Commonly Asked Questions
CPESN® USA Frequently Asked Questions
Q. What is CPESN® USA?
CPESN® USA is a clinically integrated network of community pharmacies across America.
Q. What does the term ‘clinically integrated network’ mean?
The term clinically integrated network is fairly new to the pharmacy industry, so there is a chance you might not have heard of it. A clinically integrated network is a collection of health care providers that demonstrates value to the market by working together to facilitate the coordination of patient care across conditions, providers, settings, and time to improve patient care and decrease overall healthcare costs.
It is meaningful because a clinically integrated network of pharmacists can engage with payers to receive a share of the dollars that payers save in patient care costs as a result of the services provided by the clinically integrated network.
Q. Is CPESN USA a clinically integrated network?
Yes, CPESN USA is a clinically integrated network of participating community pharmacies. The primary objective of CPESN USA is quality improvement through new enhanced services and improvement on existing service offerings. CPESN USA uses outside counsel to continually review the organizational structure and goals and to ensure that CPESN USA meets all of the criteria of a clinically integrated network.
Q. What is the value of being a clinically integrated network?
By being part of a clinically integrated network, participating pharmacies can engage with each other to improve the quality of care offered to patients and to offer value to payers through enhanced services and lower costs. CPESN USA is clinically integrated which allows its networks of higher quality, lower cost pharmacies to engage with payers.
Q. PBM contracts signed for pharmacies are "take-it-or-leave-it" contracts. Won't this just be more of the same?
PBMs aren't the target audience for the clinically integrated network. CPESN USA’s focus is the medical side of a health benefit, where savings are achieved from proper medication use and management. A clinically integrated network provides a different type of value to the plan sponsor. For example, maybe the plan sponsor has a group of patients who are increasing its costs. The plan sponsor could engage the clinically integrated network to manage that group of patients, working with other healthcare providers. If the network helps to lower the patient care costs, depending on the contract with the payer, the clinically integrated network can share in the savings, and/or they are paid for their service, potentially in new ways.
Q. Is a "payer" a "plan sponsor"?
Sometimes. Not always, though. Often times, the term "payer" used when "plan sponsor" is what is really meant. The distinction is important. A plan sponsor is at the top. It is the entity ultimately writing the check. It is usually employers, the government (aka taxpayers) or individual consumers who buy their own health insurance. Those three groups often directly or indirectly hire other entities ("payers") to take their money and pay the providers. So, a payer could be a health insurance plan, PBM, or plan administrator. A pharmacy often has to deal with the pharmacy-side payer, not the medical-side payer. The design of CPESN networks is to collaborate with plan sponsors and medical-side payers trying to manage their total health care costs.
Q. How many plan sponsors currently contract with the CPESN network?
There are dozens of local CPESN networks. Each one of those networks is identifying plan sponsors in its region (usually the state). There is a high level of interest because this is innovative and different from what plan sponsors are used to seeing. The plan contracting process is slow. The main hurdle to be cleared is "network adequacy." Having network adequacy is essential to win a contract.
Q. What is network adequacy?
The clinically integrated pharmacy network must have enough pharmacies in it to adequately cover the plan sponsor's patients that needs the network’s services.
CPESN® USA Frequently Asked Questions
Q. Why was CPESN USA created?
CPESN USA is a shared services entity for local CPESN networks to have a national presence and economy of scale for clinically integrated activities such as best practices and shared quality reporting. Its goal is to be transparent and take direction from its networks and participating pharmacies through provider run governance and a straightforward participation fee structure without "middlemen cuts.” CPESN USA's objective is to empower local CPESN networks—and will not compete with them.
Q. Does a pharmacy need to be in CPESN USA in order to be in a local CPESN network?
Yes, in order to be included in a local CPESN network, a pharmacy must also participate in CPESN USA.
Q. Can a pharmacy participate in more than one local CPESN network?
Yes, a pharmacy can participate in as many local CPESN networks as they wish. The CPESN USA participation fee remains the same regardless of the number of local networks a pharmacy participates in each month.
