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CTPP Certification Review
A Review Guide for the Certified Telepharmacy Pharmacist (CTPP) Exam
BAA: Business Associate Agreement
BOP: Board of Pharmacy
CCM: Chronic Care Management
CMM: Comprehensive Medication Management
CMS: Centers for Medicare & Medicaid
CPA: Collaborative Practice Agreement
CPOE: Computerized Provider Order Entry
EHR: Electronic Health Record
HHS: Department of Health and Human Services
HIE: Health Information Exchange
HIPAA: Health Insurance Portability and Accountability Act
HPSA: Health Professional Shortage Area
IT: Information Technology
MCO: Managed Care Organization
MTM: Medication Therapy Management
NABP: National Association of Boards of Pharmacy
OCR: Office for Civil Rights
P&P: Policies and Procedures
PBM: Pharmacy Benefit Manager
PCP: Primary Care Provider
PHI: Protected Health Information
POS: Place of Service
QA: Quality Assurance
QI: Quality Improvement
RPM: Remote Patient Monitoring
SUD: Substance Use Disorder
TCM: Transitional Care Management
- Definition of Telepharmacy: The provision of pharmaceutical care by a pharmacist through the use of telecommunications and information technologies to patients at a distance.
- Models of Telepharmacy: Differentiating between **Remote Dispensing** (a pharmacist supervises a technician at a remote site), **Remote Counseling/MTM** (pharmacist provides clinical services via telehealth), and **Remote Order Verification** (pharmacist verifies orders for a hospital or other institution from a remote location).
- The Goal of Telepharmacy: To improve patient access to pharmaceutical care, especially for those in rural or underserved areas (e.g., HPSAs).
- Synchronous vs. Asynchronous Technology: Synchronous involves real-time, two-way audio and video communication. Asynchronous involves "store-and-forward" technology where data is captured and reviewed later.
- The Quadruple Aim: An extension of the Triple Aim, it seeks to 1) Improve the patient experience, 2) Improve population health, 3) Reduce costs, and 4) Improve the work life of healthcare providers. Telepharmacy can contribute to all four goals.
- State-Based Regulation: The practice of pharmacy is regulated by individual state Boards of Pharmacy (BOPs). Telepharmacy laws and regulations vary significantly from state to state.
- Pharmacist & Technician Licensure: Understanding the licensure requirements for both the pharmacist and the technician at the remote site. Often, the pharmacist must be licensed in the state where the patient is located.
- NABP Model Act: The National Association of Boards of Pharmacy provides model language that states can adopt to regulate telepharmacy practice, but it is not a federal law.
- HIPAA & Technology: Ensuring that the technology platform used for telepharmacy is secure and HIPAA-compliant to protect patient privacy and PHI. This includes having a Business Associate Agreement (BAA) with the technology vendor.
- Prescribing & Dispensing Controlled Substances: Adhering to the Ryan Haight Act, which governs the prescribing of controlled substances via telemedicine. Generally requires at least one in-person medical evaluation.
- Policies & Procedures (P&Ps): The requirement for a comprehensive P&P manual that details all aspects of the telepharmacy operation, including quality assurance, emergency procedures, and technology failures.
- Informed Consent for Telehealth: Many states require that patients provide specific informed consent for receiving healthcare services via telehealth, separate from a general consent to treat.
- Essential Technology Components: A secure, high-speed internet connection, high-definition cameras, high-quality audio, and a HIPAA-compliant software platform are the minimum requirements.
- Remote Dispensing Workflow: A step-by-step understanding of the process: 1) Technician enters prescription, 2) Pharmacist remotely reviews and verifies the order, 3) Technician fills the prescription under audiovisual supervision, 4) Pharmacist conducts a final check of the product via camera and counsels the patient.
- Image Capture & Verification: The use of high-resolution cameras to capture images of the original prescription, the stock bottle NDC, and the final filled prescription for the pharmacist's verification.
