COST OF DISPENSING PRESCRIPTION DRUGS TO MEDICAID MEMBERS SURVEY

Transcription

1 COST OF DISPENSING PRESCRIPTION DRUGS TO COLORADO DEPARTMENT OF HEALTH CARE POLICY AND FINANCING JULY 13, 2015

2 CONTENTS 1. Survey overview... 1 Purpose of this survey... 1 Applicability... 1 How to submit your completed survey Profile B Profile Questions Financial Information Sales and Direct Expenses... 6 Sales... 6 Pharmacy Department Payroll Costs... 6 Non-Employee Pharmacy Department Expenses Financial Information - Overhead... 9 Facility Expenses... 9 Other Store/Location Expenses Comments Certification MERCER i

3 1 Survey overview Purpose of this survey The Colorado Department of Health Care Policy and Financing (Department) has engaged Mercer Government Human Services Consulting (Mercer) to conduct a Pharmacy Cost of Dispensing Survey to better understand and determine the approximate cost of dispensing prescriptions drugs to Medicaid members. As a result, Mercer is conducting a survey of Colorado Medicaid Pharmacy providers. Mercer created this survey to provide a process for gathering information about your costs and processes associated with dispensing prescription medications to Medicaid members. Your participation and timely response is crucial, as the information collected from this survey will be critical data for the Department to better understand the current pharmacy cost of dispensing and to help determine the dispensing fees paid to pharmacy providers. If you have questions about this survey please submit an to the following address: CODSurvey@mercer.com Applicability All participating Colorado Medicaid Pharmacies. How to submit your completed survey Please input your survey information online at You will need a username and password. The initial password for the website will be mailed or ed to you, or can be obtained by calling If you do not have access to enter your survey information online you can the completed Excel version of the survey to: CODSurvey@mercer.com The survey must be received no later than close of business Friday, August 7, MERCER 1

4 2 Profile The purpose of the Profile page is to report pharmacy specific information. If you have multiple locations, enter the information for each location in a separate column. Please do not combine costs or expenses from multiple locations. Please enter the following information on the Profile page: 1. Pharmacy Medicaid ID 2. Pharmacy NPI 3. Pharmacy name for each pharmacy 4. Street address of each pharmacy 5. Suite or second address line (if applicable) 6. City where the pharmacy is located 7. State 8. Five digit Zip code where the pharmacy is located 9. County where the pharmacy is located 10. Name of the individual to contact if there are any questions 11. Contact person s address 12. Contact telephone number, including the area code 13. Contact fax number, including the area code 14. Answer Yes or No: Does the pharmacy meet the Department s definition for Rural Pharmacy (any pharmacy that is the only Medicaid pharmacy provider within a twenty-mile radius)? 15. Answer Yes or No: Does the pharmacy dispense 340B-purchased drugs to Medicaid members? 16. Select (check box) the type of ownership (Sole Proprietorship, Corporation, Partnership, Other) of this pharmacy. 17. As type of ownership, please list whether the pharmacy is part of a chain (five or more locations), independent (not paying franchise fees), (four or less locations), or a franchise. 18. Indicate whether there was a change in ownership that would restrict the pharmacies ability to report expenses for the entire reporting period. 18a. If there was a change in ownership, please list the date of the ownership change as MM/DD/YYYY. 19. Answer Yes or No: Was the pharmacy open the entire year. 19a. If no, please list the number of months the pharmacy dispensed prescriptions. Determine the amount by taking the number of days open divided by 30 and rounding the result to the nearest whole number. MERCER 2

