Business Solutions That Make a Difference Clinical, operational, and financial services that pharmacists can fold into their business plans to support their pharmacy’s growth. page 15

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Evaluate Your Pharmacy System Using Metrics 46 may/june 2018 computertalk may/june 2018 computertalk 45 “The SoftWriters solutions work very well together. We don’t have to create a ton of patches to go here, there, and everywhere. I think that’s been one of the biggest time savers for us - you want to go with one product and we’d highly recommend SoftWriters LTC solutions. It’s wonderful.” - Mackenzie Farr, COO and Pharmacist, Community Pharmacy Services, Inc.

With fewer touches and greater accuracy, your pharmacy is able to compete effectively, maximize margin, and grow efficiently with integrated solutions from SoftWriters.

Reach out today to learn more: 412-492-9841, option 3 | [email protected] | FrameworkLTC.com 1 © 2018 SoftWriters, Inc. May | June 2018 The intersection of technology and Be like Miral- management. Save valuable time without losing Business Solutions valuable space. departments Do you need affordable and reliable tabletop counting technology but lack counter 4 Publisher’s Window space? The RM1™ is a compact, vision-based tabletop counting system perfect Thatby Will Lockwood Make a Difference Monetizing Privacy for growing or space-limited pharmacies. The RM1 quickly and accurately counts 6 Industry News solid oral medications, has an easy-to-clean surface and saves you valuable time ou’ve got to have a plan for your phar- 35 George’s Corner without taking up scarce counter space. Less than 8 inches tall and lightweight at Y A Pet Peeve macy. No matter how good or how broad only six pounds, the RM1 packs efficiency and affordability into one powerful and an array of technology you have, or how on 36 Index of Advertisers portable automated counting system. top of it your staff is, you still need to be 37 Viewpoints giving serious thought to getting the most Merger Mania Accelerates See the future of pharmacy automation and what it can do for you. out of these assets in order to power your 39 Technology Corner High-, Low-, and No-Tech Visit rxmedic.com or call 800.882.3819. business. Story begins on page 15. Approaches to Medication

Plus... Adherence Improving Adult Immunization Rates Empowering 41 Catalyst Corner “It definitely improves our workflow efficiency and it’s very easy to use. We’ve tried other counters in Pharmacies and Patients with Information. Page 22 Mergers and PBM Pricing the past and they didn’t work well for us. The RM1 works and it’s a great value. Know Your Options: Printing in Pharmacy Don’t overlook the valuable 43 Conference Circuit We have seven, one for each of our locations.” role your printer plays in your pharmacy workflow. Page 26 Computer-Rx 2018 Idea Exchange Miral Patel, RPh – Owner, Curlew Pharmacies, Clearwater, FL features * pharmacy forward 9 On the Cusp of Change 32 Getting Things Done: Putting Process Automation by Maggie Lockwood to Work in LTC Pharmacy Tiffany Barber, named the 2017 Saliba’s Extended Care Pharmacy looks to Integra LTC Solutions’ Logix to help auto- Community Care Pharmacist of mate communication tasks, maximizing efficiency to not only survive but to thrive. the Year by the North Carolina Association of Pharmacists, has 33 It Makes Sense: Enhanced Inventory Control embraced the clinical future with a Counting Machine at Hillsborough Pharmacy as Recent changes in state laws show inventory rules will likely tighten before they relax. a member of the CPESN USA In this case study, two pharmacies demonstrate how tablet counters put accuracy and network. time savings into inventory management. 12 Pharmacy System Metrics: 34 Technology-Guided Packaging: Better Med Organization at Getting the Right Masonic Villages Pharmacy manager Don Brindisi, R.Ph., at Masonic Villages was already a big propo- Software, Hardware, and nent of adherence packaging and automation by TCGRx when he saw the Smart- Workflow CardRx at a trade show last summer. by Matthew Catanzaro, R.Ph. Computer systems can have huge * ramifications on a pharmacy’s out- back page put and overhead expenses, and 44 Beyond Dispensing: The Shift in Pharmacy Practice it’s worth it to take a close look at Ketan Mehta, of Micro Merchant Systems in Syosset, N.Y., has a clear message just where your systems may be for independent pharmacy owners: Pharmacists need to practice spending less helping or hindering you. time behind the computer and more time on patient adherence and outcomes. *Sponsored Content

2 may/june 2018 computertalk © 2017 RxMedic Systems, Inc. RxMedic is a registered trademark and RM1 is a trademark of RxMedic Systems, Inc. RxMedic Systems, Inc. is a subsidiary of the J M Smith Corporation. Be like Miral- Save valuable time without losing valuable space.

Do you need affordable and reliable tabletop counting technology but lack counter space? The RM1™ is a compact, vision-based tabletop counting system perfect for growing or space-limited pharmacies. The RM1 quickly and accurately counts solid oral medications, has an easy-to-clean surface and saves you valuable time without taking up scarce counter space. Less than 8 inches tall and lightweight at only six pounds, the RM1 packs efficiency and affordability into one powerful and portable automated counting system.

See the future of pharmacy automation and what it can do for you. Visit rxmedic.com or call 800.882.3819.

