Page numbers followed by f denotes a figure, the letter n denotes an endnote, and the letter t denotes a table.
A
Abubakar, Amina, 142, 149
Academia, 78–83
Accountable care organization (ACO), 212
Accounting, 5t. See also Cost accounting; Predictive accounting
accrual basis, 9
Audit and Accounting Guide for Healthcare Organizations, 10
cash basis, 8–9
cycle, 6
fund, 9
methods, 9
patient system, 6
Accounts
chart of, 9
general ledger, 10
payable, 5t
receivable, 6t
statistic, 18
Accreditation Commission for Healthcare (ACHC), 262, 305
Accreditation Council of Pharmacy Education (ACPE), 77
Accreditation requirements, for doctor of pharmacy programs, 77
Accrual basis accounting, 9
Active pharmaceutical ingredients (APIs), 101
Acuity, 86
Acute care pharmacy, 35, 36f
Acute kidney injury (AKI), 164t
Administrative Law Judge (ALJ), 125, 128
Administrative services agreement (ASA), 226
Advance Beneficiary Notice (ABN), 118
Advanced Pharmacy Practice Experiences (APPEs), 77
Adverse drug events (ADE), 197
Advisory Committee on Immunization Practices (ACIP), 231
Advocacy support, 104
Affordable Care Act (ACA), 3, 138, 225, 232, 232t
Agency for Healthcare Research and Quality’s National Quality Strategy, 180
Aliquot, 213
Allocation methodologies, 22
Alternative funding programs, 234
Ambulatory pharmacy, 93t
Ambulatory surgery centers, 122
American Hospital Formulary Service-Drug Information (AHFS-DI), 117
American Institute of Certified Public Accountants (AICPA), 10
American Journal of Health-System Pharmacy, 111
American Society of Health-System Pharmacists (ASHP), 87, 104, 107, 196, 213, 288
Practice Advancement Initiative 2030, 170
Amherst Pharmacy, 149
Ancillary services, 115
Angiotensin Converting Enzyme (ACE) inhibitors, 232t
Annual plan, 27
Antimicrobials, 157
Antimicrobial service expansion, 168f
Antimicrobial stewardship programs (ASPs), 156–157
Antimicrobial stewardship system expansion business case proposal
business/service description, 156–157
conclusion of, 156
core positional duties, 155
environmental/needs assessment, 157–159, 158f
executive summary, 155–156
financial implications, 156
financial plan, 163–164, 164t
implementation plan, 164–165
key benefits to health system, 156
legal or regulatory concerns, 164
lessons learned with, 165–166, 167t, 168f
operating plan, 159–163, 159f, 160t, 161t, 162f, 162t, 163t
proposal, 155
supporting materials for, 165
Antiresorptive therapy, 232t
Apexus, 44, 53–54
Appeal process, 125
Areas of waste, potential, 68
Artificial intelligence (AI), 4, 58t, 126
Aspirin, 233t
Assets, short-term, 10–11
Audit and Accounting Guide for Healthcare Organizations, 10
Auditing services, 103
Automation, 126–127
Autonomous pharmacy, 211–212
Avant Pharmacy and Wellness, 142
Average Sales Price (ASP), 303
reimbursement formula, 110
Average Wholesale Price (AWP), 227, 303
B
Back-end (BE) work, 268
Backward integration, 134
Balance metrics, 67
Balance sheet, 8, 10–11, 11t–14t
Baptist Health South Florida (BHSF), 169
Barcode medication administration (BCMA), 213
Base contract, 101
Benchmarking, productivity analysis and, 85–86. See also External benchmarking; Internal benchmarking
β-blockers, 232t
β-lactam/β-lactamase inhibitor combinations, 159, 159f
Beyond-use Date (BUD), 214
Big Data, 58t, 59
characteristics, 59t
medication management in, 60t
Billing, 122–123
claims, 6
system, 6
Biologics, 104
growth of, 106–107
Biosimilars, 52, 104, 239
Blue Cross Blue Shield, 131
Board Certification for Pharmacotherapy Specialists (BCPS), 148
Board of Trustees, 27
Boesen, Kevin, 150
Botulinum toxin injections, 116
Budget, 8, 29
cycle, 30
types of, 30
variances, 39
Business
cases, 153–154
office, 5t
Business Analytics (BA), 58t
Business Intelligence (BI), 58t
C
Capital, 201, 301
budget, 7
expenditures, 27
items, 7
Carbapenems, 159
Care delivery, 97
Case mix index (CMI), 86, 88, 90t
Cash basis accounting, 8–9
Catheter-associated urinary tract infections, 160t
Cefepime, 159
