CarePointsFourth Quarter 2017

Implementation of the CMS “Mega Rule”: Phase 2 Effective November 28, 2017Are you ready for Phase 2 of the medication related changes required by the Medicare and Medicaid Programs Reform of Requirements for long-term care facilities?

We’re dedicated to providing solutions to assist you in staying compliant with regulatory requirements, enabling you to provide optimal quality of care. Our consultant pharmacists can help your facility navigate the new and upcoming CMS requirements.

Medication Related Changes for Phase 2

Monthly drug regimen review (DRR): A pharmacist must conduct required DRR each month, including a review of each resident’s medical chart. This requirement applies to all residents (whether short or long-stay) without exception. DRR should include collaborating with the appropriate members of the interdisciplinary team, including the resident, their family, and / or resident representative.

14-day restriction for antipsychotic and other psychotropic drugs: Psychotropic drugs may only be prescribed if necessary to treat a diagnosed and documented condition. New orders for PRN antipsychotic drugs beyond 14 days will require a resident evaluation to determine if a new order is appropriate. Other PRN psychotropic drug orders beyond 14 days must be accompanied by documentation in the medical record of the duration and rationale for extended use.

Antibiotic stewardship program: As part of their infection prevention and control program, facilities

must develop antibiotic use protocols and a system to monitor antibiotic use. One component of this program includes the pharmacist assessing, monitoring, and communicating information related to antibiotic use to the facility.

Omnicare provides updated policies and procedures to assist your facility with pharmacy’s participation in the new CMS requirements. These procedures are available electronically on Omniview.

To learn more, contact your Account Manager.

1 Implementation of the CMS Mega Rule Phase 2

2 2018 Medicare Part D Annual Enrollment

3 Supporting Your Antibiotic/Antimicrobial Stewardship Initiatives

4 Small Volume Infusion Solutions and Amino Acids Shortages Continue

Editorial BoardJoseph Montano Manager, Sales and Marketing

Beth Coryea, Pharm D Director, Strategic Accounts

Barbara Connolly, MS, RPh Director, National Accounts LTC

Greg Sciarra, RPh Vice President, Internal Operations LTC

Contributing Authors for this Issue

Corinne Bishop Director, National Infusion Nursing

Kelly D. Rennick Director, Digital Adoption

Robin Taylor Sr. Director, Account Management

In This Issue

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2018 Medicare Part D Annual Enrollment Only 13% of Medicare beneficiaries change plans from year to year. With many residents on a fixed income, it is essential to research plan options to avoid higher premium and co-pays in the new plan year. OmniPlanFinder is an exclusive tool available for Omnicare residents and responsible parties to easily compare the total cost of their medications among all Part D plans.

This year, Omnicare pharmacy is a preferred pharmacy provider in a number of major Medicare Part D Prescription Drug Plans that are available to our Assisted Living customers. More than 5 million members are a part of these plans.

It’s easy for residents to view preferred plans and see how much they can save on out-of-pocket costs by using our OmniPlanFinder tool. It is also easy for the dual-eligible beneficiaries (those who have both Medicaid and Medicare coverage) to find a Zero Premium plan that covers all or the majority of the medications they receive. For more information on the tool, visit omnicare.com/omniplanfinder or contact your Account Manager.

With the end of the year upon us and the New Year right around the corner, we’d like to take

this time to thank you for the opportunity to serve you in 2017. We look forward to continuing to provide pharmacy services

to you and your residents in 2018. We wish everyone a safe and happy holiday season!

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Supporting Your Antibiotic/Antimicrobial Stewardship Initiatives We’ve made enhancements to the Antimicrobial stewardship report available on Omniview to align with the updated Mega Rule requirements that went into effect on November 28, 2017.

As of November 20, 2017, Omniview antimicrobial reporting will include:

Antibiotic Only View Users will now be able to view antibiotic utilization on its own through the Antibiotic only view option and toggle between it and the original Antimicrobial version.

All Routes of Administration The original report excluded topical, otic and ophthalmic routes of administration. Historic data will recalculate to include these added routes of administration.

Access for all Post-Acute Customers Omniview’s Antimicrobial reporting was previously only available for customers sending census to Omnicare electronically. Now, customers who are not taking advantage of our electronic census capability can view the report, export the information to excel and enter their census information manually. Customer metrics will auto calculate in excel once census data is populated.

