"Inside Patient Care is an open forum for primary care providers to share trends in the industry and achieve professional success.” Retail pharmacy has traditionally focused on the prescription-dispensing activity as its core concentration and reason for existence. This dates back over 50 years to when druggists compounded many prescriptions, and it was a cash-based business with no third-party insurance plans.
Fast-forward to today, where >99% of medications are premade dosage forms, and cash business has dwindled to <10%. Pharmacy practice management systems, accompanied by automation systems, have led many pharmacies to a workflow process where prescriptions move through various discreet steps or queues, such as patient drop-off, data entry, claims adjudication, exception management, dispensing, verification, and patient pickup. Prescription claims billing is almost completely automated and paperless, and it has become a model that other areas of healthcare emulate.
These efficiencies have resulted in pharmacies accepting deeply discounted third-party reimbursement rates while increasing prescription volume to maintain comparable profitability.
Increasing Pharmacy Service Offerings
Building on this base of high-volume, efficient prescription processing, where do pharmacists want to see their profession move in the future? Very few pharmacists seem to relish the high-volume approach that includes very little patient interaction. Pharmacists who have graduated in the past 20 years with a doctorate of pharmacy degree have an extra year of clinical education—mainly with a focus on serving as an active member of the healthcare team and engaging with patients alongside other healthcare practitioners—under their belts. I believe that many pharmacists would like to see an increasing level of pharmacy professional service offerings in their future that coexist alongside prescription dispensing.
This is evidenced by retail pharmacies’ rapid adoption of flu immunizations. Less than a decade ago, pharmacies had “flu shot days,” where an outsourced team of nurses came to the pharmacy and provided immunizations. Today, pharmacies are participating in “flu shot days” by providing immunizations directly to employee groups at the worksite; pharmacists are certified in administering immunizations, and, at most retail pharmacies, are providing vaccines on demand, without any appointment needed. This affords a great opportunity for pharmacists in the form of patient engagement, where pharmacists communicate and spend time with the patient while providing the immunization. This service, previously provided by other healthcare practitioners, has been well-received by pharmacists and patients. Many physicians welcome pharmacist-administered immunizations, because they free up the physicians’ busy schedules to provide services to sicker patients with greater needs.
Now that we are well on our way to mastering immunizations in pharmacy, what is our next professional service opportunity? As is evidenced by new Centers for Medicare & Medicaid Services guidelines for Medicare Part D, it could be medication therapy management.
Based on a recent project that I worked on, I also think that there is a tremendous opportunity for patient counseling and engagement when a patient receives a medication for the first time. Yes, pharmacies all make the offer to counsel as part of the Omnibus Budget Reconciliation Act of 1990 regulations1; however, as part of this recent project, our client sought to understand how pharmacists alert patients about special instructions necessary for obtaining the full benefit of the drug, and reducing the risk for side effects. Some pharmacists indicated that they label the prescription as designated by the prescriber, use appropriate auxiliary labels, include the patient education leaflet, and wait to see if the patient has any questions when they pick up the prescription. I had hoped that our research would indicate that pharmacists do more than this when new therapy is initiated, and act in a more proactive manner.
Creative Approaches to Communicating with Patients
In the same vein, I was pleased to hear about the innovative approaches used at a number of pharmacies; low technology solutions, such as colored sticky notes stapled to a prescription bag, are used by some pharmacies to indicate that the pharmacist wants to talk to the patient at prescription pickup. Another pharmacy used a clothespin as an indicator to prompt the technician to call the pharmacist to the pickup counter to speak with the patient. One large pharmacy chain has integrated a similar—albeit more technological—process into their pharmacy-dispensing system and their point of sale. When a prescription is a new therapy, a pharmacist must counsel the patient and verify this by scanning their badge at the cash register; this attempts to ensure that pharmacists counsel the new-to-therapy patients before the technician can complete the sale.
Other pharmacists reported steps taken when a person other than the patient picks up the prescription. When appropriate, some ask the caregiver to have the patient call them to discuss proper medication usage. Others will proactively call the patient to convey the necessary information, and ensure that the patient knows how to take the drug. Pharmacists can also communicate special instructions or key side effects to the patient at this time.
Although the number of pharmacists surveyed as part of our project was small, we heard several good ideas. Inside Patient Care is an open forum for primary care providers to share trends in the industry and achieve professional success. In this issue, we provide key metrics—aside from number of prescriptions dispensed and pharmacy profitability—that are characteristic of a high-performing pharmacy (see "Question & Answers Session"). For the next issue, consider “What unique strategies do you implement at your pharmacy to ensure that patients understand the purpose of their medication, and how to take it properly?”
As 2015 comes to a close, I would like to extend best wishes to our readers and their families, and hope that you all have a successful and healthy new year in 2016.
- Centers for Medicare & Medicaid Services. Drug diversion toolkit: patient counseling—a pharmacist’s responsibility to ensure compliance. www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Provider-Education-Toolkits/Downloads/drugdiversion-patientcounseling-111414.pdf. Published November 2014. Accessed October 26, 2015.