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PHARMACY UTILIZATION MANAGEMENT - PRIOR AUTHORIZATIONS

Effective Date: 
Wed, 05/27/2020
Policy: 

UC SHIP benefit plan includes a formulary of allowed medications for prescriptions.  In an effort to reduce expenses and to follow all safety guidelines, UC SHIP has a Utilization Management Plan within that formulary.  This formulary is updated twice annually in January and July.

Establishing guidelines for use
The benefit plan has a review committee of doctors and pharmacists meets often to review medications and consider coverage under pharmacy UC SHIP. They also recommend quantity limit guidelines, exclusions, step therapy and prior authorizations.

UC SHIP’s QUANTITY LIMITS program protects patients and can help patients get the best results from medication therapy. Along with safe and appropriate doses, QUANTITY LIMITS can also keep prescription drug costs lower.

Determining quantity limits
Quantity limits are meant to lower the risk of overuse. Quantity limit rules are based on:
• Food and Drug Administration (FDA) approved uses
• Medication instruction labels
• Accepted or published clinical recommendations

PRIOR AUTHORIZATIONS are required for medication coverage because they’re only approved or effective in treating specific conditions. See the Process in the Procedure.

STEP THERAPY requires that less expensive and/or safer products be used first, before selecting newer or special products.  A PRIOR AUTHORIZATION may be needed for the newer/special product.

Procedure: 

PRIOR AUTHORIZATION PROCESS

1. Check the EMR for the formulary in Orders > Medication Orders

2. Check the EMR References for Utilization Management

3. go to the login for PreCheckMyScript (PCMS) at https://provider.linkhealth.com/#/ 

4. Enter the patient information including the Anthem Insurance Number.  Note: Use just the number, unless the number is preceded by CA.  If so then include CA.

5. Agree to the requirements

6. Enter the medication and select the formulation

7. Answer the associated questions and enter any supporting documentation if required

8. Wait for the response

9. Cut and Paste the response in the EMR in the patients medical record

10. Alert the Pharmacy with an IM or Secure Message for that encounter note, if the student will receive the medication from the UCSC Pharmacy

11. Set a "Reminder" in the EMR for the date it will expire and will need to be re-authorized

12. When the response is loaded into the EMR, acknowledge the document 

 

For any problems, call 800-626-0072

 

Attached File: 

ITS QUICKSUPPORT FOR REMOTE ASSISTANCE

Effective Date: 
Mon, 04/27/2020
Policy: 

ITS is implementing a program called QuickSupport which allows ITS staff to remotely access a computer to provide requested support.  When an IT ticket is opened, the tech who responds may request that they connect to your computer using QuickSupport in order to diagnose and/or resolve your issue.  Generally, SHS IT issues are reported to internal support staff (Robert Antonino or Cathy Sanders) who handle all issues with the EMR and minor to moderate system software/hardware issues. 

 

In the event that a SHS staff member needs to contact ITS directly for workstation support, the following procedure must be followed when using QuickSupport:

Procedure: 

