Pharmacy Practice Guidance

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Pharmacy Practice Guidance2022-12-14T11:49:15-05:00

Pharmacy Practice Resources

MPA encourages members to utilize the resources and links below to keep up-to-date on important pharmacy practice issues and regulations.

Guidelines and Research2022-09-19T12:39:14-04:00

AHRQ National Guideline Clearinghouse (NGC)
NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ) External Web Site Policy, U.S. Department of Health and Human Services. NGC was originally created by AHRQ in partnership with the American Medical Association and the American Association of Health Plans (now America’s Health Insurance Plans [AHIP]).

The NGC mission is to provide physicians and other health care professionals, health care providers, health plans, integrated delivery systems, purchasers and others an accessible mechanism for obtaining objective, detailed information on clinical practice guidelines and to further their dissemination, implementation, and use. For more information and to access the resource, please visit www.Guideline.gov.

AHRQ’s Effective Healthcare Program
When it comes to choosing the right medication or best health care treatment, reliable information can be hard to find. Most information is about a single drug, medical device or procedure. As a result, patients and their clinicians may make treatment decisions without fully considering the risks and benefits of available treatment options. The Federal Agency for Healthcare Research and Quality (AHRQ) conducts comparative effectiveness research to highlight the effectiveness, benefits, and risks of different treatment options for common conditions.

Launched in September 2005, AHRQ’s Effective Health Care Program has created free evidence-based resources for pharmacists and patients (in English and Spanish), including research summaries, continuing education modules and slide presentations, among other tools. For more information and to access the resources, please visit effectivehealthcare.AHRQ.gov.

Federal Rules and Regulations2022-09-19T12:40:11-04:00
  • Drug Enforcement Administration
    The Drug Enforcement Administration (DEA) is the premier drug enforcement organization in the world and the only single-mission federal agency dedicated to drug law enforcement. Follow the links below to access resources of value to pharmacists.

  • Provider Exclusion Lists
    Federal regulations established by the Centers for Medicare and Medicaid Services (CMS) prohibit payment for any federal or state health care program services (prescriptions, durable medical equipment, labs, etc.) be made to any individuals or entities which are included on the Department of Health and Human Services Office of Inspector General (OIG) and General Services Administration (GSA) exclusions lists. Pharmacies and pharmacists must be aware of these regulations and ensure that all pharmacy personnel or contracted entities doing business with the pharmacy are not included on these exclusion lists to avoid payment recoupments as well as possible loss in the ability to participate in state or federal programs, including Medicare and Medicaid. Recent information provided by OIG is recommending that the provider exclusion lists be checked monthly since new data of excluded parties is added to these lists.

    In addition to the OIG/GSA exclusion lists, providers also need to review the Data Bank to check for excluded individuals. The Data Bank is a clearinghouse created by Congress, which is comprised of the National Practitioner Data Bank and the Healthcare Integrity and Protection Data Bank. The Data Bank contains received and disclosed information on final actions taken against health care providers and entities. Access each of the lists at the links below.

  • U.S. Food and Drug Administration
    The U.S. Food and Drug Administration (FDA) is responsible for protecting and promoting public health through the regulation and supervision of food safety, tobacco products, dietary supplements, prescription and over-the-counter medications, vaccines, biopharmaceuticals, blood transfusions, medical devices, electromagnetic radiation emitting devices (ERED) and veterinary products. Visit www.FDA.gov for additional information or follow the links below to access additional resources.

Pseudoephedrine Product Sales2022-09-19T12:41:45-04:00
  • Combat Methamphetamine Epidemic Act (CMEA) 2005
    • Training and Certification
      Before selling products containing ephedrine, pseudoephedrine or phenylpropanolamine, pharmacies must be self-certified and comply with all provisions of the CMEA relating to employee training, product placement, photo identification of customers, sales logbooks and other procedures listed in the law. The Drug Enforcement Administration (DEA) has provided detailed training instructions for use in explaining the obligations online. Self-certification must be done annually online. Only one certificate per retail store is required, and the date to re-certify is determined by the date listed on the certificate.
    • National Precursor Log Exchange
      The National Precursor Log Exchange (NPLEx) is a real-time electronic logging system used by pharmacies, retailers and law enforcement to track sales of over-the-counter (OTC) cold and allergy medications containing precursors to the illegal drug methamphetamine.

      As of Jan. 1, 2012, in compliance with Public Act 86 of 2011, pharmacies are required to log pseudoephedrine (PSE) product sales in the NPLEx system. The provider of the NPLEx technology, Appriss, shared several resources with MPA that will assist members in utilizing the system, including a deployment guide and a complete NPLEx overview. If you have any questions, please contact Appriss by e-mail at MINPLEx@appriss.com. Be sure to include your pharmacy contact information and state license number.

Third Party Issues2022-09-19T12:44:03-04:00
  • Discrepancy Reporting Form
    This form was developed as a tool for pharmacies to report third party payment discrepancies. MPA requests that the form be submitted to MPA, as well as the third party payor, so these discrepancies may be recorded.
  • Price Discrepancy Complaint Form
    This form was developed for the purpose of filing a complaint about incorrect information on the Department of Community Health Drug Pricing Web site.

Pharmacy Audits

  • AMCP Model Audit Guidelines for Pharmacy Claims
    The Academy of Managed Care Pharmacy (AMCP) Model Audit Guidelines for Pharmacy Claims are the result of over a year-long effort by a Task Force comprised of pharmacists in managed care organizations, community practice and law; auditing administration; third party management; and network administration. Visit the AMCP website to access a copy online.
  • MAHP Pharmacy Audit Statement of Best Practices
    The Michigan Association of Health Plans (MAHP) developed pharmacy audit guidelines to promote an effective health plan compliance program. Their best practices statement seeks a reasonable balance between effective health plan compliance and equity in the pharmacy audit process. Click here to view the document.
  • PAAS National
    PAAS National has been assisting pharmacies with contract reviews and providing audit assistance since 1993. PAAS is an expert resource on third-party audits, contracts and negotiating strategies. Visit www.PAASnational.com for additional information.
Collaborative Practice Agreements2022-09-19T12:44:57-04:00

The Collaborative Practice Workgroup, convened by the National Alliance of State Pharmacy Associations, has developed recommendations for what elements of pharmacist collaborative practice authority should appropriately be defined under state law or regulation and what elements are best left to be determined between pharmacists and other practitioners when developing their specific collaborative practice arrangement. The workgroup’s recommendations can be found here.

PSI Solutions offers a Collaborative Practice Agreement for Immunizations. Click here to learn more.

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