5 20. Select the appropriate classification for the pharmacy. Please use the following hierarchy to determine which to select: Compounding Pharmacy. A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner s Prescription Drug Order or initiative based on the Practitioner/Patient/Pharmacist relationship in the course of professional practice. A compounding pharmacy utilizes specialized equipment and specially designed facilities necessary to meet the legal and quality requirements of its scope of compounding practice. FQHC/RHC. A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (For example, physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.). Home Infusion Therapy Pharmacy. Pharmacy-based, decentralized patient care organization with expertise in USP 797-compliant sterile drug compounding that provides care to patients with acute or chronic conditions generally pertaining to parenteral administration of drugs, biologics and nutritional formulae administered through catheters and/or needles in home and alternate sites. Extensive professional pharmacy services, care coordination, infusion nursing services, supplies and equipment are provided to optimize efficacy and compliance. Long Term Care Pharmacy. A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. Nuclear Pharmacy. A pharmacy dedicated to the compounding and dispensing of radioactive materials for use in nuclear imaging and nuclear medical procedures. Specialty Pharmacy. A pharmacy that dispenses generally low volume and high cost medicinal preparations to patients who are undergoing intensive therapies for illnesses that are generally chronic, complex and potentially life threatening. Often these therapies require specialized delivery and administration but are not described above. Clinic/Outpatient Pharmacy. A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist. Community/Retail Pharmacy. A pharmacy in which pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. 21. Select the location type of this pharmacy: Medical Office Building, Shopping Center, Stand Alone, Grocery Store/Mass Merchandiser, Hospital Outpatient, or Other. 22. Enter the number of years a pharmacy has operated at this location. 23. Answer Yes or No: Are one or more of the pharmacists who filled prescriptions an owner of the pharmacy at any time during the reporting period? MERCER 3

6 Square Footage Information: 24. Pharmacy Department Square Footage as of the end of the reporting period: 24a. Prescription area: List the actual square footage of the prescription area. Measure do not estimate. 24b. Non-Prescription area: List the actual square footage of the rest of the pharmacy. 24c. The total square footage is calculated by adding 25a and 25b. Please verify the total is correct. 25. If the pharmacy department square footage changed during the year, select yes. 25a. Enter the date square footage changed as MM/DD/YYYY. 25b. Prescription area: List the actual square footage of the prescription area before the remodel. 25c. Non-Prescription area: List the actual square footage of the rest of the pharmacy before the remodel. 25d. The total square footage is calculated by adding 26b and 26c. Please verify the total is correct. Prescription Counts For prescription counts, please determine the number of scripts filled during the reporting year. (The reporting year should correspond to the financial period reported in questions 37a and 37b). 26. Please categorize the number of refill prescriptions for each location and enter them as: a. Medicaid-covered new prescriptions b. Medicaid-covered refills c. Medicare-covered new prescriptions d. Medicare-covered refill prescriptions e. All other New prescriptions f. All other Refill prescriptions g. The total prescriptions for your pharmacy should tie to 26g. 27. Please list the number of prescriptions compounded. If none, enter Please list the number of Medicaid prescriptions compounded. If none, enter List the number of prescriptions delivered to recipients. 30. List the number of Medicaid prescriptions delivered to recipients. MERCER 4

7 3 340B Profile Questions Answer only if you answered Yes to question 15: Does the pharmacy dispense 340B drugs? 31. Select the type of 340B program under which the pharmacy operates. Choices include: Black Lung Clinic (BL), Children s Hospital (PED), Comprehensive Hemophilia Treatment Center (HM), Consolidated Health Center Program (CH), Contract Pharmacy, Critical Access Hospital (CAH), Disproportionate Share Hospital (DSH), Family Planning (FP) Federally Qualified Health Center Look Alike (FQHCLA), HIV/AIDS Clinic (HIV), Rural Health Clinic (RRC), Urban Indian Organization (UI), Other please provide type of entity in the comments section of the survey. 32. Please select whether the pharmacy is a covered entity or is under contract. 33. Answer Yes or No: As a 340B participant, are drugs purchased through the 340B Prime Vendor Program? 34. Answer Yes or No: Does the pharmacy use a 340B administrator? If yes, be sure to report all costs in question 62a on the Financial-Direct page. 35. As an integer, please list the number of 340B prescriptions filled during the reporting year. (The reporting year should correspond to the financial period reported in questions 37a and 37b). 36. As an integer, please list the number of 340B prescriptions that were billed to Colorado Medicaid during the reporting year. MERCER 5

