EP314: Why Do SNF (Skilled Nursing Facility) Patients Need Two Pharmacies and a PBM? Following the Kinda Long Long-term Care Pharmaceutical Supply Chain, With Sheldon Weiss, MD

In Episode 314, Stacey Richter talks with Sheldon Weiss, MD, former COO of a long-term care pharmacy, about the confoundingly messy pharmaceutical supply chain that skilled nursing facility patients depend on — and why it takes two pharmacies and a PBM to get a drug into a SNF resident's hands.

WHAT YOU'LL LEARN

✅ Why SNF residents often need both a wholesale pharmacy and a long-term care pharmacy, plus a PBM

✅ Why long-term care pharmacies don't negotiate directly with PBMs, and how volume drives pricing

✅ How overmedication happens in the long-term care pharmacy model, and how consultant pharmacists help prevent it

✅ Why adverse drug events are a leading reason SNF patients wind up in the ER

✅ Why people aging in place at home lack the kind of pharmacist oversight SNF residents get

WHY THIS MATTERS

SNF patients are often under the care of ten or more specialists prescribing medications with no visibility into what the others are prescribing, which is a big part of why adverse drug events are a leading cause of SNF-to-ER trips. A consultant pharmacist working alongside a medical director and director of nursing is a genuinely promising model for catching this kind of overmedication — but it only works if physicians actually listen to the pharmacist, and the same oversight simply doesn't exist for the much larger population aging in place at home.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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00:00 Introduction.

04:19 What's the role of a wholesale pharmacy in a SNF?

04:48 What's the connection between a wholesale pharmacy, a long-term care pharmacy, and a retail pharmacy?

07:00 Why does a SNF need two players? Why can't a long-term pharmacy also take on the role of the wholesale pharmacy?

09:43 Why don't long-term care pharmacies negotiate directly with PBMs?

10:02 "The key for … getting the best prices for medications is on volume."

10:11 Who are these wholesale pharmacies negotiating the best prices?

11:19 "The goal of driving health care costs down by helping out the residents is a good model."

13:43 "Ultimately the resident gets the same quality of medication, but yet it's at a much more reasonable price."

14:35 How does overmedication happen in the long-term care pharmacy model?

15:19 "The lower the amount of medicines, the less the chances of someone to become overmedicated."

17:50 "I would think that most of the time it's subtractive."

19:00 "The idea in health care should be and is … that we only prescribe medications that are necessary."

20:26 How does aging in place impact pharmacy?

22:11 "When you're aging at home, there's no one there looking out for you like a consultant pharmacist."

24:39 How do we make aging in place safer from a pharmacy perspective?

25:58 "Physicians are very intelligent, but they tend to know their medications in their field."

26:21 "Anything that increases the multidisciplinary approach model is going to benefit the patient."

27:10 "The cost of medicine and the outcome of medicine really don't equate."