The Outlook 2019: Are You Ready?

What one area of operational or clinical focus will yield the best returns for pharmacy in 2019?

The role of the pharmacist is in the midst of a transformation in order to accommodate for the rising cost of healthcare and the strain caused by the doctor shortage. With provider status now emerging in many States, pharmacy is finally breaking free of its shackles to practice beyond the commoditization of pharmacy.

Empowering pharmacists to practice at the top of their license brings an opportunity to generate more income, and insulates pharmacies from external threats. At the same time, there’s already a ton of pressure on pharmacists to fill a high volume of prescriptions quickly. Pharmacies must move towards delivering enhanced engagement with patients.Technology innovations in the pharmacy management and workflow will facilitate this shift.

What new development could prove to be an unexpected challenge for pharmacies in 2019?  

In the near future, there will be several barriers that prevent Amazon from competing with wholesalers and PBMs. Alternatively, Amazon will likely focus on building a retail pharmacy presence, as they have begun to do so with last year's acquisition of PillPack. This action aligns with Amazon's preference to add essential and frequent customer needs in order to retain and attract new Prime members. Patients who occasionally refill medications are an ideal target group. Who knows, Amazon may even add physical pharmacies in its Whole Foods location.

What one area of operational or clinical focus will yield the best returns for pharmacy in 2019?

The ability to perform medical billing for clinical services in workflow directly within the BestRx system. Currently medical billing for pharmacies is cumbersome as it requires the use of an alternate platform or requires them to submit manual paperwork. Our new features will streamline this billing process. In addition, we will alert pharmacies when there are opportunities to bill a patient for a clinical service to help pharmacies maximize potential revenue and increase patient care at the point-of-service.

What new development could prove to be an unexpected challenge for pharmacies in 2019?  

The acquisition of PillPack by Amazon and the uncertainty of how it will affect pharmacies once Amazon moves forward with whatever plans they have. As younger patients start to age and require medications, their comfort level with technology may lead them to the convenience that an online pharmacy such as PillPack may provide. Independent pharmacies will need to find ways to combat that by providing services that will differentiate them from the competition. Also, the uncertainty of how mergers between various PBM's and payers will affect pharmacy networks and prescription reimbursements, particularly when it comes to DIR fees.

What one area of operational or clinical focus will yield the best returns for pharmacy in 2019?

Today’s independent pharmacy continues its struggle to be profitable. With drug costs continuing to increase, operational costs soaring, insurance reimbursements declining, Cypress has seen the market flooded with schemes and programs that require the pharmacy to bind themselves to either lengthy contracts and/or multi-agreements which yields the opposite of saving money (paying Peter to pay for Paul). These agreements also bind them into practicing pharmacy without alternatives. We’ve encouraged our users to look at all the options, to provide multiple options to choose from and in some cases, engage in new ventures, if it benefits the pharmacy. We have teamed with other companies that are like-minded with the philosophy of honestly putting our customer first, dedicated to increasing their profitability.

What new development could prove to be an unexpected challenge for pharmacies in 2019?  

Education and understanding of cloud pharmacy with specifically targeted technology. It’s human nature to fear what we cannot see. The fundamentals of cloud pharmacy is what Cypress is all about. The elimination of costly servers and the regular upgrades of them. Cloud pharmacy enables secure mobility. There are many communities in very rural areas that cannot get to the pharmacy to receive pharmacological healthcare. Over the many years, we’ve delivered pharmacy products but never really have delivered the full pharmacy service. Cloud pharmacy opens the door to do exactly that. Mobile pharmacy also reduces cost by maximizing the employed staff. In the opportunistic locations, both pharmacist and technician can work together at different addresses.

Using cloud pharmacy promotes uninterrupted patient care. We’ve begun to see a huge benefit for pharmacies operating in high-risk locations to practice pharmacy in the cloud. Inclement weather, floods, fires, and the like all can have devastating effects for the pharmacy and their patients. Creating disaster recovery plans, structuring your business with cloud pharmacy including cloud IVR allows patients to call the pharmacy regardless of where the pharmacy may be established to provide care and service.

