Good medicine Retail Independent Pharmacy | 2018 - Cardinal Health
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good medicine Retail Independent Pharmacy | 2018
Dear reader, Independent pharmacies continue to be the cornerstone of the community—supporting your local teams, doing what’s best for your town and going out of your way to make sure each of your patients is uniquely served. I love hearing the stories of how each of you go above and beyond for your patients, and sharing these stories with fellow readers in good medicine magazine. This edition, we focus on publishing stories that share tangible steps for success. Our solution spotlight section includes examples of how pharmacy owners are creating opportunities by implementing a variety of solutions, ultimately improving patient care. In the innovative ideas section, you’ll read about how independent pharmacies used out-of-the-box thinking to grow their businesses, and in read all about it, we help you stay on top of the latest industry news. For five years, we’ve been publishing good medicine magazine. Our goal is to provide a place to share best practices, offer education on the latest industry trends and foster a sense of community among you and your peers. I hope you enjoy the fifth edition of good medicine magazine. Thank you for reading, Steve Lawrence Senior Vice President, Independent Sales
Innovative Ideas
02 - Patient advocacy: Connecting patients with services
03 - Lose to Win: Weight-loss competition attracts customers
table of contents
05 - Blogging outside the box: Connecting online with clients
07 - Quick tips: Enhance your social media presence
08 - Noteworthy: Smoking cessation program finds success
08 - Noteworthy: “Give a shot” program benefits local charity
09 - Integrative health: Finding balance through yoga
11 - Community connection: Embracing a legacy for the future
13 - Technician Product Verification: Focusing on patient care
Solution Spotlight
16 - TelePharm: The changing face of pharmacy
19 - Point-of-Care Testing: The new wave of reaching clients
21 - Inventory Manager: More than an out-of-the-box program
23 - Medication adherence: Tools for success
- 5 ways to improve adherence
- Dispill® Multi-dose Packaging
- Know your patient better
- Reimbursement services
27 - Pharmacy Transition Services: Keeping pharmacies independent
29 - Securing your pharmacy: What you should be doing
31 - Order Express: Optimize SOURCESM Generic purchasing
33 - Pharmacy Marketing Advantage: Let’s get digital
35 - Conversion conundrum: Who are your consumers?
Read All About It
38 - Provider status: Why pharmacists must be providers
39 - Preparing for the worst: The aftermath of Hurricane Maria
41 - Industry predictions: Moving forward in 2018
43 - NCPA updates: News from the legislative front
45 - 340B contract pharmacy: Expanding access to care
47 - Forefront of pharmacy: What women leaders have to say
49 - Closing the gap: Women in Pharmacy emerges in Puerto Rico
50 - Generation Rx Champions: Transforming chronic pain care
51 - Generation Rx: Fighting prescription drug misuse
52 - Opioid Action Program: Combating the opioid epidemic
innovative
ideas
Sometimes it takes a little out-of-the-box thinking to find
success. Check out how pharmacies used innovative ideas
to grow their businesses.
cardinalhealth.com
Patient advocacy: Connecting patients with services
Lose to Win: Weight-loss competition attracts customers
Blogging outside the box: Connecting online with clients
Quick tips: Enhance your social media presence
Noteworthy: Smoking cessation program finds success
Noteworthy: “Give a shot” program benefits local charity
Innovative Ideas
Integrative health: Finding balance through yoga
Community connection: Embracing a legacy for the future
Technician Product Verification: Focusing on patient care
01
Game changer –
Community Liaison program
improves patient adherence,
community outreach
Through an innovative approach developed two ramps built due to health diagnoses or finding resources to
years ago, Chris Han has seen a change in the meet non-pharmacy needs, such as community programs
landscape of patient care. patients would not otherwise be aware of,” Buck said.
The CEO of Cannon Pharmacies, a seven-store group in the As a result, patients may no longer have to choose
greater Charlotte, N.C., area, hired Amanda Buck, a social between filling their prescriptions and getting other needs
worker for 17 years with the Department of Social Services. met. They also may have better health outcomes, reduce
rehospitalization, and be better caregivers for loved ones.
“There are often more issues going on for patients than meets
the eye,” Han said. “The aging population is growing at a rapid pace,” Han said.
“In terms of getting connected into that aging population and
Buck, who serves as community liaison outreach director, leveraging those relationships, it’s been pretty exciting.”
says her experience has trained her to look at the patients,
who may be polypharmacy and have medication adherence The exposure this program has brought to Cannon
dilemmas, with a different lens and to develop a team to Pharmacies through networking, outreach and word-of-
address those dilemmas as they arise. mouth has shown professionals and the community that
Cannon is more than just a prescription-filling pharmacy,
This community outreach team includes Buck, patient but rather a place that believes in making life easier for
advocates who research grants and patient assistance its patients.
programs for medications, and a social worker who works
with patients to identify the unmet assistance and resource “It has fostered better relationships with our patients and has
needs that may have contributed to their medication allowed us to be a trusted source of help for others in the
adherence issues. community,” Buck said. “It has been a game changer for us.”
“If someone isn’t able to afford medicine, the pharmacists
and patient advocacy staff do an amazing job with
finding cost-saving alternatives to medicines that include
less-expensive generics, grants, coupons and patient
assistance programs,” Buck said.
The team’s social worker and Buck work toward identifying
the underlying needs of the patients, as well as finding
resources that help address the needs that can be related
to medication adherence issues.
“These vary widely and can range from finding ways to get Amanda Buck, Cannon Pharmacy
For more information on Cannon Pharmacies’ enhanced services, go to cannonpharmacies.com.
good medicine 2018 02
Tennessee pharmacy uses the
scale to attract new customers
It’s not often the biggest loser is the
biggest winner.
Joe McKamey knows that firsthand. After
all, he has had a lot of “losers” walk through
cardinalhealth.com
the doors of the pharmacy he manages in
Manchester, Tenn.
Through a weight-loss competition program
he created at Marcrom’s Pharmacy and
Wellness Center, McKamey has helped
improve the health of more than 2,000
Innovative Ideas
residents in the region, many of whom have
become regular customers since signing up
for the contest.