“It definitely improves our workflow efficiency and it’s very easy to use. We’ve tried other counters in the past and they didn’t work well for us. The RM1 works and it’s a great value. We have seven, one for each of our locations.”

Miral Patel, RPh – Owner, Curlew Pharmacies, Clearwater, FL

may/june 2018 computertalk 3 © 2017 RxMedic Systems, Inc. RxMedic is a registered trademark and RM1 is a trademark of RxMedic Systems, Inc. RxMedic Systems, Inc. is a subsidiary of the J M Smith Corporation. publisher’s window

Bill Lockwood www.computertalk.com Chairman | Publisher Volume 38, No. 3 may/june 2018 Bill can be reached at [email protected] STAFF William A. Lockwood, Jr. Chairman/Publisher Maggie Lockwood Vice President/Director Monetizing Privacy of Production WHAT IS DISTURBING TO ME contend with. One aspect of this federal Will Lockwood is how an individual’s privacy is being legislation is to protect a person’s medical Vice President/Senior Editor compromised of late. It seems like a day record information. HIPAA also details the Toni Molinaro doesn’t pass without reading about ran- security procedures that covered entities Administrative Assistant somware dealing with a person’s medical must comply with to protect the person’s Mary R. Gilman information. Hackers have fine-tuned the privacy. I advise every pharmacy owner Editorial Consultant art of invading the computer networks to have his or her security procedures in ComputerTalk (ISSN 0736-3893) is of clinics and hospitals in the quest for compliance with the HIPAA requirements published bimonthly by Computer- making a profit from the theft. To under- well-documented and routinely re- Talk Associates, Inc. Please address score our vulnerability, the April 30 issue freshed, to avoid any penalties that might all correspondence to Computer- of Bloomberg Businessweek showed the be incurred by the Office for Civil Rights Talk Associates, Inc., 492 Norris- results of Verizon Communication Inc.’s should the pharmacy be subjected to an town Road, Suite 160, Blue Bell, PA 2018 Data Breach Investigations Report. audit as a result of a security breach. The 19422-2339. Phone: 610/825-7686. The top three most likely threats are Office for Civil Rights is cleaning up with Fax: 610/825-7641. personal, payment, and medical. This was the fines it is levying on covered entities Copyright© 2018 ComputerTalk based on data collected by Verizon from that fail to comply with HIPAA. Associates, Inc. All rights reserved. 67 organizations around the world for the Re­pro­duc­tion in whole or in part There are two aspects to the privacy without written permission from 12 months ended Oct. 31, 2017. issue. One is data that is hacked, and the the publisher is prohibited. ­Annu­al A person’s medical record has monetary other is data that is mined. Combined, subscription in U.S. and terri­tories, value. But a person’s personal data is be- these are the forces behind a person’s life $50; in Canada, $75; overseas, no longer being private. We also live in $95. Buyers Guide issue only: $25 ing monetized in other quarters as well. a world where identity theft lurks in the Printed by Vanguard Printing. Facebook has gotten a lot of negative press for the use of its data by Cambridge shadows. The Equifax and Target data General Disclaimer Analytica (which has since shut down), — breaches were headline news. We just Opinions expressed in bylined ar- a classic example of how personal data do not know how many people were ticles do not necessarily reflect the adversely affected as a result. opinion of the publisher or Com- can be monetized. In this case it involved puterTalk. The mention of product the data on some 87 million Facebook It is amazing what companies know about or service trade names in editorial accounts. This is called data mining. us. What products we buy, when we buy material or advertise­ments is not And a company by the name of Palantir them, our demographics. Our lives seem intended as an endorsement­ of Technologies, founded by Peter Thiel, a to be an open book. And there have been those products or services by the Stanford Law School graduate and one of publisher or ComputerTalk. In no countless stories about people who post the co-founders of PayPal, has developed manner should any such data be things on their Facebook page that have highly sophisticated algorithms that can deemed complete or otherwise caused lost employment opportunities. represent an entire compilation of be used to monitor an employee’s every One caveat is to watch what you post so it available data. move, inside and outside the place of doesn’t come back to haunt you. Member employment. Is there a quick fix to the privacy issue? I ASAP In the healthcare world we have HIPAA to doubt it. CT 2018 4 may/june 2018 computertalk Bill Lockwood Chairman | Publisher Bill can be reached at [email protected]

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TabulaRasaHealthCare.Com may/june 2018 computertalk 5 industry news

