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Trena Weidmann, R.Ph., is the owner of P & S Pharmacy, a long-time pharmacy fixture in Corsicana, Texas. Long-term care (LTC) has been part of the offerings for years, and Weidmann decided to convert her LTC operations to a closed-door pharmacy in 2006.

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Trena Weidmann, R.Ph., is the owner of P & S Pharmacy, a long-time pharmacy fixture in Corsicana, Texas
Trena Weidmann, R.Ph.

She serves various types of local LTC facilities, though one challenge has been corporate rollups that have led to prescriptions being filled by the facility owner’s corporate pharmacy, which is often some distance from Corsicana. Still, in these cases, Weidmann has been able to maintain a niche providing a local backup for emergencies and first fills for new residents.

When Weidmann switched over to PioneerRx she wanted to maintain the continuity of running the same software in her retail and LTC pharmacies, which has worked out well for her. Among the key tools within the system, as she reports, is being able to group patients by facility and then process prescriptions by individual facility, set up various billing cycles, and produce medication administration records (MARs), though she notes that many facilities have moved to electronic MARs (eMARs) at this point.

Weidmann was in the process of getting PioneerRx connected to one facility’s eMAR last year, so that the facility could meet its goal to order medicines without calling. That effort ended when the facility changed owners and decided not to continue with eMARs, though Weidmann is glad to know that she has the capabilities within PioneerRx to connect if needed.

Next on her list is PioneerRx’s ability to print special labels both for single-dose packaging, used in skilled nursing facilities, and for multidose adherence packaging, which is an important service for the group homes that P & S Pharmacy serves for people with cognitive disabilities. “These group homes are not staffed by skilled nursing providers,” she explains, “and the residents are active and work in the community during the day. So they benefit greatly from the independence afforded by the multidose packaging that P & S Pharmacy provides.”

Returning to the topic of creating groups within the software, Weidmann is able to segment not just by facility, but also to create subgroups of residents with those facilities, for example by wings. “This way we can fill prescriptions and manage patients one wing at a time,” says Weidmann, “instead of having to do the whole nursing home at once. It’s very helpful for us to be able to manage our filling volume this way, so we’re staying organized and efficient. I can remember days when we filled the prescriptions for every resident at a facility on the first of the month.” The ability to organize and pace the prescription filling means that the staff always has the time to provide service and address any issues as they arise.

Finally, Weidmann appreciates PioneerRx’s ability to record immunizations and report to the state registry. “We do a lot of vaccines for group homes,” she explains, “and everything has to be recorded and reported electronically to the state.” This capability is only going to be more important, notes Weidmann, when a COVID-19 vaccine becomes available.

Tom Hyde, R.Ph., is founder and CEO of Procare LTC, which serves a variety of facilities in New York, Connecticut, Rhode Island, Massachusetts, and Ohio from five pharmacies.

Tom Hyde, R.Ph., is founder and CEO of Procare LTC, which serves a variety of facilities in New York, Connecticut, Rhode Island, Massachusetts, and Ohio from five pharmacies.
Tom Hyde, R.Ph.

Procare LTC has been working with IND Consulting for about 10 years now, which offers data entry, consulting, and technology solutions. “We started out with IND to bring on remote operators that would allow us to outsource some highly repetitive data entry tasks,” says Hyde. “From there we started to integrate with them more and utilize a number of their services to supplement our own internal teams.” For example, Hyde explains, IND Consulting can help Procare LTC handle certain billing rejects or, depending on state laws, enter an order for Procare LTC during times of peak demand or after hours and queue it up for a pharmacist to see.

Procare LTC can even bring on extra, remote pharmacist-level staffing on demand, as state laws allow, using PODS, or Pharmacist On Demand Services, a sister company to IND Consulting. “We may use this if we are short pharmacist staff,” says Hyde, “or when we are seeing growth. IND and PODS can help queue up a lot of that data and take a lot of the burden off my internal team so our team can still be customer facing.” PODS is also crucial as an after-hours and emergency support resource. “If something happens at 4 o’clock in the morning,” says Hyde, “they can handle that call for us.”