03
How it works How it happened
As part of the “Lose to Win” Implementing a program that has
weight- loss competition, participants been responsible for 51,000 pounds
come into the pharmacy once a week lost over the past 11 years doesn’t
for 10 weeks for a weigh-in. Customers come without smart, strategic
participate as individuals, but are planning.
also assigned to a team if they do not In addition to using tools like social
register with one. media and direct mail marketing,
As individuals, they compete for the the pharmacy—owned by
highest percentage of weight lost. McKamey’s father-in-law Ray
As a team, participants earn points Marcrom—piggybacked onto other
for attending weekly educational promotions that already were part of
meetings the pharmacy hosts, as well the marketing budget.
“ Weserve
as completing other activities during
the week.
For example, Marcrom’s Pharmacy
regularly pays for a radio spot.
want to
“Around the kick-off of the contest, our
we just use that time to promote the
How it benefits
competition, so it’s not new dollars community,
being spent,” McKamey said.
In addition to emphasizing education,
but when you
Each participant pays an entry fee
to compete, with those funds going
motivation and accountability
to the participants, McKamey
serve without
toward paying for T-shirts, meeting
space and cash prizes given to the
says pharmacy owners and staff expecting
beginning a community-based
winners at the end of the competition.
program like “Lose to Win” must anything in
“Even at $100 per person, the pharmacy follow the same pillars to find success
does a little better than break even and ultimately draw more customers. return, ultimately
on the competition, but ultimately,
we end up gaining several more
McKamey held himself accountable
by embarking upon his own weight
good things “
customers each session,” McKamey
said. Participants often transfer their
loss journey, losing 75 pounds. happen.
prescription medications to Marcrom’s “Utilize your story and give people
Pharmacy, as well as purchase several hope,” he said. “It then slowly begins — Joe McKamey,
of the health products available at the to grow and over time when people Marcrom’s Pharmacy
store, including protein bars and mixes. see you’re consistently committed
to something, you’ve then proven to
“It’s good branding and marketing, but
them that you’re trustworthy and you
that’s not why we do it ultimately,”
aren’t going anywhere.”
McKamey said. “We want to serve
our community, but when you serve
without expecting anything in return,
ultimately good things happen.”
Follow the “Lose to Win” program on Marcrom’s Pharmacy’s Facebook page.
good medicine 2018 04
Blogging outside
the box
Pharmacist uses wellness blog
to connect with customers
Though it’s often the writing on a prescription pad
that connects Carmina Lolley with her customers, it’s
her own written words that have created a unique
method of communication with local residents.
The staff RN, herbalist and co-owner at
Medicine World in Nashua, New Hampshire,
publishes a wellness blog, allowing customers
to connect with Lolley beyond the pharmacy
window. In the blog, called “Carmina’s Corner,”
she offers a variety of tools and other advice
for better health - from spring cleanses to ways
to fight off cold and flu season. She updates
her blog about once a month, and promotes
it using social media - an addition to her
marketing tools that has helped spread word-
cardinalhealth.com
of-mouth and drive traffic to her pharmacy.
Lolley shared her advice for using creativity to
reach customers in an evolving world and what
it takes to do a little thinking outside the script.
Innovative Ideas
— Carmina Lolley, Medicine World
05
How has publishing a blog helped drive traffic to
your pharmacy?
Advertising to keep your name out there is tough. My best advertising dollar was in the yellow pages, but that has now
passed. I tried social media and it seemed to give me a little response. Now I mention to my customers to go out and
read my blog and guess what they do? Now they actually go looking for at least a monthly post.
”
HAVING A BLOG HAS... What advice do you
reinforced my belief have for a pharmacist
who is thinking of
that educating your starting a blog?
clients is something Be consistent. This will keep your regulars reading and
that they want.
”
new eyes will happen—slowly, but surely. I also am
working with local magazines now who publish my
— Carmina Lolley, RN blog and I advertise with them as well. No matter how
you slice it, it is important to keep your name out there
and it definitely takes a little creativity today.
How much work did it
take to start the blog?
What challenges did you face?
I finally found someone who works with me—after many failed
attempts. There are three of us, one who helps with graphics,
one who works at keeping the website clean, and myself who
writes the content. I am spending a little more than I spent in
the yellow pages. I work a little more, as well, because content
is updated monthly. However, this has reinforced my belief that
educating your clients is something that they want.
To check out Carmina’s Corner, go to medicineworldnh.com.
good medicine 2018 06
8
1
WAYS
you can enhance your
social media presence
Highlight photos of your customers (with their permission).
2 Communicate sales and events to your followers.
3 Offer contests and drive engagement/excitement through
Facebook.
4 Use your cover photo to communicate the various ways
patients can refill their prescriptions.
5 Offering something your competitors don’t have? Make sure to
promote it!
6 Patients see you as their healthcare expert — share your
opinion on current health news/trends.
7 Post photos of your staff and capitalize on events in the area
cardinalhealth.com
that your patients are excited about.
8 Feature spotlights on your employees so your patients can get
to know your staff more.
Innovative Ideas
07Noteworthy
Getting the community
excited to give back
Woodward, Okla., only has a population of around 12,000, yet with six retail
Erik Hudson, Western Drug
pharmacies, Erik Hudson knew the importance of finding new and innovative ways
to promote his store, Western Drug. Though “Get a Shot. Give a Shot.” campaigns
had become popular, Hudson decided to localize this concept further and donate
a percentage of every vaccination his pharmacy administered to a youth shelter
in Woodward. After implementing the program, Hudson approached the city,
explaining that his program benefited local youth. Officials liked the idea that
donations stayed in their community and allowed Hudson to set up vaccination
clinics in the community for city employees. “The idea sells itself and gets your
community excited to come to your pharmacy for their vaccines,” Hudson said. “We
have seen tremendous growth as local employers, schools, municipalities, and fire
and police stations are choosing us over large chain competitors to do on-site flu
shot clinics because they love the idea of giving back to local charities.”
