Freedom of Choice of Pharmacy
PDF Version of BQA 05-002 (PDF,
DATE: March 15, 2005 BQA Memo 05-002
TO: Adult Family Homes AFH –
01, Community Based Residential Facilities CBRF –
Residential Care Apartment Complexes RCAC -
FROM: Kevin Coughlin, Chief, Assisted Living Section
Via: Cris Ros-Dukler, Director, Bureau of Quality Assurance
This memo addresses a resident’s right to choose a pharmacy provider
while residing in an assisted living facility. These facilities include adult
family homes (AFHs), community-based residential facilities (CBRFs), and
residential care apartment complexes (RCACs).
Wis. Stat. § 50.09(1)(m) states that every resident in a community-based
residential facility shall have the right to use the licensed pharmacist of
the resident’s choice.
Wis. Admin. Code § HFS 83.21(4)(q) states that every CBRF resident has the
right to exercise complete choice of pharmacist.
Wis. Admin. Code § HFS 88.10(3)(i) states that every AFH resident has the
right to exercise complete choice of pharmaceutical services.
Wis. Admin. Code § HFS 89.34(6) states that every RCAC tenant has the
right to the facility’s non-interference with the tenant’s choice of
pharmaceutical services. A tenant shall not be required to use pharmaceutical
providers who are employed by or affiliated with the facility or to whom the
tenant is referred by facility staff.
Residents make choices at all levels of their care. Usually their first
decision involves the facility to which they wish to be admitted. Other
choices include the services they wish to have, whether they want a private
room, and whether to participate in leisure-time activities, etc. Residents
who choose to manage their own medications have the complete choice of the
pharmacy and pharmacist they wish to use. Residents who choose to
self-administer their medications or who must have their medications managed
and administered by the facility, still have the right to select their own
pharmacy and pharmacist. However, that pharmacy and pharmacist must be willing
and able to meet certain facility standards. For example, in a CBRF that does
not have an RN who supervises medication administration, the facility must
have all staff-administered prescription medications packaged in unit dose or
unit time packaging by a pharmacist. In some cases, the resident’s chosen
pharmacy may be unwilling or unable to meet these packaging requirements. If
this is the case, a resident’s choice of pharmacy and pharmacist will be
The issue is what reasonable criteria or standards, if any, can an assisted
living facility have in place regarding choice of pharmacy? Assisted living
facilities responsible for medication administration have additional
regulations that must be followed. These regulations reference packaging,
labeling, storing, administration documentation, physician notification, and
medication error reporting requirements. A pharmacy that provides medications
to be administered by the facility needs to adhere to the applicable
regulatory requirements. A resident’s choice of pharmacy will be limited
when a resident’s chosen pharmacy does not wish to provide medications under
the appropriate regulatory standards.
In some situations, facilities have unknowingly created standards for
pharmacies that have completely eliminated complete choice for residents. In
other cases, facilities have presented their residents with information that
suggests the residents have no choice but to use the pharmacy preferred/used
by the facility. It is in this context that the following guidelines are
provided to assisted living facilities that establish their own
criteria/standards for pharmacies. These standards must apply to all
pharmacies the resident chooses, and include the pharmacy the facility
Choosing a non-preferred pharmacy may subject the resident to additional
reasonable fees or charges. Any additional fees or charges for choosing a
non-preferred pharmacy must, by rule, be communicated to the resident.
The standards for the drug distribution system include:
. This may be in prescription
vials, punch cards, unit time packets or unit dose packages. If the unit
dose system is selected, it will apply only to the items that are supplied
in unit dose (i.e., tablets and capsules). If liquids are not in unit dose,
the facility cannot prevent a pharmacy from providing bulk liquids. If punch
cards are selected, the pharmacy must provide medications in a card system.
Systems do not need to be from the same manufacturer, but may be similar in
Pharmacy information to the assisted living facility on proper use of
medications. Each pharmacy is expected to give information to the
facility and resident about special requirements for medication use or
administration. The pharmacy is also expected to attach auxiliary labels to
the containers as required by state pharmacy regulations. The pharmacy must
have a resident medication profile that allows checking for drug interactions,
allergies, and duplications before the prescription is filled and sent to the
facility. Any concerns identified by the providing pharmacist must be brought
to the attention of a facility representative and the prescribing physician.
- Packaging and labeling of medications
The following items are not part of a drug distribution system for
purposes of pharmacy choice. A pharmacy is not required to provide these
services in order to provide medications to an assisted living resident. The
items included below are examples and are not meant to be all-inclusive.
- Medication forms or records, including the medication administration
records, treatment records, and other computer printouts;
- FAX machines, computers, or other such equipment;
- Intravenous services;
- Medication carts and equipment for administering medications, e.g.,
- Consultation services, including drug regimen reviews, drug storage
inspections, medication pass observations, committee meetings, and
assessment reviews not related to dispensing of the medication;
- In-service training; and
- Emergency dispensing or "24/7" availability.
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