Pharmacy regulators back central processing

Drug Store News, Oct 30, 2000 by James Frederick

PARK RIDGE, Ill. -- Providing a likely boost to the chain drug industry's efforts to establish off-site prescription dispensing sites, the group representing the nation's state pharmacy regulators has effectively approved the concept of centralized fill.

The National Association of Boards of Pharmacy released a report from its task force on centralized prescription filling late last month and adopted the task force's recommendations for new regulatory guidelines. Those guidelines now move to the state boards of pharmacy, where they could lay the legal foundation for the creation and operation of off-site dispensing centers by chain and independent pharmacies.

The organization's new model language proposals don't mandate state board approval or adoption, but they are an effective template for a new set of operating procedures for central-fill pharmacies, said Janice Teplitz, assistant executive director of the NABP. "The states are under no obligation to adopt that language, although many will probably use it, at least as a basis for new legislation in their jurisdiction," Teplitz told Drug Store News.

In an era of booming prescription drug demand, low pharmacy margins and intense competition for the limited pool of available new pharmacy school graduates, many drug chains see off-site dispensing as a potentially powerful tool for cutting their operating costs, boosting efficiencies and stretching a tight professional labor pool. That makes the task force's proposals significant, as they could pave the way for the removal in many states of the regulatory barriers which still impede the progress of central fill efforts.

As such, they are likely to spur the development of off-site dispensing by drug chains--particularly those operating many stores close together in densely populated markets. Some independents also may pursue the concept through their wholesaler buying groups or other means.

Among the chains that have taken steps toward operating central fill facilities are Duane Reade in New York and the Kroger supermarket chain. Indeed, Duane Reade was scheduled to move its existing central fill operation into a larger facility this fall, but still inside one of the chain's retail stores. Its expected to service up to 50 of the chain's Manhattan stores.

Task force drivers

The task force was created by the NABP executive committee early this year "in response to a growing interest among the state boards of pharmacy in central fill pharmacies and dispensing systems," according to Teplitz. Its recommendations were incorporated with the NABP's Model State Pharmacy Act and Model Rules.

"Our goal was to develop model language and procedures that would enable and encourage innovative practice procedures while assuring the necessary safeguards to protect the public health," explained S. Patricia McSherry, NABP executive committee liaison to the task force.

Among the group's recommendations that found their way into the Model Act was a definition of centralized prescription processing, as "processing by a pharmacy of a request from another pharmacy to fill or refill a prescription drug order or to perform processing functions such as dispensing, DUR [drug utilization review], claims adjudication, refill authorizations and therapeutic interventions."

Also included in the model language adopted by the NABP was a clear set of requirements for pharmacies performing or outsourcing central-fill prescription drug processing. Those pharmacies linked in a central-fill network, the new model rules stipulate, must have the same owner or at least a written contract outlining the services to be provided and spelling out the responsibilities of each party in complying with federal and state law. In addition, they must share a common electronic file or at least "the appropriate technology" to allow for information sharing.

Drug store operators opting for central fill also must maintain appropriate records, adequate security to ensure patient confidentiality and mechanisms for tracking prescription orders, assuring quality and identifying all pharmacies involved in the dispensing of the order, according to the model language. In addition, the new rules state that all drugs dispensed must include a label "containing an identifiable code that provides a complete audit trail of the dispensing of the drug and pharmaceutical care activities," according to the NABP.

Issuing its report, the central fill task force also recommended that NABP convene a new study group to scrutinize Internet pharmacy dispensing.