Pharmacies must weigh their exemption options

Tuesday, November 23, 2010

To be or not to be accredited is a question that many pharmacies are asking right now, say industry stakeholders.

"It's still chaotic," said Mary Ellen Conway, president of Capital Healthcare Group. "They don't know what they are doing and they are not sure why they should renew or not renew and they are looking at cost."

The Affordable Care Act, passed earlier this year, included an accreditation exemption for certain pharmacies (see story above).

The National Community Pharmacists Association (NCPA) lobbied hard for the exemption.

"I don't understand why they wouldn't," said Chris Smith, director of policy and regulatory affairs for the National Community Pharmacists Association. "Accreditation is expensive, so I would think the ones that can, would."

But many pharmacies, especially those in competitive bidding areas, had already gone ahead and gotten accredited rather than risk running afoul of Medicare rules.

Now they must decide whether to maintain their accreditation status or let it eventually expire.

"I would say we are seeing a higher percentage that are staying with it as opposed to leaving the program," said Sandra Canally, president of The Compliance Team. "A lot of the little guys are choosing to stay accredited."

Canally expects many of the big chains--which can exempt certain locations--will stick with it, too, rather than try to juggle which stores need it and which don't.

Pharmacies that do meet the exemption requirements should bear in mind that other payers may require accreditation, said Conway.

"It doesn't make sense to give it up just because one payer says you don't have to have it," she said.

One thing that all parties agree on: Don't opt out of accreditation--or let your current accreditation expire--until you are sure you qualify for the exemption.

"If you are in doubt, whether it's about meeting the five-year requirement or the 5% requirement, get accredited," said Tim Safley, clinical manager of HME, pharmacy and sleep services for ACHC. "If there's any gamble at all, you'll be better off."