packaging.

Does Xubex Care Pharmacy offer any advice or assistance to Medicare Part D questions and concerns?

Our reimbursement representatives are knowledgeable in all aspects of Medicare Part D enrollment regulations, third-party insurance drug formularies and beneficiary requirements. They will gladly review resident drug profiles at facility or resident request and identify those Medicare Part D programs that would be the most advantageous to the individual.

How can Xubex Care Pharmacy save our staff time and/or money?

Utilization of clinical best practices and continuous quality improvement initiatives creates the framework for generating notable savings in time and money for Xubex Care clients.

Our medication reduction effort decreases medication administration time for the nurses and delegated staff. Proactive formulary application by our pharmacists reduces drug costs to both the facility and resident. This savings is accomplished on resident admission through our PAR Program and throughout the resident’s stay when new medications are ordered or when the attending physician accepts the Consultant Pharmacist’s recommendations.

Our dedicated STAT process and controlled substance ordering protocol minimizes nursing interaction time with Xubex Care staff and expedites the dispensing and delivery of these medications. The medical records department monitors corrections to resident medical records and identifies opportunities to the respective facility for saving nursing time at monthly turnover.

Complimentary drug storage audits relieve nursing staff of the time-consuming responsibility of ensuring the safe and secure handling of medications. Additionally, we offer an efficient one-touch drug replacement system for both the manual and automated emergency drug supplies that saves nursing time and expedites the return of those medications to the facility stock.

Our automatic calendar fill and cycle fill systems save nurses a vast amount of medication re-ordering time every day and dispensing initiatives, such as multi-dose packing, not only saves medpass and reordering time but reduces potential for medication errors as well.

We also provide a unique purchasing opportunity to facilities that allows them volume pricing discounts on over the counter medications not normally available from other resources

And lastly, our Medicare Part D transition team assists facilities and families helping residents choose the most suitable drug plan. We provide third-party formulary comparisons that support the best coverage and potential savings based on each individual’s medication regimen so that residents and families can make independent, informed decisions regarding their coverage.

 

Xubex LTC Pharmacy utilizes a 5 Star Medication Tracking System to ensure accuracy. Packaging and labels are inspected and errors are identified before the medications leave the pharmacy. There are five pharmacists checks relative to every medication received and dispensed.


1. Orders are triaged and organized in order of importance upon receipt
2. Orders are then checked by two Pharmacists prior to being filled
3. Visual check by Pharmacist after orders are filled
4. Pharmacist completes a Bar Code Scan to match drug/Rx to each patient
5. Pharmacist Delivery Manifest check – Bar code scan matching right patient, right drug, right strength, right facility

Drug Profile/Interaction

 
Monitoring drug/drug and drug/food interactions will be coordinated through computer-based drug profiles maintained for all residents. Drug interactions and drug/food interactions are flagged prior to filling. When interactions occur that could lead to clinical complications, the facility is notified immediately. Drug allergies will also be monitored via our QS1 First Data Bank computer system. Pharmacy data entry personnel are warned of drug allergies prior to prescription dispensing. The facility is notified and alternative therapies recommended.

Medication Reduction


Xubex Pharmacy clinical pharmacists conduct prospective drug utilization reviews at intake. The goal is medication reduction via elimination of duplicate therapies, overdoses and unnecessary medications. Our clinical pharmacist will work collaboratively with facility’s D.O.N. and medical director.

Formulary Management


With the plethora of insurance plans and corresponding formularies today, we understand that it is a challenge for doctors to be aware of what is covered for a patient. That is why we make it a part of our job to assist the doctor and the patient in obtaining the most cost effective medications. We constantly evaluate patient Med D plans to ensure the selected plan meets patient needs. Disease states change and it is important that this function be part of pharmacy practice.

Fiscal Responsibility


Xubex Pharmacy has experience working with multiple payers. Pre Admission screening is an integral part of pharmacy performance to aid residents in cost analysis. When medications or products are not covered, the facility and/or the patient’s representative are contacted.

Multi Dose Packaging

Multi dose packaging offers the best in flexibility. We can mix or separate meds as needed. Unit dose or multi-dose, critical or non-critical drugs. No matter what packaging protocol you prefer, we can accommodate it quickly and efficiently. Designed with your medication scheduling needs in mind, multi dose packaging dispenses medications in a timelier manner and with shorter durations in response to changing prescriptions. This better facilitates your patient medication schedules, reducing waste and time handling excess or discontinued medication.

