Pharmacy Support

Aligning a patient’s routine medications to be filled at the same time each month. The pharmacists will provide clinical medication management and monitoring for progression toward desired therapeutic goals during the patient appointment at time of medication pick-up or delivery. 

Screening patients for ACIP recommended immunizations, educate patients about needed immunizations and administer immunizations when appropriate. 

Comparing a patient’s medication orders to all of the medications that the patient has been taking (active, chronic, as needed and OTC including herbal) to avoid medication errors. This service is especially important during transitions of care when patients are most vulnerable to medication errors or mishaps. 
 

Providing each patient a comprehensive list of current patient medications manually or from dispensing software. 

Providing each patient receiving a dispensed medication from the participating pharmacy ready access to unscheduled face-to-face meeting(s) with a pharmacist employed by the participating CPESN pharmacy during operational hours. For pharmacies not staffing a pharmacist during operational hours, a non-pharmacist involved in the patient’s care must be available for the unscheduled face-to-face visit as well as a pharmacist via appropriate telecommunication methods upon request by the patient or the pharmacy staff-person who provides service in support of that pharmacy.

Pharmacy must have workforce member(s) that is locally available, employed by the pharmacy and is capable to deploy in the community to provide billable enhanced services (i.e. community vaccination clinic, health screenings, point-of-care testing)

• Use of mailing for delivery shall be limited to maximum of 10% of prescriptions filled via UPS, USPS, FedEx or similar. This does not include contracted courier services whereby workforce may be trained to execute trainings and other patient-related services.
• Pharmacy services no more than 10% of non-facility patients outside of 50-mile radius of registered pharmacy location. A waiver may be applicable in circumstances where a pharmacy is serving a population in rural areas.
• Pharmacy must be willing and capable to meet all CPESN Technology, Compliance, Quality Assurance Data Collection and Transmission Standards.
• Pharmacy must select a primary local network when joining CPESN

• Pharmacy must have a LTC NPI [CMS Requirement]
• Pharmacy must provide delivery of medications to patients [CMS Requirement]
• Pharmacy must offer adherence packaging services [CMS Requirement]
• Pharmacy must provide Transitions of Care Management: Support the needs of patients transitioning between levels of care by providing medication reconciliation and communicating with the patient and other health care team members [CMS Requirement]
• Pharmacy staff is available 24 hours a day, 7 days a week (as defined in CMS guidelines) [CMS Requirement] 
• Pharmacy must provide or assist in providing patient with sterile compounding medications [CMS Requirement]
• Pharmacy must have capacity to provide IV medications to LTC resident as ordered by a qualified medical professional. [CMS Requirement]

CPESN USA was created to provide local networks of independent community pharmacy with 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. CPESN USA's objective is to empower local CPESN networks—and will not compete with them.

There currently are 49 CPESN USA networks in 44 states, and 3,540 participating independent community pharmacies. 

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. 

CPESN USA uses outside counsel to continually review the organizational structure and goals and to ensure that CPESN USA meets all the criteria of a clinically integrated network.

A clinically integrated network can engage with payers, purchasers, and partners as a single contracting organization. For CPESN USA, that means the ability to engage on behalf of its local networks and participating pharmacies under a single contract. With 3,540 pharmacies, CPESN USA is pharmacy’s fourth largest single contracting organization.

CPESN USA is a limited liability corporation with 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.

The CPESN USA Board of Managers is led by 28 community pharmacy owners, in addition to one representative for each of the member owners. You will find a listing of our Board of Managers here.

• 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.

CPESN USA supports local CPESN networks, and through the networks, that support extends to participating pharmacies to include:

• Legal and clinic integration expertise
• Payer contracting resources and support
• Marketing resources and support
• Quality and Practice Transformation best practices

Additionally, CPESN USA supports each CPESN participating pharmacy with best practices and information sharing as well as access to vaccine and medicine through the optional Federal Retail Pharmacy Partner program.

The participation fee is $95 per month, per participating pharmacy. Payment options include bank draft or credit card. 

Pharmacy participation fees fund CPESN USA operations and include a shared investment in meeting quality assurance and reporting requirements for clinical integration. Clinical integration allows for:

• Collective marketing of all participants
• Direct negotiation with payers
• Partnerships and risk-bearing arrangement with other providers

Click here to learn more about CPESN USA’s budget process and use of participation fees.

CPESN USA accepts ACH bank draft and credit card.

The pharmacy should e-mail CPESN USA at [email protected] and request to change the method of payment for participation fees. CPESN USA will provide the secure means to collect banking information.

The per pharmacy monthly $95 participation fee is based on the primary network the pharmacy joins. Additional networks may be joined at no added charge from CPESN USA.

No. The $95 per pharmacy, per month fee remains $95 regardless of the number of CPESN pharmacies that join under a single owner.

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 monthly participation fee per pharmacy. As a clinically integrated network, CPESN USA requires participating pharmacies to have a financial commitment to the network of at least 50% of the monthly fee.

Decisions on participation fees for local CPESN networks are made by local CPESN network leaders.

A unique ACH form is required for each participating pharmacy.

Monthly ACH bank drafts process mid-month.

Participating pharmacy locations may initiate disenrollment from CPESN USA by completing a secure electronic form click here. Or the pharmacy may send notice to [email protected]. Refer to the Notices section of the CPESN USA Clinically Integrated Network Agreement for written notices. Please note, outreach may be made by CPESN USA and/or local Network Leadership to the disenrolling pharmacy.

There currently are 49 networks and there are CPESN participating pharmacies in 44 states.

Yes, a pharmacy can participate in multiple local CPESN networks, but will need to designate one as its primary affiliation. The $95 CPESN USA monthly participation fee per store remains the same regardless of the number of local networks a pharmacy participates in each month.

A current list of technology solutions for your consideration can be found on the eCare Plan Initiative website. Click here.

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: 
• Reason #2 to do Care Planning: 
• Reason #3 to do Care Planning:
• Reason #4 to do Care Planning: 

As a clinically integrated network (CIN) of community-based pharmacies, CPESN USA is legally required to maintain minimum standards for pharmacy participation. The requirement for care planning is one of the CPESN USA participation requirements. 

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 where it goes 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 is the standard that is driving care plan submission requirements. You can access the Quality Assurance standard here. Additional questions about CPESN USA Quality programs can be addressed to [email protected].

Pharmacies new to CPESN USA have six months in which to prepare before they are expected to begin submitting eCare plans for quality review. The standard is set by the CPESN USA Quality and Performance Committee.

No. CPESN USA takes care of that by sending its technology partners a list of CPESN pharmacies on a monthly basis to ensure any eCare plans submitted are being sent to CPESN USA on behalf of the pharmacy.

Yes, click here to view the information that you can document as a test/example eCare Plan. Consider reaching out to your selected technology partner for eCare Plan for a use demonstration.  

Yes, each pharmacy that has its own NPI affiliated with CPESN USA needs to submit eCare plans within the first 6 months after joining.

CPESN pharmacies deliver consistent, systemic health services across all locations. Those services are delivered under the brand of EngageRx Services, and are divided into EngageDM, or Disease Management, and EngageSync, or medication synchronization services.

There are currently more than 85 active and contracted payer/purchaser programs. That number is increasing rapidly as results demonstrate how health services delivered by CPESN pharmacies contribute to improved population and individual health outcomes and help lower total cost of care.