Long-term care at home (LTC@Home) is quickly emerging as a transformative model for independent pharmacies, offering a new revenue stream, enhanced patient care, and a competitive edge over traditional retail.
Todd Eury of the Pharmacy Podcast Network hosted a 3-part series on LTC@Home. Part 1, "Building Your LTC Pharmacy at Home Business" covers how pharmacies can transition into the LTC@Home model, what infrastructure is required, and how automation and proper credentialing can unlock higher reimbursements.
Featured guests were:
Below are some podcast highlights. The transcript has been edited for clarity and length.
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Todd Eury: So much is happening. But I do want to bring to your attention that there is a gelling of multiple organizations inside pharmacy, more specifically how long-term care is going to continue to expand throughout the nation. By the way, just a shout out to pharmacy owners out there, just continue to build your networks. That's really going to help us pull through a lot of the transformational times that we're in.
All right, the subject—and this made national news earlier this year—it was exciting to see such a partnership, Eyecon, RxSafe, PharmaComplete, and the Long-Term Care at Home Network forge a strategic partnership, and there's a reason for this. This is cultivating of so many companies and ideas of what we've seen happening with the evolution of pharmacy care throughout our nation, throughout our communities, and how the positioning of our technologists and our processes, our pharmacy management systems, and then insights that you bring, Paul, is really bubbling up.
So, if you're listening right now and your pharmacy hasn't taken the official leap, but you're doing it, you know damn well that you're doing long-term care at home pharmacy services anyway, but to be paid for it, to be positioned, to have the right tech, Paul, I'm going to kick it off to you just to start out. Give us just some groundwork. Tell us more about the evolution of long-term care at home through pharmacy.
Paul Shelton: Yeah, absolutely, Todd. So, I think long-term care at home and pharmacy started in the early 20-teens when we first started putting compliance packaging into community-based pharmacy, seeing a need for pharmacies to treat patients a little bit differently.
I think the very first pharmacy that did this anywhere in the country was actually in Nashville in 2001/2002, and then they suspended that program in the late 2000s, and then it got picked back up by some folks who were trying to figure out how to change how patients could stay in their home, happy and healthy as long as possible. There were some early innovators in the process in the mid-2000-teens that kind of took it and ran with it before it was known as LTC@Home, and then starting in 2018 and 19, it started being talked about more and more at CMS. So, by 2021, CMS mentioned that it's appropriate to be paid for patients in the home, but plans would have to negotiate individually to come up with an actual solution there.
So, that really was the birth of LTC pharmacy at home as we know it today. Starting in 2023, we founded Long-Term Care at Home Pharmacy Network to educate pharmacies to really codify what that looks like. What does it look like when it's done correctly? And take some things that we've learned through some of our pharmacy partners through our consulting firm and make sure that we're able to get that out to as many people as possible and get that education in their hands, make sure they're using the right paperwork, make sure they're using the right attestation forms so that they're not running at risk or running afoul of audits.
Right now, as of today—the week of May 16th, we have two pharmacy benefit managers (PBMs) that pay enhanced retail reimbursement for the LTC@Home model. There are two other PBMs out of the "big four" that don't recognize it currently. However, what we found is it's not the reimbursement necessarily that's driving the process. It's the process itself of helping patients stay at home and healthy and changing how your pharmacy is operating, becoming a proactive pharmacy versus a reactive pharmacy, using automation to change fundamentally how you staff, how you fulfill for your patients. It's really a paradigm shift in how pharmacy in the United States should be and can be performed.
Todd Eury: I remember talking with both of you years ago before this really became a thing. When I think of you, Matt, and what you've done through the evolution of RxSafe and now, of course, Eyecon and the fusion of multiple technology platforms that are deliverable right there into our community pharmacies—we were calling it combo shops.
As that started to accelerate and here we are today, technology had to keep up. You've been watching this happen. You could literally probably have a blueprint of sorts to show the evolution of where RxSafe was throughout the years, but now we're here and now we've officially called it something and the leverage of adherence packaging is a key piece of actually making this happen.
So, Matt, give us your kickoff and your overview of long-term care pharmacy at home.
Matthew Gilbert: Yeah, I think it's been interesting seeing that evolution over the years like you've been talking about. I mean, when we think back to when we first launched the RapidPak probably 2018-ish, the big focus back then was, hey, let's go take on Amazon.
