A

At-home medical care

Medical treatment carried out in cooperation with various occupational disciplines, such as physicians and nurses. Pharmacists visit the homes of patients who find it difficult to visit a hospital or clinic due to a physical disability or other reason, and give instructions about medicines and monitor and manage the patient to ensure they take the medicine.

Automatic drug picking device / Fully automatic PTP sheet dispensing device

In Japan, patients usually take drugs that have been sealed in PTP sheets. At pharmacies, PTP sheet-packaged drugs are picked by staff. These two devices store PTP sheets in cassettes, and they are becoming popular as a machine to prepare the required number of PTP sheets by transmitting prescription data.

A Vision of Pharmacies for Patients

A vision announced by the Ministry of Health, Labour and Welfare in October 2015. The announced vision is a guideline for fulfilling functions such as pharmaceutical management and guidance, which includes centralizing drug use data and constantly acquiring new information about drugs and dealing with at-home medical care within the integrated community care system. The guideline also attempts to achieve the separation of the roles of drug prescribing and dispensing for patients who live locally. The guideline also shows the direction that dispensing pharmacies should take and the functions required.

B

Basic dispensing fee

A fee that is paid one time per prescription when the pharmacist performs “drug dispensing at the pharmacy.” The number of points varies depending on whether that pharmacy fulfills the role of a family pharmacy or pharmacy chains or focuses on responding to demand for prescriptions made by specific medical institutions.

April 2020 revision (amendments in bold)

Number of prescriptions Concentration ratio Points
Basic dispensing fee 1 Basic dispensing fee other than 2, 3 and special basic dispensing fee 42 points
Basic dispensing fee 2 2,001 – 4,000 prescriptions per month Exceeding 85% 26 points
More than 4,000 prescriptions per month Exceeding 70%
1,801 – 2,000 prescriptions per month (addition) Exceeding 95%
More than 4,000 prescriptions per month from specific medical institutions
Basic dispensing fee 3-a 35,001 – 40,000 prescriptions per month within the same group (addition) Exceeding 95% 21 points
40,001 – 400,000 prescriptions per month within the same group Exceeding 85%
Basic dispensing fee 3-b More than 400,000 prescriptions per month within the same group 16 points
 

April 2018 revision

April 2020 revision

Requirements Concentration
ratio
Points Requirements     Concentration
ratio
Points
Special basic
dispensing fee
  • Real estate transactions with hospitals
  • Other special relationships
Exceeding 95% 11 points
  • Real estate transactions with medical institutions (including clinics)
  • Other special relationships
Exceeding 70% 9 points

 

April 2018 revision

  • 50% reduction in basic dispensing fees if basic work related to family pharmacy role is less than 10 times per year

 

April 2020 revision

  • 50% reduction in basic dispensing fees if basic work related to the role of a family pharmacy is less than 100 times per year

C

Community support system incentives

Newly established to coincide with the April 2018 revision of medical service fees for the purpose of assessing the record of community services (e.g. nighttime and holiday services) provided by pharmacies where family pharmacists contribute to medical care in their local communities within integrated community care system.

  April 2018 – March 2020 Points April 2020 – March 2022 Points
Community support
system incentives
  • In case of basic fee 1, meet all of the following requirements

(1) Narcotics retailer license
(2) At-home medical care: At least once per year
(3) Family pharmacist notification
・Management pharmacists employed in pharmacies for five years, employed by the current pharmacy for one year, and worked for at least 32 hours per week

 

  • For cases other than basic fee 1, add all of the following results to the requirements for each full-time pharmacist for one year

(1) Results of nighttime/holiday response: 400 times
(2) Results of narcotics guidance control incentives: 10 times
(3) Results of incentive for preventing harmful drug interactions and duplicate prescriptions, etc.: 40 times
(4) Results of family pharmacist guidance fees, etc.: 40 times
(5) Results of outpatient medication support fees: 12 times
(6) Results of medication adjustment support fees: 1 time 
(7) Results of at-home drug management of one patient in single building: 12 times
(8) Results of the medication information and other information fees: 60 times

35 points
  • In case of basic fee 1, meet all of requirements (1) – (3) below and either (4) or (5)

(1) Narcotics retailer license
(2) At-home medical care: At least 12 times per year
(3) Family pharmacist notification
(4) Results of the medication information and other information fees: At least 12 times per year
(5) Attendance at regional collaboration meetings with other occupations: At least once per year
 
・Management pharmacists employed in pharmacies for five years, employed by the current pharmacy for one year, and worked for at least 32 hours per week
 

  • For cases other than basic fee 1, meet 8 of requirements (1) – (9) below ((1) – (8): Number of times annually per full-time pharmacist, (9) is number of times annually per pharmacy)