IND Consulting’s staff is well trained in using Procare LTC’s technology suite, including its FrameworkLTC pharmacy management system from SoftWriters. “We have workflows where our on-site staff are in different parts of a building. So in reality, if we are leveraging IND Consulting and PODS remotely, the workflow would be the same. As long as you can be compliant in allowing people to come into your system remotely, it works very smoothly,” says Hyde.

IND Consulting has also provided Procare LTC with network and IT infrastructure services, again supporting and expanding on the capabilities of in-house resources. “Managing our IT is a 24/7 job, and the IT support team we’d otherwise need to maintain in-house would be significant.”

Medplus Solutions operates an LTC pharmacy in an 18,000-square-foot facility located in San Juan, Puerto Rico. The pharmacy currently services around 500 facilities and 10,000 beds, ranging from assisted living to mental health and cognitive disabilities and skilled nursing.

Sultan Yassin, Pharm.D., president of Medplus Solutions, which operates an LTC pharmacy in an 18,000-square-foot facility located in San Juan, Puerto Rico.
Sultan Yassin, Pharm.D.

Sultan Yassin, Pharm.D., president of Medplus Solutions, reports that the pharmacy has just implemented the MedWise medication decision support platform from Tabula Rasa HealthCare, rolling it out in August. As a new process, Medplus is working with physician partners to get widespread adoption from the medical community on the recommendations they are able to make based on MedWise.

“Over the past nine years that we’ve been in the LTC space, we’ve continually tried to raise the bar in terms of our services and our patient safety offerings,” Yassin says. “We started off doing some basic analytics for which, based on the patient profile, we would send out questionnaires to facility nurses with the goal of assessing fall risk. And our clinical pharmacists had also developed some basic algorithms to identify potentially misused psychotropic medications. We made a substantial impact, but we were looking for something where we could do more for our patient population.”

MedWise brings sophisticated decision support and recommendation tools to Medplus pharmacists, as well as the MedWise Risk Score that stratifies the patient’s risk. It’s not, as Yassin puts it, a simple input-output solution, but a framework within which pharmacists apply their knowledge of pharmacology and their analytical skills. “As a pharmacist, when you think of medication safety or medication safety systems,” explains Yassin, “you typically think of DUR [drug utilization review] systems where you type in a prescription and you get severity-ranked errors or possible drug interactions. But MedWise is much more nuanced, and pharmacists have to really understand the pharmacokinetic principles behind things like competitive inhibition — and they have to consider just which therapies are truly relevant given the patient’s disease states in order to be able to leverage the tool to its maximum potential.”

MedWise provides extensive training, with Medplus Solutions pharmacists being one of the first cohorts to take part in the new Tabula Rasa University online. “There’s 16 hours of training followed by a series of group discussions of example cases led by the Tabula Rasa University pharmacists. We get to learn about both the science and the art of using MedWise. I think it was actually very gratifying for our pharmacists to use all their skills this way,” says Yassin.

MedWise can be applied both retrospectively and in real time. “We’re currently doing weekly reviews in MedWise,” says Yassin, “and moving toward daily, and then eventually real time.” Once the tool is applied in real time — and this is particularly important, according to Yassin — pharmacists will be able to provide prospective recommendations whenever there’s a transition of care or a therapy change. “We will be able to see if a change results in a significant shift in the MedWise Risk Score and focus our attention on developing recommendations in those cases.”

As MedWise becomes the standard of care at Medplus Solutions, Yassin expects to generate important outcomes data that will prove the benefits of the pharmacist’s recommendations. “That really is part of our goal,” he says. “We want to be able to document and demonstrate impact. And then we would like to work with Tabula Rasa to jointly publish results and outcomes. We’re very much looking forward to being able to share those results with the rest of the world and show the impact we can have.”

LTC Rx is located in Chippewa Falls, Wisc., where it services about 2,000 LTC beds, according to owner Paul Winger, R.Ph.
Paul Winger, R.Ph.

LTC Rx is located in Chippewa Falls, Wisc., where it services about 2,000 LTC beds, according to owner Paul Winger, R.Ph. This pharmacy produces both bubble packs and strip adherence packaging, currently using RxSafe’s RapidPakRx for the strip packaging. “The reason we added RapidPakRx,” says Winger, “is because of the ease of checking the strips and a better quality of packaging than the previous strip packaging automation we had.” He also highlights a much easier time changing NDCs (National Drug Codes).

