Adherence packaging can give independent pharmacies a competitive advantage over retail chains, mail-order pharmacies – and even over giants like Amazon – by enabling better customer service for patients.
Todd Eury of the Pharmacy Podcast Network hosted the webinar “Is Offering Compliance Packaging Right for Your Pharmacy?” to discuss the importance of adherence packaging, the problem of DIR fees, and the advantages of offering Medical-at-Home.
Featured guests were:
• Angela Stokes, Pharmacy Services Coordinator at the Village Pharmacy of Wake Forest in North Carolina
• Margie Lydon, LTC Strategy Manager at Value Drug Company
• Erich Cushey, Owner and Pharmacist at Curtis Pharmacy in Pennsylvania
Below are some podcast highlights. The transcript has been edited for clarity and length.
Todd Eury: My first question is going to go out to Erich. Let's talk about assessing the need for adherence packaging. How did you come up with the need for adherence packaging in your area before you acquired the technology?
Erich Cushey: So, we used to do the very manual system of multi packaging Dispill.
We grew that to probably 200 patients between the two stores, and it was incredibly time consuming, both for the technician and for the pharmacist to check it.
We felt if we were going to grow that book of business, that it was about time. Amazon bought PillPack and everyone freaked out because Amazon was going to take all your businesses. But you know, for us that just was another situation where a large corporation was going to take a concept and really screw it up and provide us an opportunity to step in and say, "Hey, we can do this better.”
So, before the world shut down, I was at the NCPA Multi-Locations Conference, talked to Bill and his staff, and they had this amazing machine that we agreed to buy. COVID shut everything down. We brought it in, the state made us close our doors. So, we brought it in when the state closed our doors and figured it out.
“…Everyone freaked out because Amazon was going to take all your businesses…for us that just was another situation where a large corporation was going to take a concept and really screw it up and provide us an opportunity to step in and say, ‘Hey, we can do this better.’ ”
We got all of our Dispill patients moved over and then realized the timing was pretty incredible, because at that point, people were pulling loved ones out of nursing homes, needing some type of solution to help people manage their medications, and it just blew up for us.
Todd Eury: But were your patients at the facilities asking for it? Were there any competitive issues in the implementation of this new service, compliance packaging?
Erich Cushey: Facilities aren't a big hit for us unless they're more personal care, long-term people and medications. You know, we do do some personal care group homes in the compliance packaging. Our thrust has been the Medical at Home component with GeriMed. Margie and Value (Drug) have helped us with that as well. And you know there's a lot of people out there trying to figure out how to age in their homes, and we think we provide an important service for that.
Todd Eury: I want to ask Angela, before you were introduced to adherence, how did you address adherence packaging needs for patients that were needing their meds ongoing?
Angela Stokes: Traditionally, pharmacy has always been an emergency situation. The patients came. They were out of medicine. You had to fill it, and we waited for everything to come to us. It was very hard to regulate your volume that you kept in the store. It was hard to anticipate. Well, I first did sync. I synchronized everybody's medications to start with. So, I really started with that first to try and figure out how can I manage my inventory? How can I spend less on that? How can I make patients compliant? What can I do as a service for patients?
When I started this about almost 20 years ago, I started trying to figure out a way to help people and figure out a way to do this. So, the natural progression was to synchronize them for less gas money, less trips to the pharmacy, but also to help me. I do them a week in advance. So, I'm also anticipating the need. I didn't want to open on the weekends, because I could save so much overhead, not being open on the weekends.
I could fill their medicines a week ahead of time, and always have their medicine ready and call them and let them know. So, there are so many advantages to why I wanted to start compliance packaging, and also the fact that people just don't take their medication properly.
It is amazing. Even the people that you think are the most compliant.
They're just not taking their medicine. Nobody sits down with anybody and says, “What time of day are you taking it?”
“Well, I just take it whenever my blood pressure is up.” How do you know your blood pressure is up? Do you have a blood pressure cuff? “No, I just feel it.”
It just doesn't work that way. And the beauty of compliance packaging and synchronization is that you are providing a service.
And in response, you're getting several services back. So even when I talk to the public, the first thing they want to know is what's in it for you, and there's a lot in it for us. So, it's a win-win situation. And that usually really makes people want the compliance packaging and the synchronization.
Todd Eury: Margie, tell us from your viewpoint, what's the biggest challenge that community pharmacy is facing today?
Margie Lydon: What I'm hearing from most of the owners is the DIR fees and becoming unable to dispense brand name products without losing their shirt, quite honestly. I’m seeing some staffing issues. But the DIR problems seem to be the most significant impact right now.
Todd Eury: So that's kind of a point for you, Erich. So, from your perspective is that the number one issue that you're facing as a pharmacy owner and a pharmacy business that you're trying to grow for communities?
Erich Cushey: Everybody wants to talk about the 2024 DIR hangover. I did the math. I know our number, so if we do nothing else, when we open our doors January first, we're $100,000 in the hole. So, every patient, every move we can make to get them into this Medical at Home model of ours just chips away at those fees.
