Screening for Food and Drug Allergies

As of January 1, 2006, CMS required that food and drug allergies must be screened for before each prescription is dispensed to a Medicare Part D beneficiary. HMSA believes that this program is a valuable component in ensuring patient safety as it relates to medications, and will require that this standard be applicable to all HMSA members (HMSA private business plans, HMSA QUESTand HMSA Medicare Part D plans).

Participating pharmacies must have a method in place for maintaining up-to-date information on food (as related to medication therapies) and drug allergies for HMSA members. These allergy contraindications must be screened for through the pharmacy's concurrent drug utilization review system before each prescription is dispensed to an HMSA member. If a member is found to have an allergy to a prescribed medication, the pharmacist should take appropriate clinical action to assess/validate the situation and/or contact the prescribing physician to ensure the member receives an appropriate alternative.

Currently, standards of pharmacy practice require that pharmacies retain information on drug allergies.  If the pharmacy's software system does not enable pharmacies to retain information on food allergies, alternative methods of documentation may be used.

On-site audits will be used to verify that pharmacies are in compliance with this CMS and HMSA requirement. Failure to screen for and document food and drug allergies for HMSA members may result in recoupment of reimbursement on the associated claims.

Pharmacies are required to maintain documentation in the patient’s profile for known food (as related to drug therapy) and drug allergies. Documentation will need to be prescription specific. The following has been recommended by HMSA's independent pharmacy auditor to ensure compliance.

• Known food and drug allergies must be documented in the patient’s electronic or paper profile or patient record. This documentation must identify how the pharmacy obtained the information and demonstrate how the pharmacy performed the screening. The pharmacy must provide a copy of the procedures used in the screening.
• Documentation should be maintained in the patient’s profile and used to screen for allergies prior to dispensing of any prescription for HMSA members. Pharmacies must also maintain documentation that is prescription-specific to demonstrate that the screening occurred before each prescription was dispensed to the patient. 

Electronic documentation complies with HMSA’s Food and Drug Allergy policy and will meet audit requirements. Pharmacies will be requested to produce print screens of the electronic documentation. Electronically scanned documentation is also acceptable. Pharmacies will be required to produce copies of the electronically scanned documentation.

Pharmacies that exclusively use the hard copy of the prescription to document food-drug interactions and drug allergies will be required to produce the hard copy of the prescription for review and will be required to provide a copy of the prescription.

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