So, every retail pharmacy jumped in that was an early adopter and really saw, you know, here's the future. I've got to be able to battle Amazon and serve them the same exact way that they're serving via the PillPack acquisition. So, then you go through and you make it through a few years of those early adopters and then it's what's the next big thing? And the thing that we and Paul and Todd have been pumping out for the last, call it four years or so, first started off as medical at home, like you were saying, and now LTC@Home.
But, you know, we really try to position all of our equipment to specifically serve that business model because we saw that as the future four years ago and have been banging that drum the entire time. So now seeing people that are forward-thinking coming to us and saying, "Hey, I've got 20 Dispill patients, you know, what's the next step?" I want to grow the business, but I can't justify adding another technician to get into my operation and the cost that goes with that. It starts layering on automation, whether it's our RapidCard to fulfill blisters, or, if you want to move over to pouch and serve a wider net of patients.
So, with that in mind, and now with ITW behind us, their big focus is customer-backed innovation. And we've always been like that anyway, but now it's just taking it on steroids and bringing it to the next level.
Todd Eury: Paul, the evolution of this to what Matt was just saying is now having terminology that is accepted throughout our insurance systems and being able to classify a service that's happening at these facilities.
I was in long-term care pharmacy forever and the technology and how we use specific Current Procedural Terminology (CPT) codes and billing and International Classification of Diseases (ICD-9) at the time, but now it's ICD-10. And so we have to have classifications. We have to have services that are going to be pulled through.
So share with the listeners the kind of legality of some of this that's tied back to payment.
Paul Shelton: Absolutely. So, when you set up a combination shop pharmacy or a long-term care at home pharmacy, traditionally that's coming out of a retail pharmacy. But there's really two pathways that you can go here.
So, if you're coming in a retail pharmacy, you're setting it up in that second taxonomy, your second setup for LTC. You use one pharmacy permit number, one Drug Enforcement Administration (DEA) number, and then you set up a second primary taxonomy under National Provider Identifier (NPI) and National Council for Prescription Drug Programs (NCPDP) that is long-term care. And when you do that, you link that second NPI and NCPDP with a long-term care pharmacy services administrative organization (PSAO) or group purchasing organization (GPO).
There are currently four in the market, two of which are heavily focused on long-term care at home. Those two are GeriMed and Innovatix, also known as the premier continuum of care. The other two that are in the market that are more heavily focused on institutional care but can support long-term care at home are MHA and SPS Health.
SPS Health is the newest addition to this portfolio. They kicked off at the beginning of 2025. And so, when you look at that, you select a GPO PSAO partner, you get rostered with them after your NPI and NCPDP are created, and then you go through a credentialing process with ESI. Optum actually uses your NCPDP and your PSAO to link you to that account very rapidly. Usually about 30 days after you've been rostered by your GPO PSAO, you have access to Optum. And so, Optum and ESI currently are the two PBMs that actually pay an enhanced retail reimbursement.
It's important to note, I'm not saying they're paying full long-term care at home reimbursement today, because the level of service that's required to support these patients looks much more like skilled nursing than it does like enhanced retail. And so when you think about what happens in a skilled nursing facility, you've got all of your criteria for LTC. So, the 10 criteria from Centers for Medicare & Medicaid Services (CMS) that you have to be able to meet.
In addition to that, you have to provide monthly medication reconciliation, much like in the skilled nursing world where they provide monthly chart reviews. And you also have to do coordination of care and transitional care management. And so those enhanced services really should be reimbursed at a higher rate than what they are today.
But already we're seeing a significant differentiation in reimbursement. We've done long-term care at home population assessments for about 192 pharmacies to date. That's over the course of the last, call it eight months. The average is $54,700 per pharmacy and opportunity that we've identified. And this is a very conservative estimate. We are actually working with a pharmacy here in the little town I live in in North Carolina last week that just got rostered with Optum. And we moved seven patients over. They were already packaging for the patient, already delivering for the patient, already providing care coordination, monthly medication reconciliation, all the services that were necessary to be LTC@Home. And they've been doing this for two years, Todd, two years they've been servicing these patients this way.
They moved those seven patients over to LTC@Home reimbursement and they increased the reimbursement on those patients by $800 total. They've been doing this work for two years and have been getting paid standard retail rates where they should have been able to capture these enhanced retail rates for those for those patients. And so they've since moved over another nine patients and are in excess of $2,200 in monthly opportunity. And so every single month that pharmacy is making an extra $2,200 for work they were already doing.
Todd Eury: So, we have the processes, you have to fill out the right form, you have to be classified the right way. But another portion of this is the tech and being able to show through your now you're filling out your forms, you're doing it the right way. You have to you have to have the tech.
So what systems are we putting in place, Matt, in order to move forward with a true long-term care at home pharmacy?
