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My mother is 86, permanently placed in a nursing home for the long haul. Along with her Medicare, she has Tricare. The local nursing homes require her to go through their pharmacy which is costing her much more than it would if she could continue receiving her meds via the mail (as she always had) and bring them to the nursing home.


Is anyone else familiar with this 'rule' of going through their pharmacy and how we might be able to reverse it?

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I have replied on this subject before. Nursing facilities have a state scope of practice that is strictly enforced. They generally require blister packs and many require bar codes that are just not there on outside pharmacies. Is it possible to get mom into a military facility?
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Reply to MACinCT
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Another lil’ item to keep in mind on NH & RX’s....... should you move your elder from NH#1 to NH#2, you need to, need to, need to be sure to get all their RXs from NH#1. Medicaid & MediCARE have paid for these usually for 90 day cycles. They will not easily pay for a duplicate refill. Depending on just what drugs the elder are on, & where they are for needing a refill, this could be very, very expensive $$$. Elder don’t have $ if on Medicaid, so family is going to need to private pay for the meds.

Doing this never would have occurred to me.
It was the RN from NH#2 who did moms assessment (to see if new NH could do her level of care) who told me that I absolutely needed to get my moms meds. The floor nurse at old NH was actually pretty hostile about having to deal with this. The blister packs were a simple unclipping from their hanger. But the RX in a jar (it was a compounded med), she dumped on the countertop. I took ziplocks & a sharpie with me, so not an issue. Pretty well ruined her morning when I pull them out to label stuff.
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Reply to igloo572
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We signed my mom up for a new Medicare Part D plan when she entered a nursing home, choosing a plan that covered medications from the nursing home's pharmacy. There is a special enrollment period allowing Medicare Part D subscribers to switch plans outside of the open enrollment period if they live in a nursing facility. It saved us a good deal of money and there was no need to lobby for providing her own medication. See https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/special-circumstances-special-enrollment-periods
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Reply to simplyexhausted
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I love the blister pack idea. I really do. It’s not perfect though. I suppose nothing is. An LPN in a nursing home here gave my mom two pills at one time to save her a trip back later. That’s inexcusable. I did speak to them about it and they spoke to the LPN who did it.

My friend who is an RN did bring her own meds because she has seen nurses take too many liberties and put elderly residents at risk.

Yes, it depends on the individual facility and the location. Sadly our facilities are rated at the bottom of the list.

No matter where a family member is, good or bad, monitoring has to be done in order to receive the best care. It’s all we can do.

It’s a catch 22 situation because no one wants to deal with complications. No one wants an elderly resident to be harmed in any way from a mishap, whether it’s an accidental or intentional incident. In reality not everyone can or desires to care for them in their home.

Sometimes it isn’t feasible to care for someone in our home even if we desire to. Even if they are in a great facility we cannot be there every single second.

I hope all caregivers and elderly residents are able to find the best situation possible in whatever facilities that are chosen. It’s wise to do as much research as possible before placing a family member there. There is always a chance of mishaps still occurring as it did with me but at least you will know that you tried to do your best.

For those caregivers caring for their families at home, I hope that you are taking care of yourselves too, at least as much as you can. I realize that it isn’t always easy to schedule time for yourself.
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Reply to NeedHelpWithMom
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igloo572 Nov 27, 2019
NeedHelp - oh my.... I’d be filing a complaint with the State on the drug snafu. You know if NH uses RFID in their “medication management” system it should be that every pill “deblistered” or every pill removed from a locked case (like for opioids) is noted and as to the exact time. So any double dosage or too early delivery is noted. And the tech or Aide who did the med will be able to be tracked as to who it is.

I don’t know how common use of the RFID sensor systems are. My moms 2nd NH had it but her first NH didn’t.
But I think asking a NH what type of medication management system they use is a very important topic when you are looking at which NH to select. Who knew there are so many lil’ things to consider when picking out a facility!
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Under Federal Law a resident has a right to choose their own pharmacy and or doctor . The problem is that in order to exercise that right the family must follow the facilities rules for packaging the drugs. This usually requires that the drugs be unit dosed and that the pharmacy would agree to send medication ASAP in case of an emergency.