SoftWriters, a Managed Health our technology offerings under one and goals for individuals needing care,” Care Associates company, has an- leader was made to further enhance says Troy Trygstad, Pharm.D., Ph.D., VP nounced that Shantanu (Shan) our customer focus. Kevin is a highly of pharmacy and provider partnerships Bhide has joined the company as VP of respected technology leader with a for Community Care of North Carolina. technology. Shan joins SoftWriters with passion for moving pharmacy forward. “It is exciting that QS/1 can provide this more than 20 years of experience deliv- Under his guidance, QS/1 and Integra capability for their pharmacy customers ering software product and solutions to customers can expect a commitment who can begin participating in clinical a broad range of customers. to technology excellence and documentation and care planning Tim Tannert, president responsiveness,” says Turfe. workflows for all of their patients of the company, Welch was named chief technology and sharing of data with other care states, “Shan is a officer for J M Smith Corporation in team members. This is the future of great addition to 2017. He became part of J M Smith community-based pharmacy practice.” our executive team. Corporation with the acquisition of “Giving pharmacists the ability to collect His role represents Integra, which he and share patient data validates the role SoftWriters’ ongoing founded in 1997. they play in the healthcare chain,” says Shantanu commitment to the Welch holds degrees Ed Vess, R.Ph., QS/1 senior manager for (Shan) Bhide long-term care (LTC) in mathematics, customer markets and services. “QS/1 pharmacy space and specifically computer science, has been an advocate of this program listening to our customers and operations research, and worked to help give pharmacists developing our solutions around Kevin Welch and engineering a bigger voice. This information will their needs. Shan will lead the effort management from allow all involved to see the progress, or to evolve our best practices for Stanford University, and has served setbacks, in the patient’s health.” our product management, quality in senior positions at Genentech, Symantec, and Microsoft. During his assurance, and development processes.” TCGRx has acquired ARxIUM’s career he has designed and developed Panasonic FastPak pouch packag- many industry-leading software J M Smith Corporation has ing business line. This move extends applications and systems. announced that its leading innovative TCGRx’s industry position by providing technology solutions will now be under increased penetration into the hospital the leadership of Kevin Welch. Saul QS/1 has received Level 2 capability market as well as continued expansion Factor, R.Ph., who was president of from Community Care of North Car- into Canada. QS/1, will lead the wholesale distri- olina for the Pharmacist eCare Plan. bution business units Smith Drug The eCare Plan is a program that Automated pouch packaging is a Company and Burlington Drug Com- standardizes documentation of core competency of TCGRx, as the pany. “There is perhaps no one in the patient information and facilitates company has installed over 700 industry better prepared to lead Smith the exchange between healthcare packaging units since its inception in Drug Company than Saul Factor,” says providers and pharmacists. The goal is 2006. TCGRx Founder and Executive Alan Turfe, CEO and chairman of to advance care coordination, improve Chairman Duane Chudy was also J M Smith Corporation,“ Saul is a phar- patient outcomes, and reduce overall the founder of the legacy business macist with experience healthcare costs. that TCGRx acquired from ARxIUM. in every facet of the “The Pharmacist eCare Plan is a standard TCGRx based its next generation ATP 2 industry, from patient endorsed by the Pharmacy Health punch-packaging technology on the care to manufacturing Information Technology Collaborative FastPak EXP. As a result, all of the current and distribution to and serves as a standardized, solutions offered by TCGRx, including its sales and marketing.” interoperable document for exchanging InspectRx medication imaging system, Saul Factor “The decision to align medication-related activities, and plans, are compatible and can be leveraged

6 may/june 2018 computertalk industry news

by pharmacies to lower costs and states. This is a highly secure network Innovation, makers of increase production. to allow cross-state sharing, enabling PharmASSIST pharmacy automation authorized users to access more solutions, has announced the passing comprehensive data for appropriate OmniSYS has formed a strategic of company founder and chairman, prescribing and dispensing of controlled partnership with Scientific Technolo- Joseph “Harry” Boyer, after a long substances. gies Corporation. The partnership will illness. provide OmniSYS with access to immu- Prior to the White House announce- Boyer founded the company in 1972 nization history from all participating ment, NABP convened a Congressional as a research and development state and jurisdictional immunization briefing and presented details on the engineering, technical services, information system (IIS) registries. This history, success, and future of PMP and manufacturing firm. He shifted information, combined with OmniSYS’s InterConnect to approximately 30 staff Innovation’s focus to pharmacy proprietary data set, will enhance the members from U.S. Senate offices and automation in 1995 and launched the company’s OmniLINK Vaccine Manage- committees. In addition, details on company’s PharmASSIST automated ment Solution (VMS), enabling pharma- how the program enhances efforts prescription dispensing product in cies to grow their immunization busi- to combat drug diversion, abuse, and 1997. ness while improving vaccination rates addiction were discussed. This briefing, among the populations they serve. “Prescription Drug Monitoring Pro- While at the helm of Innovation, Boyer “During the most recent immunization grams — Scaling Up: One-Click Access. earned such notable achievements season we had over 20,000 pharmacies Expanding the Next Generation of Tech- as the New York State Small Business utilizing VMS to target Medicare nology to All Providers,” was presented Person of the Year and the Broome patients eligible for pneumococcal by Danna Droz, J.D., R.Ph., prescription County Chamber of Commerce Small vaccinations. Participating pharmacies monitoring program senior manager Business Person of the Year. He also realized significantly statistical at NABP; Ralph Orr, program director developed a strategic partnership improvements in their immunization of Virginia’s PDMP; and Jeffrey Forman, with Binghamton University’s rates, with one out of four flu shot M.D., F.C.C.P, M.H.C.D.S, chief medical internationally renowned Thomas J. patients receiving the appropriate officer, population health, of Bayview Watson Institute of Systems Excellence companion pneumococcal vaccine,” Physicians Group. (WISE). The Innovation and WISE notes John King, CEO of OmniSYS. teams have collaborated on numerous The value of the existing network is technological initiatives, and this The National Association of evidenced by the 380 facilities in 33 industry/academia relationship Boards of Pharmacy (NABP) states that enable point-of-care, one- continues to flourish with ongoing says that NABP PMP InterConnect is click access for healthcare providers. work in the fields of big data analysis, the answer to the White House call for Additionally, eight states — Arizona, visual process simulation, and artificial national interoperability of prescription Indiana, Kansas, Massachusetts, intelligence. Boyer’s work with the drug monitoring programs (PDMPs). In Michigan, Ohio, Pennsylvania, and university was acknowledged in 2011 March the White House announced its Virginia — have provided or have when he received the Binghamton plan to reduce demand and overpre- committed to provide one-click access University Technical Innovator of the scribing of opioids, in part by leveraging for every prescriber and pharmacist in Year award. federal funding to support states using the state. a national interoperable PDMP network. Capsa Healthcare has released PMP InterConnect is offered free of PMP InterConnect, operational since NexsysADC, its next-generation tech- charge for participating states. More 2011, currently processes over 17.8 nology for secure medication man- million requests and 39 million respons- information can be obtained by going continued on next page es per month for the 45 participating to www.nabp.pharmacy/PMP.