30 Day Blister Pack

Blister packs are commonly used as unit-dose packaging for pharmaceutical tablets, capsules or lozenges. Blister packs can provide barrier protection for shelf life requirements, and a degree of tamper resistance. In the USA, blister packs are mainly used for packing physician samples of drug products, or for Over The Counter (OTC) products in the pharmacy. The main advantages of unit-dose blister packs over other methods of packing pharmaceutical products are the assurance of product/packaging integrity of each individual dose and the possibility to create a compliance pack or calendar pack by printing the days of the week above each dose.

Billing

Xubex Pharmacy will provide monthly billing for goods and services according to facility specifications (typically, all bills are submitted directly to the resident or resident’s responsible party). A local billing representative will be assigned to work directly with the facility’s billing department to customize the billing system desired. The billing representative will ensure correct and prompt submission of statements and immediate responses to all inquiries from the facility and/or residents. All billing issues will be resolved as they arise. Our Pharmacist will conduct in-services for residents’ families to explain, billing policies and procedures, insurance plan issues (Medicare D, etc.), and answer any other questions or concerns they may have.

Medicare Part-B Services

Xubex Pharmacy specializes in billing Medicare Part-B products and services and can provide all products covered by Medicare Part-B including: diabetic supplies, nutrition products and all medical supplies and equipment.

Medicare Part-D Services

To prevent unwarranted charges to the resident, the pharmacy will constantly assess comparative plan information of Medicare PDP coverage, formulary, and costs. The pharmacy is familiar with all aspects of Medicare Part-D and will provide current information regarding plan selection and regulations to facility and resident when desired.

Discounted Pricing; Additional Cost Savings

Xubex Pharmacy is unique as a long-term care supplier in that we offer deep discount pricing for many of our products. Our automated systems and efficient internal operations enable us to reduce our expenses and pass those savings on to the facility. Xubex Pharmacy prices all OTC medications (and a number of other medications) at competitive discount retail prices. In addition, Xubex Pharmacy further reduces costs by implementing protocols such as our Drug Regimen Review (which decreases the number of medications a resident takes per day (correspondingly decreasing the number of med-passes, saving the resident dollars and the facility tie) and a seven days’ supply of medication (which saves residents dollars on discontinued medications – only offered with certain medication distribution systems).

Medical Records

Maintenance of medical records and reporting can be a burden for the facility and its staff. We will work closely with facility to reduce this burden and will provide specialized reports to meet all facility needs, including nonexclusively: Physician Order Forms, Medication Administration Records, Treatment Administration Records, Antibiotic Reports, and Antipsychotic Reports. All reports are provided at no cost. Direct Access to all reports may be made available through Xubex Facility Access Portal.

Scheduled Delivery

Xubex Pharmacy will customize a delivery schedule to meet your facility’s specific needs. Each delivery is segregated by unit and accompanied by a packing list detailing the items delivered. Deliveries are made to individual nursing units or other areas designated by the facility.

Emergency Deliveries

Xubex Pharmacy provides 24 hour on call emergency coverage, 24 hours a day, 7 days a week, 365 days a year. After hour calls are handled by a pharmacist familiar with facility protocols and needs. In addition, we will establish contracts with a local pharmacy to provide “stat” services when needed. We will be responsible for the communication and delivery arrangements with the contracted pharmacy

Web Access Portal - Integrating Pharmacy and Facility Communication

Xubex Pharmacy Web Access Portal (eMarpotals.com) is designed to maximize communication between the pharmacy and facility and reduce the burden of medical records keeping and reporting for nursing staff. Refills can be ordered online right from the nurse’s station. Physicians and Nursing Administration can access records from other locations as desired. This system will save countless nursing time hours weekly.

Inspection Support

Periodically, our pharmacy will send a Pharmacist, Technician, or Nurse to your facility to review charts and conduct a pre inspection audit to ensure compliance with federal and state regulations. At time of survey, we will send a Pharmacist to your facility to assist and provide support during the entire survey process.

Leave of Absence Medications

Our Pharmacy will supply all necessary medications to any resident going on leave on a timely basis. It is the responsibility of the facility to ensure that a resident leaving the facility on a leave of absence (LOA) has all of the medications that he/she will need. The facility will notify the pharmacy of all impending LOA’s, with a 72-hour advance notice whenever possible, including length of LOA. The facility will review the resident profile and provide the pharmacy with all needed medication information for the involved time frame, including exact quantities required. Facility should also notify pharmacy of need for inhalers, insulin, PRN medications, etc. The LOA medications will be labeled as per state regulations, and delivered to the facility in a timely manner. Please specify if requesting an alternative dispensing system.

Disposal of Medications

We will dispose of all expired and unwanted medication t the in accord with Federal and state guidelines.