(1) Results of nighttime/holiday response: 400 times
(2) Results of narcotics dispensing: 10 times
(3) Results of incentive for preventing harmful drug interactions and duplicate prescriptions, etc.: 40 times
(4) Results of family pharmacist guidance fees, etc.: 40 times
(5) Results of outpatient medication support fees: 12 times
(6) Results of medication adjustment support fees: 1 time
(7) Results of at-home drug management of one patient in single building: 12 times
(8) Results of the medication information and other information fees: 60 times
(9) Attendance at regional collaboration meetings with other occupations: At least once per year

38 points

 

D

Dispatching act

The official name is the “Act for Securing the Proper Operation of Worker Dispatching Undertakings and Improved Working Conditions for Dispatched Workers.” This is a law with established rules that temporary staffing companies and companies that hire temporary staff must observe in order to protect the rights of dispatched workers. The law has been improved by, for example, establishing the period of time that a worker can be dispatched to the same office of a company that hires temporary staff.

Dispensing fee

Points (cost) for dispensing medicine. The number of points is determined by the duration of the prescription.

Number of prescription days 1–7 8–14 15–21 22–30 31–
April 2018 – March 2020 5 points/day
(average 27 points)
4 points/day
(average 61 points)
67 points 78 points 86 points
April 2020 – March 2022 28 points 55 points 64 points 77 points 86 points

Drug history management and instruction fee

The fee (points) paid for the pharmacist to collect, analyze, manage, and record the necessary information and to provide an explanation when delivering the medicine so that the patient to use the medicine safely.

April 2018 – March 2020 Basic dispensing fee 1 Basic dispensing fee other than 1 April 2020 – March 2022 Basic dispensing fee 1 Basic dispensing fee other than 1
Revisit to pharmacy within 6 months Has a medication notebook  41 points 53 points Revisit to pharmacy within 3 months Has a medication notebook 43 points
Does not have a medication notebook 53 points Does not have a medication notebook 57 points
Not a revisit to pharmacy within 6 months Has/does not have a medication notebook Not a revisit to pharmacy within 3 months Has/does not have a medication notebook

 

E

Electronic Okusuri Techo (Electronic medication notebook)

A notebook application for centrally managing the information and records of prescribed medicines and for avoiding duplication and side effects caused by taking multiple medications. It can record information on a smartphone or other device. NIHON CHOUZAI has conducted in-house development of the electronic medication notebook Okusuri Techo Plus. Although a number of companies have rolled out their own products, the products of companies that participate in the Japan Pharmaceutical Association’s mutual browsing service can perform information browsing, including even other companies’ electronic medication notebooks.

F

Family pharmacist

The system of having the same pharmacist in charge as a “family pharmacist” by appointing the pharmacist to the patient began in April 2016. By appointing only one desired pharmacist from among pharmacists who have cleared certain nationally established requirements and signing a consent form, that pharmacist gives instructions about medicines, provides counseling and other services as the attending pharmacist next time. 

 

  1. Pharmacist understands drugs collectively
    The attending pharmacist collectively understands the patient’s drugs, over-the-counter drugs, health foods or supplements received at another medical institution or drug store. The pharmacist provides advice, such as precautions when taking drugs, including whether duplicate drugs are being taken and the interactions that drugs have with each other or with food.
     
  2. Verification of change in physical condition and management of medicines
    During the pharmacy visit, the pharmacist continuously checks the patient’s progress after taking medication, including their past medication record. The pharmacist observes the medication’s effect on the patient and changes in physical condition and contacts a medical institution, if necessary. If there is much medicine left over, the pharmacist proposes that the prescription be adjusted next time and organizes the medicines.
     
  3. Nighttime/holiday response and counseling
    As a pharmacist who understands the patient’s medication status, the pharmacist responds to requests for medication and health maintenance counseling. The pharmacist provides medication counseling, even when the patient’s pharmacy is closed, such as at nighttime or on holidays.
     

Criteria 
1. Possess at least three-years’ experience as an insurance pharmacist 
2. Works at least 32-hours per week in said insurance pharmacy 
3. Has a tenure of at least one year in said insurance pharmacy 
4. Received training certification from a training certification system that is approved by the Council on Pharmacists’ Credentials 
5. Participate in local medical activities 
6. Has independent counters separated by partitions (Added from April 2020)

Family pharmacists and pharmacies

In A Vision of Pharmacies for Patients, the three functions required of family pharmacists and pharmacies are explained, but there are no facility standards for pharmacies and notification to Regional Bureau of Health and Welfare is not required. Work required for family pharmacists and pharmacies is mainly interpersonal work, and the main work is the 9 items necessary for pharmacies other than basic fee 1 to calculate community support system incentives. The same ministry is seeking to restructure all pharmacies into family pharmacist and family pharmacies by 2025.

