New Rules Related to Dispensing Insulin Pens

On November 15, 2019, FDA published updated product labeling for all insulin pens available in the United States market that advises the product should only be sold in full, unopened boxes. As you know, this is a significant deviation from what pharmacies – particularly in the long-term care space – have performed in the past. In order to minimize waste and reduce costs to the entire system, it is customary for pharmacies to dispense single pens upon demand. Pharmacy Network Services has taken the position to delay on implementation of this change until absolutely necessary in order to minimize changes that impact its client facilities. Pharmacy Network Services has recently been in contact with a number of industry associations and other similar pharmacy providers that service other markets, and the overwhelming consensus is that we must now implement the changes in accordance with FDA and CMS guidance.

Going forward, the pharmacy has been made aware that CMS and the PBMs that administer Medicare Part D benefits (as well as commercial insurance plans and state Medicaid programs) intend to strictly follow the guidance set forth by the FDA. Therefore, pharmacies are not able to provide less than a full box of insulin pens to these patients at this time. You will begin to see full boxes of insulin pens being dispensed in order to comply with CMS and PBM guidelines in order to avoid future audits.

This change presents two important considerations for patients that are discharged from long-term care facilities:

  1. If the patient is discharging to their home, consider sending any remaining supply of the patient’s insulin pens home with the patient. Retail pharmacies may have difficulty obtaining authorization to fill an additional quantity of pens upon discharge. Please ensure your Policy and Procedure documents reflect this consideration.
  2. If the patient is potentially returning to the facility (e.g. a short-term discharge to the hospital with a likely readmission), it is recommended to store the patient’s remaining insulin pens appropriately. Do not discard remaining pens until it is clear that the patient will not be returning to the facility. It will likely be impossible to obtain authorization for readmission fills from the PBMs, resulting in potentially avoidable charges to the facility in the event pens are discarded and a patient readmits to the facility before the supply should be entirely used.

Pharmacy Network Services definitely understands that this change goes against what we all consider to be prudent goals of minimizing waste and cost to the system, and is potentially disruptive to customary practices. Pharmacy leadership will continue to monitor this situation and keep you aware of any future changes. Please reach out to the pharmacy if you have any questions.

Being Secure

Recent news related to healthcare providers becoming targets of highly sophisticated malware leaves many care partners wondering if their organization could be at risk and what associated entities are doing to mitigate the threats. Pharmacy Network Services relies heavily on its investment in technology to provide cutting edge services and knowledge to its long-term care clients. As such, the organization takes the security of its systems seriously. In addition to providing client facilities with relevant and timely clinical and regulatory information, Pharmacy Network Services is pleased to provide the tips below to assist clients with minimizing the threat of malware.

Every organization must ensure its IT systems are regularly updated. Microsoft security updates are released on the second Tuesday of each month (Patch Tuesday).

If legacy, now unsupported version of Windows are in use, consider upgrading immediately.

Good network security practice dictates removing or disabling unnecessary services to reduce the potential attack surface.

Regularly backup critical data and ensure that ransomware cannot spread to backup files.

Ransomware can take time to encrypt large volumes of files, particularly across a network share. It is imperative to ensure the back-up window is long enough to go back before any infection begins.

Implement policies and procedures that prohibit unauthorized users and devices from accessing workstations and networks.

Use secure password procedures – use different passwords for all services & sites that are complex and refrain from using simple words found in the dictionary. Change passwords routinely and never share your passwords with other users. Also, do not store password information in insecure text documents or contact managers.


PNS President Appointed to TN Board of Pharmacy

Tennessee Governor Bill Haslam has appointed Pharmacist Debra Wilson as the newest member of the Tennessee Board of Pharmacy. Dr. Wilson brings a wealth of experience as president of three pharmacy service organizations with locations in Johnson City and Nashville, including Clinical Management Concepts Inc. and its subsidiaries, ProCompounding Pharmacy and Pharmacy Network Services, Inc.

