Consultant pharmacists have worked very hard to promote and assure quality of care at nursing and assisted living facilities for many years, earning the trust of administrators, nursing staff, and physicians. Traditionally, smaller local pharmacies would provide medications for the residents and an independent consultant pharmacist would provide pharmacy consulting services for the facility. Now that facilities are responsible for a larger percentage of medication cost, large-scale pharmacy distributers have been able to provide medications at a lower cost than the small local pharmacies, and usually offer "discounted" consulting services, which is made up for in the dispensing fees they receive.

In an editorial on the American Medical Directors Association web site, titled "Biomedical Ethics & Pharmacy Issues in Long-Term Care Facilities," Jonathan Evans, MD, CMD describes how this new trend is upsetting some physicians, and perhaps even negatively effecting cost and quality of care.

Some of the issues that he describes include:

• Many consulting pharmacists are now employees of corporate pharmacy service providers whose profits were derived from the sale of medications in general, and whose profit margins in some cases are favored by the sale of certain drugs in particular.
• At least one national pharmacy provider faxed virtually identical prescriptions to physicians across the country--for their "convenience" and requiring only their signature--in order to begin their patients on lipid-lowering therapy with a particular brand of statin drug.
• Long-term care facilities have their own public image to contend with. In order to maintain their legitimate role as patient advocates, facility administrators and staff should strongly consider hiring their own independent consultant pharmacists to perform the auditing and oversight function required by federal regulations.
• It is best for the patient, and therefore best for long-term care in general, if consultant pharmacists remain truly independent from pharmacy providers, in order to avoid even the appearance of a conflict of interest.
• Complicating the role of consultant pharmacist by coupling the auditing and oversight role with marketing and formulary management is likely to alienate physicians, who may come to view consultant pharmacists with distrust. The result will be to diminish the positive impact of consultant pharmacists on the quality of care.

LLW Consulting, Inc. takes pride in being truly independent. Our recommendations are always intended to meet regulatory requirements, evidence-based clinical guidelines (carefully evaluated to determine applicability for individual residents), or are modifications intended to save cost or nursing time while maintaining quality of care.

Our facilities and their residents come first - our bottom line depends on your satisfaction with the services we provide - not dispensing fees or drug company rebates.