Family pharmacist guidance fees

Guidance fees calculated when the pharmacist (family pharmacist) designated by the patient provides medication guidance after continuously tracking the patient’s medication information in a centralized manner.

  April 2018 – March 2020 Points April 2020 – March 2022  Points
Family pharmacist guidance fees
  • Employed in pharmacies for three years, employed by the current pharmacy for one year,and worked for at least 32 hours per week
  • Qualified as certified pharmacist
  • Participate in local medical activities
73 points
  • Employed in pharmacies for three years, employed by the current pharmacy for one year, and worked for at least 32 hours per week
  • Qualified as certified pharmacist
  • Participate in local medical activities
  • Has independent counters separated by partitions
76 points

 

Formularies

These are guidelines for drug use formulated by medical institutions and regions based on a comprehensive scientific assessment of the efficacy and safety of drugs, as well as their economic efficiency. The goal is to promote standard drug treatment based on guidelines for the use of high-quality, inexpensive drugs. The spread of regional formularies is expected to promote the use of generic drugs and curb the continuing increase in medical costs. These guidelines have already been introduced in Europe and the US, and in Japan, they have also been introduced in some areas.

G

Generic drugs

A drug which, after the expiration of the term of a patent (substance patent) for the drug’s active ingredients, is manufactured and supplied by other pharmaceutical companies with the same active ingredients. Legally, this is referred to as a “generic drug.”

H

Health Check-up Station*

Exclusive areas set up within NIHON CHOUZAI pharmacies that are equipped with health consultation and health assessment capabilities in order to support the health of local community residents through disease prevention and pre-symptomatic initiatives.
*The Health Check-up Station is a registered trademark of NIHON CHOUZAI Co., Ltd.

Health support pharmacies

These are pharmacies that possess the basic functions of family pharmacists and family pharmacies and proactively support the independent maintenance and promotion of health by local residents. Healthcare centers must be notified in advance. The Ministry of Health, Labour and Welfare’s goal is to register 10,000 to 15,000 health support pharmacies by 2025.
Criteria 

  1. Cooperation with other occupational disciplines such as medical institutions and nursing care providers within the comprehensive regional medical care system 
  2. A resident pharmacist who has completed health support pharmacy training and has five or more years of practical experience 
  3. An inquiry counter that takes account of personal information 
  4. Display “Health Support Pharmacy” outside and inside the pharmacy 5. Handle guidance-required drugs, nursing care products, etc.

Source: A Vision of Pharmacies for Patients” by the Ministry of Health, Labour and Welfare

Hospital-front pharmacies

A dispensing pharmacy located near a hospital that responds primarily to that hospital’s prescription demand. However, an official definition does not exist. Some also function as family pharmacists and pharmacies that respond to prescription demand from many medical institutions, participate in at-home medical treatment, and provide other services

Hybrid-type pharmacies*

Pharmacies that combine the functions of both a Mentaio pharmacy that was opened in front of a train station or in a shopping district and meets prescription demand from a relatively wide area, without being limited to prescriptions from specific medical institutions, and a medical center (MC) pharmacy in a medical mall where a number of medical institutions are located and meets the prescription demand of those medical institutions.
* Hybrid-type pharmacy is a term for a type of pharmacy used by NIHON CHOUZAI Co., Ltd.

M

Medical service fee revisions

In Japan, fees paid in exchange for healthcare services provided by health insurance are specified for medical and dental treatment and drug dispensing by the Ministry of Health, Labour and Welfare with a medical service fee point table. In addition, the price of drugs is determined by the NHI Drug Price Standard. Medical service fees are reviewed once every two years.

N

NHI drug price revisions

With respect to the price of drugs used in healthcare services provided by health insurance, an official price has been established as the “NHI drug price standard.” A Drug Price Standard List is issued four times a year for new drugs and two times a year for generic drugs so that it can be used in healthcare services provided by health insurance. The list is revised once every two years based on a survey (drug price survey) of market distribution prices for medical institutions and pharmacies. In October 2019, NHI drug prices were revised at the same time that the consumption tax rate was raised from 8% to 10%. Starting in April 2020, NHI drug prices are scheduled to be revised annually.

O

Online medication guidance

Provision of medication guidance to the patient by the pharmacist using a telecommunication device such as a computer or smartphone. Previously, face-to-face medication guidance was mandatory, but the Pharmaceuticals and Medical Devices Act was revised, lifting the prohibition against online medication guidance nationwide in September 2020 as long as certain requirements are met.