Procedures for HIPAA Units/Clients

  • Some mechanics of receiving remote IT support:
    • ITS uses a program called QuickSupport for remote assistance.
    • ITS techs will not connect to your computer without your permission. You give your permission by providing your QuickSupport ID and password to the tech. The tech will help you do this. There will also be a screen for you to “accept” the session.
    • Your QuickSupport ID is specific to your computer. A new password is generated each time you launch the program. 
    • Once you connect, the name and phone number of the ITS technician is displayed in a separate small window during the remote control session. Make sure this matches the person on the phone with you. If you don’t have confidence that you are talking to an ITS employee, decline the session, hang up, and contact the Support Center (9-HELP) to verify.
    • Have the tech explain why they are calling before accepting a remote assistance session. The reason should match what the client expects.
  • Tell the tech that they will be working on a HIPAA machine.
  • Inform the tech if the nature of the problem means HIPAA-related data might displayed on the screen. This includes pop-ups from HIPAA-related apps. It's not OK to open or run any HIPAA-related programs during a remote assistance session. If this will be required, remote assistance isn't an option and an in-person visit will need to be scheduled.
  • Close windows and log out of all HIPAA-related sessions (PnC & other health systems, PPS, email for Benefits Office) before accepting a remote support session. No ePHI or HIPAA systems can be open or visible on the computer.
  • Be aware that if your computer is rebooted during a QuickSupport session, the tech might automatically be reconnected.
  • Files containing restricted data of any sort may not be transferred using QuickSupport.
  • Be aware that techs are supposed to confirm required HIPAA security settings when working on a HIPAA machine if this hasn’t been done in the last 90 days. This is in addition to assisting with the specific problem at hand.
  • Always quit QuickSupport when the remote assistance session is complete. The tech should tell you when to do this, but be sure to ask, just to be safe.
Key Points: 
  • ITS can  now support SHS HIPAA systems using a tool called QuickSupport.
  • Specific rules must be followed to ensure protection of SHS HIPAA systems and data.
  • Always quit QuickSupport when the remote assitance session is complete.

PHOTO GUIDELINES FOR HEALTH E-MESSENGER UPLOADS

Effective Date: 
Tue, 04/14/2020
Policy: 

Only specific photos will be accepted into the medical record. See parameters below.

Procedure: 

Objective:

This document serves as a guideline for identifying and denying unacceptable images sent through health e-messenger.

Definitions:

Acceptable images are photos of the patient’s symptoms or chief complaint. (See examples under resources)
Unacceptable images include but are not limited to:

  • Any image unrelated to the symptoms, chief complaint, or diagnosis
  • Images of a person or body part other than the patient
  • Other images deemed inappropriate by SHS staff

Guideline:

SHS staff are expected to identify and deny unacceptable images sent by a student via health e-messenger.
Unacceptable images will be deleted by the Health Information Systems Administrator.
If the image is sexually suggestive or violent, staff must immediately notify their supervisor and submit a report in RLDatix.

Resources:

Text macro to deny photographs “.denyphoto”

“Unfortunately, the image we received from you does not meet the Student Health Center photograph guidelines. We cannot accept this image and it will be removed from your medical record. Please contact our office if further assistance is needed”

Examples of acceptable images:

  • Skin rash
  • Minor wounds and burns
  • Bruising

Examples of unacceptable images:

  • Photos of another person other than the patient
  • Pets
  • Sensitive areas of the body (breasts, genitalia, etc.)

Directions for students to submit their photo:

In health e-messenger on the left side of the page click on “messages” >
Then click on “new message” >
Select medical records/photo submission >
Attach photo and submit

MAIL ORDER PRESCRIPTIONS

Effective Date: 
Mon, 03/23/2020
Revised: 
Thu, 12/03/2020
Policy: 

The UCSC Student Health Center Pharmacy will provide prescriptions by mail to UCSC students under our care if all the required parameters are met.

Procedure: 

UCSC Students may request prescriptions and refills from the UCSC Student Health Center Pharmacy.  Requests may come through Health e-Messenger, or by telephone to the UCSC Pharmacy.  When a student elects to have medications mailed to them they are agreeing for a package to the address provided.

Students will make a request of the pharmacy for the specific prescriptions to be sent, along with the address.

Pharmacy staff will fill the prescriptions, create a label with the student’s requested address and prepare a mailer for shipping.  All students will be offered a telephone consultation for any medication, and for any new or changed  prescription, the pharmacist will arrange a telephone appointment for a medication consultation prior to shipping. Any receipts and drug information, or any other instructions, and a statement regarding these services, will be included in the delivery. 

Shipping will be documented in the EMR as a secure message to the student stating what was sent.  Consultations for new medications will be documented in the Pharmacy software per the CA State Board of Pharmacy 1707.2 Duty to Consult.  Shipping will be documented in the mailing log - and will be double checked and initialed by another Pharmacy staff member.  There will be no extra charge for regular mail.