Q. Who owns CPESN USA?
CPESN USA is a limited liability corporation. CPESN USA has two non-profit member owners: Community Care of North Carolina [501c3; www.nccommunitycare.org] and the National Community Pharmacists Association [501c6; www.ncpanet.org]. Both have 50% ownership. CPESN USA is governed by a Board of Managers which is comprised of representatives from the local CPESN networks.
Q. Is CPESN USA owned by, partnered with, or aligned strategically with a pharmaceutical wholesaler?
CPESN USA is not owned, in whole or in part, by any pharmaceutical wholesaler. And, CPESN USA welcomes support by any and all wholesalers, but is not partnered with or aligned strategically with any specific wholesaler. A pharmacy can switch wholesalers without impacting their participating in CPESN USA.
Q. Is CPESN USA owned by, partnered with, or aligned strategically with any group purchasing organization (GPO)?
CPESN USA is not owned, in whole or in part, by any group purchasing organization. And, CPESN USA welcomes support by any and all GPOs, but is not partnered with or aligned strategically with any specific GPO. A pharmacy can switch GPOs without impacting their participating in CPESN USA.
Q. Since CPESN USA is governed by a Board of Managers, how are those seats appointed?
The CPESN Board of Managers was constructed to consist of 2 types of Managers:
• Member-owner appointments – Each Member-owner appoints one Manager
• Local Network appointments – Each Network with at least forty (40) participating pharmacies appoints 1 Manager. Each Network with at least four hundred (400) participating pharmacies appoints 2 Managers.
Q. Can another company or individual become an owner of CPESN USA?
Yes, with unanimous written consent of the Member-owners, so long as the initial Member-owner (CCNC and NCPA) will retain a majority interest. If the entrance of the additional investor would cause the combined ownership interest of the initial Member-owners to be less than 51% than in addition to the written consent, receipt of written consent from a majority of affirmative votes of all votes cast by participating pharmacies is required.
Importantly, ownership of each local CPESN network remains with the local network.
Q. What happens if NCPA or CCNC wants to sell their equity stake in CPESN USA?
All transfers of equity interest (except for transfers between owners and transfer between owners and their affiliates) require at a minimum, unanimous written consent of all Members.
CPESN® USA Frequently Asked Questions
CPESN USA Participation Fees
Q. When did CPESN USA start collecting participation fees?
The collection of CPESN USA participation fees began in April 2018. Back then, three options for fee collection were offered: monthly bank drafting, annual invoices, or local network fee collection, with the caveat that CPESN USA has the option to assess the efficiency and effectiveness of each mechanism at any point in time and consider changes to fee collection options.
Q. What is the current monthly fee for participation in CPESN USA?
As of July 2019, the participation fee is $95 per month. However, there a $10 per month discount to any pharmacy who uses a means of payment that is most operationally and financially efficient for CPESN USA and its networks. Those payment options include bank drafting or local network fee collection.
Q. Does CPESN use any third parties to assist with fee collection?
CPESN USA uses its bank, First Citizens Bank, to manage the monthly bank drafting. Stripe will be used to manage invoices and credit card payments beginning in July 2019. Four local networks offer collection of CPESN USA fees as of July 2019: RxSelect, Pennsylvania Pharmacists Care Network, Colorado CPESN, and LaCPESN.
Q. What methods of payment does CPESN USA accept?
CPESN USA accepts bank drafting, local network fee collecting, credit card processing, and annual invoicing. The $10 discount is only available for pharmacies choosing bank drafting or local network fee collection.
Q. How can a pharmacy inform CPESN USA that they want to change their means of participation fee payment?
The pharmacy should e-mail CPESN USA at firstname.lastname@example.org and request to change the method of payment for participation fees. CPESN USA will create an account for the participating pharmacy in Stripe and send them an initial invoice, where the pharmacy will be asked to select the means by which future monthly participation fees will be paid. This is where the pharmacy will have the option to choose credit card payments.
Q. If a pharmacy is participating in multiple local CPESN networks, will the CPESN USA participation fee increase?
A participating pharmacy will only be charged the monthly $95 fee for the primary network the pharmacy joins. Additional networks may be joined at no additional charge from CPESN USA.
Q. If multiple pharmacies under common ownership are participating in CPESN, is there a volume discount on the participation fee?
