Shannon Battle (00:05):

All right, well, hello everyone and welcome to this month’s edition of IPC’s Vendor Advantage Network, our monthly spotlight sessions. This month we’re following along with our medical at home solutions, and today I have the pleasure of sitting down with one of our preferred vendors with germed. Many of you are already familiar with them, but of course we’d like to just have a little bit of a kickback talk, really learn high level what Germed can provide and really give some information to our members. So absolutely glad to have you here, Val. My name is Shannon Battle. I am the pharmacy services manager here at Independent Pharmacy. And again, like I said, I have Val here from GeriMed Comboed. I do appreciate you being here and willing to talk to our store owners. The staff and owners are really always looking for ways that they can enhance their reimbursements within the independent pharmacy. So for anyone who’s not familiar with Germed or with you in general, please just tell us a little bit about yourself and really your whole purpose and goal with Germed.

Valeria Taylor (01:04):

Absolutely. Thank you Shannon. I appreciate the opportunity to speak to the audience here today. I’m Valerie Taylor. I’ve been with germed in my eighth year, and I support the ComboMed market, which is a very growing market of independent pharmacies that are servicing both the walk-in retail patient population as well as some long-term care settings.

Shannon Battle (01:26):

Perfect. Well, of course, all of our stores really have the same wants and needs. They want to increase their reimbursements across the board and really looking for those opportunities. So let’s just dive right into that and see how Germed can assist.

Valeria Taylor (01:39):

Absolutely. So for many pharmacies, they’re already doing the work, right? They’re doing the packaging, they’re utilizing some type of compliance and adherence packaging, they’re doing deliveries. Now there’s an opportunity for them to get paid for those services. And our ComboMed program is a wonderful program that is for these independents. I hear a lot of times that folks have to, they want to diversify. What else can we do to generate some revenue? Well, long-term care is one of those avenues to help generate the reimbursement. A lot of times when LTC is mentioned, LTC folks are like, oh, I don’t service any nursing home patients. Well, nursing home skilled nursing facilities, that’s just one setting under the long-term care umbrella, there are many others. Some of them are assisted living group homes, adult daycare centers, intermediate care facilities for intellectuals with disabilities, correctional facilities, hospice, and the ever-growing long-term care at home patient setting. So it’s more than just skilled nursing facilities.

Shannon Battle (02:48):

So for any stores who don’t feel that they’re working with any of these at all, do you have any recommendations on how to just get started? Who do you reach out to? What do you do?

Valeria Taylor (02:57):

A lot of times network. Network with your nurses from your providers in your local community network with the DOAs, the director of nursing at some of these facilities. Find out who they’re utilizing. I really do think that a lot of the home health agencies, they’re going to know all of those long-term care patients are. So those are some different avenues to tackle and go after in your community to find out where these patients are. So for a pharmacy that’s servicing long-term care patients and settings, CMS has 10 guidelines, and that’s what these 10 performance guidelines for a pharmacy to meet that criteria to service long-term care. A lot of times the packaging is one with germed. It doesn’t matter to us what type of packaging that pharmacy is using. It can be a single dose, multi-dose bubble pack bingo cards, as long as it is some type of heat or code sealed packaging, A bottles and vials do not count, not meet the criteria for LTC.

(04:03):

So any of that adherence packaging, obviously the on-call service delivery services. And of course, depending on your patient settings, some of these will be, some additional services will be required. So what is ComboMed? ComboMed is the program that we have at germed. GERMED is a long-term care GPO, but we also act as the pharmacy’s long-term care PSAO. So ComboMed is a combination of a retail independent pharmacy that is servicing both the walk-in retail population as well as any of the long-term care settings that we mentioned earlier. And all this is done under their existing DEA and state license and the ComboMed for billing purposes. It’s a fancy word called dual taxonomy. It’s just the platform for a pharmacy getting a second NPI and a second N-C-P-D-P, both with the long-term care taxonomy code for this particular book of business, and then as well on the wholesaler side for the GPO side, getting a second LTC account in conjunction with their established retail account.

