Practical Experiences Using ZULP in Cardiology
The application of a product containing ferric carboxymaltose (FCM) or the use of a contrast agent with sulfur hexafluoride in microbubbles are examples of the use of specially accounted medicinal products (ZULP) in cardiology practice. "A benefit for the patient is that they receive the indicated preparation directly in the office and do not have to procure it themselves from a pharmacy," says Dr. Jiří Veselý, head physician of the Edumed cardiology clinic in Jaroměř, with whom we discussed the advantages and disadvantages of using ZULP and his experiences with this system.
Which specially accounted medicinal products (ZULP) are relevant to cardiology practice and for which diagnoses are they used?
In the past years, we prescribed ZULP only sporadically; significant utilization began only last year after contracting the Specialized Contrast Echocardiography procedure, where we use a contrast agent with sulfur hexafluoride in microbubbles. Since the beginning of this year, we have also been frequently administering to our patients with heart failure a medicinal product containing ferric carboxymaltose, which also falls into the ZULP category.
Do you use this option in your cardiology practice?
We use the mentioned contrast agent at two of our facilities where this type of echocardiographic examination is performed. We administer FCM at all cardiology offices and a part of internal medicine offices where we care for patients with heart failure.
When and why did you start prescribing them?
Sulfur hexafluoride in microbubbles is tied to a special procedure code, so we started using it only recently. The administration of ferric carboxymaltose in patients with heart failure has clear support in the current European Society of Cardiology guidelines from 2021, and it was only recently approved for reimbursement from public health insurance under clearly defined conditions for selected patients.
What are the advantages and disadvantages for patients and doctors of using ZULP in the treatment of cardiovascular diseases compared to commonly prescribed medicines?
Working with ZULP requires an initial small time investment to gain orientation in this area. A benefit for the patient is that they receive the indicated injectable treatment directly in the office, and they do not have to obtain the medication themselves from a pharmacy – this activity is left to the healthcare facility staff. In some cases, the advantage – and sometimes the disadvantage – may be a different way of regulation by health insurance companies.
How is this process set up, and how does the cooperation between the outpatient doctor, pharmacy, and health insurance company work? How is the billing and payment for these drugs carried out?
We order ZULP from a pharmacy that we have agreed in advance will stock or be able to quickly obtain the required products. The pharmacy dispenses the medication based on a standard request form (medication order), and it is paid for within the agreed invoice due date. The administration of the medication is reported along with the corresponding parenteral application performance according to the documentation and reporting methodology. We report the cost of the product within the health insurance coverage limit monthly, and payment is included in the total reimbursement for provided care. Any influence on the annual increase in the total provided care can be individually negotiated with health insurance companies by contracting an increase in the provided advance amounts.
Does this prescription method mean more administrative work for you?
It requires a certain time investment initially to set up the ordering and billing process. After establishing the system and training the staff, most of the administrative work can be delegated to non-medical workers. In the overall volume of administrative tasks performed in outpatient facilities, ZULP and specially accounted material (ZUM) represent only an insignificant part.
How would you summarize your current experiences with ZULP?
The reimbursement of medicines through the ZULP system seems to us to be functional, and its introduction has allowed us to expand the range of care provided to our patients.
Are there any pitfalls that might deter from their use?
Some might be deterred by not being fully oriented in the system and the work associated with the initial process setup. Concern may also be about the financial burden associated with purchasing these drugs, but standard invoice due dates to pharmacies and corresponding reimbursements from insurance companies do not require a large allocation of financial resources.
Do you have information on how this option is used by other colleagues? And what would you recommend to them?
Currently, only part of the colleagues is using this option, but given the expanding range of drugs covered this way, I expect that using this system will be sustainable for most practices to maintain the full extent of provided care.
MUDr. Andrea Skálová
editorial team proLékaře.cz
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