These deliveries will be sent out daily through the UCSC Mailroom, who will pick up these packages at Pharmacy every weekday that the Student Health Center is open.

Any copays will be applied to the student’s AIS account, as will any fees for  OTC products.  A separation of duties occurs with signing out the medication from the Pharmacy software, held in one location, and matching the mailing label to the receipt and product at the mailing station.

Note: Prescriptions can only be sent within California and will be sent by regular US Postal Service (not tracked nor signature needed).  No refrigerated medications will be shipped.  Shipping will be to addresses, and not PO boxes.

 

Information will be shared on the UCSC SHS and Pharmacy Websites – to include information on lower copay fees through the UCSC Pharmacy, as well as how to transfer prescriptions to other pharmacies.

 

Statement:

All prescription sales are final.

Questions can be directed to the UCSC Pharmacy telephone at 831-459-2360, or online through Health e-Messenger.

Contact your prescriber for medical advice about side effects.

If you wish to cancel your prescription, please contact us immediately.  We can cancel most orders up until it has been processed prior to shipping.

Thank you for using our pharmacy,

The staff at UCSC Student Health Services Pharmacy

Attached File: 

KIRBY LESTER KL1 Plus USE AND MAINTENANCE

Effective Date: 
Wed, 11/13/2019
Policy: 

Use of the Kirby Lester Pill Counter nstructions for use and cleaning.

Procedure: 

USE

  • scan bar code
  • scan stock bottle
  • pour exact amount through, using bowl

CLEANING

  • done daily whenever used
  • can be done more frequently if multiple dust-generating medications or counting errors
  • use isopropyl alcohol 70% or mild soapy (dish soap) water, lint-free cloth or paper towels
  • do NOT use facial tissue, cotton balls or cotton swaps

PROCESS

  1. Turn off and unplug unit
  2. Funnel - remove funnel and channel > clean outside and inside thoroughly with alcohol or mild soapy water
  3. Glass Detector Windows
    1. wipe off excess dust on the four windows with a dry cloth
    2. wet a clean cloth with alcohol or mild soapy water and clean all four windows thoroughly to remove all the remaining dust and residue, wiping back and forth, not up and down 
    3. do NOT press hard, to not break the windows 
    4. wipe glass windows dry with clean cloth to remove streaks
  4. Counting Tray
    1. clean thoroughly with mild soapy water - NOT alcohol
  5. Tray Sensor
    1. located behind the counting tray when the tray is fully inserted... remove tray, clean the sensor window with water then wipe to remove streaks

STUDENT COMPLAINTS

Effective Date: 
Tue, 09/17/2019
Reviewed: 
Sun, 09/01/2019
Revised: 
Tue, 10/06/2020
Policy: 

It is the mission of UCSC Student Health Services (SHS) to create a caring and supportive environment to assist students in improving their physical and emotional well-being to facilitate student success. 

UCSC Student Health Services has a responsibility to the student body and the University of California to uphold our mission, vision and values which includes following all legal and ethical medical standards. All staff have a responsibility to report any breaches in our standards and patient complaints made to them immediately to their supervisor.  

All student complaints are sent to the Governing Body for review including surveys, patient complaints, Quick Comments and other communications to or through Student Health Services.

Any staff member who is aware of a student complaint or a breach of conduct shared by a student, must report the information to their supervisor on the day of that knowledge.

Procedure: 

If a student contacts SHS about dissatisfaction with services or gives negative written feedback and identifies themselves, the manager or designee communicates directly with the student.

Several options can be presented to the dissatisfied student in an attempt to resolve their complaint or concern.  The student can discuss their concerns solely with the manager, or to the appropriate director, and the student can be provided with appropriate resources and referrals.

A student may discuss dissatisfaction with the director or with a designee of the director.  If they cannot resolve the issue, along with informed consent from the student, the issue can be discussed with the Executive Director of Student Health Services.

Complaints and grievances will be documented by the manager/s in RL Datix and analyzed as necessary to determine the need for any changes to overall policy or personnel.