may/june 2018 computertalk 7 industry news continued from previous page agement and dispensing in the long- for so many providers focused on the of CPESN USA , which currently serves term care environment. NexsysADC is perfect balance of features and fast 38 affiliated networks across 35 states. designed for the onsite storage and or- ROI for medication dispensing in the In addition to representing pharmacies ganization of controlled medication and facility. This technology will maximize in North Carolina, Mutual CPESN will first doses/e-kits at these facilities, at a their budget’s buying power,” says John work to support CPESN efforts in other fraction of the price of alternative auto- Himmelstein, Capsa’s VP, extended care. states where Mutual Drug operates, mated dispensing systems, according including South Carolina, Virginia, and to the company. NexsysADC is scalable Mutual Drug has announced a West Virginia. for any volume of extended-care facility, new clinically integrated pharmacy Integrating community pharmacies as well as in specialty-care settings, provider network called Mutual CPESN into care teams supporting complex including surgery centers, critical-care (Community Pharmacy Enhanced patients was pioneered by Commu- clinics, rehabilitation facilities, and Services Networks). “We plan to improve nity Care of North Carolina under a health network medical campuses. The the care delivered to North Carolina three-year cooperative agreement with cloud-based system gives full control to patients by integrating with multidisci- the Centers for Medicare & Medicaid the LTC pharmacy, yet greatly stream- plinary care teams and leveraging the Innovation. Mutual CPESN will build on lines the nursing staff’s efficiency in skills and relationships of community that experience for the benefit of North accessing the right medication for the pharmacies,” says Patrick Brown, Mutual Carolina patients. CT right patient at the right time. CPESN lead network facilitator. Visit www.computertalk.com/pharmacy-news/ “The new NexsysADC makes sense Mutual CPESN is an affiliated network for the most recent updates.

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8 may/june 2018 computertalk feature: clinical future

by Maggie Lockwood Staff Writer On the Cusp of Change

THIS MIGHT SOUND FAMILIAR to herbal supplements and vitamins. Last year, many of ComputerTalk’s regular readers: A Hillsborough Pharmacy agreed to be the pharmacist who has found the sweet spot pilot location for the UNC clinic, carving of combining technology efficiency with out a third of its 1,000-square-foot space for human expertise to fully serve a diverse that purpose. Hillsborough Pharmacy can community. An award-winning mix, really, access the health system’s Epic EHR system and one that pharmacist-owner Tiffany to review health records and support the Barber, Pharm.D., R.Ph., has embraced at transition from the hospital to home. Hillsborough Pharmacy and Nutrition in This program is the second clinical-based Hillsborough, N.C. In this community 15 pilot Barber has engaged in. Hillsborough miles west of Durham, the pharmacy is part Tiffany Barber, named the Pharmacy is entering its fourth year in a of daily life, and Barber’s commitment to the CMS grant that started the CPESN program. community is through the lens of pharma- 2017 Community Care In North Carolina, the network is Mutual cist provider. Pharmacist of the Year by the CPESN, through the Mutual Drug Compa- The belief that community pharmacists are North Carolina Association of ny. All participating pharmacies offer the the backbone of the healthcare industry, standard CPESN clinical services, and many doing more than just checking prescriptions, Pharmacists, has embraced offer enhanced services such as adherence has been Barber’s business philosophy since the clinical future in her small- packaging and home delivery. When partici- buying the pharmacy in 2011. She has craft- pating in an integrated network, pharmacies town pharmacy as a member ed a business plan for her pharmacy that can engage with payers to receive payment reflects the movement toward pay-for-per- of the CPESN network. for the money payers save when the cost formance as opposed to pay-to-fill. The of patient care is lower. A grant from the pharmacy is participating in the Community doctors to come up with what’s best for Center for Medicare & Medicaid Innovation Pharmacy Enhanced Services Networks, them. To win this award makes me proud (Innovation Center) pays for pharmacists to known nationally as CPESN USA and locally for community pharmacy. To win is very offer patient-centered services that improve as Mutual CPESN, as well as a clinic pilot humbling.” the health outcomes of complex patients. program sponsored by the UNC School of Enhanced services include medication Nursing and North Carolina Mutual. Barber’s Forward-Thinking reconciliation, clinical medication sync, im- commitment to the community, and to munizations, clinical medical reviews (CMRs), Hillsborough Pharmacy and Nutrition is an bettering pharmacy through participating in and personal medication records. Pharmacy example of a pharmacy that is moving to the CPESN program, earned her Community management systems can communicate the clinical world. It fills between 250 and Care Pharmacist of the Year for her state in with care management systems, and phar- 275 prescriptions a day, almost 40% of which 2017. Barber is rolling all these little pieces macists can document their clinical encoun- are for Medicaid patients. The pharmacy sees together into what many industry experts ters right in the system. Barber’s pharmacy patients, regardless of their insurance, and are saying pharmacy has to do going management system, VIP, interfaces with the triages over-the-counter products versus forward. eCare Plan from PrescribeWellness, one of a recommendation to go to the doctor. It the eight validated eCare vendors. Com- “I have always loved community pharmacy,” offers delivery and adherence packaging to munity Care of North Carolina (CCNC) has Barber says. “Our customers know I know a small population, as well as a curated OTC them and that we work as a team with their (over the counter) department, including continued on next page