Ceftaroline, 158f, 163, 163t
Ceiling price, 44
Centers for Medicare & Medicaid Services (CMS), 3, 44, 156, 213, 251, 259, 298, 305
CMS 855B, 305
CMS 855S, 305
Centers for Medicare Services (CMS), 157
CenterX, 136
Central line-associated blood stream infections, 160t
Characteristic, 86
survey, 88–89, 89t
Charge capture, 6, 120–121
Chargemaster (CDM), 122
Charity care write-offs, 3
Chart of accounts (COA), 9
Chief Data Officer, 57
Chief Digital Officer, 57
Chief Executive Officer (CEO), 2, 4, 27
Chief Financial Officer (CFO), 2, 4, 8, 27
Chief Medical Officer (CMO), 2, 239
Chief Nursing Executive, 2
Chief Operating Officer, 2
Chief Pharmacy Officer (CPO), 2, 108, 239
Children’s Hospital Association (CHA), 97
Choosing Wisely campaign, 69
Christensen, Clayton, 147, 151
Chronic obstructive pulmonary disease (COPD), 278–279
Cigna, 131
Claim adjustment reason codes (CARC), 123
Claims capture, 7
Class
composition, 79
size, 78
Class of trade (COT), 101
Clean sites, 48
Clinical care, of pharmacy revenue cycle
charge capture, 120–121
clinical documentation and coding for, 121–122
prescriber order, 120
Clinical documentation, coding and, 121–122
Clinical pharmacist productivity, 35
Clinical pharmacology, 117
Clinical Pharmacy Enterprise, 169
Clinical Pharmacy Manager, 158
Clinical workload, 87, 93t
Clostridioides difficile, 156
Clostridioides difficile infections (CDI), 159–160, 160t
CMS Healthcare Consumer Assessment of Healthcare Providers and Systems (HCAHPS), 114
Collaborative Practice Agreement (CPA), 187f
College of pharmacy, 78
Collins, Jim, 147
Commercial and government health plans, pharmacy benefits for, 138–139
Commercially available vendors, 87–88
Committed agreements, 101
Community
benefit, 50
focus, 1–2
pharmacy operations, 27
Community-based outpatient clinics (CBOCs), 278
Competitive Generics Therapy Designation, 105
Community Health Accreditation Partner, 305
Compliance, 45, 156
Complicated intra-abdominal infections (cIAI), 161
Complicated skin and soft tissue infection (cSSTI), 161
Complicated urinary tract infections (cUTI), 161
Compounded sterile preparations (CSPs), 211, 213
Compounded sterile preparations (CSPs), using automation/robotics
autonomous pharmacy, 211–212
business/service description, 212–213
environmental/needs assessment, 213
executive summary, 211
financial plan, 215–219, 216f, 217f, 218f, 219f
future of IV robotics, 222
implementation plan, 219–220, 220f, 221f
legal or regulatory concerns, 221–222
lessons learned, 222–223
operating plan, 213–215
Compounding complexity, 215
Consultant groups, 87
Consulting services, 104
Continuing education programs, 80
Contraceptives, 233t
Contract
arrangement methodologies, 226–227, 227f
families, 101–102
pharmacy relationships, 53
Contribution margin, 22
Coronavirus Aid, Relief, and Economic Security (CARES Act), 105
Corticosteroids, 232t
Cost
centers, 34
of goods, 101
reporting, 5t
Cost accounting, 5t, 6–11, 11t–17t, 14, 18, 19t, 20
definitions of, 3–4
reports, 22–23
systems, 21–22
Cost-based productivity ratios, 90t, 91
Cost of goods sold (COGS), 293
Cost-to-Charge ratios, 23
Covered entities, 43
CoverMyMeds, 136
COVID-19 pandemic, 29, 252–253
drug shortages and, 105
global supply chains and, 104, 134
impact of, 40
response to, 1
Schedule II drugs and, 105
societal impact of, 97
vaccinations and, 171
Critical access hospital, 52
Culture by Design, 151
Current procedural terminology (CPT) codes, 93, 300, 303
CVS/Health (Aetna), 131–132
D
Dalbavancin, 163t
Daptomycin, 158f, 163, 163t
Darwin, Charles, 147
Data
architecture, 62
characteristics, 58t
cleansing, 58t
consumers, 61
fluency, 58t
lake, 58t
literacy, 58t, 60, 60t, 63
mining, 58t
producers, 61
scientist, 58t
stewards, 61
strategy, 62–63
visualization, 58t
warehouse, 58t
Data analytics and oversight
case study, 68–70
challenges with, 57, 58t, 59–60, 59t
driving value, optimizing utilization, and overall performance improvement with, 57, 58t, 59–73, 59t, 60t, 61f, 62t