Amanda Pfeiffer, the LTC Rx staff member who works the most with RapidPakRx, notes that it uses packaging that has paper on one side and a clear plastic on the other, rather than plastic on both sides. This simple difference has a lot of benefits. “First,” says Pfeiffer, “the printing goes on the paper side, and it is much easier to read than when it is on plastic. The strips are also much easier to open and reseal if there are any changes that need to be made. And it runs through the machine much more smoothly, without the bunching up, which was an issue with plastic on both sides.”

Amanda Pfeiffer is the LTC Rx staff member who works the most with RapidPakRx.
Amanda Pfeiffer

Winger reports a huge difference in the ease of checking the packaging produced by RapidPakRx, which is the result of having automated vision inspection built right into the technology. “With our old packaging robot the vision inspection was a separate machine,” notes Winger. “And it wasn’t cheap, so we didn’t have it. And even if we did invest in it, it required the additional step of feeding the filled strips in for inspection, rather than being integrated into the technology like it is with RapidPakRx.”

“We probably spend about a third of the time checking now,” Pfeiffer adds. “RapidPakRx’s visual inspection can tell if a pouch has been misfilled and also flags pouches in which it’s not able to differentiate between drugs for whatever reason. Though the automation fills very accurately, so these checks are really kept to a minimum.” When there is an issue, LTC Rx pharmacists are just checking the exceptions, with the potential errors marked clearly by the system, and using a large-screen TV to do it. “It really cuts down on the strain and monotony of the pharmacist check,” says Pfeiffer.

There’s one final highlight of the automation that’s bringing greater efficiency, according to Pfeiffer. And that’s a much easier process for loading in a new medication if there’s a change to the NDC. “We use a micrometer to measure a new pill and enter the dimensions into RapidPakRx,” Pfeiffer says. “And then the machine takes pictures from several different angles and learns what that specific NDC looks like. Then we’re dialed in and ready to keep going.”

Alpha Drugs consists of two pharmacies in Anaheim, Calif. The business splits 40%/60% between retail and long-term care pharmacy, where the focus is residents in assisted living facilities, skilled nursing homes, and group homes. Dave Patel, Pharm.D., is a pharmacist in this family business started by his father.

Dave Patel, Pharm.D., is a pharmacist at Alpha Drugs, a family business started by his father and consisting of two pharmacies in Anaheim, Calif.
Dave Patel, Pharm.D.

Alpha Drugs has recently moved to using BestRx pharmacy management software for both sides of the business. As Dave Patel tells it, Alpha Drugs had been a long-term customer of a pharmacy software vendor that was bought out by a large corporation. After one false start with a new vendor, Patel, who has a background in pharmacy informatics, went about developing a detailed list of requirements. The goal was to have everything set up, filtered, and tagged within the system so that the repetitive work of serving 20-plus nursing homes is as automated as possible.

“I brought this list of needs to vendors who we thought could potentially provide us with software that would work both for our retail and LTC businesses,” explains Patel. “Some said right away that they didn’t have and didn’t plan to roll out the LTC features we needed, some beat around the bush promising they could get them done. When I was talking with Hemal Desai at BestRx, I asked him about a specific feature we needed and he was back to me about five days later, saying, yeah, we did it.” That led Patel to go through his whole list of needs with BestRx. “I told them that, if you’re willing to work with us to expand your software,” says Patel, “I’m happy to help you build out the LTC capabilities.”

At the top of Patel’s list was the need to be able to tag and sort data more extensively than was typical for retail filling. “For example, we need to be able to sort patients into groups and queue their prescriptions by facility and even by wing within a facility,” says Patel. “We also need to be able to distinguish between medications that are cycle and noncycle billing, so that we can avoid the trouble that comes from short filling to match the cycle for things like creams or inhalers or for cases where there are frequent medication changes.”

Patel reports that BestRx was able to develop all of these features, and more. As a result, once patients are correctly tagged and filtered into queues, the LTC workflow at Alpha Drugs goes very smoothly. For example, when a new prescription comes in, it’s tagged as LTC and cycle or noncycle, and then it’s automatically pulled into the correct facility MAR, and with the correct administration timing for that facility.

“Overall, it’s really about how we can customize the information that we’re managing within BestRx but control when and whether it’s actually outputted to, for example, a MAR or label or submitted for billing,” says Patel. “These are just not features that you would ever need in a purely retail system, basically.”