Noteworthy
Snuffing out smoking
Marty Hinterlong has a passion for helping
Marty Hinterlong, Medicine Shoppe
others quit smoking. As owner of the
Medicine Shoppe in St. Clair, Mo., Hinterlong
started a Facebook group for his community
in support of smoking cessation. Other
pharmacies became involved, and, so far,
nearly two dozen residents have stopped
smoking. Hinterlong also began a campaign
where he offers nicotine replacement
products slightly over his cost in an attempt
to increase smoking cessation. This program,
along with monthly diabetic classes he offers
that focuses on lifestyle changes, help him
serve his community while encouraging
him and others to stay up-to-date on health
initiatives that affect his customers.
good medicine 2018 08How a pharmacist is
changing lives through yoga
A return to wholeness
Chemistry is intriguing for all pharmacists, especially the interactions
among drugs, herbs and even foods.
One chemical reaction that a pharmacist from New “The question is, can therapeutic yoga help us manage the
Hampshire witnessed, however, changed the course of his escalation of polypharmacy?” Gupta said. “I believe so.”
career – the interaction between yoga and the body.
As director of pharmacy and integrative health for a large
Jay Gupta, a registered pharmacist, certified immunizer and federally-qualified health center, Gupta has worked with the
MTM specialist, teaches yoga and meditation at his Harbor homeless population, where he has seen many suffer from
Care Health and Wellness Center as a way to step outside the serious mental health diagnoses and substance use disorders.
traditional role pharmacists play in the healthcare field. He has a space dedicated for meetings, yoga and meditation
in front of the pharmacy to help this sector of the population,
“Pharmacists are experts in the use of molecules that can as well as others.
enhance physical, mental and emotional health,” he said.
“Research is expanding these options beyond prescription “Offering seated therapeutic yoga classes enhances my
medications.” patient interaction beyond dispensing and counseling,” he
said. “I’m not just telling them to go and make a lifestyle
The National Institutes of Health lists the various components change. It’s an opportunity for me to come out of my box
of yoga as the top integrative health modality, Gupta says, and hold my patients’ hands in their journeys toward health.”
and published data indicates yoga may help more than 100
physical and mental health conditions.
“As community pharmacists, we are called upon to know and
educate our patients about everything that has a potential to
change the body’s chemistry, so why not yoga?” he said. “It
What is “polypharmacy?”
behooves us as pharmacists to be educated about yoga and
other integrative health options that can potentially interact
with the drugs—not just to avoid the risks, but also
Polypharmacy is the
to enhance health.”
simultaneous use of
cardinalhealth.com
Gupta says as the population continues to age, pharmacists
are witnessing a growing problem called “polypharmacy.”
Most pharmacists, he says, feel helpless when they notice a
multiple drugs by a
patient’s expanding medication list without corresponding
positive clinical outcomes. single patient for one
or more conditions.
Innovative Ideas
For more information, visit harborhomes.org.
09Pharmacist Jay Gupta (pictured front-row center) says incorporating yoga
classes can be a great opportunity for a community pharmacy.
Here are four components to consider, in his own words:
1
The first is education. What
2
Then, how can each
3
Then, how can we bring
4
Finally, how can we use
is therapeutic yoga? What is pharmacist enhance their this to our patients? We can all of this information to
integrative health? What is own health? In teaching begin by establishing a set develop some best practices
person-centered care? nationally, I speak with of recommendations that in deprescription to reduce
Hint: It is beyond integrated many colleagues who are strengthen our relationship polypharmacy and enhance
care models! hoping to reduce their own with our customers/patients. quality of life?
polypharmacy. This is an
opportunity for us to use
integrative health methods
to reverse toxic stress and
care for our own aching
bodies, insomnia, depression,
anxiety, etc.
good medicine 2018 10Community
Connection
Foster Drug Company embraces a
legacy in looking to the future
To Bill Foster, pharmacy meant more than filling prescriptions. Six years after his death, that loyalty and willingness to take
It also meant caring about customers and devoting oneself a chance are still embraced by those who have continued
to meeting their needs in the most innovative and effective serving the community through Foster Drug.
ways possible.
“Bill always wanted to make sure you didn’t have to come
in here and wait if you had a sick child,” says Dianne Smith,
who has worked at the store since 1974. “He wanted to have
enough employees here to take care of you and get you on
“carry
We’re doing our best to
on and do things the
your way, which is why we probably have more employees
than any retail pharmacy around.” way he would have wanted
To further enhance customer service and convenience, Foster things to be done, and one
cardinalhealth.com
Drug Company became the first pharmacy in Mocksville, N.C.,
to have a computer and a drive-thru window. of those ways is to provide
Foster also implemented programs at his pharmacy that
have helped save lives, from a drug take-back initiative to a
the highest level of customer “
program that helps first responders identify a patient’s health service available.
conditions upon arrival at a medical emergency. The “Vial
of Life Project” provides kits that allow patients to write
Innovative Ideas
— Dianne Smith,
down their medications, health conditions and other critical
Foster Drug Company
information, and place it on the refrigerator. A decal on the
front door alerts first responders to the kit.
11It can be a tall order for those following homemade soap, pottery and products “We want to do something nice to
in his footsteps, including grand- made by local artisans. The store also welcome a new baby and its family into
daughter Karlyn Armsworthy, who says performs outreach in the community, the community and to our pharmacy,”
adopting Foster’s innovative spirit and including operating a mobile flu clinic, Armsworthy said.
passion for customer service has helped hosting fundraisers for residents in
them implement a variety of fresh ideas need and participating in health expos These ideas, along with the desire to
that not only help the community to educate the public about pertinent continuously evolve as a business, are
but draw new customers to their store health and wellness information. a tribute to the pharmacy Foster built.
as well.
Most recently, the pharmacy is planning “Bill was always really good at thinking
For example, Foster Drug added a to implement a program that provides outside the box,” Armsworthy said. “He
section within the pharmacy called bags with necessities for new parents was never afraid, and the whole reason
“Community Connection” in which when they fill a baby’s prescription why we’re still here trying to do this is
local residents are invited to share for the first time, including diaper rash that we want Bill’s legacy to live on.”
handcrafted goods. Items lining the cream, baby wipes and other
store’s shelves include local honey, must-have items.