Reports will be sent to the Governing Body.

HAZARDOUS DRUGS

Effective Date: 
Tue, 07/30/2019
Revised: 
Tue, 01/26/2021
Policy: 

All pharmacies and clinical offices that dispense or administer hazardous drugs (HD) must follow the USP <800> and EPA guidelines.

Any drug that demonstrates evidence of carcinogenicity, teratogenicity, genotoxicity, reproductive, developmental toxicity, or organ toxicity at low doses, are included on the site specific list of Hazardous Drugs. Those drugs are included in NIOSH tables - Table 1 (antineoplastics), Table 2 (other hazards), and Table 3 (reproductive hazards).

The requirements for the Student Health Center include:

  • Assessment of risk
  • Hazard communication
  • Annual review
  • Training of applicable staff for receiving, storage, transport, administration, disposal and clean up

The UCSC Student Health Center orients all new staff regarding Illness and Injury Prevention (IIPP), including Hazard Communication, upon hire, with specific training depending on their work area and job description.  Similarly, applicable staff are trained whenever a new product or a new procedure is instituted.  HD products are included in the Safety Data Sheets (SDS').

The UCSC Student Health Center pharmacy staff do not compound, nor physically touch, cut or crush any of the hazardous drugs that are stocked, therefore, no special handling, labeling or packaging is required (see attachments). If cutting or crushing of an HD is needed, the student can acquire a pill cutter or crusher for individual use.  If there is any risk, staff can use gloves.

Nursing staff administer estrogen, progesterone and testosterone products, and use the appropriate Personal Protective Equipment (PPE).

Procedure: 

Designated Person and Designated Area

The UCSC Pharmacy is the lead department regarding following the requirements for hazardous drugs for UCSC Student Health Services.  The designated person in charge is the Pharmacist-in-Charge (PIC), and the designated area is the receiving area of the pharmacy. 

New products that are ordered and received will be entered into the Pharmacy software and will be reviewed against the NIOSH lists (and Confused Drug Names and High Alert Medications List ISMP list), for special handling, documentation/inclusion on the UCSC list, and any futher documentation in the Pharmacy software.  Hazardous drugs from wholesalers/suppliers are packaged separately from other medications and are double bagged.  The pharmacy staff receiving any new products will alert pharmacist/s of any new HD's (or new products on the ISMP Confused Drug Names and High Alert Medications Lists).

An annual assessment will be performed and an annual report will be made to the Pharmacy and Therapeutics Committee.

Assessment of Risk

All stocked drugs from the NIOSH Tables are assessed for risk.  See UC SHS NIOSH Hazardous Drugs shared document for risk and special handling.  New drugs are added upon order / receipt with risk assessment conducted.  Document is reviewed at least annually.

The UCSC Pharmacy department may designate that staff of reproductive capability or are pregnant or conceiving refrain from dispensing specific medications as listed in the Risk Assessment on the UC SHS NIOSH Hazardous Drugs shared document regarding risk and special handling.

Hazard Communication and Training

All staff who may come into contact with hazardous drugs (pharmacists, pharmacy technicians, nurses) will complete the Learning Center training on Hazardous Drugs.  Note: Special attention for staff with reproductive capability.

Labeling, Packaging, Transport and Disposal

The UCSC Student Health Center does not physically touch, cut or crush any of the hazardous drugs that are stocked, therefore, in general, no special handling, labeling or packaging is required for intact HD's. HD's are obviously designated with an HD label, and are separated from other drugs on the shelf via small bins (see attachments).  

Special Handling: The UCSC Pharmacy department may designate that staff who are pregnant or conceiving refrain from dispensing specific medications as listed in the Risk Assessment on the UC SHS NIOSH Hazardous Drugs shared document regarding risk and special handling.  When there is a risk of exposure, staff can use gloves.

UCSC Pharmacy staff will use a designated counting tray, and will refrain from using the shared KL counting machine.  The counting tray will be cleaned before and after counting a hazardous drug.