Todd Eury: There are community pharmacies out there right now who aren't prepared that may have to go find a buyer, or unfortunately, have to close. And that's scary, because it's going to affect a lot of people in the nation that don't have proper health care services. Sometimes the community pharmacy, just like some of your locations, I know, just like Angela, over the years in North Carolina, where there's rural areas for miles and miles. It’s really fields and nothing. Sometimes that's the only health care service they have.
Erich Cushey: Well, that's part of it. But you know the thing about community pharmacy is, think about how many other people have a business off of our backs, so to speak. You know what you do. What RxSafe does. What Value Drug does. If we all go away, it's going to be real interesting in the first quarter of 2024.
Todd Eury: Angela, tell our listeners how offering adherence packaging impacted your patients and the patient relationships that you have with being part of the community.
Angela Stokes: When you start having difficult conversations with people, first of all you've got to earn their trust, and I think that what most independent pharmacies do is earn the trust of their patients. But when you start having some of those difficult conversations, not only do you have a great relationship, but all of a sudden you have raving fans because besides all the benefits that I see with the compliance packaging, what happens to people is they start feeling better once they're on a regimen, and they start telling each other, and sometimes the best word of mouth is getting a couple of people on adherence packaging, and it goes like wildfire because they feel better.
But the one thing that I use to promote compliance packaging is saving gas money, not having multiple trips to the pharmacy. Not coming in. And we say, “Well, I've got 30. Can I give you the other 60 in the next 48 hours?” Never having to owe anybody. Having the refills ahead of time and having their medications filled all the complaints that people have of going to the pharmacy you can fix with compliance packaging and having it ready on time.
Somebody comes in with a complaint about something. “Well, my doctor didn't send my refill.” If we had you on this compliance package and it had been ready, you wouldn't have had to worry about waiting for your doctor to call in a refill.
I want to tell you about compliance packaging because it's going to fix your problems. It's going to fix your transportation problems. It's so easy to sell it, I guess. I think that you've really got to have your staff trained to answer a complaint with “I have a solution for that, and it is compliance packaging” because it really sells itself.
“I want to tell you about compliance packaging because it's going to fix your problems…It's so easy to sell it…I think that you've really got to have your staff trained to answer a complaint with ‘I have a solution for that, and it is compliance packaging’ because it really sells itself.”
Todd Eury: Erich, what about your patients? What's their feedback?
Erich Cushey: They love it.
And from a loyalty standpoint, once you get a patient into compliance packaging, they're really not going to transfer out to go back into bottles or something (along) those lines.
It's been a nice fit for us. And the one thing I’ll add to what Angela said, it's a huge assist to inventory management. Huge. Because you just don't need to keep all that inventory on hand, because it's really just in time inventory.
Todd Eury: Margie, from your perspective as a partner of community pharmacy, talk to us about feedback on compliance packaging from your clients.
Margie Lydon: We're hearing tremendous savings in what they're keeping in inventory overall, inventory reduction. Expensive medicines are ordered, as Erich said, just in time. If they're coming in tomorrow for it, you'll order it today. Maybe one more day to give yourself a buffer and just seeing the financials improve for people. I feel like they've got better control over the pharmacy. They're comfortable that they can access the products as they need it.
And I think for a lot of pharmacists, it's been quite a fiscal education. We're not really taught a lot on economics. And understanding what it costs to carry inventory is a bit foreign. But, as small business owners, my husband and I also feel some of those pressures, (we are) not a pharmacy, but we understand some of that. And I like being able to bring those ideas to our member pharmacists also and have Value Drug support them in that.
Angela Stokes: I want to address one thing. I’ve used Dispill. I’ve used Medicine on Time. Now I’m with RxSafe. So, over the years I’ve tried other products.
I will say, from the time that you're paying your employee to process these packs, your turnover time is so much faster with a mechanical system than dropping it in by hand. It is amazing. It also is going to take a picture of each square.
When you are providing that service to patients: Number one, you do it faster; number two, Amazon tried it. CVS tried it. A lot of people tried to mimic compliance packaging, but with a pharmacist involved, a technician processing, your error rate goes down. You have got RxSafe taking pictures of every square, you can go back and look, catch errors.
Nobody seems to be able to touch the accuracy of making packs like an independent pharmacy can, because you are actually talking to them. If the patient has a change within two or three days of making the pack they can call you, you can change it. Nobody has been able so far to mimic what the independent pharmacies are doing with these packs and the accuracy.
That relationship is important. And you know your patients. You know which ones you need to talk to a family member versus talking to them, because I don't know what they're talking about. Or you know to talk to their daughter-in-law who's managing their medicine, who can't get out.
A relationship is so important.
Besides your equipment, your accuracy comes from knowing your patients also.
Todd Eury: Erich, you are a numbers guy. Just in understanding some of what we were talking about before we got started with today's recording and even understanding what impact the DIR fees are going to have to you at the point of sale in January (2024). Let's talk about profitability and adherence packaging. You saw a difference in the bottom line.