Johanna Readinger is the director of operations for Guardian Pharmacy of Indiana in Indianapolis, where she oversees the various aspects of the business, such as pharmacy scheduling and IT projects.

Johanna Readinger is the director of operations for Guardian Pharmacy of Indiana in Indianapolis
Johanna Readinger

Most recently, Readinger has been focusing on ensuring the highest level of accuracy of outgoing orders. To address this she’s focused both on the tote-filling and delivery steps. Readinger reports seeing great benefits from using the delivery tote-filling steps of the workflow in Integra PrimeCare pharmacy management software. This is a barcode-driven step to match a batch of medications to the delivery tote that they are supposed to go into. If it is not the right tote, there’s an alert. “Once we have a positive match between the prescription and tote barcodes,” says Readinger, “we have the confidence that all the right meds are in the right tote and they are going to make it to the correct facility.”

Readinger wants to be able to track that delivery step as well, and has recently begun using Integra DeliveryTrack. “DeliveryTrack gives us real-time access to where our drivers are in their routes,” she says, “and instant access to details such as who at a facility signed for a delivery, at what time they signed, and what was in the order.” This has really streamlined operations and reduced the time spent on phone calls from facilities following up on details about a delivery.

Readinger points to another area in which Guardian Pharmacy is relying on PrimeCare to manage complexity in LTC: billing matrices. “We need to make sure that we have all the payers in a patient’s billing matrix,” she explains, “and then that we have medications coded correctly as primary payer, secondary payer, etc. This helps us reduce the amount of time that is involved in rebilling.”

A good example of this are hospice medication lists, which are added to a billing matrix for patients newly admitted to hospice. “Those medications that are tagged for that list are then billed automatically to the hospice, as opposed to being billed to the primary payer,” says Readinger.

Finally, Readinger notes that there’s been a boom in demand for eMAR interfaces, with Guardian Pharmacy adding five such interfaces over the last few years. “Many facilities are interested in getting away from pen-and-paper medication administration records,” she notes. “So I’ve spent a lot of time working with the interface department at RedSail Technologies, Integra’s parent company, on this.”

In the end Readinger says the big challenge for her continues to be maintaining good communication between the facilities and the pharmacy. “We are constantly working to meet and exceed expectations for facilities,” she says, “and tools like DeliveryTrack, tote-level workflow tracking, and eMAR interfaces are all part of an effective communications cycle.”

Sterling Long Term Care Pharmacy primarily packages in single-dose bubble cards for assisted-living facilities and nursing homes. The Worthington, Minn., location packages approximately 3,000 prescriptions a week in about 4,500 bubble cards. “We are always looking for ways to increase productivity,” notes Amy Paradis, Pharm.D., pharmacy manager in Worthington. This led to deploying Pillvac at all four Sterling Long Term Care Pharmacy locations three years ago, and more recently adding packaging robotics.

Amy Paradis, Pharm.D., pharmacy manager Sterling Long Term Care Pharmacy in Worthington, Minn.
Amy Paradis, Pharm.D.

“We moved from manually filling prepacks to using Pillvac,” says Paradis. “The productivity gains have been impressive. With Pillvac we can fill four or five cards in the same amount of time it took to fill one card manually.” This has allowed Sterling Long Term Care Pharmacy to expand the amount of prepackaging it does and to take on cycles for the other pharmacies, all at the same staffing level.

Another important benefit has been that Pillvac gives Sterling Long Term Care Pharmacy a tool to address USP <800> requirements for handling of hazardous drugs. “We have very specific requirements to meet for all the drugs we dispense that are on the NIOSH [National Institute for Occupational Safety and Health] lists,” says Paradis. “For example, staff have to wear gloves to handle them, which we always do anyway in our pharmacy. We also need to address the possibility of pill dust contamination, which can mean needing to dispense in a separate area. And then we have to clean any equipment used to fill hazardous drugs before we use it again.” Pillvac addresses a number of these requirements, notes Paradis. First, since it uses suction to pick up pills, it’s also vacuuming up any pill dust and capturing it using a HEPA filter. Second, there are special and clearly labeled hazardous drug trays that staff use on Pillvac whenever they are packaging NIOSH list drugs. Finally, it’s easy to clean the trays and change the HEPA filter when finished. Another benefit of the suction-based technology, reports Paradis, is that techs need to use less personal protective equipment when prepackaging NIOSH drugs, which has been important during the COVID-19 pandemic.