Spill or Alteration of Dosage Form: If a product is received and has been damaged, or a spill occurs, then clean up would be done using a spill kit with any involved staff member wearing Personal Protective Equipment (PPE) including the appropriate gloves and an N-95 respirator. 

Disposal: Any waste HD product will be contained and sequestered, then disposed of appropriately depending on the hazard. See UC SHS NIOSH Hazardous Drugs shared document for risk and special handling.  As needed, the product will be entered into the online UCSC WASTe system by designated users, for pick up and disposal by EH&S.

Administration

Nursing staff administer estrogen, progestins and testosterone products by injection and wear gloves for withdrawing contents from a vial and for administering the medication to patients.

 

ANTIDOTE STOCKING IN PHARMACY

Effective Date: 
Fri, 05/24/2019
Policy: 

In an effort to be prepared to treat UCSC Student Health Center staff, their families and UCSC students, the Pharmacy will stock a limited supply of antidotes in case of emergencies to at least begin post exposure prophylaxis when indicated and ordered by the Medical Director.

Procedure: 

The UCSC Pharmacy will maintain a backstock of antidotes. Those medications will be used in rotation for any regularly stocked product for our student patients. A special storage bin will house the Antidote Extra Stock, which when rotated into use, will have a supply replaced into the exposure prophylaxis storage bin.  Expiration dates and rotation of stock will be checked monthly.  Par levels are in parentheses. 

Antidote Extra Stock:

  • ciprofloxacin 500mg (500)
  • azithromycin 250mg (200)
  • doxycycline 100mg (500)
  • sulfamethoxazole/trimethoprim DS (200)

 

Antidote Limited Stock:

  • penicillin G benzathine inj; refrigerated (10)
  • clarithromycin 500mg (100)

Specific Antidote Medications 

  • glucagon (2)
  • naloxone injectable (2) and nasal (3)
  • calcium gluconate gel (2)
  • flumazenil (Red Cart) (1)

STORAGE AND RECEIVING PATIENTS OUTSIDE MEDICATIONS

Effective Date: 
Wed, 08/29/2018
Revised: 
Thu, 04/15/2021
Policy: 

UCSC Student Health Services (SHS) stores medications that require shipment to a medical facility and possible administration by an off campus health care professional while the patient is attending The University of California Santa Cruz. Only medications that are approved will be stored by SHS. Case Managers may be involved in this process.

This policy outlines processes for the receipt, documentation, storage and removal of the medication. 

Brown bagging or white bagging of outside injected and infused medications in the clinic setting at UC Health is prohibited, except for self-administered medication teaching for patient education.

 

Procedure: 

Upon approval, medications may be shipped to and stored in the UCSC Student Health Center Pharmacy. The shipping address for the UCSC Student Health Pharmacy is 1156 High St., Santa Cruz, CA 95064.  If necessary, we may accept products directly from the student patient.
The Pharmacy hours of operation are 9:00 a.m. to 5:00 p.m. Monday through Friday.  The pharmacy is not open on weekends or holidays. Summer hours are 9:00 a.m. to 12 p.m. and 1 p.m. to 5:00 p.m.  Medications shipped to UCSC Student Health Services Pharmacy are only received during the pharmacy’s hours of operation.  Medications stored at the pharmacy are only retrievable during the pharmacy’s hours of operation.

Enrollment:

1. The patient submits the completed “Request and Consent for Acceptance and Storage of Medication” form, (attached), to the UCSC Student Health Pharmacy at least 2 weeks before the medication is to be shipped and stored. 
2. A UCSC Student Health pharmacist reviews the form, determines storage requirements for the medication, and clarifies any information by contacting the patient, prescribing physician, or supplier, if necessary. 
3. The pharmacist determines if the pharmacy is able to properly receive and store the medication.  