introduction and background of, 57
literacy, governance, and supporting structures, 60–62, 60t, 61f, 62t
looking forward, 70–73
problem to solution, 64–66
strategic data choices, 67–68
strategy, 62–63
summary, 64
terminologies, definitions, and metaphors for, 57
Data and information best practices, 62t
Data-centric culture, 61–63
Data-centric organization, 64
Data-driven improvement, 71
Days of Therapy (DOT), 159
DEA, see United States Drug Enforcement Administration
Debt expense, 3
Decision support system (DSS), 21
Degree programs, 79
Delegation protocols, 167t
Delphi approach, 92
Delphi consensus of clinical pharmacists, 35
Delphi process, 91
Department of Veterans Affairs, 44
Det Norske Veritas (DNV), 262
Dexmedetomidine, 69–70
Diagnosis related groups (DRGs), 69
Direct expenses, 25
Discharge service, 69
Discriminatory reimbursement scenarios, 49
Disease-intervention specific approach, 69
Disproportionate share adjustment percentage (DSH percentage), 44, 47, 99
Disproportionate Share Hospital (DSH), 247
Diversion, 46
DNV Healthcare (DNV), 3
Donovan, John, 151
Dose optimization, 213–214
Drug cost savings, 47
hospitals not subject to GPO prohibition, 48
hospitals subject to GPO prohibition, 48
over time, 48–49
physical inventories (clean sites), 48
retail pharmacies and, 49
Drug(s)
COVID-19 pandemic and, 105
pricing, 227
shortage challenges, 29, 102, 104
sourcing, 234–235
Drug utilization review (DUR) screening, 271
Durable medical equipment (DME), 115, 302
Durable Medical Equipment, Prosthetics/Orthotics, and Supplies (DMEPOS) program, 305
E
Earnings before interest, depreciation, taxes, and amortization (EBIDTA), 22
Electronic health record (EHR), 51, 53, 57, 181, 255
Electronic medical record (EMR), 126, 159
Electronic remittance advice (ERA), 123
Element, 86
Emergency department (ED), 195
Emergency Medical Treatment and Labor Act (EMTALA), 119
Emmer, Marc, 150
Enterprise-wide multidisciplinary medication management analytics program, 64
Entity-owned pharmacy, 52–53
Entrepreneur (EP), 141
attributes of, 144–145
business development and, 143–144
as career choice, 142–143
decision making methodology for, 145–146
The Entrepreneur-Intrapreneur, 151
Environmental factors, 3
Epic, 136
Epropofol, 105
Equity, 10–11
Equipment and supply codes, 302
Ertapenem, 159, 163, 163t
Essential drugs list, 105
Essentialism, 151
Executive summary medication history expansion proposal, 207–209, 208f, 209f
Expenditures, planning and forecasting of, 27
Expense cycle, 7, 27
Experiential partnerships, 81
Explanation of Benefits (EOB) statement, 6
Express Scripts, 132
External benchmarking, 35, 85, 89t, 90t
definitions in, 86
deriving value from, 89–90, 91t
in health systems, 86–87
External reporting, 156
F
Facilities and administrative costs (F&A), 79
Faculty salaries, 80
Federal poverty level, 3
Fidaxomicin, 163, 163t
Finance
analysis control, 27
analytics, 5t
cost and predictive accounting, 3–4
operations, 5t
performance, 23
for pharmacy education and research programs, 77–83
planning and assessment, 77–83
reporting, 10
statements, 37
Financial Accounting Standards Board (FASB), 10
Financial assistance programs, 179
workflow, 184f
Financial counseling, 118–119
Financial donations, 80
Financial management
accounting cycle, 6
balance sheet, 10–11, 11t–14t
budget, 8
cost accounting reports, 22–23
cost accounting systems, 21–22
cost and predictive accounting, 3–4
environmental factors, 3
expense cycle, 7
fiscal services department, 4, 5t, 6
governance, 2–3
income or operating statement, 14, 15t–16t, 17t
mission and community focus in, 1–2
monthly close, 8–9
performance review process, 23–25, 24t
revenue cycle, 6–7
Fiscal services department
accounting, 5t
accounts payable, 5t
business office/revenue cycle management, 5t
cost reporting, 5t
development, 5t
financial operations/analytics, 5t
managed care contracting, 5t
overview of, 4, 5t, 6
payroll, 5t
supply chain or purchasing and materials management, 5t
