In this conversation we talk with SaluMed Pharmacy Owner Tomas Diaz, R.Ph., and Thrifty White Pharmacy’s Director of Specialty Pharmacy Jeremy Faulks, Pharm.D., about the state of chain pharmacy technology priorities and challenges. We also provide a broader look at the market by highlighting a few of the findings from the response to a survey of chain pharmacy executives and offering a few sidebars with expert advice from around the industry.
ComputerTalk: Let’s start off by talking about your latest technology initiative. Tomas, what’s been happening at SaluMed Pharmacy?
Tomas Diaz: We recently went live with Epicor’s Eagle N POS [point-of-sale] system. It’s absolutely critical for us to ensure that we’re managing our inventory uniformly in both locations. We needed one database for pricing, ordering, house charge accounts, our loyalty program, etc. Our two pharmacies are only about three miles apart, and I want patients and customers to be able to shop either and get a uniform experience.
CT: There’s a real benefit from a focus on what POS can do to manage inventory across locations, then?
Diaz: Yes, you want to look at POS that’s scalable. We’ve found it makes a big difference. It’s basically like managing one store.
Bay Shore and
EasyRx pharmacy management software
Epicor Eagle N point-of-sale system
HangRx will-call management
Jeremy Faulks: Keeping an accurate inventory is incredibly important when it comes to the prescription side of things as well. We actually run a proprietary inventory model with a first-in, first-out system to track prescription inventories across all of our stores. We’re also using TCGRx Beacon in several of our busier locations. That’s a high-density pick-to-light and put-to-light system. The fact that we fill so many prescriptions centrally helps us manage inventory more effectively, too. Local pharmacies don’t carry a whole lot of maintenance meds.
CT: Jeremy, what’s the latest addition to Thrifty White’s technology suite?
Faulks: We’re in the middle of rolling out PrescribeWellness with the goal being able to really dive deep into the clinical and the outcomes side of pharmacy. We are looking to identify patients who need some sort of clinical intervention and building the workflows that will allow us to both deliver and then document this care. It’s all part of building a model in which we are paid for more and more clinical services as prescription reimbursements continue to get squeezed.
Thrifty White Pharmacy
Ninety-five retail locations in the Midwest
Long-term care pharmacy serving 27,000 beds across 100 facilities
Specialty pharmacy serving all 50 states
Proprietary pharmacy management software
Asembia-1 specialty software
TCGRx Beacon inventory management
Knapp central fill
CT: That squeeze on prescription reimbursements isn’t letting up, is it?
Faulks: No, it’s not. It’s just getting harder and harder to be a pharmacy where the focus is just on efficiently filling scripts. And this is something that we apply resources to, with our central-fill model, but there’s still not a whole lot of wiggle room anymore to fill scripts faster and more cheaply. So we’re really putting a lot of our energy around documenting outcomes, helping patients get healthier overall, and demonstrating our value there. We want to be able to go to payers and other partners and show why we should get paid for clinical services versus just putting pills in bottles.
What Point-of-Sale System Features Are Most Important in Chain Pharmacy?
CT: And there’s a real need for technology platforms to be successful here?
Faulks: We’ve been trying to do a lot of this over the past five or 10 years, with paper and spreadsheets, but we realize now the value of pulling all our clinical care efforts together onto one platform so that there’s a single location for this in the workflow and a single view of what a patient needs.
Diaz: It’s very important to us to have a platform that streamlines the clinical work in the pharmacy. We’re automating outgoing calls for refill reminders and all sorts of clinical messaging, for example. We also focus on the dashboards we need to see how well we’re doing clinically with our patients. We can see our patient population multiple different ways and get into the specific areas that are a focus for [Medicare] Part D star ratings, such as patients on medications for cholesterol or diabetes and those on ACE inhibitors. We use Mirixa and OutcomesMTM as well, for the medication therapy management opportunities, but we really want to see how we are doing and where we’re going to have a big impact with a conversation or a phone call.
CT: Speaking of efforts around documenting clinical care, are either of you participating in the Community Pharmacy Enhanced Services Network (CPESN) and using the Pharmacist eCare Plan?
Faulks: Yes. We’re actually part of the CPESN network in Iowa and we are using the eCare Plan in some cases. And then we have another MTM [medication therapy management] vendor we use to participate in programs with the state of North Dakota.