Foster Drug added a section
within the pharmacy called
“Community Connection” in
which local residents share
handcrafted goods.
For more information, visit Foster Drug Company’s Facebook page.
good medicine 2018 12Technician Product Verification
frees
pharmacists
to
FOCUS on patient care
How does the new What did you see happen
Technician Product with error rates?
Verification practice
As the healthcare model improve the
As part of this practice model, there
was also a research study involved
landscape continues workflow at a pharmacy? where we tracked safety/error rates
and also pharmacist time. What we
to evolve, the need for Technician Product Verification
completely changes the found was that the error rate either
stayed the same or improved a bit,
providers to take a more workflow. We implemented a Drug
Utilization Review (DUR) print and pharmacist time spent in
active role in their queue so that all prescriptions (new, dispensing greatly decreased—
down to 30 percent in one of our
refill, with and without DUR), go
patients’ medication into a verification queue prior to a locations and 11 percent in the
other location. The pharmacists’
use has become label printing. Only a pharmacist
may approve a prescription from time spent in patient care activities
greatly increased— up to 60 per-
increasingly apparent. this queue and print the label.
During this phase, the pharmacist cent in one location and 84 percent
performs the DUR, looks at in the other location. Essentially, we
adherence and appropriateness, found that technicians using
For Cheri Schmit, improving patient care and and makes notes for questions or technology to perform product
developing a path to transition from a traditional information to gather from the verification was just as safe as a
pharmacy to one that better meets the needs patient. I think that our pharmacists pharmacist doing a final check, and
of customers is essential. Schmit, the 2017 are doing a much more complete it allowed the pharmacist to shift
International Clinical Innovation Award winner and thorough DUR because it is their time from dispensing activities
for Medicine Shoppe and Medicap Pharmacy not happening in conjunction with to direct patient care activities.
franchisees, implemented a new practice model product verification. This allows
that completely changed the workflow for her for a stand-alone task of DUR and
pharmacy and ultimately improved accuracy.
cardinalhealth.com
I think changes the pharmacist’s
However, the director of clinical pharmacy at GRX thought process. They can move
Holdings, LLC, in West Des Moines, Iowa, also found beyond “is this the correct drug that
that the new system allowed technicians to achieve is prescribed” to “is this drug
the same amount of accuracy - allowing pharma- appropriate for this patient, does it
cists to shift their time from dispensing activities to meet guidelines for therapy, is the
direct patient care activities. patient adherent, is it safe and
effective, are there gaps in
Innovative Ideas
Good Medicine spoke with Schmit about what this
therapy, and do they need
new model means for the future of pharmacy.
immunizations/labs?”
13What must pharmacies do to find success with How can embracing available technologies
this practice model? become easier?
They must have well-trained and motivated technicians. The To provide enhanced services, you must have efficient
technicians will likely need to take the lead in managing the technology tools to help identify, screen, document, verify,
dispensing workflow. They also need additional training and etc. And the technologies and vendor platforms are becoming
certification and there must be good communication and very valuable. We have been able to significantly decrease our
trust among the pharmacy team. Technicians, especially Direct and Indirect Renumeration (DIR) fees and improve our
certified-checking, may need to shift and delegate some performance metrics by utilization of technology tools and
tasks to non-checking technicians or even support staff when resources. I think when pharmacies see the impact this can
appropriate. Workflow will need to change, and I think have both on their practice and on their patient outcomes, the
technology is a must. We utilize bar code technology with “why use available technologies” becomes very apparent.
both our pharmacy management system and our dispensing Embracing technology is always difficult and no one likes
software. We had to physically rearrange our pharmacy to change. My advice would be to pick a platform that integrates
make for a more efficient workflow and add an additional with your dispensing software and with as many other
computer station. We also added Chromebooks to our platforms that you use as possible. If you can access one
counseling rooms to improve education and documentation platform for multiple tasks, then it is certainly much easier. You
abilities while meeting with patients. have one place to go for everything, so you get familiar with
A pharmacist’s thought process has to change. Pharmacists, the platform and you tend to have it open and available all the
by habit, have developed a thought process where we are time since you are using it for everything.
concerned with verification of product and rightfully so. The other thing is start small and build. If you are going to
Now pharmacists have to switch their thought processes to use technology to identify patients for pneumonia vaccine
enhanced care and services. A documentation system also is a or set up a sync-fill program, start with a few patients. Get
must. Many technology vendors are racing to help fill this gap/ familiar with the software and process and then gradually
need and there are several available, but you must have a way build as you become more adept and work out your policies
to document patient interaction and encounters as well as and procedures.
collaboration with other healthcare providers.
Cheri Schmit, GRX Holdings, LLC
For more information, check out pharmacy.iowa.gov.
good medicine 2018 14solution
spotlight
Pharmacy owners share how Cardinal Health solutions are
creating opportunities and improving patient care.
TelePharm: The changing face of pharmacy
cardinalhealth.com
Point-of-Care Testing: The new wave of reaching clients
Inventory Manager: More than an out-of-the-box program
Medication adherence: Tools for success
Pharmacy Transition Services: Keeping pharmacies independent
Securing your pharmacy: What you should be doing
Solution Spotlight
Order Express: Optimize SOURCESM Generic purchasing
Pharmacy Marketing Advantage: Let’s get digital
Conversion conundrum: Who are your consumers?
15The changing face
of pharmacy
How telepharmacies
improve patient
adherence and
bottom line
Nearly 68 percent of physician visits involve drug therapy, and
according to the Centers for Disease Control, 72 percent of
hospital outpatient visits result in a prescription.
Yet, ensuring patients fill and adhere to those prescriptions is
a widespread concern in the medical community.
To meet the needs of underserved populations and address
adherence concerns, pharmacy owners across the country
are using TelePharm’s cloud-based software to open new
telepharmacies that operate like traditional pharmacies, except
the pharmacist reviews prescriptions and counsels patients from
a remote location.
From the urban landscape of Chicago to the rural countryside
dotted with small towns, three Illinois pharmacists share their
stories of how telepharmacies have benefitted both their
communities and their own business models.
good medicine 2018 16The changing face of pharmacy, cont.