Erich Cushey: You do. Certainly, a reduction in DIR fees once you have your GPO arrangement set up properly.
But what you also see is explosive growth in that when you're bringing a couple in their own apartment or their own type of senior living, you're not just transferring one or two prescriptions, you're usually transferring 10,20,30, because each one is on 8 to 10 medications. So, we've seen at least 10% year-over-year script count (growth). Profitable scripts.
As a matter of fact, we just put the fourth store on. We feed all four stores into RxSafe. And last month we did 645 patients across four stores.
Todd Eury: It's incredible. Congratulations! That's good news.
Todd Eury: How important is it to have compliance packaging, a sync program in order to grow your pharmacy business?
Margie Lydon: Absolutely essential. One of the requirements to be a long-term care pharmacy is to provide compliance packaging. And now that Medical at Home or long-term care at home is recognized by CMS as being long-term care. Some of the financial benefits to the pharmacy on that, such as DIR protection, have been huge.
I am a firm believer that every independent pharmacy can participate and has Medical at Home patients, even if you're not in a situation where you can contract with a personal care, assisted living or skilled nursing, facility or other licensed residential care.
But, as I said it, it's required to provide it. And we see the huge improvement in adherence and outcome based on using compliance packaging, such as RxSafe - much faster than the manual process, although, others have said, blister cards are still widely used in the facilities. Not so much at home. I think the pouch packaging is much preferable in that scenario.
Todd Eury: How long did it take to incorporate the adherence packaging into Curtis Pharmacy's workflow?
Erich Cushey: So, much like Angela said, compliance packaging was an outgrowth of sync. We're very sync heavy in all of our locations.
In fact, we design the location, so we have a completely separate counter for sync and packaging.
It just makes managing your daily script count, staffing needs, everything a lot easier.
It’s funny because the fourth location we just purchased used no workflow whatsoever, and we turned that on day one, and it blew everyone's mind that you could see at any point in the process where their prescription was. So, if you're already doing sync, it's a very easy step into compliance packaging, because they're already altogether ready to go, and RxSafe makes a terrific product just to take that information and create the packs.
Todd Eury: So, Angela, what about implementation of a new workflow system that incorporated RxSafe? How long did that take you to get up and going?
Angela Stokes: Well, and I've done it before, but honestly, it took us less than 30 days to get going.
You have to anticipate what's going to go wrong. And workflow is life.
If you don't go ahead and anticipate the problems that are going to occur and how you're going to fix that before you roll this product out it's going to be frustrating and knowing verbiage and knowing what to say, I've recreated this program a couple of times, you know, through my history with just being a pharmacist for 30 years.
But it's just anticipating it. It's not bad. But what is overwhelming is when you look back after about three months and your first of the month rush where you're bombarded. When that goes away, everybody gets on board, and wants to offer sync, but it doesn't take that long.
It's just a good way of doing business and filling prescriptions for people in it and creating that program and getting it started. It’s not that long. Everybody just needs to be on the same page, and you need to have a workflow for when the problems happen and how to track things.
Todd Eury: But tell me, Margie, from your client base how have you helped as a wholesaler to coach in adherence package leveraging, and in workflow management, and also partnership with RxSafe?
Margie Lydon: So, I love the RxSafe technology. As I've said, I've known Bill for several years now and worked with him and his team. Yes, of course, there's some initial training required in how to use it and incorporate it into workflow. But the efficiencies and accuracies I've seen are just beyond measure.
It's really typical to walk into an independent pharmacy, and everybody's pulling their hair out. There are things on fire. It's just crazy trying to get things done. And all of a sudden, an hour before closing, you’re sweeping the floor and checking and restocking things because you've taken so much pressure off. And that, I think, also opens the opportunity to grow your business that now you have time and capacity to recruit more patients, hopefully sync and packaging patients, and hopefully they’re Medical at Home, or something where you get some DIR protection and other benefits. And even if they're not, you develop a reputation for the service level you provide and customers will definitely come your way.
I'm a big believer in operations manuals or guides, and I'm not talking about, you know, 2-inch thick pieces. But I've worked with a number of pharmacies where we grab screenshots as we're training people and put that together. And it's a great reference. if someone forgets a step, or if you have new staff to train, just making sure everybody understands. And I've seen pharmacies where they've actually incorporated, although you're using separate filling stations as Erich suggested. You know your sync and packaging patients are not on the same counter that your acute patients, who are waiting for their medications, are staying. But being able to move some of that into workflow as far as checking the final product, and the pharmacist signing off on that being good to package, that doesn't work in every situation. But I've seen pharmacies go from where they had to at the end of the day go check 50 boxes or hundreds of blister cards to now in between somebody's antibiotic and the next thing they're checking, and it just becomes so much more pleasant atmosphere to work in.
Margie Lydon: And we have Value Drug do everything we can to make changing to us for your wholesaler as smooth as possible. We have four pharmacists available as resources. Our sales team, our customer service, but it's not painful. We're very transparent and so appreciative of all of our customers and members.
To listen to the whole podcast, click here.
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