how to choose hospice why pharmacies

Use of Hospice Pharmacia does not force a person to wait 24 hours for their medication! Meds are available through almost every local pharmacy in our coverage area. We can access a 4 day supply immediately. We also have an emergency kit in the home already which will allow us to access those medications when suddenly need without requiring a trip to the pharmacy at 2 am! (And just try to find a pharmacy open at 2 am…they are few in a rural area)

My purpose is not to defend the use of “closed” pharmacies, but merely to set the record straight on that point. I have looked at the offerings of many such pharmacies and I had not seen any that did not make a provision for getting medications into the home when they are needed.

the idea of using any local pharmacy is ridiculous. Most local or community pharmacies are barely aware of the laws pertaining to hospice patients, making it more difficult to obtain medications. Frequently local pharmacies do not have the types of medications hospice patients use(i.e transdermal meds, iv’s, etc….)Also, those pharmacists are not specialist in the area of palliative/hospice care. Most physicians are not familar with how to prescribe for end of life care and a specialty pharmacist is the biggest help to us nurses and physicians. They know what meds are best for what. I agree with the last person. Hospice pharmacia has a special pak that is placed in the home at the time of admission and addresses most emergency symptom management. They also allow you to obtain meds from the local pharmacy same day. So your idea that you should not use a hospice with a “closed” pharmacy is crazy. You obviously didnt do your homework on the benefits of using specialty pharmacies. how many mom and pop pharmacies are availble 24/7 for palliative care consults??? NOT MANY. They may know what the names of meds are but they are not well educated in hospice pharmacy which is very specialized. So, before you post anymore blogs on inaccurate information, you should do a little research. thank you – HOSPICE MSN CRNP Hospice nurse practitioner.

I suspect the last two comments were left from Hospice Pharmacia employees. They are correct that HP uses emergency kits, but there’s nothing the blogger wrote that is incorrect or unresearched, or even controversial in my view.

HP has talented staff, but they are out of town and cause delays, especially on the phone. Hospice is a local mission and in most communities it makes sense to keep the partnerships locally.

There are exceptions of course, and I’m sure Hospice Pharmacia does a good job.

Our hospice has used Hospice Pharmacia for about 5 years. I have to admit, when they first said we were going to use a pharmacy out of state and have meds sent by FedEx, I thought it sounded crazy. After 5 years, I have to say it works better than the local pharmacy we used to use. Advantages are: [1] the comfort pack, [2] FedEx deliveries are very reliable. I have had only 2 deliveries go astray, out of thousands and one was due to incorrect zip code. The other delivery was tracked down and delivered correctly the next day. [3] FedEx delivers in daylight hours. No more 10 pm deliveries of routine meds. [4] I can get meds that are not controlled meds from any pharmacy that has them. [5] We have a network of pharmacies that promise to carry the controlled meds (Roxanol, Lorazepam Intensol, etc) and we know which ones are open 24 hrs. Sometimes that involves driving to that 24 hour pharmacy, but I have heard very few complaints about the way we are doing things. Our goal is always to ensure the patient comfort, and we have been able to do that under this system.

Most of the Walgreens, CVS, Rite Aide, Wal Mart, Target, Kroger, Albertsons, etc. pharmacies do not routinely carry CII narcotics, so writing off “Closed door” pharmacies is ridiculous. As with anything else, you have to evaluate the service you receive, whether the pharmacy is down the street or 1500 miles away.

JG

Our hospice switched over to HP a few years ago. Contrary to popular opinion…it wasn’t to cut costs. We cover a pretty large service area including several “rural” communities. Trying to manage our patients pharmaceutical needs relying soley on the local “open door” pharmacies was a nightmare. As has been said by others…not all towns have pharmacies that are able to maintain the drugs our patients need. The second quality initiative was providing “emergency comfort Paks”. Anyone who’s been in hospice for awhile knows that patients can develop unexpected symptoms…and they usually do so in the middle of the night. We tried researching what it would take for us to make up our own packs and it was a truly overwhelming project. With HP all of our patients are assessed and if it’s safe we put a Comfort Pak in the home for “emergencies”. Our On Call staff are extremely pleased with the outcomes. I have had several family members praise them as well…saying things like “It was such a relief to be able to do something to make mama feel better while we were waiting on the nurse to get here…I didn’t feel quite so helpless”
Our patients continue to get their non hospice meds from their regular pharmacies and we do purchase same day rxs from these local pharmacies if needed to maintain the patient until the meds arrive.
Last word…has it occurred to you what a relief it is for the family not to have to keep running to the pharmacy? Before we switched we use to limit the number dispensed to a 14 day supply…as I believe is common practice for most hospice providers…the families love having the meds delivered to their homes!
And no I am not a HP employee…if anything I’m probably one of their more demanding customers…and yet I am pleased with the service they have provided and consider your painting “closed door” pharmacies with such a broad brush a poor indication of your “Neutrality”

We too are a more rural hospice and getting our meds via UPS, FedEx, or reg mail. Generally not a problem except for the number of calls required to re-order scheduled. We’ve been told that the pharmacy cannot automatically ship scheduled medications due to Medicare or Medicaid rules. Likewise we are told we have to contact the physician when the refills run out. This creates more calls. Do other mail hospice pharmacies provide automatic shipment of scheduled meds? We may have to change pharmacies if they do. Thanks

Do other mail hospice pharmacies provide automatic shipment of scheduled meds?

I can only speak of my experience with Hospice Pharmacia. There is no automatic shipment of meds. You have to call the Pharmacy Tech or access the automated refill line or go on line. Most meds are filled every 15 days. Sometimes they will agree to provide 30 day supply of routine daily meds (like Lasix or Dexamethasone, for example), if you assure the pharmacist that the patient is relatively stable, as hospice patients go.

The issue about refilling prescriptions for non CII meds is pretty simple and can be taken care of with a phone call by the hospice nurse.

No, I am not an HP employee, but have been using HP for about 7 years. It has not all been smooth sailing; like belladonna, I think I am a fairly demanding customer.

JG

Mail order is a #2 choice — only a good choice if there is not a local pharmacy that is specialized to work in hospice hospice care settings. Also, local pharmacies, in addition to not having specialized capability, don’t seem to like dealing with Hospice Pharmacia.

HP's model of getting a few days supply at local pharmacies has hurt hospices reputation in their communities. It isn't fair to expect your local pharmacy to keep limited amounts of expensive drugs on hand – they make no money off of a 3 day supply. Also, HP is overcharging hospices by charging a fixed cost per day. We have saved money by paying only for what we use. Also, HP forces hospices to use such a strict formulary you are always getting charged extra. There are other options, hospice pharmacy benefit managers, that let you use both local pharmacies AND have the optional mail-order too – AND get consults with hospice PharmDs. Having local relationships in the community is important. If a patient has been using the same pharmacist forever and is already getting his non-hospice meds there, it can be an easier transition into hospice for him and his family. On the other hand, sometimes a patient in a rural area can really benefit from mail-order. You actually can have both. There are a few hospice PBM's out there… I would suggest any hospice that's looking to research all the possibilities and find a good fit for your hospice. A good place to start is to search NHPCO's website, Vendor Guide, pharmacy providers.