What one area of operational or clinical focus will yield the best returns for pharmacy in 2019?

With new legislative action underway in several states, telepharmacy will continue expanding into new markets. These new laws will give hundreds of underserved communities the chance to have local pharmacy access and even help prevent low volume pharmacies from closing. A retail telepharmacy, or remote dispensing site, operates similarly to a traditional pharmacy but is staffed by certified pharmacy technicians and is supervised by one or more pharmacists in another location. Once a technician in a telepharmacy receives a prescription, the technician enters the prescription into the pharmacy management system. A pharmacist, working in another location, verifies the prescription by either a live video or still images sent by the technician. Once the prescription has been verified by the pharmacist, it is dispensed to the patient. Counseling takes place via a two-way audio/video connection between the pharmacist (working in another location) and the patient (inside the telepharmacy). Telepharmacy can help pharmacies expand operations by reaching patients in underserved areas, and many more states will be introducing telepharmacy rules and regulations soon.

What new development could prove to be an unexpected challenge for pharmacies in 2019?  

A significant challenge that many pharmacies are overlooking is the Controlled Substance Registry. Currently, 26 states require a separate registration in the battle against opioid abuse. Filling a prescription for a controlled medication from a prescriber with an outdated, incomplete or non-existent Controlled Substance Registry number could trigger costly fines levied at under-prepared pharmacies. Maintaining accurate prescriber files is essential for busy pharmacies that are filling hundreds of prescriptions per day. Among the most common violations to avoid include: Filling prescriptions from practitioners who do not have a valid DEA number; Incorrectly recording the practitioner’s DEA number; Filling prescriptions outside the scope of a practitioner’s DEA registration; Filling prescriptions that do not contain the required information; Failing to maintain accurate dispensing records; Failing to maintain records for central fill locations.

What one area of operational or clinical focus will yield the best returns for pharmacy in 2019?

It will be continuing to expand patient contact and services through health screenings, outreach, and low level health services (flu shots, etc). This will bring the patients into the stores more and increase adherence to medication instructions and renewals. "Traditional" drug stores will delve into areas previously handled by specialty stores such as diabetes and oncology to draw more people in. Just as doctors offices now use physician assistants to provide first level of care, Pharmacies will start to employ nurse practitioners and others to allow patients to be treated, prescribed medications, and receive those medications, all in one visit.

What new development could prove to be an unexpected challenge for pharmacies in 2019?  

As the merger trend continues with big tie ups like CVS and Aetna, it will force Walgreens and others to do the same. Eventually this could lead to lower reimbursement rates for anyone outside of CVS and Walgreens. You will see the pharmacies selling and explaining health care plans to customers while in the stores, tailoring plans to individual needs, from families to Medicare supplemental plans. It will make it harder and harder to compete with the big chains.

What one area of operational or clinical focus will yield the best returns for pharmacy in 2019?

The RxMedic ARS is an automated will call bag solution that allows pharmacies to efficiently retrieve prescriptions and maintain the will call area. By automating the will call area pharmacies will be able to present a professional image to their customers, quickly and efficiently retrieve all of the patients prescriptions, reduce HIPAA violations, improve star ratings, and manage inventory for easy return to stocks. Automating the will-call saves time and money by ensuring that, once the prescription is filled, there is an automated process to help the prescription make it out the door.

What new development could prove to be an unexpected challenge for pharmacies in 2019?  

Reimbursement rates and DIR Fees are not new issues, but continue to affect pharmacies profitability. Pharmacies can free up time behind the counter by automating their pill counting with a RxMedic RM1, a visual based tabletop pill counter. With an accumulation mode and bulk container the RM1 can not only count daily prescriptions, but help with inventory counts. This will allow them to spend more time with customers for functions like MTMs and immunizations, which can help their profitability.