treasury, 5t
typical, 4, 5t, 6
Fiscal year pharmacy expenditures, 27, 28t
Fiscal year retail pharmacy expenditures, 29t
Fixed budget, 30
Fixed costs, 23
Fixed expenses, 22
Flex budget, 37
Flexible budget, 30
Flexible data stores, 63
Fluoroquinolones, 159–161, 159f
Food, Drug, and Cosmetic Act, 45
Food and Drug Administration (FDA), 73, 100, 104
Formularies, 133
Formulary management, 229
Forward integration, 134
Free clinics, 3
Friedman, David, 151
Front-end (FE) work, 268
Full-time equivalents (FTEs), 36, 36f, 90t, 159, 165, 280
costs, 49, 277
definitions, 18, 85
financial plan for, 249t
proposal, 155
staffing of, 259t
Fund accounting, 9
Fund balance, 10–11
G
General ledger
accounts, 10
chart, 9–10
close, 8
Generally Accepted Accounting Principles (GAAP), 10
Global supply chains, COVID-19 pandemic and, 104
Governance, 2–3
literacy and, 60–62, 60t, 61f, 62t
Governmental Accounting Standards Board (GASB), 10
Gross domestic product (GDP), 1, 68
Group purchasing organization (GPO), 45, 97, 188
bid process, 100–101
biologics and specialty pharmaceuticals and, 106–107
contracting, 98–104
contract types, 101–103
engagement opportunities, 103–104
evolution of, 104–107
prohibition, 48
relationship, 107–111
as resilient supply chain, 104–106
services overview, 98
H
Healthcare
“business” of, 1
spending in, 1
utilization, unnecessary, 180
Healthcare-acquired infections (HAIs), 155–156
Healthcare Common Procedure Coding System (HCPCS), 121–122, 260, 300
HCPCS Level II, 302
Healthcare Effectiveness Data and Information Set (HEDIS), 279
Healthcare Supply Chain Association (HSCA), 97
Health Impact Profile, 50
Health Insurance Portability and Accountability Act (HIPAA), 59, 251
Health literacy, 180
Health maintenance organizations (HMOs), 138, 230
Health plan financial models, managed care pharmacy and, 136–138
Health Resources and Services Administration (HRSA), 43, 231, 252
Health savings account (HSA), 230
Health system mail order pharmacy
business/service description, 267–268
environmental/needs assessment, 268
executive summary, 267
financial plan, 271–272, 272t
implementation plan, 273
legal and regulatory concerns, 273
lessons learned, 273, 274t, 275–276
operating plan, 268–269, 269t, 270t, 271
Health system pharmacists, 78
Health system specialty pharmacy (HSSP)
background, 287
business/service description, 290–291, 291t
environmental/needs assessment, 288–290, 289t, 290t
executive summary, 287–288
financial plan, 293
future directions and resource needs, 293–294, 294t
lessons learned, 295
operating and implementation plans, 291–293
HealthTrust, 97–98
Helling, Dennis, 148, 151
High-deductible health plans (HDHPs), 230
Higher education, 81
financing for, 78
High performing revenue cycle team, 128
High reliability organization (HRO), 222
Home health care, 115, 302
Home infusion pharmacy
environmental and needs assessment, 298–299
executive summary, 297
financial plan, 301–304, 301t–302t, 304t
implementation plan, 305–306, 306t
legal and regulatory concerns, 305
lessons learned, 307
operating plan, 299–300
service description, 298
supporting materials, 307
Horizontal approach, 69
Horizontal integration, 134
Hospital-based infusion center
business/service description, 256
environmental/needs assessment, 256–257
executive summary, 255
financial plan, 261–262, 261t, 262t
legal or regulatory concerns, 262, 263t
lesson learned, 264
operating plan, 257–261, 258t, 259t, 260t
supporting materials, 264
Hospital-Issued Notices of Noncoverage (HINN), 118
Hospital-owned home infusion pharmacy, 298
Hospital outpatient (retail) pharmacy
business description, 247–248
executive summary, 247
financial plan, 249, 249t–251t
implementation plan, 252
legal and regulatory concerns, 251–252
lessons learned, 252–253
needs assessment, 248–249
operating plan, 249
Hospital Readmissions Reduction Program (HRRP), 298
Hospital(s)
eligibility, 43–44
for-profit, 2
nonprofit/community, 2
pharmacy, 23
How Will You Measure Your Life?, 151