As noted earlier, Sterling Long Term Care Pharmacy has recently added blister card packaging automation as well. The robot serves, however, as a complement to Pillvac rather than a replacement. This is in part because while the robot has the advantage of being able to run in off hours, it is, in fact, slower at filling cards than staff using Pillvac. It also does not work well for all medications. “For example, if the pill is the wrong shape or too powdery,” says Paradis “then it’s better to prepack it with Pillvac.”

And Paradis has also found that staff members using Pillvac are more consistently accurate. “It’s very easy to see if you have missed a capsule in those bubble cards,” she says.

Taylor Drug has a combination shop in Arkansas City, Kan., with retail, long-term care, DME (durable medical equipment), and compounding, and a closed-door shop in Oklahoma City, Okla. Owner Jonathan Taylor, Pharm.D., says the pharmacies are significantly different, but both use the Speed Script pharmacy management system.

Taylor Drug has a combination shop in Arkansas City, Kan., with retail, long-term care, DME (durable medical equipment), and compounding, and a closed-door shop in Oklahoma City, Okla. Owner Jonathan Taylor, Pharm.D.
Jonathan Taylor, Pharm.D.

The Oklahoma City location serves 100% intermediate care patients who are intellectually and physically disabled and living in a variety of settings. The groups serving these homes are under the umbrella of the Development Disabilities Service Division. While the pharmacy services approximately 1,000 beds between the two locations, most patients take multiple medications, resulting in a higher overall prescription volume. Taylor says the volume is such that his pharmacy is on the verge of installing a robot.

Taylor uses the Speed Script web-based eMAR module with about half his intermediate care clients. He says clients like the ability to log in and access real-time data on the pharmacy services.

Some of his clients allow the pharmacy to access the facility’s eMAR to update orders and discontinued scripts or modify dispense times. Through his contract the pharmacy is compensated for the work.

Although Taylor Drug has used adherence packaging for about 10 years, Speed Script recently wrote an interface to the system that eliminated the need to enter patient and prescription data twice. “Orders that are entered into the pharmacy system get transmitted directly to the packaging system,” says Taylor. “It streamlines the process and gives me more confidence that I don’t have to verify the second input. That’s a major weight off our shoulders.”

When COVID-19 hit his facilities, Taylor immediately bulk-compounded hand sanitizer using 80% alcohol and ordered PPE (personal protective equipment). The Speed Script compounding module made it easy to bill for the hand sanitizer. While they did bill their facilities, on the retail side the pharmacy donated these supplies to area first responders. “I wanted to be able to offer this service to my community, and it was easy with the compounding module,” he says.

Serving the intermediate care patients, as well as offering compounding to retail, doctor’s offices, and vets, are examples of the diversification Taylor says pharmacy needs today to thrive. He also uses Speed Script to manage a med sync program for retail patients, in addition to the intermediate care patients. Taylor praises his buying group (the Compliant Pharmacy Alliance) as a key to helping profitability. “I think there is a lot of hope in being a pharmacist. I’m not going any place,” he says.

Randy Peck, R.Ph., principal, Peck Purchasing Consultants, near Chicago, Ill.
Randy Peck, R.Ph.

The COVID-19 situation has had dramatic and possibly long-term effects on the long-term care pharmacy business, says Randy Peck, R.Ph., principal, Peck Purchasing Consultants, near Chicago, Ill. He says that at the height of the pandemic, census in many homes was down by 40% or more. Rehab, which is a big part of LTC today, and an important revenue driver, is down by 90% or more.

“I’m seeing pharmacies down anywhere from 25% to almost 40% of their typical volume,” says Peck. “Obviously, it puts a significant crunch on cash flow and profitability for the pharmacies.”

With all this going on, pharmacies are also tied to performance contracts with their primary wholesalers. Peck will help pharmacies evaluate their purchasing practices and advises on finding the sweet spot to meet their prime vendor agreements to save money on generics through the use of tools such as PharmSaver.