CT: Overall, what’s the state of actually creating a business model for clinical care?
Faulks: I think we’re getting there. We’re trying to get it more streamlined from a billing standpoint. I think that’s one of the areas of opportunity that we’re engaging in through the ability we’re gaining to document care in a manner in which we can submit for medical billing and populate, for example, an 837P [professional] form for Medicare billing. So in terms of finding the business model, as we’re building clinical services, we’re keeping an eye on what it’s already possible to bill for.
Clinical Services Generating Revenue in Chain Pharmacy
CT: Do workflow and staff roles need to change for this?
Diaz: Our workflow has been changing. For instance, we had a robot in the pharmacy for about 10 years, but now we’re just using counting machines and workflow stations. We’re finding that’s really efficient. Something else we have that’s been very positive for us is a TV monitor that alerts patients when their prescription is finished. It’s HIPAA compliant. It just puts the patient’s name up when the prescription is ready.
CT: And you are using will-call management as well, right?
Diaz: Yes. That’s a system that uses lights to show us where the prescription is in will-call. It speeds up that process a lot. That does work well.
Faulks: We’ve incorporated clinical-care opportunity reminders for patients in the will-call queue in our pharmacy system. So when you look up a prescription, you also see, for example, if the patient should have a CMR [comprehensive medication review] or if they’re eligible for a flu shot or plan comparison. This is helping us address one of the biggest problems we’ve had in the past, which is that patients were just picking up prescriptions and walking out of the store without our team realizing that these other opportunities existed. We’ve found that the reminder to our team within the will-call queue works very well.
Technology for Chain Pharmacy’s Business And Regulatory Needs
CT: Jeremy, what’s Thrifty White’s strategy for deploying dispensing automation?
Faulks: Similar to Tomas, we haven’t had great success with robots in stores. We’ve had much better success using them as part of our central fill.
CT: The premise of in-store robotics has always been that it’s a time saver, though, right?
Faulks: Honestly, we found that it took a decent amount of work to keep dispensing automation at the store level running properly, which meant that we weren’t saving as much time as we expected. But as we’ve been able to gain scale with central fill, we’re actually seeing great results. Probably half of what gets dispensed in our stores gets filled centrally right now. Interestingly, the big key for getting to that point for us was building our med synchronization program enrollment. Central fill takes all that work out of the store. So all the store team has to do is dispense the medication and then handle the clinical opportunities.
Buy or Build?
by Matthew Johnson, Pharm.D., CEO and Co-founder, Amplicare
Progressive pharmacies look to technology to help them accomplish their goals. But the burning question is: Should chain pharmacies buy or build such technology?
CT: So a strong med sync program is a key component of making central fill work. And the details of the med sync program are handled centrally as well?
Faulks: Yes, the 10-day check-in call ahead of the fill date to find out about any med changes, any scripts that need to go out for refills or need PAs [prior authorizations] or anything like that, it’s all taken care of upstream. At the local pharmacy the team’s not worried about trying to fill these scripts that we can plan ahead for using med sync. And that is a real time savings, which is important for doing clinical work because something that we’ve learned is that it’s hard to add staff to do that. So the more work that we can pull out of the stores and do centrally, the more time the team has to spend with patients and focus on the clinical.
CT: We’ve talked a lot about clinical care, and rightfully so. What other opportunities are out there for building pharmacy revenue?
Diaz: Retail is very important to us. It probably generates half of our income, because the salaries and the cost of running it are so much lower than the prescription business.
The State of Pharmacy Automation: Trends in Chain Pharmacy
RxMedic Vice President David Williams discusses two trends he’s seeing and how RxMedic is focusing on these areas to meet the needs of the chain pharmacy market:
• Breaking Down the Benefits of Will-Call Automation
• Basic Features: Keeping Counting Technology Simple
• Will-Call Management: Beyond Pickup Reminders
CT: Retail’s an area where you can find more margin?