- Remote Patient Counseling: The requirement for a live, real-time audio and video link to be available for the pharmacist to counsel the patient. The offer to counsel must be made for every new prescription.
- System Downtime Procedures: Having a clear, documented plan for how the pharmacy will operate in the event of a power outage or internet failure.
- Quality Assurance (QA): Implementing a QA program that includes regular audits of the remote site, technician competency assessments, and monitoring of key performance indicators.
- Comprehensive Medication Management (CMM): Providing the full CMM/MTM process via a telehealth platform, including conducting a CMR and developing a Medication Action Plan.
- Chronic Care Management (CCM): Using telehealth to provide ongoing management for patients with multiple chronic conditions, often in collaboration with a physician under a CPA.
- Transitions of Care (TOC): Performing post-discharge medication reconciliation and counseling for patients via telehealth to reduce readmission rates.
- Remote Patient Monitoring (RPM): Using technology to monitor patient data outside of a traditional clinical setting, such as blood pressure, glucose, or weight, and using this data to make medication adjustments.
- "Webside" Manner: The telehealth equivalent of "bedside" manner. Involves skills like looking at the camera to make eye contact, using clear and simple language, and actively listening to build rapport.
- Digital Therapeutics (DTx): Understanding the emerging field of evidence-based therapeutic interventions delivered through software to prevent, manage, or treat a medical disorder or disease.
- Dispensing Reimbursement: For remote dispensing sites, reimbursement for the drug product is typically handled through PBMs in the same way as a traditional pharmacy.
- Reimbursement for Clinical Services: This is more complex and variable. Key mechanisms include MTM CPT codes, "incident-to" billing, CCM codes, and direct contracts with payers or ACOs.
- Place of Service (POS) Codes: Using the correct POS code on the claim form is critical. POS 02 indicates telehealth services provided other than in the patient's home, and POS 10 indicates telehealth provided in the patient's home.
- Originating Site vs. Distant Site: The originating site is where the patient is located. The distant site is where the provider (pharmacist) is located. Reimbursement rules can vary based on this.
- Payer Policy Variability: Commercial payer policies on reimbursement for telehealth services vary widely and are constantly changing. Verifying coverage before providing a service is essential.
- Pharmacist Provider Status: Understanding the ongoing advocacy efforts to achieve provider status for pharmacists at the federal level, which would greatly expand reimbursement opportunities for clinical services.
Patient Satisfaction Surveys
Using validated surveys to measure the patient's experience with the telepharmacy service, including ease of use of the technology and the quality of the interaction with the pharmacist.
Medication Adherence (PDC)
(Number of Days Covered by Fills / Number of Days in Period) * 100
Tracking adherence metrics for patients served by the telepharmacy to demonstrate impact on quality measures.
Clinical Outcome Metrics
For clinical services, tracking improvements in key clinical markers, such as A1c, blood pressure, or cholesterol levels.
Operational & QA Metrics
Tracking internal metrics such as prescription turnaround time, intervention acceptance rates, and the number of near misses or dispensing errors identified and prevented by the remote pharmacist.
- Access to Care is the Driving Force: The fundamental purpose of telepharmacy is to extend the reach of the pharmacist to provide care to patients who would otherwise have limited or no access.
- Equivalency of Care: The commitment to ensuring that the quality of pharmaceutical care provided via telepharmacy is equivalent to the care provided in a traditional, in-person setting.
- Technology is the Tool, Not the Service: The understanding that technology is simply the medium through which care is delivered. The core of telepharmacy is still the clinical judgment and expertise of the pharmacist.
- Trust is Built Through the Screen: The skill of using effective verbal and non-verbal communication to build a strong, trusting pharmacist-patient relationship, even without being physically present.
- The Pharmacist is Always in Charge: The principle that while a technician is essential at the remote site, the pharmacist is ultimately and legally responsible for all aspects of the dispensing process and patient care.
- Adaptability is Key: The ability to be flexible and troubleshoot technical and workflow challenges in real-time to ensure a seamless experience for the patient.