Humana Pharmacy Solutions, 132
I
Important Message from Medicare (IM), 119
Income statement, 8, 14, 15t–16t, 17t
Incremental budgeting, 78
Infectious Disease (ID), 158
consult services, 156
pharmacist, 155
Infectious Diseases Society of America Center of Excellence, 156
Information technology (IT), 256
Injectable iron agents, 100
Innovatix, 97
Inpatient volume indicators, 93t
Institute for Safe Medication Practices (ISMP), 213
Insulin, 100, 232t
Insurance carrier, 6
Integrated delivery networks (IDNs), 110, 134
Integrating teams, 127–128, 127f
Intentional culture, 146–147
Interactive voice response (IVR), 268
Intermediate preparations in standardized concentrations, production of, 214
Internal benchmarking, 35, 85, 92, 93t
definitions, 91
getting started with, 94
standardized comparisons within, 93–94
Internal Health System legal counsel, 164
Internal productivity monitoring, 91
methods for, 92
Internal Revenue Service (IRS), 232, 232t
regulations, 2
International drug importation, 235
International IV Robotics Summit, 211–212
Intersectta, 97
Intrapreneur (IP)
attributes of, 144–145
business development and, 143–144
as career choice, 142–143
decision making methodology for, 145–146
Intravenous immune globulin (IVIG), 69
Introductory Pharmacy Practice Experiences (IPPEs), 77
Investment, 148–150
J
Johnson, Samuel, 151
The Joint Commission (TJC), 86, 156–157, 305
K
Kaiser Permanente, 148, 151
Key performance indicators (KPIs), 4, 18, 19t, 164, 181, 260, 271
L
Label, default, 215
Labor, 119, 172
expense, 24
market, 97
productivity ratios, 88, 90t, 91
productivity report, 24t
Leadership: Pharmacist, Entrepreneur, or Intrapreneur, 141–151
Letters of commitment (LOCs), 102
Lexi-Drugs, 117
Liabilities, 11
Liabilities, short-term, 11
Licensed independent practitioner (LIP), 259
Limited distribution drugs (LDDs), 288
Liquidity, 18
Local Coverage Articles (LCAs), 117
Local Coverage Determinations (LCDs), 117
Long-term assets, 11
Long-term liabilities, 11
Low-Income Subsidy (LIS) program, 139
Low-value care, 68
M
Machine learning (ML), 58t, 126–127
Mail Order Pharmacy, 133
Managed care
contracting, 5t
function of, 133
future of, 139–140
organization, 132
Managed care pharmacy, 131–132
function of, 133
health plan financial models and, 136–138
pharmaceutical value chain, 135–136, 136f
program types, 136–140
vertical integration in ecosystem, 135
vertical integration in supply chain, 134–135
Manual admixtures, displacement of, 214
Market dynamics, 106
Marketing, sales and, 150–151
Master Patient Index Number (MPI), 116
Maximum allowable cost (MAC), 303
McKeown, Greg, 151
Medicaid, 44, 119, 138
Medicaid Drug Rebate Program (MDRP), 44
Medically unlikely edit (MUE), 124
Medical necessity denials, 124
Medical record number (MRN), 116
Medical support assistant (MSA), 278
Medicare, 44, 116, 181
Advantage, 118, 123
appeals council, 125
benefit manual, 117
fee-for-service, 123
Modernization Act, 110
Part A home health benefit, 303
Part B drugs, 110
Part D, 138–139, 185f, 302
Prescription Drug Benefit, 118
reimbursement, 175, 175t
Medicare Administrative Contractors (MACs), 116
Medicare Advantage prescription drug plan (MA-PD), 139
Medicare+ Choice Nursing and Allied Health Education (NAHE) programs, 175
Medicare cost report (MCR), 44
Medicare Home Infusion Therapy (HIT), 302
Medicare Outpatient Observation Notice (MOON), 119
Medicare Severity-Diagnosis Related Group (MS-DRG), 86
Medication
access, 53
adherence, 4, 180
costs of, 180
discrepancies, 197
management, 60t
reconciliation, 197
Medication Access Program (MAP)
executive summary, 179
financial assistance workflow, 184f
financial plan, 188–190, 188f, 189f
implementation plan, 190, 190f–192f
legal/regulatory concerns, 190
lessons learned, 192–193
Medicare Part D coverage, 185f
needs assessment, 180
operating plan, 180–181, 182f, 183f, 184f, 185f, 186f, 187f
prior authorization workflow, 182f
refill authorization workflow, 187f