“It’s an honor to be appointed by Governor Haslam to ensure the concerns of Tennesseans across the state are addressed,” says Dr. Wilson. “Pharmacy is a very important part of the overall public health spectrum that includes consumers, physicians, nurses and healthcare facilities. We all must improve our collaborative efforts to achieve better outcomes for the citizens of Tennessee. Anything dealing with public health is of the upmost importance and this board is vital to continue to guarantee the health of our citizens and to keep our profession at the highest level.”

Dr. Wilson will serve a six-year term on the board.

Comments or questions are welcome.

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Anticholinergic Side Effects in the Elderly

Anticholinergics make up quite a big portion of the Beer’s Criteria. As patients age, changes in their body increase the chances of side effects, drug-drug interactions, and a prescribing cascade. Below is a list of common side effects to anticholinergic medications.

  1. Confusion
    • Check for anticholinergic medications and side effects prior to starting patients on dementia medications like donepezil or memantine.
  1. Drowsiness/sedation
    • Patients may already suffer from lethargy and have great difficulty completing simple activities of daily living with additional anticholinergic sedation.
  1. Blurred vision/Dry eyes
    • Difficulty seeing may lead to increase falls among other things. Watch for patients on artificial tears to see if any anticholinergics may be contributing.
  1. Difficulty urinating
    • Watch for additional medications like tamsulosin, see if anticholinergics could be cut back instead.
  1. Dry mouth
    • Monitor for increased thirst and addition of saliva substitutes.
  1. Constipation
    • This is a major contributor to prescribing cascades, patients keep going up and up on laxatives. Check for opportunities to cut back on anticholinergics.

 A few examples of anticholinergic medications:

Antihistamines, antipsychotics, muscle relaxants, cyproheptadine, tri-cyclic anti-depressants, oxybutynin, olanzapine, promethazine, ipratropium, atropine, rivastigmine, Spiriva.

Comments or questions are welcome.

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Expiration Dates Data Sheet

“Many of our facilities and colleagues frequently request expiration dates on various products. These can vary from injectables to different types of inhalers. At Pharmacy Network Services, we have created a reference sheet to help with some of the most frequently requested medications. We hope this resource is helpful to all of our facilities and patients. As always, if there are any questions or concerns, please call your pharmacists at Pharmacy Network Services”


Comments or questions are welcome.

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Online Statements and Payments Available

Pharmacy Network Services is pleased to announce that patients and guarantors now have the convenience and safety of going green to receive statements for pharmacy services electronically. Payments on individual patient accounts can now be made from our secured web portal using credit cards or e-checks 24/7/365.

• Access statements 24/7/365 at your convenience of time and place
• Rest assured that online statements and payments are secured and organized
• Know that you’re making an environmentally friendly choice by reducing paper and fuel consumption
• Schedule one-time or recurring, automated payments – it’s your choice!
• Responsible parties for multiple patients can easily view statements for all patients using the same login and password
• Save time and money – no need to write checks, stuff envelopes, or purchase postage to make payments on accounts

Statements mailed after September 1, 2015 will contain a unique PIN that can be used to register for electronic delivery of statements and/or payments from our website. Please visit and click on “Pay My Bill” to register and access your account.

Comments or questions are welcome.

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August 7, 2014 – PNS launches electronic prescribing of controlled substances

In partnership with DrFirst, PNS pharmacy is now offering electronic prescribing of controlled substances for its customers. The EPCS Gold software from DrFirst, creates a paperless process for controlled substances prescribing fully approved by the DEA. This ensures the prescription is accurate and eliminates nursing time currently used to follow up on incomplete scripts and refills.

DrFirst is the only vendor to pioneer EPCS in a 3 year reserarch pilot program with AHRQ, Massachusetts Department of Public Health and the DEA. The software was created by doctors for doctors and maintains all state level requirements within the application.

For more information please contact Pharmacy Network Services. For more information on DrFirst, please visit their website at

Comments or questions are welcome.

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Combining amazing service with the down home pharmacy you are used to.