What one area of operational or clinical focus will yield the best returns for pharmacy in 2019?

A shift is coming. Pharmacies are quickly becoming data-rich. Soon, pharmacies will be in the unique position of having a tremendous amount of data without a unified, systematic way of harnessing it to make informed decisions about the health of their patients. Outcomes will continue to be important, but instead of simply having the ability to report on what’s happening to their patients, pharmacies will need to demonstrate their impact on these outcomes. This begins with understanding and interpreting the data, followed by appropriate action. Advanced Pharmacy Clinical Services (APCS), ScriptPro’s clinical platform, collects targeted, meaningful patient data and then provides evidence-based recommendations that allow pharmacists to make informed clinical decisions for the individual needs of their patients

What new development could prove to be an unexpected challenge for pharmacies in 2019?  

Patient access to health information, and with it, misinformation will be a challenge to healthcare practitioners. Pharmacists, in particular, have always ranked as some of the most respected professionals in the country. But because complex medical information is now readily available to the public, it may not be enough to ensure they continue to be the knowledge gatekeepers. The host of barriers that drove the public to consult with professionals, are no longer in place. Pharmacists will need to balance the positive effects (improved health literacy and increased patient engagement) with the potential downsides (an inability to fully comprehend the medical information without the aid of a healthcare professional and, more alarmingly, misinformation masquerading as fact). In the fight for truth, pharmacists will be needed more than ever. As the market for community pharmacies shifts and institutional pharmacies continue to compete with large chains, pharmacists will need to act as the sources of truth for their patients and their communities. Understanding the concepts, sifting fact from fiction, and encouraging continued engagement will be the challenge. With the right motivation and tools rooted in evidence, pharmacists can not only face the challenge, but successfully overcome it.

What one area of operational or clinical focus will yield the best returns for pharmacy in 2019?

A report was released in early December by the Departments of Labor, Health and Human Services, and Treasury on health care competition in America. The report recommends that states consider changes to their scope-of-practice statutes to allow all health care providers – including pharmacists – to practice to the top of their license. Further, the report supports policies allowing pharmacists to be paid directly for their services if a pharmacist can safely and effectively provide the needed care.
Community pharmacists are highly accessible health care professionals, trained for and licensed to provide services that promote patient health, prevent disease, and reduce the total cost of health care. This report, and some logical thinking by our legislators, could gain ground against the negative reimbursement pressures from insurers and pharmacy benefit managers and the inability of pharmacists to bill Medicare Part B.

​Pharmacist provider status would, and enhanced services pharmacy networks do, provide pharmacists the opportunity to positively impact patient outcomes while lowering overall health care costs. While provider status remains in the hands of Congress, Community Pharmacy Enhanced Services Network (CPESN) is in play today and making an impact. CPESN is an initiative committed to providing expanded professional services, and the documentation of their value, that provide the foundation from which equitable agreements with payers may be established.

More involvement of pharmacists on the health care team provides a great return on investment for patients, insurers, and the profession.

What new development could prove to be an unexpected challenge for pharmacies in 2019?  

With much attention on drug pricing and theories on how to control it, one thing is certain – it’s been purposely confusing, and everyone within the pricing chain has someone else in the chain they want to blame. The finger has been pointed at manufacturers, pharmacy benefit managers, wholesalers, group purchasers, hospitals, and others.

After President Trump announced his “plans” for drug pricing reform, it was pointed out that he specifically did NOT implicate pharmacies or pharmacists in targeting the problems.
The solutions for reform are often proposed by those with an eye on protecting their turf. And with Elizabeth Warren’s suggestion of a government-owned and -run generic company, we have to wonder where we’ll end up.