service description, 179–180
supporting materials, 192
for uninsured, 186f
Medication Therapy Management (MTM), 135, 248
Medigap policy, 123
Medimpact Healthcare Systems, 132
MEDS Act, 105
Member cost share, 230, 230f
Meropenem, 159, 163t
Metadata, 58
Methicillin-resistant Staphylococcus aureus (MRSA), 160t
Midcycle, of pharmacy revenue cycle
billing for, 122–123
chargemaster, 122
Minibid, 100
Mission organizations, 1–2
Momentum, 150
Monthly budget performance report, 40
Monthly close, 8–9
Morgan, John, 141
N
National Association of Boards of Pharmacy, 305
National Comprehensive Cancer Network (NCCN), 116
National Council for Prescription Drug Programs (NCPDP), 143, 251, 305
National Coverage Determinations (NCDs), 117
National Drug Code (NDC) number, 45, 123, 300, 302
National Home Infusion Association (NHIA), 298, 301–303
Reimbursement Training Center, 302
National Home Infusion Foundation (NHIF), 299,
National Institutes of Health, 80
National Provider Identification (NPI), 305
Natural language processing (NLP), 127
Natural language understanding (NLU), 127
NCCN Drugs and Biologics Compendium, 117
Nephrotoxicity, 162
Net assets, 10
Net income, 22
Net present value (NPV), 267, 271
New technology add-on payments (NTAP), 121
Noncoverage, notice of, 118
Normalization, 86
Notice of Noncoverage, 118
Novaplus, 98
Novaplus Enhanced Supply (NES) strategy, 105
Nursing budget expenditures, 27
Nurse liaisons, 297, 299, 302t
O
Office of Medicare Hearings and Appeals (OMHA), 125
Office of Pharmacy Affairs (OPA), 43
Office of Pharmacy Affairs Information System (OPAIS), 45
Operational benchmarking, 35
Operation statistics, 34t
Optimization, 45–46
OptumRx (UnitedHealth), 132
Orphan drugs, 45
Outcome metrics, 67
Outpatient Infusion Clinic Indicators, 93t
Outpatient pharmacy
contract pharmacy relationships, 53
entity-owned, 52–53
Outpatient Prospective Payment System (OPPS), 122
Over-the-counter medications (OTCs), 199
P
Pareto Principle, 69
Pasteur, Louis, 150
Patient accounting system, 6
Patient aligned care teams (PACTs), 277–278
Patient care capacity, 82
Patient Day (PD), 159
Patient volumes, 22
Payer contracts, 8, 126
Payroll, 5t
Peer group, 86, 88, 90
Percentile, 86
Performance
contract, 101–102
key indicators of, 4, 18, 19t, 164, 181, 260, 260t, 271
metrics, 18
monthly budget report, 40
ratios, 20t–21t
review process, 23–25, 24t
Personal protective equipment (PPE), 97, 134
Personnel costs, 27
Pharmaceutical contracts
financial aspects of, 97–111
introduction to, 97
Pharmaceutical manufacturers, 3
Pharmaceuticals, 27
Pharmaceutical value chain, 135–136, 136f
Pharmacist, 141–151
Pharmacist Coordinator, 155
Pharmacist in Charge (PIC), 249
Pharmacodynamics, 156
Pharmacokinetics, 156
Pharmacy
benefit contracts, 226–228, 227f, 228t
benefits, 138–139, 302
computer systems, 35
data elements, 89t
executive, 35, 64
informatics, 62
licensure, 251, 304t, 305, 306t
manager, 39
network, 133, 231
practice standards, 35
productivity monitoring, 93t
productivity ratios, 90t
services, financial components of, 35
technicians, 181
Pharmacy Accountability Measures (PAM), 87
Pharmacy and Therapeutics (P&T), 229
Pharmacy and therapeutics committee formulary review biosimilar financial analysis
business case, 239
business/service description, 240
environmental/needs assessment, 240–241
executive summary, 239–240
financial plan, 241–243, 243t
implementation plan, 244
lessons learned, 244–245
operating plan, 241
supporting materials for, 244
Pharmacy benefit management (PBM), 179, 226, 288
Pharmacy benefit management (PBM) cost containment
drug sourcing, 234–235
executive summary, 225
formulary and utilization management programs, 229
introduction, 225–226
pharmacy benefit contracts, 226–228, 227f, 228t
pharmacy benefit managers (PBMs), 226
plan design, 229–233, 230f, 232t, 233t
summary, 235, 235t
terminology, 235t
Pharmacy Benefit Manager (PBM), 6, 131–133, 132f
Pharmacy budget