(05:12):

So what are the benefits of being a ComboMed member? Well, who wants to overspend for branded drugs? No one. So any opportunity that you can save some money on some branded drugs, that’s great. And on the with ComboMed, that is one part of the benefit. So on the GPO side, we have a full portfolio of branded drugs only. A lot of times I’ll say it’s a brand load only, meaning this is just the contracted branded drugs that Germed has. There are no generics on the drug file for coed members, strictly only brand drugs. It’s not every brand drug, but it is the contracted branded drugs that we have for this portfolio for our ComboMed members. So a decreased cost of goods for them, and then that’s going to help put a footprint in that long-term care space to maybe if they’re purchasing certain drugs such as anti-psychotics, which I’ll go into more detail on a couple more slides, but that might open the door for them to have an opportunity to speak with psychiatric offices that they’ve not explored.

Shannon Battle (06:18):

Alright, so reimbursements, that’s what we’re looking for,

Valeria Taylor (06:21):

Right? So here by servicing long-term care patients, the long-term care reimbursement goes back to the foundation of that dual taxonomy the pharmacies have to have in a combo pharmacy, they have to have the LTC and PI and N-C-P-D-P for billing purposes. In this space, there are certain fields that have to be identified within the software and then those fields have to be correctly populated in order for that claim to hit ED’S contract in order to have the higher reimbursement. So all those components have to play a role together in order for the pharmacy to actually see, oh, I do have a higher reimbursement now when that claim comes back through to them. Our network is for Medicare part D patients. There’s no commercial plans, no state Medicaid contracts. The contracts that GERMED holds with the PBMs are only the Medicare Part D. Now, by saying that under the Med D, under this particular settings like the long-term care at home population, we know that some of the payers recognize this setting and some of the payers do not.

(07:38):

So many times in the conversations we have with pharmacies who are looking to join, we mention make sure your payer mix as well as where your patients are residing, what’s really going to drive this reimbursement, making sure you know exactly where that patient resides and what that code is. Proper coding will drive proper reimbursement every single time. LTC purchasing. So again, the ComboMed portfolio currently consists of about 1800 different brand items. That’s anywhere. A couple of those Xarelto by j and j, Brez Tree by AstraZeneca. There’s a slew of vaccines on there, there’s antipsychotics on there. Many of the items under the drug file or the combo portfolio, germed file is an average two to 3% off wac. And then the customer has a supply agreement. That supply agreement cost of goods percentage is then applied to the LTC account that the wholesaler creates for them. So it’s a stacked benefit for the customer. Right. Now, I know that says hundred, but we’ve had several different, some manufacturers added on. So that is our portfolio is currently over 1800 NDCs. In addition to the branded portfolio, we also have a non-farm vendor portfolio. So that’s going to include vendors that we have on contract and as a germed customer, that pharmacy gets those discounts for automation packaging. Just any other things related in the LTC pharmacy space.

Shannon Battle (09:23):

So our entire pharmacy services team has really been working closely with you guys lately and we’re seeing significant opportunities where stores maybe aren’t ordering from their LTC accounts. How do you recommend that they manage that and make sure that they’re ordering the correct place?

Valeria Taylor (09:38):

By looking at each week, germed will send out a what’s called combo, med cost capsule. And in that publication is the current drug file, and it’s going to show what those savings are of wac, if that drug has any type of applicable backend rebate associated with that. So a very quick overview. I don’t expect anyone to look at that and memorize all 1800 NDCs, but if you have an idea of the top eight 10 brand drugs you’re purchasing week after week, take a look and confirm and make sure that those are those part of that LTC account. And if there is a price discrepancy under your LTC account, obviously notify your GERMED representative as well as your wholesaler representative to get that discrepancy resolved.

Shannon Battle (10:26):

Great tips. Alright,

Valeria Taylor (10:30):

The long-term care at home patient population, this is just growing day after day after day. Many of our folks, they’re especially post covid, many of the folks are aging into the population and remaining in their own home. They’re not going to some type of assisted living facility or skilled nursing facility. So the medical in home population is truly growing, and I do believe even though the payer mix is growing as well, that this will be the future for our long-term care patients, for them to age in and then to remain in their own home with their loved ones.