An evolving field “We are now looking at a couple other locations
that are in rural areas to see if it makes sense for us
Age is no barrier for pharmacist to go into those areas,” Colee said.
who embraces change Although Colee wondered how difficult it would be
to learn the technology associated with operating a
A pharmacist for nearly 45 years, Dale Colee has
telepharmacy, he says the system is very easy.
seen the field of pharmacy evolve.
“Telepharmacy is cutting edge,” he said. “It’s added
At 68 years old, his advice for his counterparts is to
to our identity in the community.”
embrace change, especially in the area of technology.
After a 340B community health improvement
center approached Colee about opening a
Even in urban areas,
pharmacy inside its new Decatur, Ill., clinic to telepharmacy is popular
help encourage more adherence among patients,
he began researching telepharmacy. It may be just minutes from the heart of Chicago,
but the need for a telepharmacy is undeniable in
As owner of Dale’s Southlake Pharmacy in Decatur,
the Bellwood neighborhood.
Ill., and Colee’s Corner Drugs in neighboring
Though located in the middle of an urban sector, a
Forsyth, Colee knew the location was perfect, but
telepharmacy has the potential to serve a portion
he wanted opening a new pharmacy to make
of the community who may live close by, but still
financial sense as well. It has, he says.
face challenges in filling their prescriptions.
To address this need, Tushar Mehta, who owns
“ The wave of the future is, no doubt,
technology. I’ve seen a lot of different
two independent pharmacies nearby, opened
a telepharmacy inside a local health clinic to
provide convenient dispensing at the point of care.
things over the years, but embracing “In the Chicago area, parking can be an issue for
technology is how you keep up residents, so not everyone has access to a car,” he said.
“Time is a very big concern for patients, especially for
with it. If you want to survive as a parents during the winter months when Chicago sees
greater amounts of snow and rain. These conditions
pharmacy in today’s environment,
“ make it very difficult for patients to go to the clinic
you have to do this. and then go elsewhere for their medications.”
Because most patients served at the telepharmacy
are children, Mehta knows the importance of
“The fact that we have a telepharmacy has allowed providing convenience for families.
us to cost effectively increase the number of
Serving about 40 patients a day from the clinic
prescriptions we are doing with very low overhead
and an additional 50 to 60 who refill their
and with no additional pharmacist needed on the
prescriptions, the telepharmacy is staffed by a
payroll,” he said.
certified technician. Though it reduces payroll and
—Dale Colee The neighboring clinic, which sees about 18,000 allows someone to own a pharmacy without high
cardinalhealth.com
patients a year, serves both adults and children overhead costs, Mehta says it took some time for
and includes OB-GYN and radiology services. customers to acclimate to a new style of service.
“They asked us to put one onsite as a resource “It was a different way of accepting there is a
for the community to reduce barriers for people pharmacy without an in-person pharmacist,” he
trying to get their medications,” Colee said. “If said. “People came up and would ask if it was even
they walk right by the pharmacy, they have a legal. Now after three years of being open, people
greater potential to fill their prescriptions.” don’t ask that question. People are amazed with
Solution Spotlight
Since opening Colee’s Community Pharmacy, the the fact that you can go to a cubicle and talk with
family-owned group of pharmacies has increased a pharmacist on screen.”
its business by about 30 percent.
17“ Patients go to the doctor, but they technology in a new way wasn’t always easy. Several
customers assumed they would have to drop off
may not make a second trip to get their prescriptions and come back in 24 hours so
that the prescriptions could be filled elsewhere and
their medications. With telepharmacy, transferred back to the Atwood location.
this service discourages the patient Working with the clinic next door, Falk began
an education campaign that included direct
from doing this sort of thing. They mailings, as well as encouraging clinic staff to
get the care they need and go home “ clear up any misperceptions.
He also advises those thinking of opening a
with the whole package. telepharmacy to get the community behind
them first.
Rural telepharmacies fill void, “Get yourself in front of a city council or town hall
meeting, and before you open or shortly after you
lead to growth open, hold an open house so people can come in
and learn how a telepharmacy operates,” he said.
After noticing the increasing number of deliveries
“Most people who have been taking prescriptions
David Falk and his team at Sav Mor Pharmacies
for a long time don’t want any hiccups.”
—Tushar Mehta were making to the small community of Atwood,
Ill., Falk recognized potential. Once Falk did that, he began seeing an uptick
in business.
“We saw a market that was like a desert that wasn’t
“We were kind of fearful that the older population
being fulfilled,” he said.
would be a big stumble point because of the
Up until his telepharmacy opened, the rural technology, but it really wasn’t,” he said. “We have
community of 1,200 people hadn’t seen a a private consultation room where the monitor is.
pharmacy in town for more than 15 years. Most of them knew the pharmacist from the host
“People were driving 10 miles each way to get store, so they were already a familiar face and it put
a prescription filled,” Falk said. “By adding a them at ease.”
telepharmacy there, we knew we would probably
pull some business out of the pharmacy closest
to Atwood, but we also knew there was a lot of
business in Atwood that we could tap into.”
With a health clinic operated by Kirby Medical
Center already located in the village, it seemed like
the perfect fit to open a telepharmacy next door.
“The village of Atwood really stepped up to the
plate and made a building available to us and
pushed through permits,” Falk said. “Not only has
it helped us as a pharmacy, but it has helped the
community and the clinic next door.”
That forged relationship then led Falk to open
an additional telepharmacy inside another
Kirby clinic in the region. Falk now operates five
telepharmacies, all in rural areas.
“It’s been a snowball effect,” he said.
Though about 1,100 prescriptions are filled per
month at Falk’s first telepharmacy location in For more information, visit
Atwood, changing customers’ perceptions of using cardinalhealth.com/telepharm.
good medicine 2018 18Health and wellness
destinations
Point-of-Care
Testing allows
pharmacies
to diagnose flu,
strep on
the spot
It’s a pattern pharmacist Sally Salib The process is easy, Salib says. Using treatment
protocols that outline patient screening eligibility,
sees every year — ill patients coming
testing and medication initiation, she swabs a
to the pharmacy looking for relief customer if that person is displaying classic influenza
from severe symptoms. or strep symptoms. If the test comes back positive,
she contacts the customer’s physician immediately.