continuous financial planning and forecasting in, 27, 28f, 29–30, 29f, 31t–33t, 34–37, 34t, 36f, 38t–39t, 39–40
management, 27, 28f, 29–30, 29f, 31t–33t, 34–37, 34t, 36f, 38t–39t, 39–40
preparation, 29
profile, 27
Pharmacy education and research programs
financial economics of academia, 78–83
financial planning and assessment for, 77–83
Pharmacy intensity score (PIS), 86, 88, 90t
Pharmacy revenue cycle
categories of, 113
clinical care, 120–122
conclusion, 128–129
high performing team, 128
integrating teams, 127–128, 127f
midcycle, 122–123
phases, 114f
post access, 123–126
pre-access, 114–120, 114f, 115f
role of automation, 126–127
Pharmapreneurship, 151
Physical inventories, 48
Piperacillin, 159, 163, 163t
Plan cost share, 230, 230f
Pneumonia, 160t
Point of sale (POS) system, 251
Population Health Management
comprehensive COPD management, 282–284, 283t, 284t
equity-focused diabetes care, 282
executive summary, 277
finances, 277
implementation plan, 284, 285f
lessons learned, 285
needs assessment, 278–279
operating plan, 279–280, 280f, 281f, 282
organization, 277
practice site, 277–278, 278t
service, 278
service description, 277–278, 278t
supporting materials for, 284
Posaconazole, 163, 163t
Post access, of pharmacy revenue cycle
allowed vs. actual, 125–126
appeal process, 125
payer contracting, 126
remittance advice, 123–124
The Practice of Groundedness, 146, 151
Pre-access, of pharmacy revenue cycle
financial counseling, 118–119
notice of noncoverage, 118
preregistration, 116
prior authorization and medical necessity review, 116–118
registration, 119–120
scheduling for, 114–116, 115f
simultaneous processes in, 115f
Preauthorization requirements, 116
Predictive accounting, 3–4
Predictive analytics, 4
Pre-exposure prophylaxis (PrEP), 232
Preferred provider organizations (PPO), 138, 230
Premier, Inc., 97–98, 105
PremierPro, 98
PremierProRx, 98
Premix drug shortage assistance, 214–215
Preregistration, 116
Prescription drug plan (PDP), 139
Price protection, 103
Prime Therapeutics, 132
Prime Vendor Program (PVP), 44, 50, 53–54
Prior authorization (PA), 116–118, 133, 179, 181
management, 60t
workflow, 182f
Process metrics, 97
Product
formulation, 101
substitution, 213
Productivity, 27
analysis, 85–94, 89t, 90t, 93t
benchmarking, 85
index, 91
ratio, 91
Profitability components, 22
Profit and loss statement (P&L) reports, 14, 23
Protocol efficiency, 215
ProvideGx® Program, 106
Provider Order Entry systems, 120
Provider Transaction Access Number (PTAN), 251
Provista, 97
Proxy metrics, 67
Pseudomonas, 160
Public universities, 78
Purchasing and materials management, 5t
Q
Qualified Independent Contractor (QIC), 125
R
Rabies, 122
Radio frequency identification (RFID) technology, 269
Radiology, 27
Ratios, 18, 19t, 20, 20t–21t
Readmissions, 4
Ready-to-administer (RTA), 211–212
Rebates, 102, 227–228, 228t
Refill authorization workflow, 187f
Registered nurse care manager (RNCM), 278
Registration, 119–120
Regulation, compliance, and optimization, 43–54
Regulatory exemptions, 137
Relative value unit (RVU), 91, 93–94
Remittance advice, 123–124
Remittance advice remark code (RARC), 123
Remote and telehealth services
capital, 201
executive summary, 195–196
financial analysis/overview, 196
financial plan, 201–203, 203f
implementation plan, 196, 203–205, 204f
legal/regulatory concerns, 203
operating plan, 198–200, 200f, 201f
operational, 202–203, 203f
service description/needs assessment, 196–198, 197f
Research
collaborations, 82
grants, 79
Residency program expansion
background, 169–171, 170t, 171t
costs, 174t
executive summary, 169
financial sustainability, 174–176, 174t, 175t, 176t
growth in, 171t
implementation plan, 176–177
labor pool and, 172
lessons learned, 177
net costs, 176t
program infrastructure, 172–174, 173f
program value, 171–172
Resiliency measures, 104
Resource allocation planning, 27
Responsibility Center Management (RCM), 78
Retail pharmacy, 36, 36f, 37
budget, 30, 31t–33t
Return on investment (ROI), 188, 211, 215, 218–219
Revenue
