Reimbursement for nondistributive pharmaceutical services in hospitals

Abstract

The literature on reimbursement, especially by third-party payers, for clinical pharmacy services is reviewed. Allocation of total departmental expenses on a per-dose basis, subsidization of clinical pharmacy services through general pharmacy revenues, and inclusion of service charges with drug-product charges have been used successfully to support clinical services. Identification and documentation of benefits resulting from clinical pharmacy services is a vital element in the justification process; a new service has little chance for approval unless it documents cost savings. Published reports of clinical pharmacy services that obtained third-party reimbursement include programs in a cardiac-rehabilitation unit, patient education and monitoring, pharmacokinetics, and laboratory-results interpretation. Published guidelines for obtaining reimbursement for clinical pharmacy services are reviewed. An eight-point guide for obtaining reimbursement is recommended. It embodies: a commitment by the director of pharmacy, via departmental goals and objectives, to clinical services; presentation and acceptance by various key elements in a hospital's structure; accurate analysis of costs and benefits associated with the services; requests for reimbursement from third-party payers; continued analysis of the services' effects; and communication of experience with the services to the general public and the pharmacy profession. It is concluded that reimbursement by third-party payers is a step in the right direction and that clinical service charges should be separated from product charges. Further program development and research are needed.