8 4 Financial Information Sales and Direct Expenses Direct costs or personnel shared by multiple location pharmacies should be allocated to individual locations. Methods of allocation must be reasonable and conform to generally accepted accounting principles. Please explain any allocation procedures used to allocate expenses in the Comments section. 37. Enter the dates of the reporting period: 37a. Begin Date 37b. End Date Sales Sales in the categories below determine allocation rates for certain administrative costs to the pharmacy department as a cost of dispensing. Enter amounts rounded to the nearest dollar. 38. Sales a. Enter Prescription sales other than those purchased through the 340B program. Do not include over-the-counter sales dispensed by a pharmacist. b. Over the Counter sales dispensed by pharmacy department. c. Over the Counter sales dispensed other than by pharmacy department. d. Sales of drugs purchased through the 340B program. e. Enter the portion of federal grants attributable to pharmacy, if any. f. Other sales such as retail sales and services. If amounts exceed 5% of total sales (e), please comment on the nature of the other sales and provide more detail. g. Total sales is automatically calculated. It should tie to the total sales for the reporting period. Please verify for accuracy. 39. Row 39 is to inform you that costs relating to the acquisition of drugs and pharmaceuticals are NOT included in the cost of dispensing survey. Do NOT include drug and pharmaceutical purchase or changes in inventory in the survey. Those costs are captured in average acquisition cost surveys. Pharmacy Department Payroll Costs 40. Add up salaries, wages, and bonuses paid to Pharmacists and Pharmacist managers who are owners of the pharmacy. 41. Add up salaries, wages, and bonuses paid to Pharmacist managers who are NOT owners of the pharmacy. 42. Add up salaries, wages, and bonuses paid to staff pharmacists who are NOT owners of the pharmacy. 43. Add up salaries, wages, and bonuses paid to pharmacy technicians. MERCER 6

9 44. Add up salaries, wages, and bonuses paid to other staff and personnel working in the pharmacy department. If a staff member is shared between pharmacy and non-pharmacy lines of business, allocate that staff members costs based on the percentage of hours spent working in the pharmacy versus other areas. Be sure not to include amounts in line 44 elsewhere. For example, if a staff member worked 25% of the time in the pharmacy and 75% of the time in a retail (non-pharmacy) area, then 25% of the staff members wages should be allocated to line 44, and 75% allocated to line Enter payroll taxes. Payroll taxes should reflect the employer s share of payroll tax expense, not the amount withheld from the employee. 46. Enter the costs of other employee benefits. Other employee benefits include expenses such as employer s contribution toward health insurance, contributions to retirement funds, or other fringe benefits. 47. Line 47 sums lines 40 through 46. No entry is needed. Line 47 will not display in the online version of the survey. Non-Pharmacy Personnel and Labor Non-Pharmacy personnel and labor is for labor expenditures related to non-pharmacy lines of business only. Personnel costs for administration, such as accounting and legal fees should be included in line 76, which will be allocated to the pharmacy department as a percentage of sales. 48. Please enter the sum of all Non-Rx department employees wages, salaries, bonuses, and guaranteed payments. 49. Please enter the sum of all Non-Rx Payroll Taxes incurred by the employer, including Social Security, Medicare, and unemployment taxes. 50. Please enter the sum of all Non-Rx Benefits, including pension/profit-sharing/retirement expenses. 51. Line 51 will calculate automatically. The amounts should tie to the total payroll and benefits expenses for the pharmacy. Please verify for accuracy. Line 51 will not display in the online survey tool. 52. Line 52 adds line 47 and line 51. Line 52 will not display in the online survey tool. Non-Employee Pharmacy Department Expenses Do not include ingredient costs in any of the questions in this section. Please enter, in whole dollar amounts, the costs of the following: 53. Prescription containers, labels, and other pharmacy supplies. 54. Professional liability insurance for pharmacists. 55. Prescription department licenses, permits, and fees. MERCER 7

