FEATURE: A Look Abroad
Community Pharmacy in the European Union
Robert Tinsley makes a summer trip to Europe and pops into a community pharmacy to learn how a German pharmacy operates.
Scroll to the end of the story for a gallery of photos.
When I travel I make it a point to stop into pharmacies in the cities I am in and see how they handle their operations. Sometimes I am fortunate to be able to create a personal connection with the pharmacy and the staff. In these cases, I get a more in-depth idea of what they are doing and can have a candid conversation about what is working and what they are thinking of changing. Sometimes appearances can be deceiving!
Over the summer I had the opportunity to visit Kempen, Germany, which is my wife’s hometown. Kempen is where Dr. Michael Gehlen owns and operates Hubertus Apotheke pharmacy, and it just happens that Dr. Gehlen and my wife’s family are friends. Using this connection, I was privileged to spend several hours with Dr. Gehlen, and would like to share with you what the doctor and I discussed. In addition, I will share some of what makes German pharmacies different from what we have stateside.
Hubertus Apotheke is a small community pharmacy. The pharmacy staff was very friendly and knowledgeable, and on several occasions I noticed them step out from behind the counter to help or greet their customers. It felt like the old drugstore that you would have found in most rural towns throughout the United States a generation ago. Hubertus Apotheke has a small retail OTC front end with selected items one would expect to find in a community pharmacy. Regulations limit what the pharmacy can sell at the front end to items that are pharmacy related.
Dr. Gehlen has his own line of vitamin and herbal supplements called Apotheker Dr. Gehlens. Currently, the product line is only sold through his pharmacy; it allows him to educate his patients on the importance of maintaining a healthy diet and lifestyle.
The Pharmacy Management System
Dr. Gehlen shared with me the technology in use in the pharmacy. Hubertus Apotheke is a progressive pharmacy that deploys several technology tools for its staff and patients. The pharmacy management system has a fully integrated point-of-sale (POS) module, unlike most U.S. pharmacies that deploy separate POS solutions that may
or may not interface with the pharmacy management system. The integration makes Hubertus Apotheke’s POS a vital part of the pharmacy management system.
It’s important to point out that most European pharmacies do not adjudicate the prescription claim via a switch or processor. Once the physician writes the prescription, the patient brings the paper prescription into the pharmacy. After the pharmacy fills the prescription, the pharmacy sends out all paper prescriptions to a third-party billing company. The billing company processes all claims, and the pharmacy receives payments twice a month.
What the pharmacy management system does is manage patient history, drug interactions, allergies, and drug formularies for the insurance companies. I was surprised to find out that Germany has a variety of different insurance plans, each with its own drug formulary and preferred drug manufacturers. I had associated Germany’s universal healthcare with a single-payer system, but that is not the case.
Patient history is available to the staff right at the POS. As the patient picks up the prescription, all relevant information on drug allergies or interactions is right on the screen. The pharmacy staff can review the information with the patient or add notes as they ring the patient up for co-pays.
Dispensing automation is not needed with most European pharmacies, since the majority of the prescriptions are dispensed as packaged from the drug manufacturer directly to the patient. Several of the pharmacies I visited, including Hubertus Apotheke, had two rows of drawers that held this unit-of-use inventory. This prepackaged inventory is sorted and stored in these drawers alphabetically. Another thing I noticed in all the pharmacies I visited was a mural decorating the wall between these two rows of drawers; I thought this brought a warm feeling into the store.
If the pharmacy wishes to repackage and count out a 30-day supply for the customer, the pharmacy is required to get a license and insurance as a producer. So repackaging only happens in specific circumstances. For example, unit-dose cards that are mainly used in homes for the elderly might be something the pharmacy would request a license and insurance to produce.
Inventory management for controlling expenses and reducing waste is an essential part of Dr. Gehlen’s business strategy. As with U.S. pharmacies, inventory is one of the biggest costs in the pharmacy, and it is necessary to monitor it closely. Dr. Gehlen’s pharmacy management system has a perpetual-inventory function that allows him to set up reorder points and quantities and keep a specific amount of inventory on hand. This is all similar to the systems employed in stateside pharmacies.
The pharmacy management system generates orders throughout the day. Each order must be approved by pharmacy staff before being sent to the wholesaler. Special orders can be manually added to the order, which allows the pharmacy to reduce costs by not stocking expensive drugs.
Hubertus Apotheke is located about 30 minutes from its main distribution center. The pharmacy wholesaler agreement allows for up to five deliveries a day — something that’s definitely different from what we see in the United States. Most orders are delivered within three hours. This allows the pharmacy to manage inventory very precisely and reduce their on-hand quantities to a minimum. Dr. Gehlen estimates that the pharmacy has over 20 inventory turns a year, compared to the pharmacies I ran, where we were lucky to get 12 inventory turns a year.
Germany has been working on e-prescribing for several years. Several pilot programs were put in place and, although several studies showed significant reduction in errors, the program has not moved forward yet. Dr. Gehlen indicated that security concerns are posing a significant barrier to the project. He did ask me about how e-prescribing in the United States handles security and how we can assure patient privacy. While Dr. Gehlen’s concern about security is valid, I explained that our system makes security of the transactions and data a top priority.
While it’s clear from visiting Hubertus Apotheke that a German pharmacy provides patient services similar to those of U.S. pharmacies, it’s interesting to note that the technology needs are different. In many ways, Hubertus Apotheke’s technology needs may seem similar, but as you take a deeper “dive” into the functions you find many differences between German and U.S. pharmacies.
For example, Hubertus Apotheke’s billing process is more in line with what we would expect to see at a physician’s private practice setting. Not having to adjudicate a claim in real time may seem like a gamble, but the approval of the prescription starts with the doctor writing the script. Having five deliveries a day from your wholesaler is a huge advantage and allows pharmacies to keep tight control on inventory costs. And Dr. Gehlen’s concern about e-prescribing security really makes me think about how important it is for U.S. systems to meet HIPAA and HITECH requirements so there are no questions about data security.
I would like to thank all of the pharmacists and pharmacies I visited on my trip, with a special thank-you to Dr. Gehlen for taking a good portion of one morning answering all my questions. I look forward to visiting with him next year when I return to visit my extended family. CT
Robert Tinsley is VP of pharmacy services for Independent Pharmacy Cooperative (IPC). He has been involved in the pharmacy industry for over 15 years, during which time he’s worked to further clients’ efficiency and create a stronger bottom line through improved technology systems/automation, operational workflow, retail services, and retail store appearance. He can be reached at firstname.lastname@example.org.