Commonly Asked Questions
CPESN® USA Frequently Asked Questions
What is CPESN® USA?
CPESN® USA a clinically integrated, nationwide organization of local networks whose participating pharmacies are accountable for the care they provide to patients.
The benefits of evidence-based, patient-centered care – both in cost savings and improved quality of care – are proven. CPESN USA harnesses the value of individual, community-based pharmacies that each provide enhanced services into a collaborative organization that delivers evidence-based care and services to thousands of patients.
A network of high-performing, accountable pharmacies is attractive to patients and payers – both public and private. Patients and payers benefit when quality of care improves and overall costs decrease. The pharmacies that produce these results benefit by sharing in the cost savings and being rewarded for performance.
Being part of CPESN networks empowers community-based pharmacy practice by recognizing the value of enhanced services and encouraging other care providers to include community-based pharmacies in the patient care team. As part of a broader patient care team, CPESN pharmacies integrate with the other providers to coordinate medical treatment. Care coordination leads to better medication adherence, higher patient satisfaction, and lower healthcare costs. All of which are valued by payers and patients.
CPESN® pharmacy provider networks are now in 45 states across America.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Is CPESN USA owned by, partnered with, or aligned strategically with any owned by 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.
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.
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.
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.
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 Participation Fees
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.
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.
Why does CPESN USA charge a $95 participation fee?
The $95 participation fee is an investment in the quality assurance and reporting functions that enable CPESN networks to concretely show that the enhanced services offered by its pharmacy providers do improve healthcare. Payers require performance reports to assess the value of the offering and then to reward outcomes tied to performance. The fees also provide financial support for CPESN clinical integration programs and basic organizational operations. A portion of every member’s participation fee is returned to the local network to support its programing and operations.
Like any investment, the participation fee shows your belief in the value that CPESN networks offer to the marketplace and that you are willing to support that belief with skin in the game. Like other clinically integrated healthcare provider networks across the U.S., CPESN pharmacy networks improve the quality of healthcare and patient outcomes, lowering overall costs in the long run. The improvements in quality and cost are possible only through collaboration and adherence to service sets, which is spurred by altruism and the risk of failure. If the network doesn’t meet its quality and cost measures it will fail because it hasn’t performed. If it fails, participants lose their investment. So, in addition to the organizational functions that the $95 fee supports, the fee is a concrete way to identify those pharmacies that believe in the potential of CPESN networks and that are willing to invest the time, effort and money to make it successful.
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 is used to manage invoices and credit card payments. Four local networks offer collection of CPESN USA fees as of July 2020:
Pennsylvania Pharmacists Care Network, and
the RxSelect CPESN®
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.
Will check payments be accepted?
Yes, a participating pharmacy can pay in advance for a full fiscal year with a check.
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 email@example.com 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.
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.
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.
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.”
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.
Are CPESN USA participation fees refundable?
No. CPESN USA participation fees are not refundable.
Participation Fee Drafting Questions
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.
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.
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.
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.
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.
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.
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 firstname.lastname@example.org.
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.
If a pharmacy terminates its participation, how does it 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.
Care Planning Requirements
Does CPESN USA have a care planning requirement?
Within the CPESN Quality Assurance standard, which has been approved by the CPESN Board of Managers, there is a requirement of 10 care plans per quarter.
When are pharmacies required to begin meeting the care plan requirement?
Pharmacies have 6 months after they have joined CPESN USA to begin documenting care plans.
Which technology solutions offer the ability to document care plans and send them to CPESN USA for quality assurance purposes?
A current list of technology solutions can be found on the eCare Plan Initiative website by clicking: https://www.ecareplaninitiative.com/software-solutions.
How do CPESN Pharmacies know if CPESN USA received the care plan that they submitted?
Each CPESN pharmacy has a collaboration site profile. In the profile, the care plan submission count and the confirmation number is updated regularly.
What should a pharmacy do if a care plan was submitted, but their chosen technology solution did not accurately transmit that care plan to CPESN USA (meaning the pharmacy has not received credit for the submitted care plan)?
The pharmacy should complete this questionnaire: http://careplanissues.cpesn.com/ so that the CPESN technology team can research the care plan submission alongside the chosen technology solution.
If a pharmacy has multiple locations, do they need to submit a care plan at each location?
Yes, each pharmacy that has its own NPI affiliated with CPESN USA needs to submit 10 care plans per quarter beginning six months after the join date.
Why is there a requirement to submit care plans?
There are numerous reasons that care planning is important to the future of local community-based pharmacies. CPESN USA distributed to CPESN U videos that describe the spirit and the essence of care planning. Click here and check them out:
Reason #1 to do Care Planning: https://conta.cc/2Zoib5x
Reason #2 to do Care Planning: https://conta.cc/2NdBehB
Reason #3 to do Care Planning: https://conta.cc/2YbJvmy
Reason #4 to do Care Planning: https://conta.cc/32wLgNZ
Additionally, CPESN USA is a clinically integrated network (CIN) of community-based pharmacies. There are a number of legal requirements to which a CIN must abide, and one of them is having minimum standards for participation. See more information on our minimum standards further down the page. Another key requirement of a CIN is using data (usually clinical data) to drive quality assurance and quality improvement efforts. CINs of medical providers typically accomplish this by sharing data from their electronic medical record with the CIN. Since pharmacies don’t have full medical records, CPESN USA is using pharmacy care plans as our clinical data to drive overall performance and quality.
Remember that you as a pharmacy provider own your data and can direct it where to go, unless you’ve given those rights away. The participation agreement that you signed with CPESN USA limits our use of your data to the following: 1) for quality assurance and quality improvement efforts; 2) for care coordination with other care team members; and 3) for program administration, such as with use in a payer program.
While CPESN USA has several minimum standards to which CPESN pharmacies must adhere, the Quality Assurance standard (shown below) is the standard that is driving care plan submission requirements.
Summer 2020 Recruitment Event
During the CPESN USA Summer 2020 Recruitment Event, how much does a new pharmacy need to pay to participate in CPESN USA?
From May 20, 2020 to August 31, 2020 any new pharmacy who signs the CPESN participation agreement will have its monthly participation fees waived for June 2020, July 2020, and August 2020. That is a savings of up to $255-$285 per pharmacy.
(As of May 20, 2020 the monthly participating fee is $95 per pharmacy with a $10 per month discount for 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.
Are current participating pharmacies eligible for the Summer 2020 Recruitment Event promotion?
No, participating pharmacies enrolled prior to May 19, 2020 are not eligible and will not have their monthly participation fees waived.
Can new pharmacies participate in an existing or new payer program?
Yes, participating pharmacies are eligible for payer programs; however, if a pharmacy chooses to participate in an active payer program they lose their eligibility for the Summer 2020 Recruitment Event and must pay monthly participation fees.
How can a pharmacy join CPESN USA?
Type in https://join.cpesn.com/ into any web browser (Chrome preferred) and complete the brief online form.