I would suggest you find out what the facilities packaging rules are then call around to local pharmacy to see who will do packaging to meet their guidelines. As I said most facilities require unit dosing, there are some private pharmacies who are willing to do this for families.

The other requirement I often see is that the pharmacy must ship the drugs directly to the facility. A family can not handle the medication it must come directly from the pharmacy.
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Reply to cjwilson
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In the facility I worked at as an LPN, it was in our "Patient's Bill of Rights" that they had the right to use any pharmacy of their choosing. I'm certain the facility got a deficiency that year for not "allowing" her to use the pharmacy of her choice. We also had some VA patients that didn't use our contract pharmacy.
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Reply to Kartman77
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Hi. I just told them. Her meds are already established at CVS. I’ll bring the meds to the facility. Absolutely no problem
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Reply to EllieP
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I'm going through the same thing with my dad's facility. His mail order is so inexpensive and he's on a lot of drugs. But the AL requires blister packs and the insurance pays only a little now. After incurring a very large initial bill for prescriptions when he first moved to his facility, they are now burning down the extra pills we had on hand from the mail order facility. They told me I am welcome to go find a different place to get his prescriptions in blister packs, but they will charge me an extra $200 per month if I don't use their company. I have not done the research on that one yet.
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Reply to Babs75
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This may involve a liability issue in regard to the Nursing Home.
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Reply to Llamalover47
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My Moms ALs pharmacy allowed her to use her plan which included a mail order. If ur insurance requires you to use their mail order for maintainence drugs then that may be why the cost is higher. I know the OTC meds were a little more expensive.
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Reply to JoAnn29
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It’s a liability & management issue for NH skilled nursing facility.

On management, NH gets sealed individualized blister packs on most RXs in 90 day units designed to be stored in whatever medication management system this facility uses. Like stored in a larger glass front walk in closet which the med cart goes into or next to load up. The packs usually have an RFID sensor or old school barcode that get scanned & linked to their chart. The only RX outside this I ever saw was refrigerated drugs or specialty dermatology type of RX or a compounded RX or serious black box warning drugs - these came in smaller units & went into another secured entry box in the closet.

liability is about that with outside meds, they can’t verify that meds sent by mail or picked up at local pharmacy have not been tampered with and can go thru many hands till at the nurses station. At N
h my mom or mil were in, Family could not bring in vitamins or other otc - like Zyrtec - either.

if NH living is fairly new to you & your family, you may also find that at some point in time, all elders drugs and medical care will be completely under the direction of the MD who is the medical director of the NH with the DON ( director of nursing) as the day to day point person for decision making. So her old cardiologist or ophthalmologist RX or treatment plan or orders won’t necessarily be done till forever. Her care is now done by order from the NH MD or other NH staff. Her old docs can ask NH doc to put in an order or medication but it’s up to the NH physician to have it as a part of her care plan. Care plan meetings are held every 90 days, you should get a letter as to when it’s coming.

If this is a VA facility, the same thing happens & VA clinic & hospital systems should dovetail to her NH chart. VA ones seem to rotate the MD type medical directors or maybe have a PA acting as it.

Should your mom should go onto Medicaid to pay her room & board costs, (MediCARE does not pay R&B), there’s likely to be only 1 or 2 pharmacy groups that do all the Medicaid & Medicare scripts for your region. Ditto if the NH is part of a big chain, they are gonna have a preselected pharmacy for fulfillment. Rxs under contract & prices set & in a format that works for administration.
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Reply to igloo572
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One of the reasons is because they need the medication in blister packs to make dosing and record keeping easier. So unless her online pharmacy will do that (most don’t) then they will use a preferred pharmacy. At my dad's NH there are two to choose from. I made that choice. You might ask if this is the reason and if so are there more than one to choose from
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Reply to Harpcat
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From the facility point of view:
1 - It is easier for the facility to have an adequate supply of mom's medications on hand - and easier to get emergency refills
2 - Most of the medications have been carded - placed on notebook paper sized cards to make storing and dispensing medications easier for staff.
3 - The doctor for the facility and the pharmacy have a good working relationship - pharmacy will know what this doctor usually prescribes and can get it out faster to facility.
4 - Billing for medications is streamlined = less hours of administrative staff time working on billing, paying... with pharmacy.

