Pharmacy

How do you compare to other providers? How are you different?

Enclara’s innovative business model was designed by hospice experts to address the unmet needs of the hospice nurse. Based on this knowledge and insight, we have developed a program that truly works for hospices.

Our foundation, and our most prominent feature, is our clinical dominance and support: Management Algorithm Pharmacopoeia (MAP). Our MAP formulary is printed in a pocket-size handbook which provides flexible, yet consistent clinical guidance for all patients and all staff—eliminating guesswork and relieving Medical Director’s of the burden for formulary management.

Enclara pharmacists are available 24/7 for consultation on all patient symptom and conditions. Regardless of the delivery model for medications, local or from our mail order facility, Enclara’s clinical support is a constant for all customers regardless of their billing and delivery model. All medication orders, both home and facility patients, are reviewed and documented per the CoP requiremements. We provide the same level of service (clinical, formulary management, reporting) for patients in all locations: home, IPU, ALF and SNF’s.

Your staff and the needs of your hospice are our first priority. Flexibility in our service model allows us to accommodate your unique needs, mail order or local delivery, fee-for-service or per diem billing, etc.

Enclara also facilitates cost management. Our proactive non-formulary management process keeps high-cost drug expenses in check based on your specifications. You designate the level of control and Enclara manages the authorization process on a proactive basis so that non-formulary expenses are managed up front.

How do you handle documentation for the medication component of the CoP’s?

All medications, both dispensed and profiled, are reviewed by a licensed pharmacist upon admission as well as each time a medication is added or changed within the profile. This medication review occurs for all dispensing models, mail order and local pharmacy. A medication review is initiated upon changes to the drug, strength, dose or directions. The review consists of checking for drug-drug interactions, drug-disease state contraindications, drug-allergy interactions, therapeutic duplication, etc. Hospices have two reports available to them that document and support the medication review process.

How do you help reduce costs?

We serve as a working partner to hospices in both pharmacy management and client development. Our pharmacy services maximize the efficiency of drug utilization, which allows our hospices to provide patients with the best quality care while conserving valuable fiscal resources. Our proactive non-formulary approval process assures that add-on charges are approved. An annual business review is conducted to review clinical items including costs. Along with the evaluation, we provide recommendations to reduce pharmacy costs, streamline processes and support market share growth. Enclara’s pharmacy services are purposefully designed to support nurses in their patient care role and thus avoid shifting the work of “pharmacist” to the hospice staff.

How can you support us for emergency orders that occur in the middle of the night?

The Enclara Pharmacy Network (EPN) is a comprised of thousands of retail and institutional pharmacies. These pharmacies dispense medications to your patients and process the claims in compliance with the formulary and per diem for your hospice. However, not all of these pharmacies may understand hospice regulations nor stock typical hospice controlled substances. For routine medications, the EPN is effective and efficient.

Enclara’s Neighborhood Connection is a subset of EPN and consists of local pharmacies (generally one per county or hospice service area) that support your hospice in managing emergency hospice medications. Enclara has directly contacted these pharmacies and verified their willingness to support your hospice. They have been asked to support a standard list of the hospice emergency medications.

Enclara’s pharmacists are available 24/7. When an emergency medication need arises, the hospice nurse contacts us for assistance in finding the medication. The support we provide saves your nurses time and assures the correct medication is available.

How does Enclara deliver medications to patient homes?

We support two delivery models: mail order and local pharmacy/pharmacy benefit manager (PBM).

Mail Order
For our mail order customers, medications are dispensed from our 25,000-square-foot pharmacy and shipped directly to the patient’s home via FedEx overnight and second-day shipping. Mail order customers are supported by 24/7 pharmacist access, full clinical documentation, formulary management and management reporting.

Local Pharmacy–Pharmacy Benefit Manager (PBM)
Hospices can also obtain their patient’s medications from local pharmacies through the local pharmacy/PMB delivery model. The same Enclara formulary management and clinical support as the mail order program is followed. Delivery of the medication to the patient varies based on the local pharmacy, including courier, hospice staff or the patient’s family. We proactively process claims and we are available 24/7 to solve claims problems so that hospice staff does not waste time on administrative functions. Enclara’s PBM services reduce costs, centralize billing and reporting, and streamline the ordering process.