Without definitive proof, Salib could not know with
The physician then sends a prescription back to the
certainty what ailment was causing their suffering.
pharmacy for the appropriate treatment, such as
That’s why the owner of Briargrove Pharmacy in Tamiflu or an antibiotic.
Houston, Texas, implemented the Cardinal Health
“The doctor’s office usually gets back to us right
Point-of-Care-Testing Program, which provides
away, normally within 30 minutes while the
tools and resources that allow retail pharmacies
cardinalhealth.com
customer is still at the pharmacy,” Salib said.
to offer flu and strep testing to their customers on
the spot. This rapid diagnostics practice ensures Briargrove
Pharmacy fills the prescription.
The program positions pharmacies to go
beyond interpreting, dispensing and counseling “By adding this service in our pharmacy, we have
on medication, to become true patient care attracted new customers,” Salib said. “Our customers
destinations — ultimately promoting business know we are here as a community pharmacy, and
sustainability and providing increased access to we can help them more than any other pharmacy.”
Solution Spotlight
healthcare in their communities. In fact, Salib said she didn’t face any real
challenges to get Point-of-Care Testing up and
running in her pharmacy.
19“ benefits
As an independent pharmacy, this is really adding strong
for our patients because it is increasing access to “
healthcare and helping keep our community healthy.
— Sally Salib, Briargrove Pharmacy
Prior to implementing the service, Salib did some discovered this first-hand, when after advertising
of her own research to gauge physicians’ reactions, the program on Facebook, patients began coming
by contacting a few physicians from whom she fills in on their own, inquiring about the tests.
prescriptions. The feedback was positive. Although Salib must call or fax physicians to report
“They’re happy because they’re able to help more positive test results in order to receive and fill a
patients,” she said. “Some doctors don’t even do prescription, she says it’s part of the job.
the flu test. This is a good thing because the doctors “As pharmacists, we work with physicians all day
who aren’t doing the tests are sending patients to us.” long as part of the service,” she said. “It’s worth
In just two months during the most recent flu and doing that for someone who has the flu.”
cold season, pharmacists at Briargrove performed She advises those considering Point-of-Care
70 tests. Continuing education courses and training Testing services to “just be brave and do it.”
videos through the Point-of-Care Testing Program
provided the knowledge and tools necessary to “As an independent pharmacy, this is really adding
integrate the service into the pharmacy’s normal strong benefits for our patients because it is
daily operations. increasing access to healthcare and helping keep our
community healthy,” Salib said. “It’s easy to get started,
“This seemed intimidating at first, but it’s very easy and many primary care practitioners are supportive.”
to learn,” Salib said.
At a time when consumer-driven healthcare is at
the forefront, this program helps meet the demand For more information, visit
for increased access for convenient healthcare cardinalhealth.com/poctesting.
services in the retail pharmacy setting. Salib
good medicine 2018 20BETTER
inventory management
Cardinal Health™ Inventory Manager creates
balance, helps pharmacies navigate 340B orders
For independent pharmacist The program also has the ability to
map 340B orders — a key benefit for
Kevin Duane, better managing
Duane because his pharmacy dispenses
his inventory is essential in 340B-eligible prescriptions. 340B is a
improving business metrics. government-regulated program that
requires drug manufacturers to provide
That’s why he turned to Cardinal Health™ outpatient drugs to certain covered
Inventory Manager (CIM) to help create entities, such as hospitals, at a reduced
a more balanced inventory at Panama price. The program provides low-cost
Pharmacy in Jacksonville, Fla.—a move medication for safety net providers who
that has helped him increase cash flow, use it to further their mission to serve
improve patient service levels and vulnerable patient populations.
Kevin Duane reduce outdated products.
As a contract pharmacy, Panama
Panama Pharmacy CIM is a web-based program that Pharmacy dispenses the eligible
helps pharmacies manage prescription prescriptions from its retail inventory
inventory. The program combines and receives replacement inventory
“just in time” replenishment, driven once a full bottle of a specific item is
by automated order points and gone. Contract pharmacies typically
sophisticated reporting capabilities, do not know when the replacement
with dedicated inventory consultation inventory is coming, often leading to
and support. inventory swell.
5 FACTS
You didn’t know about CIM
2 You have a support team — including our IT team
which is part of Fuse, the Cardinal Health commerical
technologies and innovation center.
How is it that we can customize settings to meet your inventory
Cardinal Health Inventory™ Manager (CIM) is built management goals? We have a CIM-specific team here to
cardinalhealth.com
to help manage your prescription inventory, but help! In addition to your sales rep and pharmacy operations
consultant (POC) in the field, you have a corporate-based team
did you know that it’s much more than an “out-of-
of inventory experts here for you.
the-box” program? Here are five surprising
things about CIM that make it a far more
robust solution for your pharmacy. 3 The audit list isn’t just comprised of random items —
it has logic behind it and has helped to identify theft.
Solution Spotlight
One of the keys to maintaining a clean inventory is to
1 We can customize settings such as days-inventory- complete ongoing audit (cycle) counts. Each day, CIM provides
on-hand (DIOH). a list of items that should be counted. The goal is to facilitate
CIM’s standard settings help you manage your inventory more counting through your entire inventory several times per year
effectively; but, we can also tailor the system to your specific and to help point out items that continually seem to be “off.”
needs. Want to increase on-hands of popular generics while
decreasing seldom-used brands? We can do that!
21Duane has helped prevent this swell because CIM maps Q What are key features you rely on most heavily?
340B orders to the pharmacy’s account. 340B items that
A: We use the ordering function daily. It gathers pricing data
have been put on order for shipment by the covered
from our buying group and we can use the “analyze cart
entity get taken into account as CIM builds the daily
function” to make sure we are buying in the most efficient
demand-based order.
way in regards to our buying group matrix. It also takes into
Good Medicine spoke with Duane, who has incorporated CIM account rebates on generics, so we are able to compare net
into his pharmacy’s day-to-day operations for four years, about to net with our buying group in real time. We manage the
how it has benefitted his business and helped mitigate his excess inventory report weekly and I see a direct reflection
340B inventory concerns, as well as what key features he relies of that in our decreased wholesaler bills and increased cash
on daily. on hand.