Matthew Gilbert: Yeah, so on the automation side it generally falls under two buckets for us. We've got the Eyecon brand, which is in 16,000 retail independent pharmacies throughout the country. So, I'd say just about every pharmacy at this point and chains as well.
But on the LTC@Home side for the RxSafe product line, the RapidPak pouch packaging machine is kind of our gold standard. We have a lot of people that want to stick with Dispill Medicine-On-Time. Sure, med cards from OmniCell and they can stick with those. And the great thing that we built into the RapidCard line was that that machine will work with any multi dose blister card format. We customize the software, we customize the plate that actually accepts the card and the machine is able to read any card type. On the pouch side, we always try to steer people to that because it all comes down to cost and depth and breadth of populations you can serve.
So if you're looking at a Dispill or Medicine-On-Time card, you're probably looking at $6-$7 all-in in consumable costs, where I can get that same box or monthly supply out the door through a box and our strip packaging for in the $3-$4 range. So as you scale, we're trying to help you save in the long run, but also expand into those different patient populations that you can serve.
Paul Shelton: And Matt, I think it's important to point out, too, in the strip packaging, the level of flexibility you have in the number of dose times that you can support, whereas with some of the cards, it's either you can either support two or four dose times a day or if you're doing a monthly card, you can support a large number.
But that becomes as confusing to a patient as just having vials where with the strip packaging, you really do get that flexibility of all right, if I've got a 30 minutes before breakfast, a breakfast dose, a mid-morning snack dose, a lunchtime dose, a 5 p.m. dose, a 6 p.m. dose and a bedtime dose, which that's actually unfortunately not that not that uncommon for these patients because these are highly acute patients averaging between 11 and 14 medications per day. That flexibility the strip packaging provides is just exceptional for this patient population.
Matthew Gilbert: Yeah, it takes me back to the days when I was still running pharmacies and delivering out two brown bags filled of Dispill cards for one patient. So, I completely agree there wholeheartedly on many facets. Yeah.
Todd Eury: All right. But there's some evidence to this and we always like evidence-based practice, including evidence-based business practice. And that is you have a calculator, Matt, that you can kind of share in the in concept with a specific pharmacy who's listening right now who may not have implemented the plan and they need to implement their long-term care pharmacy plan. Go through us a little bit about that calculation to be able to come up with how many patients you need to basically go right into the black within a specific period of time of paying, you know, paying this investment off.
Matthew Gilbert: Yeah, typically it varies by state, but just slightly. So, if you're in California area, your patient that could cost-justify a machine could be at 20 or 30 patients once you start calculating in labor and cost of consumables. But, we go through on both the RapidCard line and the RapidPak and we'll go through, plug in your numbers with your real world data. And what we do as a company through that partnership with Paul and his team is we'll go through and we'll take care of that LTC@Home analysis on top of that.
So out of the gate, everybody we've done it for just on Paul's piece alone is cash flow positive from the jump if they can convert a small amount of those patients over. So, then you layer in the operational efficiency from a labor perspective and a consumables perspective—if you're making the switch from cards to pouch—and it just knocks it out of the park. You're talking $5,000-$10,000 in net profit after paying for our machine every month.
Todd Eury: I love it because this isn't a guinea pig anymore. This is happening. This has been absolutely ready to go. You can get involved—it's all 50 states, right, Paul? Every state has a lead in.
Paul Shelton: Yep. There's actually—we have members in the network in all but two states at this point. We also have members in Puerto Rico. So it's literally every state and territory. There's an opportunity—and, as to Matt's point—it really depends on mix. So like, if your plans are heavy in Optum and ESI, okay, that's going to be a good answer for you.
Of the 192 assessments that we've done, we've only had seven pharmacies that it didn't make sense for them to move forward with LTC@Home. Of those three were rural contracted pharmacies with low Optum and ESI populations. And, you know, if you're already rural, the PBMs are already recognizing you're doing something special. So great. Continue doing that.
The other four pharmacies that didn't make sense were actually all in New York City because they were extremely high Medicaid populations. And Medicaid, unfortunately, does not recognize long-term care of any kind, not just long-term care at home, but any type of long-term care for enhanced reimbursement. And so for those pharmacies, it didn't make sense because they were 85+% Medicaid pharmacies. And so they didn't have any outliers. But 192 - 7, unless my math is terrible, is 185 pharmacies. That's a lot of pharmacies that are seeing a huge amount of benefit from this.