Yes, it probably appears to "cost more" for mom's medications, the "cost" is reflection of being carded and administered by nursing staff.
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Reply to Taarna
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If you look at the situation from the facilities viewpoint. They have many residents who need all sorts of different combinations of medications. It should be computerized. The doctor who visits residents prescribes as needed. That is then ordered to the pharmacy the facility uses. In many cases the resident is paying a co pay for these medications. Everything is in a chart and administered daily.

Now you come into the picture providing the medication you feel is right. Are you administering it at the times of day it is needed. What if you miss a day or a dose? How is the facility supposed to cope with any adverse effects if they do not know just what was administered?

In the 2nd AL facility my mother has been in I provide all her personal needs. I know I am saving alot from the previous AL facility which was charging regular drug store retail as opposed to me buying items at Target. I would not want the responsibility of having to deal with all her prescriptions as well as some over the counter products as needed.



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Reply to Riverdale
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Geaton777 Nov 19, 2019
Agree! I cannot imagine how difficult it would be to manage meds coming from all different sources for hundreds of people. Not to mention the liability. I'd rather have the staff spending their time actually giving personal attention to your LO rather than counting pills and checking rosters.
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My dad is in AL - I get all his meds from the VA. No charge. The AL is fine with that - though it does require me to stay on top of supply - and to plan ahead.

Rules may be different in AL vs SNF.

The SNF I recently toured said most prescriptions are covered by their monthly fee - or by Medicaid.

This is NY.
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Reply to Dianed58
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You need to familiarize yourself with your State's Medicare, Tricare, and Medicaid regulations/guidelines and the nursing home's policy regarding “Medications Brought Into the Nursing Home” . 

http://file.cop.ufl.edu/ce/consultwb/2015Workbook/CHAPTER%2027.pdf
discusses Florida’s Law regarding “Medications Brought Into the Nursing Home”. You might want to review this document. I think that it can provide some suggestions as to how to “apply” for the “right” to bring medications into the nursing home from another pharmacy.

Good Luck.
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Reply to DeeAnna
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At my mothers nursing home it was required that all prescription medication dispensed by their “Med Room” come to them in blister packs - each individual pill was in its own plastic bubble on a sheet of however many. They said it was to ensure the ethicacy(sp?)of the pills.

Most larger pharmacies will do that for patients in “institutional” settings but not for individual customers - regular folk.

My mothers suplimential insurance had a pharmacy branch that dealt exclusively with places like nursing homes and would fill the prescriptions into the approved blister packs when ordered by the Med Room. Because of this I was able to get around the homes requirement that their chosen pharmacy be used.

Still - all my mothers medication was required to be filled/refilled only by their staff. And - for this service we had to pay a monthly fee. It was cheaper than using their pharmacy so that what we did. I never touched or even saw the medications - they were delivered directly from the m pharmacy to the nursing homes Med Room.

One way or another, I figured the
nursing home was gonna get their profit from the pharmaceutical industry.
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Reply to Rainmom
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It will be up to her doctor or those who have diagnosed her condition. My own brother entered with something saying he had miniscule cognitive changes and could leave on his own, take public transit, conduct business and etc. But the doctor automatically clicked the "needs help with meds" thing. Firstly he takes nothing but one ASA daily, and secondly is totally capable so we had to go to the admitting doctor to get that changed. It would otherwise have been another 400.00 a month whether one pill or a dozen. Speak with the doctor about level of dementia and about getting this changed and wishing you good luck.
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