Q What made you decide to use CIM in your pharmacy? Q What impact has your 340B affiliation had on
What features and benefits of CIM made it impossible your business?
to pass up? A: 340B has allowed us to serve a wider scope of patients
than we would have been able to before. We are able to
A: When I purchased the store it had CIM in place, but I work closely with the 340B physicians to discover creative
looked heavily at alternatives to ensure we were dealing solutions to better cater to that specific patient group.
with the best solution. CIM’s ability to manage multiple
wholesalers and its ability to quickly display excess Q How has CIM helped mitigate your 340B
inventory for return made it an indispensable part of inventory concerns?
the pharmacy.
A: Since CIM receives data from our traditional account, our
Q How has CIM helped your business? buying group account and our 340B account, we can use it
as a true “dashboard” and see how each piece fits together
A: It has helped improve cash flow by letting us manage in a real-time basis. 340B replenishment shipments can
our inventory on a “just in time” basis. Our turns are be tracked and compared to dispenses, which ensures our
higher than ever, so we have more predictable cash flow. 340B inventory is reconciled. Without CIM, we would have
Excess inventory is definitely reduced using its reporting to do this manually by hand and it would take quite some
functions, and we have fewer drugs expiring because we time. It is a real time saver in that regard.
can stay on top of slow/no moving items.
For more information, visit cardinalhealth.com/CIM.
4 We can add a 340B account to reduce inventory swell.
One of the pains often felt as a 340B pharmacy is the
inventory swell that comes from receiving the replacement
bottles without warning. CIM has the ability to map 340B
orders to your account, taking the ordered 340B items into
consideration as it builds your daily demand-based order,
thus limiting inventory swell.
5 You can manage inventory from secondary
suppliers, too.
We get it. There are just some products that you have to buy
from sources other than Cardinal Health. You may not buy
all of your products here but you can track them here. CIM
enables you to manage prescription inventory from
all of your suppliers in one place.
good medicine 2018 22medication adherence
5 ways to improve
medication adherence
Understand why your patients aren’t taking
1 their medications. Adherence is a multidimensional
phenomenon, in which multiple cultural and practical
factors affect a patient’s behavior and capacity to adhere
to treatment.
2
Educate your patients on their
medications. Show patients how their
medications can improve their quality of life.
3
Tailor a solution. Depending on each patient’s
needs, you may need to tailor a solution to
address specific adherence obstacles.
Provide workflow solutions that address
all of your patients’ needs. Not all of your
patients will face the same adherence obstacles,
but workflow solutions can help in various ways. 4
cardinalhealth.com
Market your pharmacy as a healthcare
destination. Help more patients improve
Solution Spotlight
5 adherence by promoting your pharmacy and
the services you provide to your community.
23medication adherence
Dispill® delivers
a dose of
independence
After Gabriel Guijarro began offering Dispill®
compliance packaging at his Lufkin, Texas,
pharmacy in 2015, he immediately saw just
how valuable the service was to patients.
Hearing from nurses at home health agencies who routinely
packaging worked. They also found the most
came in contact with patients with disorganized or missing
success in targeting home health agencies.
medications, Guijarro realized he could help.
“Oftentimes, a nurse would visit a patient’s house
He now has more than 200 patients using Dispill in their own
and find out that several of the prescriptions needed
homes, helping customers with what they want most—to
to be refilled, and the patient would have to rely on
remain independent.
a family member to pick up the missing drugs and
then revisit that patient later,” Guijarro said. “So, the
administrators at our local home health agencies
How it works immediately recognized the value that Dispill could
Providing a safer way to take medicine, Dispill offer in eliminating the amount of time nurses spend
packaging provides prescribed medication in an sorting out medications and re-visiting customers.”
all-inclusive blister pack—eliminating the need for
pillboxes and single-dose bingo cards.
This, in turn, decreases the risk of patients mixing How to expand
up medication or forgetting the time of day they Looking to the future, Hargroue says the next step
have to take them. is to target assisted living facilities.
“Dispill packs are easy to fill once you have a “There is an owner who is building a new 50-room
system in place,” Guijarro said. “The pack is easy facility in our community and he is a proponent
to read, organized, includes the pharmacy contact of compliance packaging,” he said. “So there
information and I can display my logo.” is a potential to bring in 50 new patients to our
pharmacy on Dispill!”
Other ideas for expansion include reaching out
How to market to adult daycare centers, partnering with county
As owner and pharmacist at The Medicine Shoppe, agencies that focus on keeping seniors independent
Guijarro knew he had a great service members of his and marketing Dispill to family members and
community needed. How to create awareness about caregivers who will have better peace of mind that
the service, however, would take some strategy. their loved ones are taking the correct medications.
Guijarro hired Johnny Hargroue as the pharmacy’s
specialty sales executive, who then targeted
For more information, visit
local doctor’s offices and demonstrated how the
cardinalhealth.com/dispill.
good medicine 2018 24medication adherence
Improving patient
adherence and
the bottom line
Simple steps can lead to big outcomes when
utilizing Reimbursement Consulting Services
Today, 145 million Here’s how:
Americans suffer from • When on the RCS dashboard, go into Out of every
chronic disease, yet Individual PDC measures. Set to Medicare 100 prescriptions
Patients/Rolling Year. written, only*:
only one-third take
their medications • Review the patients who are 70-79 percent
50-70%
on the PDC measures. These are the
as prescribed. patients who are most likely just one fill
This causes a ripple effect— away from being compliant, Kaempf says. are filled by a pharmacy
affecting the entire cost of Using tools like auto refill or medication
48-66%
care. When patients adhere to synchronization can easily help improve a
prescribed medication; however, patient’s adherence.
both clinical and financial
• For patients who are at 40 to 60 percent are actually picked up
outcomes improve. That includes
on their PDC measures, simply reviewing by the patient
performance scores that ultimately
dispenses for obvious errors can make
affect a store’s bottom line and
direct and indirect remuneration
(DIR) fees.
a significant difference. “If a patient is
getting a 30-day supply every 60 days,
the pharmacist should talk to the patient
25-30%
are taken properly
Lisa Kaempf with Cardinal Health to confirm how they are taking the
Reimbursement Consulting
Services, says pharmacists know
that it is important to work with
•
medication,” she said.