April 2020 – March 2022

Points

Drug history management and guidance fee 4

When getting medication guidance via information and communication equipment
Patients who received prescriptions through online medical treatment
Patients who received face-to-face medication guidance within 3 months, in principle
(1) Create a medication guidance plan, implement based on that plan
(2) Pharmacists who provide online medication guidance are the same, in principle
(3) Check drug history and current medications with a medication notebook

Up to 43 points per month

Home patient visiting drug management guidance fee

Home patient online medication guidance fee
Patients who have been given a prescription by home visit medical treatment
Patients who receive a monthly visit for at-home medical care
(1) Can be calculated up to 10 times a week, for a total of up to 40 times a week including home patient visiting drug management guidance fee 1 – 3 for each pharmacist
(2) Create a medication guidance plan, implement based on that plan
(3) Pharmacists who provide online medication guidance are the same in principle
(4) Provide written information to doctors who have done home visit medical treatment

Up to 57 points per month

On-site pharmacies

It became possible to open on-site pharmacies within hospital premises following the easing of restrictions on the structural independence of pharmacies and medical institutions in October 2016. These pharmacies can cooperate with hospitals is possible and support for advanced medicine is required. On the other hand, the basic dispensing fee has been set lower than hospital-front pharmacies.

P

Partial Revisions to the Pharmaceuticals and Medical Devices Act

A proposed revision to the Pharmaceuticals and Medical Devices Act was submitted to the Diet on March 19, 2019, and this proposal was passed and enacted on November 27, 2019. It has been decided that the new law will be enforced in stages from September 2020. Looking at trends related to pharmacies, online medication guidance will be widely implemented starting in September 2020. In addition to remote medication guidance, which was only allowed in National Strategic Special Zones until now, this will also cover prescriptions where online medical treatment is performed by video calls, and the target area will be expanded nationwide. In addition, the diseases that would be covered will also expand including the prevention of severe diabetes and chronic headaches. In addition, from August 2021, the functions of pharmacies will be defined by the Pharmaceuticals and Medical Devices Act, and with a license from a prefectural governor, pharmacies will be able to display signboards, etc. according to their functions. This will enable patients to choose the right pharmacy for them.
Regional-cooperation pharmacies 
Pharmacies that can collaborate with other medical institutions at the time of hospitalization or discharge and at-home medical care
-Structural equipment with consideration for privacy (partitions, etc.) 
-Providing information to medical institutions on medicine that patients bring when they are hospitalized Participation in meetings with doctors, nurses, care managers, etc. (discharge conferences, etc.) 
-Placement of pharmacists who received training on integrated community care, including welfare and nursing care 
-Development and participation of a local dispensing response system including responses at nighttime and on holidays 
-Dispensing of drugs necessary for at-home medical care including narcotics/sterile dispensing 
-Home visits
Specialized medical instructions cooperation pharmacies 
Pharmacies that can collaborate with other medical institutions for specialized pharmaceutical management of diseases such as cancer
-Structural equipment with consideration for privacy (partitions, private rooms or other space for consultation, etc.) 
-Providing information to medical institutions on medicine that patients bring when they are hospitalized Participation in meetings with doctors, nurses, care managers, etc. (discharge conferences, etc.) 
-Sharing treatment policies with doctors and pharmacists, etc. at specialized medical institutions 
-Conducting joint training with specialized medical institutions, etc. 
-Sharing medication information with regional-cooperation pharmacies that are used by patients, etc. 
-Placement of pharmacists with a high degree of expertise, such as accreditation by an academic society
Source: Prepared by NIHON CHOUZAI based on materials submitted by the Ministry of Health, Labour and Welfare (May 2019)

Premium for generic drug dispensing system

This is a fee added to the basic prescription fee for pharmacies that actively dispense generic drugs. Each time there is a revision, the calculation standard is being raised in order to further promote the use of generic drugs.

  April 2018 – March 2020 Points April 2020 – March 2022 Points
Generic pharmaceuticals dispensing system incentive 1 75% or more 18 points 75% or more 15 points
Generic pharmaceuticals dispensing system incentive 2 80% or more 22 points 80% or more 22 points
Generic pharmaceuticals dispensing system incentive 3 85% or more 26 points 85% or more 28 points

 

  • April 2018 – March 2020
    2 points subtracted from basic dispensing fee if dispensing quantity ratio of generic drugs is 20% or less
     
  • April 2020 – March 2022
    2 points subtracted from basic dispensing fee if dispensing quantity ratio of generic drugs is 40% or less

Prescription dispensing fee revisions

This refers to the portion of revised medical service fees that is utilized for prescription dispensing services. Dispensing fees are revised once every two years.

S

Separation of drug prescribing and dispensing

This is a system whereby physicians examine patients and prescribe drugs, and based on the prescriptions made by physicians, pharmacists, who are independent entities from a management perspective, dispense drugs, manage medication histories, and provide guidance in using drugs, thus demonstrating their expertise in these areas. In this way, the system strives to raise the quality of medical care.