adjustment, 86
center, 35
cycle, 5t, 6–7, 27 (See also Pharmacy revenue cycle)
streams, 78, 82
Reverse auction, 100–101
Reverse distribution agreements, 103
Risk management, 4
Roberts, Jonathan, 141
Robotics, 103, 211–212, 223. See also Compounded sterile preparations (CSPs), using automation/robotics
RxRevu, 136
S
S-codes, 302
Safety, quality and, 156
Sales, marketing and, 150–151
Scaling Up, 148
Scheduled outpatients, 115
Scheduled patient, 114
Scheduled recurring series, 115
Schedule H (Form 990), 50
Schedule II drugs, 105
Scheduling, for pre-access, of pharmacy revenue cycle, 114–116, 115f
School of pharmacy, 78
The Schools of Experience, 147
Secretary of Veterans Affairs Federal Supply Schedule, 44
Sedative drugs, 69
Selective Serotonin Reuptake Inhibitors (SSRIs), 232t
Self-funded health plans, 137
Self-reporting, 92
Sepsis, 160t
Sheridan, Martin, 150
SinfoniaRx, 150
Skilled nursing facility, 115
Smart, Bradford, 147
Social Security Act, 98
Software data integrity, 51
Sole-source manufacturer products, 99
Specialty distributor agreements, 103
Specialty pharmacy, 37
Specialty pharmacy budget, 31t–33t
Stakeholders, 2, 69, 107
State board of pharmacy, 3
State department of health, 3
Statement of cash flows, 8, 18
Statins, 232t, 233t
Statistic accounts, 18
Step Therapy, 133
Strategic data, choices, 67–68
Strength, weakness, opportunity, and threat (SWOT) analysis, 290, 290t
Structures, 61–62, 62t
Stulberg, Brad, 146, 151
Supply chain, 5t
management, 97–111
payer impact on, 107
Surescripts, 136
Sweat equity, 148
SWOT Analysis, 150
System Community Hospital, 157
T
Tabula Rasa HealthCare, 150
Tax-exempt status, 2
Tazobactam, 159, 163, 163t
Tdap vaccine, 122
Technology innovation, 72
Telehealth, 113
services, 195–205, 197f, 200f, 201f, 203f
Telepharmacy, 97
They Ask, You Answer, 150–151
Third-party administrator (TPA), 225
Thomson Micromedex DrugDex, 117
340B Drug Pricing Program
compliance, 45–46
compliance maintenance costs, 49
documenting use of savings, 49–50
drug cost savings, 47–49
financial management of, 45–54
forecasting pricing for, 52
formulary selections, 52
hospital eligibility for, 43–44
home infusion eligibility for, 299, 303, 307
introduction to, 43–45
new hospital departments or clinics, 51–52
OPAIS function, 46–47
optimization, 50–53
outpatient pharmacy opportunities, 52–53
oversight structure and internal resources for, 46
patient eligibility for, 46
pricing for, 44–45
quarterly pricing changes, 50–51
software data integrity, 51
value, 47
weighted average pricing, 51
340B Program Handbook, 54
Time standard, 91–92
To Err is Human, 70
Topgrading, 147
Transition of Care (TOC), 247
Treasury, 5t
Tuition, 78–79
U
Uncomplicated skin and soft tissue infection (ucSSTI), 161
United Healthcare (UHC), 131
United States Drug Enforcement Administration, 251, 252, 305
Unit of service (UOS), 18, 260
Universities, public, 78
Unscheduled emergency, 115
Unscheduled inpatient, 115
Unscheduled observation, 115
Utilization management programs, 229
V
Valuation, 148
Value, 45, 47, 58t, 69
Vancomycin, 159–160, 159f, 162–163, 163t
Vancomycin-induced acute kidney injury avoidance, 162t, 164t
Variable co-pay programs, 234
Variable expenses, 22
Variety, 58t, 59
Velocity, 59, 59t
Veracity, 58t
Vertical approach, 69
Vertical integration, 101
in healthcare supply chain, 134–135
in pharmacy ecosystem, 135
Veterans Health Administration (VHA), 277
Vice President of Pharmacy (VP of Pharmacy), 239
Virality, 58t
Virtual care, 196
Virtual Medication History phase, 207
Viscosity, 58t
Visualization, 58t
Vizient, 97–98, 104–105, 107
Volume, 59, 59t
indicator, 91–92, 93t
in pharmacy productivity monitoring, 93t
W
Wage, 24
Wholesale acquisition cost (WAC), 102
variance, 48
virtual replenishment inventory, 45
Wilson, Andrew, 54
Workforce shortage, 82
Workload, 27
metrics, 35
Worksheet S10 (MCR), 50
Y
Year-over-year (YOY) growth, 188
Z
Zero-based budget, 30, 34
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