may/june 2018 computertalk 9 feature: clinical future continued from previous page

25 technology vendors participating in the ing to Trista Pfeiffenberger, the network’s VIP system. VIP gives staff access to import- Pharmacist eCare Plan, which uses existing director of quality and operations. Not only ant patient data in the course of the regular standards adopted by medical providers in has Barber adopted the eCare Plan, but over workflow, and allows Barber to focus her en- electronic medical records to develop an the four years of the program, Barber has ergy on clinical decision-making. The key to electronic pharmacy care plan. developed a dynamic relationship with local being successful in CPESN is documenting physicians, who see the value in her staff clinical interventions while in the pharmacy “Pharmacists help make changes to prescrip- monitoring patients for clinical measures like workflow and then delivering the reports to tions and counsel patients, but we aren’t blood sugar levels. providers and payers. Patient data is updated getting paid. People don’t know we are regularly in VIP, giving Barber’s staff immedi- doing this,” explains Barber. “ The Innovation “If pharmacists are identifying drug prob- lems and making recommendations to ate access to a patient’s medication informa- Center grant has further solidified our place tion, health information such as when the in the healthcare system so the doctors providers, essentially they are doing the type of activities that warrant eCare Plans,” patient was released from the hospital, and know they can look to us to help dose the what referrals might be useful. medicine or talk them through something says Pfeiffenberger. “Pharmacists want to or recommend a formulary medicine. Help- document these interventions — it’s just as Barber says the VIP system presents patient ​ ing doctors with the medication therapy has relevant in physician practice.” insurance ​information, medication regi- been good for patients and doctors.” mens, and risk scores. This is a huge help, Technology-Supported Care as Barber can​ immediately see the likeli- Hillsborough Pharmacy has definitely been The ability to offer personal attention with hood of hospitalization based on the risk an outstanding participant in CPESN, accord- on-demand data comes from Hillsborough’s score ​when a patient is in the pharmacy. ​A pharmacist can make a recommendation for vaccination based on the immunization history provided by VIP​. Barber documents all SPOTLIGHT: CPESN the care her staff provides in the eCare Plan Community pharmacists participating in the Mutual CPESN® Network (and from PrescribeWellness, which records the all 39 local CPESN Networks by the end of the year) create care plans for high clinical interventions and shares the data in risk patients that are designed to improve outcomes related to medication use a standard format with the CPESN network. ​ and coordinate with other care team members. This effort uses existing stan- VIP loads all patient data into the Prescribe- dards adopted by medical providers in electronic medical records to develop Wellness platform, making documentation an electronic ‘pharmacy’ care plan or Pharmacist eCare Plan. A Pharmacist for the eCare Plan seamless. All pertinent eCare Plan is a shared document detailing a patient’s current medication reg- imen and health concerns, including drug therapy problems and medication data regarding each patient is already popu- support needs, in addition to the pharmacy’s interventions and the patient’s lated and the pharmacist simply documents health outcomes over time. the type of intervention. eCare plans are immediately sent electronically to CCNC to Being able to efficiently and effectively create and share care plans is crucial to integration with the larger care team. The Pharmacist eCare Plan standard al- justify the pharmacy’s value-based care and lows pharmacists to generate care plans within the technology already in use in receive payment. Barber also runs phone the pharmacy and utilizes existing standards for data exchange. Documenting campaigns, immunizations, adherence, their work using Pharmacist eCare Plan capabilities allows community pharma- and Medicare Part D enrollment programs cies to clearly demonstrate the nature of their contributions to patient care to through PrescribeWellness. Although care team members, payers, and other partners. you have to go to a separate platform to Twenty-five technology companies from the pharmacy industry have participat- document, VIP makes it simple through data ed in Pharmacist eCare Plan training with six having achieved Level 2 and Level sharing and implementation of risk scores. 3 (advanced) Capabilities with Active Medications. Seven other technology The VIP system is fast and straightforward companies have partnered with those that have achieved that same capability in processing prescriptions. “VIP helps us level. For a list of these companies, visit https://www.cpesn.com/ecare-plan/. because we spend very little time on the