If the patient is not taking the prescription 15-20%
are refilled
according to directions, the pharmacist
cardinalhealth.com
patients to be adherent to their
should call the doctor to get a new
medications, but struggle with
prescription. “By targeting that patient, it’s
how to fit that into their daily
a quick win,” Kaempf said. “They go from
workflow. However, improving
a non-compliant patient to a compliant
just one patient’s adherence can
patient on the list.”
make a significant difference in
increasing prescription counts
and decreasing DIR fees.
Solution Spotlight
For more information, visit cardinalhealth.com/rcs.
*Source: Ruppar, Todd. (2017, February 21). Overcoming Barriers to Medication Adherence for Chronic Diseases.
25 Retrieved from https://www.cdc.gov/grand-rounds/pp/2017/20170221-medication-adherence.html.medication adherence
New Action Center within
RCS prioritizes the patient,
workflow
Reimbursement Consulting Services (RCS) will In addition to providing patient-level opportunity
information through the Action Center, RCS also offers
now include the new Action Center, which will
dedicated pharmacy advisors who help locate the most
incorporate a prioritized patient and workflow optimal opportunities that are important to an individual
that will make it much easier for pharmacies business at that point in time.
to identify revenue opportunities and
communicate with patients.
“We have significantly enhanced RCS to allow customers to
quickly focus on clinical opportunities and communicate
effectively with patients,” said Mike Zabonik, senior manager
for Product and Solutions Marketing.
This patient work queue will provide adherence workflow
improvements, as well as provide other opportunities such as
customer trends, identification of patients with immunization
needs and improved direct and indirect remuneration (DIR)
estimation tools.
The goal is to improve overall store performance and make it
easier and more efficient for pharmacists to use this tool.
How to improve a patient’s adherence
Every patient’s needs are different, and each patient may respond better to one solution over another. Here are a variety of
services that help improve patient adherence so that you can best meet each patient’s individual needs.
Auto refill and refill reminders: Compliance packaging: Prescription assistance
Remind patients they need to Deliver prescribed medication programs:
refill their prescriptions or that to individuals in an all-inclusive Offer free or discounted medicine
their prescriptions have been auto blister pack. utilizing a drug company
refilled — via telephone, web, Medication Therapy program or a discount program.
app, text, email or social media. Management (MTM): Home/worksite delivery:
Medication synchronization: Provide MTM services to help Offer same-day delivery services,
Consolidate and coordinate a patients get the best benefits for eligible prescriptions, to
patient’s prescriptions so they from their medications by actively patients’ homes or places
can all be refilled on the same managing drug therapy and of work.
day each month. by identifying, preventing and
resolving medication-related
problems.
good medicine 2018 26Pharmacy Transition Services
Keeping
pharmacies
INDEPENDENT
cardinalhealth.com
“ We really consider Cardinal Health our strategic partner.
It really is top-to-bottom help.
“
Solution Spotlight
— Kevin Faris, independent pharmacist
27How one team takes
on the challenges of
buying and selling
Life is full of transition, even with the From start to finish, Pharmacy Transition Services team
members work with buyers and sellers to provide
ownership of your pharmacy.
consultation to ensure each transition is completed
“To our estimation, just over 1,000 independent successfully. They specialize in analyzing pharmacy
pharmacies transition each year by selling to a valuations, on the buy side and sell side, to ensure
chain, closing their doors or transitioning to another fair market value. Team members also provide
independent owner,” says Judd Wilstead, director of consultation, align buyers and sellers, offer financing
pharmacy acquisition on the Pharmacy Transition options and purchasing structures, arrange legal
Services team for Cardinal Health. “Over the last 10 years, counsel when necessary and develop succession
our Pharmacy Transition Services team has focused on planning and exit strategies.
helping independent pharmacies remain independent. Most recently, Faris worked with this team to purchase
We have completed nearly 2,000 pharmacy valuations seven locations in San Diego. Logistically, selling or
and over 700 transitions. We can help you form a game purchasing one store can be complex. Seven stores
plan to ensure a successful transition.” compounds that complexity.
While some independent pharmacy owners have a “This was a very large purchase,” Faris said. “Financial
desire to acquire other pharmacies or sell theirs to help, cost of goods help and everything that Cardinal
fellow independent owners, navigating what can be a Health does, we needed. We had to dot our i’s and cross
complicated process is difficult for someone without our t’s because this was such a large transaction.”
acquisition experience.
Prior to the San Diego acquisition, Faris also worked with
“Most pharmacy owners went to pharmacy school to learn Wilstead and his team on transactions in Nevada, Hawaii,
how to be great pharmacists. They weren’t necessarily Idaho and Alaska.
educated on how to buy and sell businesses,” Wilstead
“We really consider Cardinal Health our strategic partner,”
said. “We are here to help every step of the way.”
Faris said. “When we look at a store or stores, without
When Kevin Faris, an independent pharmacist on the their help, we wouldn’t be able to transition some of
West Coast, began to expand the number of pharmacies these, and it’s not just financing or valuation. It really is
he operated so his team could better compete in his top-to-bottom help, even when you get to the actual
ever-evolving local market, he realized he needed help acquisition and it’s passed to the local sales team. It’s
to ensure the acquisitions went smoothly. getting accounts set up and getting everything ready
“We want to grow, but grow responsibly, because at the for the new owners to take over.”
same time, it can get overwhelming,” Faris said. “If you
aren’t taking the right steps, it can come back and bite you.”
The Pharmacy Transition Services program is focused
on helping those who are thinking about succession
planning, retiring or buying another pharmacy.
For more information, visit cardinalhealth.com/pharmacytransitionservices.
good medicine 2018 28You can also read