Todd Eury: Absolutely. It's hopeful too, because we've seen the reports, we've seen some of the testimonies that you can find at RxSafe.com, some of the people that've already implemented and done it. But also just the camaraderie between pharmacy owner to pharmacy and they want to see in operators, they want to see each other succeed.
There's some things that are happening and obviously in PBM reform. When I think about getting together, I think about the trade show world. Matt, before we wrap up this segment of this week in pharmacy, talk to us about the trade show season and where Eyecon-RxSafe is going to be.
Matthew Gilbert: Yeah, well, we'll only be at about 40 trade shows this year. We're slimming down, I think, a little bit on those. It was weird for it to be home with my family for a month. They were telling me to get back out around the holidays. So, we've got Pioneer Catalyst, which about 60% of our customers are Pioneer. So that's kind of our bread and butter wheelhouse. We'll be there. We'll be at RBC is another big one. Cardinal's show at the same time as McKesson. So, splitting up our teams for IdeaShare and RBC. And then we're actually going to have Paul in our booth at Cencora ThoughtSpot later this summer. So, we're doing a ton of smaller state shows. But those are the big four for the rest of the summertime anyways.
Todd Eury: All right, there's another piece of the puzzle that we really didn't go over today. It's organizations like GeriMed, for example. Paul, what category is that? And then tell us about what we're going to be hearing in future episodes to come in the series.
Paul Shelton: Yeah, absolutely. So, as we spoke about earlier, GeriMed and Innovatix both definitely lean into long-term care at home in a meaningful way. And they are part of what's called a GPO or PSAO. And so, GPO is a group purchasing organization. Their goal is to bring class of trade discounting to long-term care pharmacies.
And then they're also a PSAO, so pharmacy services administrative organization. And in that organization, they actually negotiate on behalf of their pharmacies with PBMs and find ways to enhance reimbursement for new service models. And so, both of those organizations have done a phenomenal job in staying engaged with PBM partners and really driving this process forward.
I mean, I think I don't think it's any surprise that there have been leaders at both organizations that have been talking about first medical at home as early as 2017 and 18 and more recently, long-term care pharmacy at home, which is kind of what the new normal is for this nomenclature is there has been a lot of movement in the hospital space to provide care in the home. And so, it was getting confusing when they were saying, well, we're medicine at home and we're medical at home—which is which? And so, we changed the nomenclature to long-term care pharmacy at home in large part because of both Gerimed and Innovatix wanting to make sure they were more clear in what was happening in this industry.
Todd Eury: I love it, I do, and every piece of the puzzle that you're listening about when you're listening as you're listening to this podcast right now, you're wondering, how do I get started? There's multiple pieces. Don't worry, if you reach out to RxSafe, if you reach out to Paul Shelton at Pharma Complete, you're going to get all the answers. They're all part of the players. Actually, Gerimed and Innovatix, too. They all know what's going on. They all understand the pieces of the puzzle that have to be put together.
Don't wait anymore. Just set an appointment up with Paul. Reach out to Matt at Eyecon- RxSafe, and just ask questions and say, hey, how do I have to do this? What do I have to do to make sure that it works for me? Are there any pitfalls? Is there anything that I have to watch out for? I mean, they've been doing it for so long. It's ready to go. And if you have patients, if you're serving in your community, you need 20, 30 patients to really kick this off the ground. So, I'm sure you do. I'm sure you're listening right now. You have some. And let Matt and the team and Paul identify those patients for you and with you.
Don't go at it alone. But in wrapping up, what do you what do you want to share for our next episode, Matt? Is there anything that I forgot to mention?
Matthew Gilbert: I think the biggest thing that Eyecon-RxSafe is really big on is strategic partnerships. And with Paul and his group or GeriMed or anybody else, if it's MedSense, we introduce you to for an RTM program. Just know that's not a financial reward for us. That's us putting you in the best spot with people who know the industry the best. And like you were talking about earlier, building your network. We built our network. You know, I pride myself on that.
And if I hand somebody off to Paul, I know Paul is going to take care of them and give them the best information to make an informed decision, whether it's with our technology or a competitor or whatever it is. So, I think leverage those strategic partnerships. And that's what we do better than anyone else, in my opinion.
Todd Eury: I agree. I agree. All right. Have questions? Reach out to RxSafe.com. Just want to give a shout out to RxSafe for sponsoring today's This Week in Pharmacy. Paul, it's always good talking to you and seeing you. Cannot wait to do the next one with you. We will be at IdeaShare. We'll be at another one that you mentioned, I know. So, we're definitely going to run into each other. So, I'll be looking for you on the on the trade show floor.