10 56. Dues, subscriptions, and continuing education for the prescription department. 57. Delivery expenses (only prescription related). 58. Bad debts for prescriptions (including uncollected co-pays). 59. Computer systems related only to the prescription department. Do not include depreciation costs. These costs will likely include software licenses. 60. Depreciation - directly related to pharmacy department, including computers, software, and equipment. 61. Professional education and training. Include costs for tuition and registration for education and training related to maintaining pharmacy licenses. 62. Enter costs directly attributed to 340B programs. a. 340B Program management: If program management is subcontracted, include costs associated with the contract. Do not include actual drug product costs. b. Other: List any other costs attributable to 340B programs. Do NOT include costs for carrying inventory or costs related to the acquisition of drugs from the 340B program, as those would be captured in an average cost of acquisition survey. 63. Other prescription department-specific costs not identified elsewhere. (If greater than 5% of total prescription department cost (line 64), please attach supporting details in the Comments section). 64. Line 64 sums lines 53 to 63. Line 64 will not display in the online survey tool. MERCER 8

11 5 Financial Information - Overhead Expenses such as administration, central operating, or other general expense incurred by multiple location pharmacies should be allocated to individual locations. Methods of allocation must be reasonable and conform to generally accepted accounting principles. Please explain any allocation procedures used to allocate expenses in the Comments section. Facility Expenses Background information is needed to ensure appropriate expenses are captured and to identify potential outliers that require adjustment or exclusion. 65. Do you own the building? If rent is paid, select no and go to question 67. If the building is owned, please answer questions 66a, and 66b. 66a. If owned, enter the cost basis of the building. Do not include land costs. 66b. If owned, enter the balance of accumulated depreciation for the building at the end of the measurement period. Please enter, in whole dollar amounts, the costs of the following: 66. Rent (If building is owned, rent should $0). 67. Utilities (gas, electric, water, and sewer). 68. Real estate taxes. 69. Facility insurance. 70. Maintenance and cleaning. 71. Depreciation expense (not accumulated depreciation) for the building and/or leasehold improvements. 72. Mortgage interest. 73. Other facility specific costs not identified elsewhere. (If greater than 5% of total facility cost (line 74), please attach supporting details in the Comments section). 74. Line 74 is automatically calculated. Please verify the amounts for accuracy. Line 74 will not display in the online survey tool. MERCER 9

12 Other Store/Location Expenses Please enter, in whole dollar amounts, the costs of the following: 75. Marketing and advertising 76. Professional services (for example, accounting, legal, consulting) 77. Telephone and data communication 78. Transaction fees, merchant fees, or credit card fees 79. Computer systems and support 80. Other depreciation not related to the building, leasehold improvements, or depreciation reported in line Amortization 82. Office supplies 83. Other insurance 84. Taxes other than real estate, payroll, or sales 85. Franchise fees, if applicable 86. Other interest 87. Charitable Contributions 88. Other cost not included elsewhere. (If greater than 5% of total other store/location costs (line 89), please attach supporting details in the Comments section). Line 89 is automatically calculated. Please verify the amounts for accuracy. Line 89 will not display in the online survey tool. Line 90 is automatically calculated. Please verify the amounts for accuracy. Line 90 will not display in the online survey tool. MERCER 10

13 6 Comments The comments page is to explain answers and provide clarifications. If reporting more than one location, please be specific as to which location the comment pertains. MERCER 11

14 7 Certification For use in determining payment rates, CMS requires data be certified. Therefore, please enter the name of the individual who has certified this cost report and the position/title of the person who has certified this cost report. This should be signed by an owner, officer, or delegated representative who works for the company. If the survey was prepared by someone who does not work for the company, please provide the name of the person who prepared the cost report if other than the provider, the position of the person who prepared the cost report if other than the provider, and the name of the company for whom the person who has approved the cost report works. MERCER 12

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