Diaz: It’s an opportunity that a lot of pharmacies miss. The prescription business has a huge revenue number, but look at the bottom line and you can see how important retailing is. As I mentioned, we brought in a new POS from Epicor to strengthen our programs. We want to be able to offer a great frequent shopper program and easy house charge accounts, and take advantage of promotional pricing efficiently. And our POS system really helps us with that. It’s crucial for just making it easier for people to shop. We’re also finding that there are good opportunities to take advantage of as the retail environment changes. Right now, for example, malls aren’t doing well, and companies like Hallmark and some other prestigious brands that shoppers look for want to be in the local communities. So there’s an opportunity there for us to develop the front end.
CT: Jeremy, how is Thrifty White approaching retailing and the front end?
Faulks: We’ve actually taken the opposite approach as retail competition has intensified. We made the decision that we didn’t want to try to get cheaper than Walmart or Amazon, and we’ve been remodeling our stores over the last five or six years to shrink the front end and add more space for clinical counseling suites. All of our new footprints now have three clinical suites that are in space taken away from the front end. We still offer a variety of OTCs, but we’re more selective.
Knowing the Score: Managing Cumulative Medication Risk
Orsula Knowlton, Pharm.D., M.B.A., co-founder, president, and chief marketing/business development officer at Tabula Rasa HealthCare shares
• How to manage drug interactions in complex medication regimens.
• How pharmacogenomics can identify opportunities to improve outcomes.
• Why it’s critical for these tools to be in pharmacists’ everyday software workflows.
CT: Let’s talk about the regulatory environment. What are the challenges there right now?
Faulks: There’s been a little more press pressure lately on the diversion side of things, with controlled substance reporting and track and trace requirements. We’re working on a new suspicious-order monitoring program because we operate a generic warehouse for our stores, some of our affiliate partners, and other independent pharmacies as well.
CT: What are your priorities for the end of the year? What are the things that are top on your to-do list, Tomas?
Diaz: We’re making efforts to address DIR [direct and indirect remuneration] fees, which is actually something that improving patient outcomes and star ratings helps with. Then, it’s always important to increase margins. The number of prescriptions doesn’t really matter anymore. We have to look at having the right insurance mix so that we can increase our prescription margins a bit, and we’re focusing more attention on the front end. We’re also focusing on DME [durable medical equipment]. We’re doing something interesting there, which is working with wholesalers that will actually deliver DME items for us. We help our customer find the right product and do the billing, and the wholesaler ships the item directly to the patient’s home, with our name on it. It never has to stop at the pharmacy.
CT: Jeremy, what about Thrifty White Pharmacy?
Faulks: We’re rolling out a big update to our dispensing system over the next three to four months in all of our stores. This will bring a lot of big changes to the in-store workflow process. We’re streamlining a lot of things that these teams were doing manually before. This is another big piece for making the store process more efficient and faster. Then, alongside that, we’re continuing to roll out the PrescribeWellness clinical platform to the rest of our stores to enable them to really leverage the time we’ll be freeing up with the new workflow updates. Then next winter we’re looking at upgrading central fill and scaling further there.
Rethinking Your Printing: Who Are You Labeling Your Prescriptions for?
Wes Moffett, President, Printed Solutions
With 50 separate state regulatory agencies telling us what we need to put on prescription labels, it is difficult for any multistate pharmacy chain to comply. National chains may have 50 separate label formats, and often more. But even if you only have to comply with one state’s requirements, in many cases it is still difficult. This is because of the very limited space available on small pill vials. Wes considers ways to rethink your pharmacies printing to make it more cost effective and customer focused.
CT: Can you give a good example of a change coming to the in-store workflow?
Faulks: One of the biggest changes is that we’re going to be capturing all prescription images electronically, using a camera, essentially, rather than a scanner. So instead of having to print all the labels and a sticker and check on hard copies, everything will be checked against the image of the prescription within the system. Labels won’t print out until the store staff scans the product at the fill station. So instead of having baskets and labels everywhere, you won’t even get your paperwork until you have the right drug and you are ready to fill.
CT: Will you be using counting technology for this?
Faulks: We’re piloting some of that in our stores. We want to try to roll out some more systems into the stores that can actually capture images of the product that was filled, and then the pharmacists check against that image of the pills rather than from looking into the vial. We’re familiar with this kind of process already, since we do telepharmacy in about eight stores right now. We’re looking at trying to take the same technology we use for telepharmacy and apply that to the community pharmacy workflow so we can get away from having pharmacists stuck behind the counter. CT