Pharmacy has historically come out on the losing end of the pricing game. First it was MAC issues, then DIR fees. We need to remain vigilant that those with louder voices, and deeper pockets, do not find a way to pin this on pharmacy. We must be engaged with the discussion, and that is best accomplished by being personally involved in your state and national pharmacy associations. APhA, NCPA, and others are working diligently to advance the profession of pharmacy, but they need our help.

What one area of operational or clinical focus will yield the best returns for pharmacy in 2019?

Pharmacists needs to continue utilizing technology that allows them to focus on their role as the face of neighborhood healthcare.  As many as 89% of Americans live within five miles of a pharmacy and pharmacists continue to be trusted healthcare professionals across the nation.  There’s no question they need new forms of technology that allow them to spend more time providing patient consultation and working to improve patient adherence.  One area where technology is assisting pharmacists today is the management of the medication supply chain.  Pharmacist need to have the right medication, in the right location at the right time without spending time and energy managing those efforts. Supplylogix offers a suite of Software-as-a-Service applications that help lessen the burden of managing inventory so pharmacists can focus on patient care and rest assured they will have the medications their patients need, when and where they need them. We use sophisticated algorithms to help pharmacies create daily inventory order points with our Pinpoint Order tool and take it a step further with Pinpoint Transfer which allows pharmacies to redistribute inventory between locations to minimize potential losses from unsalable returns. We also offer solutions to help pharmacies ensure appropriate on-hand quantities and ultimately make sure they are stocking the most cost-effective medications for their dispensing needs. In the end, eliminating as many manual tasks as possible truly gives pharmacists the time they need to be the face of neighborhood healthcare.

What new development could prove to be an unexpected challenge for pharmacies in 2019?  

Failure to make the right technology choices could prove to be one of the biggest challenges for pharmacies this year. The industry has long embraced the use of technology to enhance the pharmacist’s ability to improve patient care, increase adherence and ensure the patient has the right medication at the right time. With increasing drug costs and reduced reimbursements, pharmacies are also acutely aware of the overhead cost associated with running a business. With so many new solutions on the market, it’s increasingly important to choose technology that aligns with your business objectives, whether that be adding clinical services, improving patient care, or managing the health of your business. Just as failing to implement technology to increase medication safety could be harmful to their patients, failing to capitalize on technology that optimizes inventory costs can be just as harmful to their business. Software like that offered by Supplylogix takes the burden of inventory management away from the pharmacist, allowing them to spend less time managing the business and more time focusing on the patient. And, better management of inventory spend ultimately means more resources can be redirected to patient care.

What one area of operational or clinical focus will yield the best returns for pharmacy in 2019?

Increasing medication adherence is critical to improving patient outcomes, reducing 30-day readmissions, reducing penalties and driving revenue. Medication non-adherence results in an estimated 125,000 deaths and may be the cause of 10% of all hospitalizations in the United States each year. The costs associated with deviations from the medication plan range from $100 - $289 billion annually. Twenty to thirty percent of medication prescriptions are never filled and approximately 50% of medications for chronic disease are not taken as prescribed. It will be critical for pharmacies to evaluate their patient base and determine which patients qualify for a medication adherence solution. Compliance packaging is becoming widely available and has very high consumer appeal. Pharmacies offering this ahead of the large chain and mail order operators will not only be in a position to retain their customers but will also have an opportunity to grow their business by partnering with local health systems and providers.

What new development could prove to be an unexpected challenge for pharmacies in 2019?  

Pharmacies are running out of space due to increased demands in operations, more patients, more orders and more drug inventory. Pharmacies are under pressure to do more with less and we are seeing a demand in the market to optimize the overall pharmacy by consolidating the footprint through high-density storage solutions, right-sizing and managing inventory perpetually while driving better workflows. Continued high generic usage, along with reimbursement pressures continue to impact top-line revenue. It’s important to have a plan to grow volume and increase profitability. Reducing inventory carrying costs through technology, providing solutions to allow staff to be more efficient, freeing up space for added services, and enhancing patient compliance are all strategies for remaining competitive.