No. The $95 per pharmacy, per month fee remains $95 regardless of the number of CPESN pharmacies that join under a single owner.
Q. Can CPESN USA participation fees be subsidized by a local network sponsor or partner?
Yes, a third party can subsidize CPESN USA participation fees up to a limit. Local networks can find sponsors or partners to offset up to $45 per pharmacy, per month of the $95 per pharmacy, per month fee or up to $40 per pharmacy, per month of the discounted $85 per pharmacy, per month fee. As a clinically integrated network, CPESN USA requires participating pharmacies to have a financial commitment in the network, commonly referred to as “skin in the game.” Each participating pharmacy’s financial commitment must be at least 50% of the required monthly fees in order to demonstrate “skin in the game”.
Q. In addition to CPESN USA participation fees, will a local CPESN network charge participation fees?
Decisions on participation fees for local CPESN networks will be made by the local CPESN network leaders.
Q. Are CPESN USA participation fees refundable?
No. CPESN USA participation fees are not refundable.
CPESN® USA Frequently Asked Questions
Participation Fee Drafting Questions
Q. What is ACH drafting?
The Automated Clearing House (ACH) service is a safe and convenient way to electronically collect bill payments for insurance, mortgage, utilities, and loan payments from customers or business partners. ACH can also be used to collect membership or participation fees. The Automatic Payments service requires a participant to grant authority in writing to submit the transaction.
Q. Who is performing the ACH drafting?
CPESN USA is utilizing the ACH service offered by our financial institution, First Citizens Bank, to collect participation fees from CPESN pharmacies on a monthly basis.
Q. Why is using ACH draft beneficial to the participating pharmacy?
For a busy pharmacy, writing checks each month is a time-consuming practice. Utilizing ACH frees up time. There are no charges on credit cards that could accrue interest. Automatic drafting allows for payments to be set on autopilot. The pharmacy also benefits from the increased security of ACH payments over physical checks.
Q. Why is using ACH draft beneficial to CPESN USA?
From CPESN USA’s perspective, this process drastically reduces the administrative burden caused by accepting checks and depositing in to the bank, handling lost checks, and manually monitoring collections. Electronic payments are received quickly and reliably, can be utilized over long distances, and less costly than credit card payments.
Q. How does the service work?
Each pharmacy will provide authorization for CPESN USA to make ACH withdrawals in writing by completing the ACH Authorization form via DocuSign. Beginning the first month after singing the participation agreement and recurring on the first of each subsequent month, CPESN USA will automatically draft from each pharmacy’s account, which will appear as a debit on your bank statement. For the first payment, the ACH Authorization form needs to be submitted to CPESN USA by the 20th of the month, in order for withdrawals to begin on the 1st of the following month.
Q. Does a pharmacy need to do anything other than completing the ACH Authorization Form?
No, a participating pharmacy does not need to anything other than provide written authorization and banking information via the ACH Authorization Form. There is no need to make changes to your bank account.
Q. If multiple pharmacies are listed on a CPESN USA participation agreement, can a pharmacy owner complete a single ACH form for all locations? What if the pharmacy owner needs to designate different ACH information for each location?
If multiple pharmacies are identified on one participation agreement and entities are under the same tax identification number and use the same bank account information, a single ACH form may be submitted. If pharmacies listed on the participation agreement fall under different tax identification numbers OR use different financial institutions OR different bank accounts, then a unique ACH form will need to be submitted for each participating pharmacy. Additional ACH forms may be requested from email@example.com.
Q. When will the ACH draft occur?
On the first of each month, the participating pharmacy shall pay to CPESN USA the total participation fee that is owed no later than ten (10) days following the end of each month in which pharmacy is participating in CPESN USA.
Q. If a pharmacy terminates its membership, how does this affect their ACH draft?
In the event of termination, any participation fees owed by pharmacy shall be paid to CPESN USA within thirty (30) days of termination. The participation fee for the last month in which pharmacy is a participating pharmacy shall be prorated to the date of termination. CPESN USA legal team will notify finance upon termination request. The CPESN USA Pharmacy Participation Agreement outlines requirements for contract termination.