“It’s a matter of survival right now — and a tool that can deliver savings, help you manage your prime vendor agreement to its utmost, and not take up much time with your staff is just an enormous benefit right now,” says Peck.

The comparison tools PharmSaver offers aren’t new to the long-term care space, but the pandemic has accelerated their use and importance in keeping a business running.

With patient census down, pharmacies can’t meet both top-line targets and generic compliance. Wholesalers are also penalizing pharmacies for not complying with contracts, with brand discounts as well as rebates being cut. The reimbursement-driven model that’s been in place for years is putting even more margin pressure on pharmacies during the pandemic.

“Depending on your brand and generic mix at a particular pharmacy, it could be the case that, well, yes, we will be giving up two tenths of a percent or a quarter of a percent on brands,” says Peck. “But when you quantify those dollars, versus what you might pick up saving 50%, 60%, and in some cases, 75% on a generic or a basket of generics, then it more than offsets the move to a lower tier.”

When the pharmacy gives the range they want to achieve to PharmSaver, the software presents the best options, comparing the primary wholesaler’s pricing with other wholesalers. The staff can then add items to a shopping basket and see what the savings will be and how it impacts their contractual requirements.

You have the ability to identify to PharmSaver your brand and generic discounts, the rebate tier that you’re targeting, and the minimum percentage savings or dollar savings that you’re looking for, says Peck. And when you export a file from your prime vendor, that file denotes which generic is a source generic or not. The PharmSaver algorithm shops against the net price that the pharmacy is ultimately going to pay, rather than the invoice price.

Typically, Peck says, customers save twice what they spend on PharmSaver. One client, who just started using PharmSaver in December, has told Peck that without the service he would not have been able to keep his pharmacy afloat with the significant decrease in script volume because of the pandemic.

“A tool like PharmSaver was always valuable, but with the situation that most people are facing in their long-term care pharmacy business these days, it’s even more critical,” says Peck. “The savings are real and fairly immediate.”

PCA Pharmacy, based in Louisville, Ky., has been serving the LTC community since 1994. The company has grown over the years, says Lance Miller, R.Ph., VP of operations, through organic growth, joint ventures, and acquisitions, to nine pharmacy locations and 525 employees that service about 32,000 patients in 13 states. They have used the SoftWriters system in one of the pharmacies since 2007 and have started transitioning more locations to the platform.

Lance Miller, R.Ph., is VP of operations at PCA Pharmacy, based in Louisville, Ky.
Lance Miller, R.Ph.

“It’s hard to be an independent pharmacy in today’s market, and so we look for partnerships in our markets that fit our culture and can provide us with an advantage. From our perspective, it’s an advantage to all of our long-term care customers to have insight into what they need and how we can help them. Due to our joint venture relationships, we gain the advantage of being able to do trial processes, see how they work, and then branch out into the marketplace with the new processes to assist our current customers and potentially attract other customers,” says Miller.

One example is the “Meds to Home” program, where the pharmacy follows patients after discharge from a facility to increase adherence. “We wanted to ensure patients were compliant by providing them with a 30-day supply of their medications when they discharge home,” says Miller. PCA developed processes around the logistics on the facility side, to have the information in a timely manner and get the meds to patients prior to them going home. They also have created a meds-to-beds program that provides a three-day supply of medications to the patient upon admission to the skilled nursing facility from the referring hospital partners. They partner with the hospitals to coordinate this process so the residents have what they need during their transition.

“It’s been beneficial for both sides,” says Miller. “In these times, the hospital partners are looking for ways to reduce the risk of recidivism and obtain additional revenue as well.”

Miller says SoftWriters offers efficiencies in both workflow and billing that led him to install Framework at a second location. A key reason is the ability for the PCA business analytics team to easily create dashboards to monitor key performance.

“Data is key going forward,” he says. “It’s going to help our pharmacies and our customers by providing information to run their businesses better. Framework’s SQL back end attracted us because we have immediate access to the information we need.”

The interface to EMR (electronic medical record) and electronic emergency kit systems keeps the pharmacy system current on medication orders and usage from the emergency kits. When the facility accesses the kits, the information is transferred directly to PCA pharmacies, and they can bill automatically as well as refill the medication as it is used. This ensures the facility doesn’t have to delay therapy for a patient because it doesn’t have a medication in stock.