How does Enclara price its services?

Enclara offers two pricing models to choose from: per diem and fee-for-service.

Per Diem
Per Diem rates distributes the risk between the hospice and the pharmacy. Formularies apply to create cost boundaries. Per Diem rates include all services: shipping, CareKits, reporting and clinical support. Rates are differentiated by the patient’s locations: home, institutional or inpatient unit. Within the care setting, the rate is fixed for the term of the contract, which leads to predictable costs. All drugs used outside the formulary are individually billed to the hospice at a fee-for-service price. Per Diem rates also generally include retail emergency drugs.

Our formulary provides maximum drug options and minimizes out-of-formulary charges. When comparing per diem rates, it is critical to compare the formulary and any related diagnoses restrictions or step therapies that drive out-of-formulary costs. Not all per diem rates are not equal. Upon conversion, most Enclara customers reduce non-formulary costs by 30- 50%.

Fee-for-service (FFS)
Fee-for-service (FFS) rates are typically differentiated for branded and generic drugs, based on a discount from AWP, and include a dispensing fee. If applicable, shipping charges are usually billed separately. Typically, there is no differentiation in pricing for formulary and non-formulary medications. Enclara’s FFS rates include formulary management and the required CoP clinical support as a component of our standard practice—we do not charge additional fees for this service.

Do you have Carekits? What’s in them? Will you customize?

Our CareKits contain a forty-eight-hour-supply of medications that are commonly used to manage end-of-life symptoms. The purpose of the CareKit is to have specific medication in the home for emergency situations. Enclara’s CII authorization process assures that every patient receives a complete CareKit within the desired time frame—nurses are not required to obtain physician signatures nor are they left wondering if the kit will arrive on time with all medications enclosed.

A variety of CareKit options are available and are configured upon the hospice’s medication preferences. Additionally, we offer add-on medications that may be included based upon the patient’s co-morbidities. An Injectable Cardiac CareKit is available for hospice nurses, or for families and caregivers that have been trained in injectable medication administration.

Are you available to process orders 24/7? If I call during the night am I waking the pharmacist up?

We provide 24/7 direct access to pharmacists with specific training in end-of-life issues and hospice medication. Our process assures immediate access, without waiting on hold, giving nurses more time to spend on patient care. During operating hours, Monday-Friday 8am-9pm and Saturday-Sunday 8am-7pm ET, a pharmacist answers the phone immediately. Outside of operating hours, the on-call pharmacy staff also answers the phone immediately (and you are not waking them up). On-call pharmacists routinely support emergency admissions, locating emergency medications locally, addressing local pharmacy claims problems, clinical consultations, etc.

Are Enclara’s pharmacists trained in end-of-life care?

Our pharmacists are specifically trained in end-of-life issues and hospice medication. They provide medication therapy management for hospice patients in all care settings. The pharmacist guides the nurse through the patient’s symptoms, conditions, current medications and physician orders in order to finalize the therapy most appropriate for the patient’s terminal diagnosis. Enclara profiles and reviews all medications, including those related and unrelated to the terminal diagnosis. We perform the required medication profile reviews including: drug-drug interactions, drug-disease state contraindications, drug-allergy interactions and therapeutic duplication. Any significant drug interactions are reported to the appropriate nurse or physician for review. Medication profiles reviews are documented to support hospice CoP regulatory requirements.

Pharmacists are available to speak with both hospice medical directors and community physicians. These conversations can support formulary requests or assist nurses in communicating complicated therapy requirements.

Who designed your formulary? Do you customize?

We enlisted hospice physicians and healthcare professionals to develop our new innovation for hospice formulary management—Medication Algorithm Pharmacopies (MAP).

Nurses love this handbook! It is a bed-side formulary tool formatted in a convenient pocket-size book. Feedback from our customers indicates that the MAP handbook enhances nursing care and nursing satisfaction. It is the most up-to-date hospice formulary, both experience-based and evidenced-based, and organized based on symptoms and conditions and in an easy-to-use table format.