10 may/june 2018 computertalk actual computer,” she says. “It’s really easy to out there as the big “what if,” Barber says we can impact the healthcare landscape.” CT process the script so that the insurance is pharmacy has no choice but to embrace the Maggie Lockwood is a VP, staff writer, and out of the way. We can be really present with move to showing quality outcomes. director of production at ComputerTalk. Her the patient.” “We’ve got to build clinical services and get pharmacy profiles serve as case studies on The pharmacy’s staff includes Barber, who is paid for that,” she says. “We know when we the power of technology. See more photos of the pharmacy manager, two part-time phar- look at what we can do as pharmacists that Tiffany Barber and her pharmacy and staff at macists, and a part-time clinical pharmacist. www.computertalk.com/barber-feature Barber has shared the clinical pharmacist for the past year and a half, as she builds clinical services as part of the CPESN program. The Pharmacist eCare Plan Now goal is a full-time clinical pharmacist with a support technician. Currently, a clinical Active in the Marketplace technician floats between traditional phar- Eight Technology Vendors macy routines and then helps the clinical Have Pharmacist eCare Plan Functionality pharmacist with adherence packaging, checking electronic health records (EHRs) to see if the medication list has changed, Clinical documentation through the calling the patient for an update, and setting Pharmacists eCare Plan is an important step for up deliveries. interoperability and connecting pharmacists with the rest of the health care community. The clinical pharmacist is constantly review- ing patient records in OutcomesMTM and Mirixa. The more patients the pharmacy manages well, the more patients are sent to the pharmacy. “If the insurance companies see pharmacies are working with the pa- tients with high-risk health needs, and they are staying healthy, this increases star ratings and the insurance companies will continue to send us patients,” says Barber. ”When we first started this, we didn’t know how much work the clinical pharmacist would have. We’ve seen there really is a need here, and how this is going to be the future of the pharmacy.” Empowering Community Pharmacies to Improve Care Coordination and Health Outcomes On the Cusp of Change with Use of Pharmacist Electronic Care Plans Barber sees that the biggest challenge for community pharmacy is having enough prescription volume to pay for the clinical pharmacist. The old model of pharmacy is not sustainable, as reimbursements are constantly cut and pharmacy moves to the For more information visit cpesn.com/ecare-plan pay-for-performance model. And while get- ting paid for these services is still lingering

may/june 2018 computertalk 11 feature: system metrics

Pharmacy System Metrics: Getting by Matthew Catanzaro, R.Ph. the Right Software, Hardware, Director of Correctional Services, Diamond and Workflow Pharmacy

IT IS NO SECRET THAT PHARMACY keep obsolete computers? In our practice the right software is a very personal and margins are shrinking and pharmacists are in 2012, we took a control group of 24 business-specific decision. While pharma- expected to do more and more to try to technicians on computers that were five cists are not expected to be information keep up profits. In the past few decades, years of age or greater. These comput- technology specialists, it serves anyone the practice of pharmacy has changed ers were communicating with a central purchasing software to dig in for a better with the times, but one companion has server to push and pull data from the core understanding of the company supplying been ever present: the computer. As prac- database, but a reasonable amount of the software, the platforms it runs on, and titioners, we often accept the computer processing was done at the terminal level the underpinning architecture, to make system as is in our setting, and frequently as well. After replacing the terminals with certain it is keeping up with the 21st only look to other aspects of the business new models, we saw a little more than century. A number of software companies for cost savings and profitability boosts. 10% increase in output. The replacement have been in business since the 1980s, But the computer and computer systems models were not top of the line. In fact, but that doesn’t mean you want 1980s’ are one aspect that can have huge ram- they were bare-bones processors, but programming and structure. That can ifications on your output and overhead because technology had improved in that degrade performance and make it difficult expenses, and it’s worth it to take a close time frame, the most basic of models was to improve your productivity. The last look at just where your systems may be a substantial improvement over what was thing anyone wants to do is take the time helping or hindering you. being used. In our practice, this improve- and effort to review, buy, install, and train ment saved salary dollars, since that 10% on software only to find out in six to 18 There are many ways to look at comput- increase in output was like getting an ad- months that the company is defunct or erization and how it can be improved in ditional technician’s worth of production that the software is being abandoned in your practice setting. Traditionally, the for every 10 technicians we employed. favor of an upgraded structure. hardware is one of the easier items to Our return on investment on the proj- Next, let’s consider concepts around get upgraded, and new hardware can ect was a little under three months. The workflow, which may depend upon the absolutely make an impact on your tech- intangible values of this enhancement layout of your environment. Sometimes it nology’s performance. But don’t underes- were that staff felt appreciated in being is impractical to have a consistent flow to timate the impact of software, workflow, given new computers, and their increased the work, but don’t ignore evaluating this. or even data entry shortcuts to increase production served to help their quality of Many of the larger retail pharmacies have work efficiency. Let’s look at ways in which life, as business developed a workflow plan and have both hardware upgrades and attention demands were more easily met. Overall, expectations of how staff should func- to your software and workflow can help we saw improved morale, making for a tion. Organized workflow helps to reduce make a difference. better work environment. It was unques- errors and increase efficiency. This may be In an age where computers become tionably a win for management, owner- very evident to anyone working in a busy obsolete in a few short years, has your ship, and employees. store, but what can be overlooked is how practice setting kept up with and replaced Beyond hardware, consider your soft- the software is designed in conjunction your computers in keeping with that ware. It is difficult to know if slowness with the flow. As a rule, people dislike trend? Hardware, such as the computer and delays experienced are related to change, and this is important to keep in or server doing the heavy lifting, can be hardware, software, or some other factor mind when you bring in a new software expensive, but how expensive is it to such as internet connectivity. Choosing system, since you are likely bringing in a

