Over the years pharmacy has been resilient in addressing adversity. This has been proven time and time again. Now the adversity comes in the form of lower margins on generics; DIR (direct and indirect remuneration) fees, thus clawing back dollars from adjudicated claims well after the fact; preferred networks; and other aggressive moves by the pharmacy benefit managers to squeeze out more profits from prescription drugs dispensed, at the expense of pharmacy margins. Even the major chains are not immune from these new pressures.
That said, what must happen for pharmacy, particularly the community pharmacy, to survive? Clearly, pharmacy must take steps to reinvent itself. Specialty pharmacy is one avenue, but this presents its own set of challenges in handling the high-priced drugs involved.
SPOTLIGHT: Solutions for the Pharmacy of the Future, an interview with Kevin Welch, president of Smith Technologies, parent company of QS/1, and chief technology officer of J M Smith Corporation.
An NCPA (National Community Pharmacists Association) recent survey of its members found that 58% stated that they are somewhat likely or very likely to close their doors in the next two years if things do not improve. That’s a scary finding. Yet pharmacy is not resting on its oars. The Community Pharmacy Foundation launched a flip-the-pharmacy campaign to change the focus of pharmacy to clinical-based services with care plans and documentation. Lisa Schwartz, who is senior director of professional affairs at NCPA, reports that pharmacists across the country are part of the flip-the-pharmacy initiative. “This seeks to refine the scalable models for pharmacists practicing in the community and taking care of the whole patient over time,” says Schwartz. However, she adds, “Scalable pharmacy practice transformation requires changes to workflow, care processes, and business models in repeatable, consistent, and achievable increments.” This is a change that system vendors must recognize and address to help pharmacists move in this direction.
Paul Baldwin, from the Baldwin Health Policy Group, sums it up this way: “The dispensing function will become increasingly automated, but cognitive service opportunities abound. Pharmacists will engage in places they never imagined and will be able to pave new roads into direct consumer interactions, even without any official designation as providers under the Medicare program.”
Along those lines, Jason Turner, owner of Moundsville Pharmacy in Moundsville, W.V., feels that pharmacies need to develop opportunities to ensure they are maximizing the outcomes for patients — to be focused on providing those services consistently at the highest level for every patient. “This will require pharmacy owners and managers to develop processes for the services being offered and training for the pharmacy staff,” he says. He recognizes that many of the services are being offered at no charge to the patient, so it will be important to understand the staffing and expenses required for each service and which of these are having a beneficial outcome for the patient and pharmacy.
He projects that pharmacies will continue to innovate with new technologies and services, including patient communication tools, medication synchronization, and medication adherence packaging, with more focus on immunizations, nutrient depletion, and therapy optimization.
At Osborn Drugs in Miami, Okla., Bill Osborn, president, has clinical services on his agenda moving forward. Osborn says he is starting to see patient acceptance of adherence packaging and is working on ways to improve clinical services and quality outcomes; he also notes the expansion of NCPA’s CPESN (Community Pharmacy Enhanced Services Network) program.
Indeed, Synergy Medical is finding steady growth in adherence packaging. Its research has found that in 2015 less than .5% of all U.S. prescriptions were dispensed in adherence packaging. Today’s usage is at 2%. “Given the activity we see with pharmacy chains and independents, it is not a stretch to think adherence packaging will represent 4% of all retail prescriptions dispensed in 2021,” says Mark
Rinker, the company’s VP of sales for North America. He finds that for most pharmacies there can be a period of indigestion as new workflows and processes related to adherence packaging are absorbed. “Often with emerging markets, exponential growth is initially disguised as modest linear growth,” Rinker says. “It is inspiring to see pharmacies endure this period knowing that, on the other side, this new service will lead to better patient outcomes, customer retention, and new business opportunities.”
Virtual health is something we are going to hear more and more of as a way of staying connected with the patient. Pharma companies are already moving in this direction. It makes sense for pharmacists to jump on board as well.
Among the emerging technologies that can benefit pharmacy in this manner are secure text messaging and video chat. That’s what Cathy Kuhn, director of strategy for UpDox, sees as the future. “These tools can help pharmacists engage existing patients by meeting them where they are,” she says. “Patients want to receive text and email reminders about refills or the need to follow up with their prescribers or being informed about immunizations.” Having this connection should happen within the workflow of the pharmacy, which Kuhn sees as a way to improve clinical services and revenue, but just as importantly, enabling pharmacists to expand their role as “healthcare’s most accessible provider.”
Digital healthcare is also what Ken Thai, co-founder and CEO of 986 Pharmacy in San Marino, Calif., feels will be the new wave “that will affect how pharmacy reinvents itself to start the new decade.” Thai points out that it’s all around us, from analytical data to the smart watches that monitor our physical health. One theme that weaves throughout our findings is how the pharmacist serves as the medication specialist and needs to leverage this position through deployment of virtual health technology. “Healthcare no longer has to measure only snapshots of our health when we come in for a visit, but our health can be tracked instantaneously,” notes Thai.
“The next big thing for pharmacy will be a disruption to the current business through the use of new technology tools,” says Orsula Knowlton, president of Tabula Rasa HealthCare. Specifically, she is talking about the company’s MedWise program. MedWise takes a completely different approach to managing a person’s drug therapy, particularly when multiple drugs are taken. It allows the pharmacist to personalize the medication regimen. “This improves medication safety and wellness,” says Knowlton. MedWise goes a step further than the traditional drug interaction checking that pharmacists have relied on in their pharmacy systems. MedWise identifies risk for dangerous cumulative side effects, unintentional overdose, and ineffective medication regimens, and presents actionable opportunities using the MedWise Risk Score for risk mitigation. This includes precision dosing systems. MedWise is an indication of where we are headed in providing pharmacists with a new decision support tool that dovetails nicely with the growing emphasis on clinical services.
Tapping the Medical Benefit
Helping to move pharmacy into new revenue streams is what Mike Coughlin, ScriptPro CEO, envisions as the next big thing. Here he is talking about integration of medical billing into pharmacy management systems: “This will allow specialty pharmacy and ambulatory infusion reimbursement to be received from either the pharmacy benefit or medical benefit coverage.”
BestRx is another company that sees opportunity here. An optional medical billing component was recently added to its software to allow
pharmacies to submit claims for professional services, medical supplies, drugs, and immunizations covered under the patient’s medical benefit. Stephen Barnes, director of sales and marketing for the company, encourages pharmacists to pursue the medical benefit in their growth strategy for the pharmacy. This is revenue that can offset what is being lost on traditional prescription drug billing.
There you have it. While the current environment may be considered bleak, there is opportunity for pharmacy to move the needle in its favor. The use of technology-based products and services will continue to play an important role in the survival of community pharmacy. CT
Cover story by Bill Lockwood, chairman and publisher at ComputerTalk. He can be reached firstname.lastname@example.org.