Medications

1. 14-day antiobiotic coverage
2. Ultram without step therapy
3. Ambien
4. Claritin
5. Celexa
6. Tussionex cough syrup
7. Fentanyl patch without step questions
8. Oxycontin

Support Tools

1. Multiple Opioid conversion charts
2. Alternate dosage form guidance
3. Formulary conversion tables
4. “Do not crush” list
5. Elderly medication caution list
6. Analgesic comparisons
7. Federal medication disposal guidelines

Do you provide non-sterile compounding?

Non-sterile, compounded medications can be procured from Enclara as we maintain a comprehensive pharmaceutical compounding service .The pharmacy stocks the ingredients and fulfills compounding protocols to compound many medications for alternative dosage forms. For manufactured products that are not available in a particular strength, we might be able to compound that product. Medications can also be flavored to improve patient compliance.

Do you provide CEU-Nursing training?

We produce four programs per year for nurses to acquire 1 CE credit per session. Each session is offered at two different times to accommodate schedules. The sessions are conducted over the internet for the visual portion and by telephone for the audio portion. A CD of the program is available for later viewing and training purposes.

What kind of reports does Enclara generate? How do we access reports?

Our sophisticated, proprietary information technology system supports the detailed and complex nature of our clients’ data that is necessary to provide effective reporting. All web-based reports are available to any designated hospice staff member via a secure password protected system.

A variety of reports are available via the internet and sent electronically. Routine reports include:

1. Active Medications
2. Refill Notification
3. CoP pharmacy documentation
4. Monthly billing details
5. Shipped package tracking
6. Facility (institutional pharmacy) patient notification
7. Non-formulary management reports
8. Antibiotic and narcotic reports

To communicate general service updates we utilize an alert email system. The recipients for each hospice are designated by the hospice prior to beginning service with Enclara. There is no limit to the number of email recipients for each hospice.

How do we enroll a patient with your pharmacy?

You may enroll a patient using two options. You may call Enclara Health with all patient information, including the medication profile using our toll-free pharmacy number, 866-640-6445. The other option is to complete and fax the pre-printed form provided by Enclara Health to the toll-free fax number, 866-640-6447.

Will all prescriptions for a patient be filled by Enclara Health?

Upon admission, an Enclara Health Pharmacist will collaborate with a Hospice Nurse to evaluate the patient’s medications. For a home based patient, all medication relating to the terminal diagnosis will be filled by Enclara Health. Other medications will need to be filled by a pharmacy of the patient’s choice. For an institutional patient, all medications will be filled by a contracted institutional pharmacy.

What if the patient or caregiver is at the local community pharmacy and the pharmacist is having problems using the Enclara Pharmacy Network (EPN) card?

The pharmacist should follow the instructions on the card and call Enclara Health for assistance.

How many days of medication will a patient receive from Enclara Health?

All patients, regardless of home based or institution, will only receive a 15 day supply.

What if a patient is no longer under hospice care?

Please fax or call Enclara Health within 24 hours of discharge, revocation, or expiration. Be sure to include patient information and reason for termination. This will ensure the system information is updated.

Why do I need to contact you about a patient who has passed away?

There are several reasons to keep Enclara Health informed.

1. Your hospice is protected from being charged for medications that should not have been filled.
2. It prevents abuse from family members who try to refill prescriptions for patients who have passed away.

Where is your pharmacy located?

Our company owns and operates a fully licensed 25,000-square-foot pharmacy located in West Deptford, New Jersey.

Are you JCAHO/CHAP Accredited?

Enclara complies with all state and federal pharmacy licensing requirements as well as OSHA within the pharmacy operations. Our pharmacy model is not eligible for JCAHO accreditation (JCAHO does not have an accreditation category for a pharmacy that is not directly involved in patient care and not directly billing third party insurance.)

What is a PBM?

Pharmacy Benefit Manager. By definition (Wikipedia): a PBM is a third party administrator of prescription drug programs. They are primarily responsible for processing and paying prescription drug claims. They also are responsible for developing and maintaining the formulary, contracting with pharmacies, and negotiating discounts and rebates with drug manufacturers.

What does FFS stand for?

FFS stands for fee for service. FFS allows the hospice to pay for only those drugs ordered and dispensed.

What kind of mail carrier do you use?

Customers on our mail order service have their medications shipped directly to the patient’s home via FedEx overnight and second-day shipping.