The Framework dashboard also tracks where prescriptions are in the workflow at each step, from order entry to delivery. Miller says this lets the staff adjust in real time to be able to handle any problems, ensuring consistent delivery to the facility and building trust.

“It allows the facility to manage its workday better,” Miller says. “The nurses know when the delivery is arriving, and that allows them to spend their time on more important processes around patient care.”

As pharmacy moves to the forefront as potential vaccination sites, LTC pharmacies are looking into how to provide this service to their patients. Miller says that since many skilled nursing facilities have nurses on site who administer vaccines, PCA Pharmacy is looking at different scenarios, either with flu vaccines or a COVID-19 vaccine, of how they can assist with distribution and administration of these services and products.

Andrew Mize, Pharm.D., bought Debbie’s Family Pharmacy in Rogers, Ark., six months ago after working at a local independent.
Andrew Mize, Pharm.D.

Andrew Mize, Pharm.D., bought Debbie’s Family Pharmacy in Rogers, Ark., six months ago after working at a local independent. He signed the ownership papers on March 2, and on March 15 he made the decision to close the pharmacy’s retail lobby temporarily and offer just delivery and drive-thru.

The pharmacy came with the RxMaster system, and Mize says he feels it’s been flexible. He’s adapted features to the new COVID-19 workflow, which includes medication sync for LTC facility patients and single delivery order sheets that are searchable back in the pharmacy.

Debbie’s has a dedicated long-term care side that serves facilities throughout Northwest Arkansas.

The workflow syncs patients to allow for monthly deliveries, and for additional deliveries of inhalers or new orders such as antibiotics.

With the RxMaster fill history, the staff can run a patient profile and, depending on the facility, send the order to a ScriptPro robot. “Obviously our fast movers are in the robot, and that definitely saves a lot of time,” Mize says.

There is a distinction between the retail and LTC divisions of the pharmacy, but both use RxMaster. “In the store it’s a doorway between the two, and they are vastly different processes for how the workflow is handled,” says Mize.

Sensitive to the fact that facilities did not want a COVID-19 outbreak, Mize worked with each to know their protocols. His pharmacy may have made multiple deliveries during the course of the day, Mize says, but the pharmacy shifted to sync patients and now makes one delivery.

One feature that has been indispensable during the COVID-19 crisis is the house accounts. Copays are applied when the prescriptions are processed, along with any other supplies for that month, and the charges are put through to the house account. An ACH draft or a credit-card payment is charged at the end of the billing cycle.

The pharmacy prints a sheet with all the medications for patients who are on delivery for that day, which requires just one signature. “While we’re able to store the paper list, we can access the list in RxMaster,” says Mize. “We can look up when a prescription was filled and sort by facility to see when it was delivered.”

The facility staff will call if they can’t find something, and Mize says the search feature lets his staff look up when the order was delivered and signed for.

Interfaces with PointClickCare and QuickMAR give Debbie’s access to the facility records, making it easy to review any changes to a patient’s medication list.

RxMaster’s ability to identify low insurance reimbursements has helped the pharmacy’s finances. “When insurance reimbursements are too low, you can set a certain reimbursement percentage and RxMaster will alert you if it’s ever below that,” says Mize. “If insurances are paying you at usual and customary, you know you may need to go back and look at your cash prices. If set too low and insurances will pay you more than that, it’s very obvious because it pops up a box in front of you as soon as that happens.”

Mize says any special pricing that is saved when those scripts are processed, the system defaults to that same price.

The internal calendar is a feature Mize relies on for managing prescription processing. It’s easy for everyone to see what’s important each week. Also, patients are cross-referenced by facility, giving the staff two ways to look up a patient when conducting medication reviews.

Since he’s new to long-term care, Mize will ask the facilities questions about issues and possible solutions. With flu immunizations, he hopes to expand his offerings going into the fall and pursue new clients. He sees long-term care as a way to grow his business.

One example of the customized approach that the pharmacy offers is the delivery schedule. Prior to COVID-19, the drivers would go to the nurse’s station in the facility. To reduce the amount of time nurses spend meeting drivers at the door, Mize says the pharmacy has gone to once-a-day delivery, unless there is an emergency.

There you have it, a resilient response to unprecedented times. And technology is a leveraging factor. How has your pharmacy responded? CT