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. Right now, there are only two local CPESN networks with solid “network adequacy” — Iowa and Arkansas (as of March 2018). Not coincidentally, those two states are getting the most interest from plan sponsors.
Q. I knew local CPESN networks were forming, but 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.
CPESN® USA Frequently Asked Questions
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. 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. How much is the CPESN USA participation fee?
The participation fee, as agreed upon in your participation agreement, is $85 per month for each participating pharmacy.
Q. If you are in multiple local CPESN networks, will the CPESN USA participation fee increase?
No, the $85 per pharmacy, per month fee remains $85 regardless of the number of CPESN Networks the participating pharmacy joins.
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 $40 per pharmacy, per month (47% of the $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 53% of the required monthly fees which is the portion of the fees that directly cover the costs of clinical improvements.
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. Will CPESN USA draft fees on behalf of a local CPESN network?
If asked to support a local CPESN network, CPESN USA will draft participation fees on behalf of a local CPESN network. That network must be a legal entity and have both a tax ID and bank account.
Q. What if a local network has a legal entity established but does not have a tax ID or bank account? Can they ask CPESN USA to draft local participation fees on their behalf?
CPESN USA can draft participation fees on behalf of local CPESN networks if the local network is both a legal entity and has a tax ID and bank account established.
Q. When starting a new network, when will participation fees begin?
Participation fees for participating pharmacies are due by the 10th of the month following the month they sign their CPESN USA participation agreement. Networks are not charged a separate fee for CPESN services.
Q. Are CPESN USA participation fees refundable?
No. CPESN USA participation fees are not refundable.
Q. What is going to happen to pharmacies that have signed CPESN USA participation agreements but fail to provide Automated Clearing House (ACH) draft information or other means of payment?
Pharmacies that fail to make timely payment of participation fees will violate the contract (in the CPESN USA participation agreement). Pharmacies that fail to make payment for participation fees will receive a notification letter indicating CPESN USA’s intent to terminate the agreement for a material breach. The pharmacy will have ten (10) days to provide payment for participation fees, otherwise the agreement will terminate and the pharmacy would need to sign a new participation agreement if they choose to rejoin in the future. At this time CPESN accepts monthly payments for participation fees by ACH or the participating pharmacy can pay in advance for a full fiscal year with a check.
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. Do I need to do anything other than complete the ACH Authorization Form?
No, as a participating pharmacy, you do 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 my CPESN USA participation agreement, am I able to complete a single ACH form for all locations? What if I need 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 I terminate my membership, how does this affect my 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.
Q. Will credit card payments be accepted?
Due to the cost, CPESN USA is not currently accepting credit card payments, but we are looking into this option.
Q. Will check payments be accepted?
Yes, a participating pharmacy can pay in advance for a full fiscal year with a check. As a reminder, participation fees paid to CPESN USA are non-refundable.