Traditionally, when a doctor prescribes a medication, the prescription is for a supply of 30 days or more. Some pharmacies even give discounts if a 60 or 90 day supply is prescribed. This can result in substantial waste, particularly for patients in long-term care facilities (LTC). The doctor may decide to change the medication within just a few days. A patient may be discharged from the facility before needing the entire amount of medication prescribed or the patient may even die.

New law designed to prevent medication waste in LTC facilities.

In order to decrease the amount of medication waste, under the Patient Protection and Affordable Care Act, the legislature made changes to prescription requirements under Medicare Part D, the prescription portion of Medicare. Short cycle dispensing for LTC facilities is part of the new program and was to be implemented beginning January 1, 2012. This required prescriptions for LTC patients to be for a maximum of seven days or less. It was estimated that this would save $5.7 billion.

Pharmacies Initial Concerns

Pharmacists claimed that this would actually be more costly for them in time required for repeatedly filling prescriptions for small amounts. They claimed this would increase their workload and, in some cases, require the addition of personnel which would not decrease costs but had the potential for increasing them. Their concerns prompted changes to the law.

New rule to be implemented January 1, 2013

After considering the objections from pharmacies and the LTC facilities themselves, the rule was modified. Beginning January 1, 2013, for patients in LTC facilities, new provisions for short cycle dispensing will be implemented. The main provisions are:

• Brand-name drugs will be prescribed for a maximum of 14 days. Fewer days are preferred but not required.

• Generic drugs may still be prescribed for any period of time.

• Liquid medications are not included in the new law which only applies to oral medications taken in solid form, i.e. pill or capsule.

• Pharmacies are required to keep records on their dispensing methods and how much of the dispensed drugs actually ends up unused.

Benefits to LTC facilities of Short Cycle Dispensing

Even though the mandate does not begin until January 1, 2013, a number of facilities have already instituted the plan. They have found a number of benefits.

• Short cycle dispensing has decreased the amount of time staff formerly spent properly disposing of unused medications.

• Medications provided to the LTC facility by the pharmacy in seven-day prepackaged supplies has eased time spent by nursing staff in preparing medications for administration and actual administration of the medications.

• Medication errors have been reduced.

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