Shannon Battle (11:14):

I agree. There’s so many more capabilities now that we have that maybe we didn’t have 10, 20 years ago, and people are choosing to stay at home now for sure.

Valeria Taylor (11:22):

Absolutely. Long-term care at home, how does it differ from a retail patient? So we spoke before about this patient. The pharmacy may already be meeting these requirements that they’re packaging for these folks, they’re delivering to these folks in their home. The biggest thing is to confirm that that patient has a caregiver and that they’re Med D. That’s how you’re going to have a better understanding to know is this patient going to be eligible for me to receive LTC reimbursement? Making sure that, I always tell customers that if the patient cannot leave their home independently, meaning this pharmacy is packaging and delivering out of pure 100% pure necessity, it’s not a convenience factor. Like here I’m in Kentucky and spring is starting to come around all the allergies, but in the winter months we get a lot of snow. So a pharmacy, if they’re just delivering to Ms. Smith during the winter months because she doesn’t want to get out, that’s not going to qualify.

(12:33):

This pharmacy is delivering these medications to Ms. Smith out of pure necessity. She is home bound. She is not leaving her home independently, therefore, she’s relying on the pharmacy to be compliant for her to have these medications. So if the patient has the opportunity to leave their home independently, they’re not going to qualify. But if they meet the rest of that criteria, then the patient may qualify, but then the pharmacy has to look what’s their payer because the patient could have all the boxes checked that they qualify for LTC, but their payer does not recognize that. And that’s something that we educate every day on knowing, okay, the patient met the criteria, but as we’ve educated in the past, this particular payer does not recognize it. So again, it’s a day-to-day education on this space because it’s changing every day. More and more payers are recognizing this space and some of those requirements, the attestation forms that we provide. There’s a constant change in this space, but it all is to have a better outcome for the patient and pharmacy overall.

Shannon Battle (13:47):

Well then we have one last section here. The leis we spoke about.

Valeria Taylor (13:51):

Yeah, so the anti-psychotics with germed, we have some programs, the contracts that we have with the manufacturers, and one of those is with their j and j Otsuka. If a pharmacy is servicing by delivering those type drugs, let’s say an injectable anti-psychotic, and they’re taking that drug to the doctor’s office or behavioral health outpatient clinic, there is opportunity for them to purchase that drug and save some money with those cost of goods under the LTC account. Now, chances are there’s not a lot of billing opportunity. Very, very seldom is there a billing opportunity for these folks because a lot of these folks are Medicaid and they’re retail patients. But our contracts with these manufacturers allows a pharmacy that’s part of ComboMed to utilize the cost of good savings. Depending on their volume, there is an opportunity for them to have a backend rebate for some of these items through the manufacturer, because these are some high dollar drugs and many of the pharmacies, they’re underwater as it is for some drugs. So if there’s an opportunity for them to get a potential backend rebate, that’s a win-win for everyone.

Shannon Battle (15:16):

Definitely. And they’ll know if they’re dispensing these drugs in the pharmacy, they’re going to know if it’s an opportunity or not.

Valeria Taylor (15:23):

Absolutely.

Shannon Battle (15:25):

All right, perfect. Well, Val, this is definitely just the tip of the iceberg. There are so many conversations we’re already having with our members. We’ll continue to have with our members and send ’em your way. I do appreciate you presenting the information today and really being there for our members when they need you.

Valeria Taylor (15:41):

Yes, thank you. I appreciate the time and the opportunity. And as you said, this is the tip of the iceberg. There’s a lot of additional detailed conversations that can be had with each topic that we discussed today. And here, GeriMed, we’re happy to have those conversations with existing customers as well as customers that are looking to move into the LTC space.

Shannon Battle (16:03):

Perfect. Well, for those of you out there watching, there will be additional blogs and outreach this month to all of our GPO members. So if you want more information or if you want to get started right away, you can use the QR code on the screen to go directly to IPC’s Germed landing page, or you can reach out to either of us at the contact information here as well. Again, va, I do appreciate you for being here with us. I thank you all for watching and we do hope you have a successful pharmacy day.

Valeria Taylor (16:28):

Thank you.

Shannon Battle (16:29):

Thanks. Bye.