Wayne MacArdy, R.Ph., is co-owner and managing pharmacist of Phillips Pharmacy, which is in its 70th year serving the people in and around Mauston, Wisc. There are two, separately licensed pharmacies on the site: one is what MacArdy describes as a traditional retail business, while the other is a closed-door operation serving nursing homes and assisted-living facilities. Earlier this year, MacArdy made the decision to leverage his experience on the long-term care (LTC) side of the pharmacy by installing ATP-384 compliance packaging automation from TCGRx in the retail pharmacy. Find out what motivated him, what changes he had to make to adapt the technology to the retail setting, and what he’s learned so far.
ComputerTalk: Wayne, start off telling us a little about your experience with compliance packaging automation in the LTC setting.
Wayne MacArdy: We were pretty early to the game with strip compliance packaging automation. packing. We’ve been using pouch packaging or strip packaging for over 20 years now. It’s gotten a lot more sophisticated as the years have gone on. We’ve made it our niche in the long-term care and assisted living areas. That’s all we do there. And now that there’s been a lot of buzz regarding adherence and star ratings, we decided to see if we couldn’t implement something like that for our retail customers.
CT: And this led to adding strip packaging automation from TCGRx about four months ago?
MacArdy: That’s right. I think it’s fair to say we were their first customer. We’ve been with them as long as they’ve been around.
CT: Were you running a med sync program for retail patients before adding the compliance packaging?
MacArdy: Yes. We use the PrescribeWellness program to assist us. The TCGRx automation has allowed us to layer on a compliance packaging piece for patients when it’s warranted, or ift the patient requests it.
CT: What was the “aha” moment when you said, “Hey, let’s see how strip packaging is going to work for retail?”
MacArdy: Honestly I’ve been thinking about for a long time; a couple of years. We had gotten very good at using the packaging in the nursing home arena. I am very invested in it for those patients. The strip packs give the exact day, date, and time that meds should be taken, so it’s extremely accountable and easy to use. It’s also very portable. So, I thought, why are we overlooking our retail customers? They can benefit from this too.
CT: How much work went into rolling out the strip packs for retail?
MacArdy: It took some planning. We had to bring in another machine, and then we had to create an interface with our pharmacy system in retail, which is different from our LTC system. We had to find that interface, and move up the learning curve. Then we had to design some boxes to pack the strips, and these had be more applicable to a retail customer.
CT: So you had to have an implementation strategy for how to apply this at retail, even though you already had experience with it in LTC?
MacArdy: Yes. There are some challenges, no question. We designed the packaging a little differently, a little more at-home friendly. We have more graphics on the retail packaging, instead of the times of day we use on our institutional packaging. For example, for retail we have a picture of the sun on the pouch with the morning doses. And we’re running longer, 30-day strips, so we had to find a way to roll them up and package them so that they were easy to use. We created these boxes where it pulls out the end.
Another big challenge, and we’re still working through this, is perpetual inventory.
The claims submission process is also different when we’re packaging or retail. We’re doing a little more in terms of post-dating some of these claims, so we had to make sure that we put systems in place to make sure that we were going to get paid for these meds.
CT: That’s interesting. Tell us more about that.
MacArdy: Well, we’re setting up the dates on which the automation will package a given patient’s prescriptions in advance, because that’s what our interface required. We don’t let the meds go out of here until we arrive at that date, but we want to prepare them a couple days ahead of the date on which we can actually submit the claim. We’re working on a solution to this with our pharmacy sysem vendor, but in the meantime our solution has been to postdate. That way we can fill in advance, and prepare the product before the patient comes through the door. It improves the workflow. Then we adjudicate the claims, usually the day they come and pick them up.
We didn’t have that issue when we were just doing Med Sync, and putting medications in a bottle, so we could fill them a few days ahead and then adjudicate them as we normally would on the day we were scheduled to dispense them to the patient. In that case, there was no date pinned to the very beginning of the strip.
CT: How do you decide who’s going to be a candidate for the packaging?
MacArdy: We take into consideration patients’ lifestyles, their age, and the level of family support. The packaging is not the perfect fit for everyone, and we do have some other solutions. We use some limited blister packing too. But the important thing to realize is that strip packaging is not just for the elderly. We have younger customers that have made inquiries about it. For example there are younger patients taking medications for ADD that are being sent into the schools with the nurse. It’s very handy in a case like that to be able to tear off what you need and send it in to school with the patient.
Then there’s the portability of the packaging, which I’ve been a little surprised to find interests a lot of people across a range of ages. There are a lot of people who want that extra help staying on track, staying organized with their medications. And they like how the packaging is very accountable, because it has the day, date, and time of administration. They can really see at a glance that they or their loved one have taken their medications properly.
CT: How popular has this been?
MacArdy: It’s pretty early in the game, but I’d say about 5% of our patients are using the packaging right now and that’s growing very quickly. We have a lot of interest in it, and we are promoting it in the community. We’ve gotten some new customers as a result of it too, which is great. Everybody likes new business. It’s a niche for us, but it’s definitely early in the game for us. We think it’s going to be the wave of the future.
CT: There’s, in fact, a bit of a growth opportunity here potentially you think?
CT: You mention assigning duties. Who is primarily responsible for the automation and the workflows around it?
MacArdy: It’s really a technician- and clerk-driven program. The techs run the med sync program. They manage the automation and run the claims. And then the clerks are rolling the strips of meds, stocking them in the boxes, and getting them put on the shelves.
CT: Finally, what would be some takeaways for colleagues of yours who are looking at this?
MacArdy: I think there are a few important things people will want to consider. First, be sure you are laying out the workflow in advance and assigning duties to everybody. We had lots of meetings with staff, which were key for getting buy-in on it. We actually made some changes in our pharmacy space when we brought in the machine. We created new counters and work areas, and places to check, store, and stack the boxes that we put the strip packaging in. And be sure you are doing the work to identify customers that might benefit from this.
Overall, strip compliance packaging was something I think we have gotten pretty good at in the long-term care area. And based on that experience, we realized we could be a success with it in the retail arena too. Obviously, it’s a different class of trade that’s a little more margin challenged, but we’re going to build a niche with packaging in retail too and we’re picking up new customers. CT