Combo Shop Pharmacy Inventory Considerations

Independent pharmacies are diving into the long-term care world to improve care for their patients and maximize revenue. Pharmacies can run both retail and combo-shop LTC pharmacies under one roof; typically with the same computer system. However, even though the pharmacies have a single location, the processing of claims and sharing of drug inventory can be challenging.

With a new NCPDP number for the combo-shop LTC, pharmacies will have new wholesaler accounts for ordering medications. Combo-shop LTC locations often have access to lower-cost brands through their LTC agreements. While the two NCPDPs operate in the same location, in many aspects, they need to be treated as two separate “pharmacies”. This raises two key questions that PAAS National® has received from members:

  • Can claims be strategically billed under different NCPDP numbers to take advantage of better reimbursement?
  • Can inventory be transferred between the retail and LTC pharmacies?

PAAS recommends …

Become an audit assistance member today to continue reading this article. As a member, you’ll have access to hundreds of articles and receive our monthly proactive newsletter!

Join today!

classifying a patient as either retail or LTC (i.e., not both based on reimbursement for individual prescriptions). When determining the classification, consider patient qualifications (e.g., for LTC Pharmacy at Home) and the patient reimbursement profile holistically. Billing prescriptions between the two NCPDP numbers and different Pharmacy Service Types simultaneously can raise red flags to the PBMs and draw scrutiny to claims. 

The separation of inventory can also be important in the event of an invoice audit. If a pharmacy receives an invoice audit for the retail NCPDP number but brand drugs are being ordered via the LTC agreement (and used throughout the pharmacy for both LTC and retail), this could result in class of trade issue and a shortage/recoupment of claims that don’t have enough inventory to cover the dispensing.

PAAS Tips:

  • PAAS recommends, at a minimum, keeping a separate brand inventory to prevent any future audit problems.
  • Review Newsline March 2025 article, The NEW Inventory Transfer Log and Why it Could Save You Big! for other pharmacy transfer inventory considerations.
  • The Alliance for LTC Pharmacy at Home has published LTC Pharmacy at Home guidelines to help pharmacies with meeting the requirements developed by CMS’s Long Term Care Facility Standards.
  • Avoid filling prescriptions for the same patient between the LTC and retail side—billing a specific drug on the retail side and the rest of the medications on the LTC side may raise red flags from the PBM.

Erin McDonald, PharmD
Latest posts by Erin McDonald, PharmD (see all)