4. The pharmacist contacts the patient to confirm that the pharmacy will accept and store the medication, or to tell the patient why the pharmacy is unable to accept and store the medication.  If the medication is to be received and stored at SHS, the pharmacist reaffirms the following information to the patient:

a) The SHS Pharmacy shipping address, as above, to the supplier of the medications.  Medications are only received and are only available during the pharmacy’s hours of operation.
b) The patient is responsible for all communications with the supplier of the medication.  This includes making sure there is adequate supply, and arranging for shipment to an alternate address.

The UCSC SHS pharmacist completes enrollment by performing the following:

1, Preparing storage labeled with the patient’s name, SID, and medication name and setting up the proper storage location.
2. Enters the medication name and dosage on the patient’s record in the Pharmacy software program.
3. Places the “Request for Acceptance and Storage of Medication” form, along with a “Patient’s Own Medication Inventory Record”, with the patient’s medication.
4. Shares the patient’s name, medication, and storage instructions to the pharmacy staff, so that the information is disseminated to the entire pharmacy staff via IM or Secure Message.

Acceptance of Delivery

1. The UCSC Student Health Pharmacy staff signs for and receives the shipment of medication from the delivery service.
2. The staff member immediately places medication requiring refrigeration into a location labeled with the patient’s name and SID in the pharmacy medication refrigerator. 
3. Medication that does not require refrigeration is stored in a location labeled with the patient’s name and SID.
4. The technician enters the amount received on the “Patient’s Own Medication Inventory Record” that is located with the patient’s medication storage.  The technician informs a pharmacist immediately of any discrepancy in the total inventory count.

Storage of Medication

1. The patient’s own medication is stored and labeled with the patient’s name, SID, and name of the medication.
2. Medication that does not require refrigeration is stored in the designated location.
3. Medication that requires refrigeration is stored in the refrigerator.

 

Discontinuation of Storage of Medication at the UCSC Pharmacy

1. The patient is responsible for contacting the supplier of the medication to change the shipping address whenever a medication is to be administered at an alternate medical facility.
2. If the patient no longer wishes to have medication received and stored at SHS, the patient must contact the SHS Pharmacy directly to arrange and take care of shipment of any remaining medication to an alternate medical facility. 

3. After this time, the patient would need to re-enroll to once again have medication stored at SHS. 

4. Any medication and supplies that remain after the expiration date of the medication or the end of the enrollment session, whichever comes first, is discarded or provided to the patient. 
5. When a patient notifies the Pharmacy that medication will no longer be received and stored at SHS, the UCSC Student Health pharmacist performs the following to complete disenrollment:

a) Provides any remaining medication and supplies to the patient.
b) Confirms with the patient that the patient has arranged for future shipments to be sent to an alternate address.
c) Completes the “Patient’s Own Medication Inventory Record” and files it, along with the “Request and Consent for Acceptance and Storage of Medication” form, in the appropriate file in the file cabinet.
d) Enters an encounter in the patient’s electronic health record stating that the pharmacy is no longer accepting and storing the medication.
e) Submits the information about the patient’s disenrollment to the pharmacy staff via IM or Secure Message.

 

The UCSC Pharmacy is not liable for the medication, as stated in the Request and Consent for Acceptance and Storage of Medication form.

OTC SALES OF PSEUDOEPHEDRINE PRODUCTS IN THE PHARMACY

Effective Date: 
Fri, 08/24/2018
Revised: 
Wed, 10/03/2018
Policy: 

The UCSC Pharmacy sells pseudephedrine, and combination pseudoephedrine products over the counter and follows all the laws and regulations within the Combat Methamphetamine Act of 2005.

Pharmacy staff will review the rules annually, and only sell the allowed amounts after checking official photo ID (UCSC Student ID is acceptable for our student patients).  The purchaser must be over the age of 18.

Purchasers must acknowledge / document their agreement in the pharmacy record and sign for the product at sign out with the cashier.

Note: prescriptions for pseudoephedrine, phenylpropanolamine, and ephedrine are exempt from this requirement, and the UCSC Pharmacy only stocks OTC pseudoephedrine and not the other included products, phenylpropanolamine, and ephedrine.

Attached File: 
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