Providing convenient access to data is critical to monitoring the impact of your activities is just one of many ways Omnicare can support your stewardship activities. To learn more please contact your Omnicare representative.

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Small Volume Infusion Solutions and Amino Acids Shortages Continue Amino Acids, Mini Bags and Mini-Bag-Plus 50mL and 100mL product shortages continue to plague hospitals, clinics and pharmacies worldwide. The available supply of these products has been severely impacted by Hurricanes Irma and Maria, causing closures to Baxter manufacturing facilities in Puerto Rico.

Baxter, a global leader in the manufacturing of infusion solutions and products, has also reported critical shortages of Amino Acids, the protein component of parenteral nutrition solution.

Omnicare/CVS Trade Relations teams continue to work daily to manage the shortages. The situation remains dynamic with alternate products being sourced to meet the needs of our customers.

In an effort to address the ongoing shortages, Baxter is coordinating with the US Food and Drug Administration (FDA) to improve the availability of critical IV solutions. Baxter has initiated the temporary importation of products from manufacturing plants in Ireland, Mexico, Australia and Canada.

Products coming from different countries contain some slight differences, particularly with regards to packaging, description and labeling. Although the packaging and labeling may appear different, all imported product administration port systems are compatible with Baxter administration spikes sets used by Omnicare pharmacies.

The availability of the imported products is a welcome development. Our hope is that the import of products will prevent the need to use alternative administration methods. However, at this time, we cannot guarantee that.

Omnicare has implemented several inventory control and pharmacy operational strategies to ensure safe and effective infusion products are available. Omnicare Infusion pharmacies have been provided an algorithm to determine the best way to deliver the infusion medication that will provide optimal outcomes for the

patient, while minimizing the impact to nursing staff responsible for the administration. The algorithm includes a variety of alternative administration methods including, but not limited to:

• Use of imported products, when available

• Use of commercially available, pre-mixed, ready-to-use formulations

• Conversion to alternative point-of-care activated admixing systems (Pfizer ADD-vantage Infusion System in lieu of Baxter Mini Bags and Mini Bag Plus system)

Nursing Considerations: Instructions for use for alternate point of care activated systems are available in the Critical Shortage Guidelines: Customer Resource Packet on Omniview.

• Administration of intermittent medications as continuous infusions (24 hour bags) via

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CADD or Curlin Ambulatory Pumps, or Sigma Spectrum Infusion Pumps

Nursing Considerations: Omnicare Infusion Pharmacists will make every effort to pre-program the pump for intermittent infusion of the prescribed medication with a basal rate in between the intermittent delivery of medication. In the event the nurse inadvertently “clears” the program she/he will need the steps for re-programming a multistep program. See Critical Shortage Guidelines: Administering Intermittent Anti-Infective Medications as a Continuous Infusion via Sigma Spectrum Infusion Pump found in the Critical Shortage Guidelines: Customer Resource Packet on Omniview.

• Administration of infusion via the intravenous “push” (IV Push) route or intramuscular (IM) route where clinically appropriate

Nursing Considerations: Omnicare has included Guidelines for IV Push Administration, IV Push Administration Procedure, and IV Push Skills Checklist in the Critical Shortage Guidelines: Customer Resource Packet located on Omniview. Staff administering IV Push medications may only do so if allowable by State Nurse Practice Act and when competencies have been demonstrated and documented.

• IV to PO conversion when medication bio-availability is equivalent and patient can tolerate oral medications

Nursing Considerations: IV to PO conversion recommendations will require additional prescriber follow up and verification of orders to convert from IV to PO.

Recommendations for alternate, clinically equivalent medications or solutions that may be more readily available in pre-mixed, ready to use formulations

Nursing Considerations: Conversion recommendations for alternative medications will require additional prescriber follow up and verification of prescriber orders to convert.

• Conversion of prescribed parenteral nutrition formulations to more readily available products including Clinimix and compounded TPN solutions containing lower Amino Acid concentrations

Nursing Considerations: Conversion recommendations for alternative products will require additional prescriber follow up and verification of prescriber orders to convert.

We remain steadfast in our efforts to closely monitor the critical shortages. Omnicare infusion staff is available to assist with any questions you may have regarding the shortages, alternative solutions and recommendations.