12 may/june 2018 computertalk new workflow with it. That’s because Some basic details of the comparison study: trying to shoehorn existing processes into a new Pool of pharmacists: 43 system is a recipe for disaster at best and com- Time frame: One year plete failure at worst. It is best to learn how the Duties: software company envisions its product being • Compare in an electronic fashion the data entered to the used. The vendor will have extensive experience with prescription image/order for accuracy. how its customers use the system and, if asked, can • Validate that the technician entered information versus the most likely help you understand the best ways to func- prescription. tion using the software. If possible, ask to visit existing software users to see how they function, and get their • Clinically screen the order for interaction and appropriate feedback and experiences with the software. While this dosage. is an expense in time and research, it will pay off if you • Indicate the prescription is acceptable to move onto fulfill- find that customer support is lacking or that the billing ment, or reject with direction on how to correct. component of the software is rife with errors. Don’t ignore the workflow within the software itself, either, a difference a computer system can make, consider the following as this is just as important as how the software is envisioned to assessment we performed. In a practice setting with the same function within the pharmacy. For example, some software plac- pool of pharmacists, all of whom were expected to do the same es the provider at the top of the screen, while others place it at duties and at the same level of scrutiny but using two different the bottom. Make sure that the logical flow of order entry works software systems, we found one system led to a performance for your staff and how they are trained. metric average of 41.75 prescriptions per hour, while another rated at 96.5 per hour. Good software should have shortcuts and best-practice guid- ance. Shortcuts are ways to get from one screen to the next or to The evaluation indicated that a good pharmacy system can trigger an event. Shortcuts should be clearly indicated within the equate to 1.3 full-time equivalent (FTE) of pharmacist time help menus of the software or as a “hover over” tip that can act as savings. These values can most certainly be offset by system a reminder to staff. Using a mouse should be minimized as much costs, but it is evident that a computer system really can allow as possible during data entry, which means it should be rela- you to do more with less help. The concept of saving one-third tively easy and logical to navigate the screen via a series of tabs, of your pharmacist’s time is a huge advantage in settings where reverse tabs, and enter/return keys for completion of a given there are limited resources available. Unfortunately, the above field. The ultimate goal is to allow the typist to move through the study did not afford a comparison for the technician staff, as their fields without being inhibited. Shortcuts are not just confined to duties were substantially different. special keys on the keyboard, but also include concepts such as Taking a good look at your current or prospective pharmacy searching the database. When looking for patients, searching by software, keeping hardware up to date, and understanding phone number or insurance ID is always going to be more reli- the best ways to implement and use them for your pharmacy’s able than searching by name, especially if the name is common. workflow should be embraced by anyone wishing to be more This same concept holds true for drug searches. Learn how the profitable. Cutting-edge technology should always be acquired software searches for items and use as many tricks as are offered with due diligence, but once proven, that technology could be so that the drugs brought back on the search are minimized. If the salvation for tight margins. Pharmacy should never be afraid the software allows search criteria to include dosage forms or to explore new options. CT strengths, get staff members in the habit of using these fields when they are able. The closer you get in a query to the drug you Matthew Catanzaro, R.Ph., is director of correctional services at desire, the less chance of a mistake getting selected. Diamond Pharmacy in Indiana, Pa. He can be reached at [email protected]. All of that stated, why be bothered upgrading at all? If it works, then that is truly all one needs, correct? To exemplify how drastic

may/june 2018 computertalk 13 We are united by what makes us different. We are united by independence.

Our Promise to You. To protect the rightful place of the independent pharmacy in community-based care; honor the unique identity and entrepreneurial spirit of each pharmacy owner; and partner together in our shared purpose to create healthier futures.

