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Six years ago, Lois, R.Ph., and Kim Koontz, R.Ph., Blue Ridge Pharmacy Midtown owners, noticed the buzz around adherence packaging. Pharmacy owners for 20 years, they were curious about what packaging could do for their pharmacy. They looked at a number of systems and decided on cards by Omnicell. Using their VIP pharmacy system, they would create Excel spreadsheets for techs to follow in filling the cards and for patients with med pass times. The filling process had two steps: first, the traditional fill of a prescription bottle that was then walked back to the packing area, and second, techs then filling the cards and verifying the prescriptions again. Patients liked the service, but the process was cumbersome enough that growth would have been tricky.

Kim and Lois Koontz
Owners, Blue Ridge Pharmacy “We weren’t ready to expand our adherence program until the interface was going,” says Kim. “Now, we’re ready to take it up a notch.”

Two years ago, when Omnicell introduced new cards and a guided packing system called SureMed, the Koontzs looked to VIP to build an interface. VIP was committed to the process, and Blue Ridge made the switch to SureMed in the fall of 2019.

“We weren’t ready to expand our adherence program until the interface was going,” says Kim. “Now, we’re ready to take it up a notch.”

Eliminating Steps

Prescriptions now go directly from VIP to the guided packing screen. All the patient information is on the screen, and techs scan bottles before filling the card. If there is a discrepancy, the system will stop the fill. The move to the new packing system has been pretty smooth. The staff, which includes four technicians and three pharmacists, has been patient and quick to learn the new workflow. In fact, because the adherence packaging and med sync programs go hand-in-hand, prescription volume is predictable. A few hiccups around loading the drug file were addressed quickly by VIP. Most over-the-counter medications are already in SureMed, and the system flags those that aren’t in the system, alerting staff to add it the first time it’s used in the packaging. Otherwise all the medication and patient information is in the VIP system with a flag for those who receive adherence packaging. The staff sorts for the SureMed patients and sends the file directly to the guided packing system. Prescriptions are verified in the VIP system to run through the cash register. But the main verification is performed in the SureMed interface, again saving a step. And there is added safety, with no additional work, because the system verifies when the techs scan the medication before filling the card.

Kim says confidently that any pharmacy can do this. “You just have to be able to invest some time and money to get it started,” he points out. “And it’s a low investment. We basically had to get a special printer.”

Currently they don’t charge for the packaging, which Kim acknowledges is a cost, but his philosophy is that the pharmacy will gain patients and make more money in the long run. And, Lois adds, their patients need this type of packaging. One doctor was eager to switch a patient to adherence packaging because she struggled to take her medications properly. It has kept her out of the nursing home.

“This gives you the niche that you can use to actually grow your business in a day when competition is so tough,” says Kim.

Additional Advantages

The adherence interface with the VIP pharmacy system has other, unexpected, advantages. Currently there is no drive-thru, and the pharmacy offers limited delivery although it serves a radius of 30 miles. With the packaging, Kim says, they can offer long-term-care-like service but to retail patients. The workflow is similar to long-term care in that the staff reviews patient medication lists with the patient before filling the cards. If there is a change to their medications mid-month, patients can bring the card in and Blue Ridge staff can change the remaining doses on the card and repackage. Since this model is based on individuals as opposed to facilities, it reduces the risk of losing a big chunk of business at one time.

Adherence packaging “gives you a niche that you can actually grow your business in a day when competition is so tough.”
— Kim Koontz

Another niche the Koontzs are targeting is group home accounts. Within a few months of implementing the guided packing interface, Kim says, the pharmacy picked up three new group home accounts. They feel group homes will see adherence package as a way to make it easier to get state accreditation, as the packaging is out ahead of what state regulations require. Since they offer personalized service, change in medication regimens are easy to handle.

“We’re able to offer the group home or the caregiver the service they need based on what’s happening that month or that week,” says Kim. “This is especially important with mental health patients. Some doctors don’t want their patients to have all their meds for the month at one time. We have certain patients who come in weekly to get their cards.”

The success with adherence packaging has led to the idea of expanding service to surrounding counties, and offering it to anyone who needs special packaging to improve adherence.

As a pharmacist, Lois observes, you assume patients are taking their medications. She says as they move patients to med sync and the adherence packaging system, they’ve learned that isn’t always the case. One patient, she says, came in with a paper bag full of prescriptions.

“It’s been an eye opener, since you assume that people take their medications, but we’ve learned compliance really is a problem,” says Lois. “Sometimes patients have multiple bottles of the same thing.”

How do they deal with a paper bag full of prescriptions? “We just try to get them started fresh,” says Lois. “If we see that compliance has been a real problem, we contact the doctor and let them know, and ask how they want to handle it.”

Starting Small, But Thinking Big

While they are starting small, with the new streamlined workflow Lois and Kim see growth potential. Even without advertising, they have seen demand for the packaging rise thanks to doctor referrals, and they anticipate an uptick in business once they do advertise. Lois says that before she wouldn’t have even thought about adding automation, but as the business grows, she can see automation as the next step.

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Some things are hard to do in pharmacy, says Kim, but the interface with the VIP system has not been hard. “It’s been rewarding,” he says. “I would highly recommend doing something like this. We’re seeing other stores that are going downhill. They are losing volume. Reimbursements are less now. This gives you something to hang your hat on and keep your business going and actually grow it.” CT

Maggie Lockwood is VP, director of production at ComputerTalk. She likes sharing the stories of pharmacist entrepreneurs who use technology to find success. You can reach her at