WeAreGNP.com14 may/june 2018 computertalk We are united by what makes us different. Business Solutions That Make a Difference We are united Clinical, operational, and financial services that pharmacists can fold into their business plans to support their pharmacy’s growth. by independence. by Will Lockwood You’ve got to have a plan for your pharmacy. No VP | Senior Editor matter how good or how broad an array of tech- Will can be reached at [email protected] nology you have, or how on top of it your staff is, you still need to be giving serious thought to getting the most out of these assets in order Our Promise to You. to power the business. Better business leads to more and better care opportunities for your To protect the rightful place of the independent pharmacy in community-based care; patients, too. In this story, we’ll find out from honor the unique identity and entrepreneurial spirit of each pharmacy owner; and three pharmacy owners not just what technology partner together in our shared purpose to create healthier futures. they’re using to make the most of their business, but just how they’re leveraging it.

continued on next page >

WeAreGNP.com may/june 2018 computertalk 15 cover story: making a difference continued from previous page

TOP TOOLS AND SERVICES with a dedicated advertising budget. It’s a big portfolio that underpins much At Drug World Pharmacies, President of what happens at Drug World Phar- and CEO Heidi Snyder is making the macies, which works in concert with most of the Elevate Provider Net- Rx30’s pharmacy management soft- work, AmerisourceBergen’s pharmacy ware and a point-of-sale system from services administrative organization Summit. “These are tools that allow us (PSAO), and as a member of Good to work on our business, rather than in Neighbor Pharmacy (GNP). it,” says Snyder. “We use Elevate not just Snyder is the second generation to run to help ensure day-to-day tasks like Drug World Pharmacies, with locations reconciliation, inventory management, Heidi Snyder, CEO, in Cold Spring and Croton-on-Hudson, and clinical interactions with patients president, Drug World New York. One location is a full-line get done right, but to set the strategy Pharmacies, with her son pharmacy, and one is a department in for our business as well.” a supermarket. Her son, Mark Snyder, Mark Snyder, who helps Pharmacist Cliff Holt’s flagship Hurri- works in the business as well. manage the business. cane Family Pharmacy in Hurricane, Elevate and GNP make a suite of critical Utah, has been open for nine years. adherence lab, which is where he does services available, according to Heidi Over that time, Holt has built the medpacks and strip packaging. “We Snyder, ranging from expert guidance business with the intelligent use of a started with me, one tech, and two via business coaching to comprehen- technology suite that addresses the cashiers,” Holt says. “We now have 38 sive data-supported business and clin- needs of the pharmacy’s three main employees, among whom are six full- ical metrics, to services such as claims components: retail dispensing, a com- time pharmacists, 14 technicians, two reconciliation and marketing support pounding lab, and what Holt calls the RNs, and three delivery drivers. We’re now one of the busier independents in Utah.” CPESN: Financial Incentive Aligned Holt’s focus is on efficiency, and he’s found that the best way to achieve with Pharmacy this is by minimizing distractions — Ravin Shah, pharmacist and owner of A1 Pharma- forget multitasking. Holt is leveraging PioneerRx pharmacy software linked to cy and Surgical Supply in Lexington, N.C., has taken remote staff via a VPN (virtual private advantage of the fact that his pharmacy system from BestRx network), a voice over internet proto- col (VoIP) phone system, the Beacon was the first to become certified by CPESN USA for Pharma- pharmacy inventory management cist eCare Plan capabilities. “I was a very early supporter of from TCGRx, and dispensing automa- CPESN and initiated the relationship between BestRx and tion from Parata and Eyecon to create an environment in which pharmacists CPESN USA so that we could use our existing pharmacy man- and technicians place their full atten- agement platform to further enhance patient care, tion on the task at hand. compliance, and quality of life,” says Shah. “The platform And finally, there’s Carter High, R.Ph., who is director of legislative affairs for provides a financial incentive for doing what is already aligned continued on page 18 with our pharmacy’s mission.”

16 may/june 2018 computertalk may/june 2018 computertalk 17 BEST02.23.18_20 WAYS AD_R3_printer ready.indd 1 2/22/18 5:50 PM cover story: making a difference continued from page 16

Best Value Pharmacies and owner of the Rhome, Texas, loca- tion. Best Value Pharmacies is a collection of 14 pharmacies Sharing Data: The Future of that seeks to leverage the advantages of chain operations while keeping the independent mindset that centers each Community Pharmacy pharmacy firmly in its community and brings a level of ser- A number of pharmacy vendors are vices to patients that the big-box stores just cannot provide. moving ahead with integrating the Best Value Pharmacies built out a multilocation management Pharmacist eCare Plan into their system. platform on Computer-Rx pharmacy software and a propri- etary workflow engine. High’s Rhome Pharmacy will also be QS/1, for example, recently achieved Level 2 piloting enhanced pharmacy services documentation tools eCare Plan capability. Just what is the eCare via CPESN USA (Community Pharmacy Enhanced Services Plan? “The Pharmacist eCare Plan is a stan- Network), with the goal of rolling these out across the group. dard endorsed by the Pharmacy Health Infor- mation Technology Collaborative and serves GETTING THE MOST FROM YOUR TEAM as a standardized, interoperable document While technology’s role is central in pharmacy, we’re going for exchanging medication-related activities, to start by talking about the people. This is fitting, since Heidi plans, and goals for individuals needing care,” Snyder puts such a strong emphasis on hiring the best team says Troy Trygstad, Pharm.D., Ph.D., VP of members at Drug World Pharmacies and then empowering them to do their best each day. She has also found a lot of pharmacy and provider partnerships at Com- munity Care of North Carolina. With Level 2 capabilities, Trygsatd notes, ven- dors can provide the capability for their pharmacy customers to begin The future of participating in clinical documen- tation and care planning workflows IVR is here. for all of their patients, as well as the sharing of data with other care Fusion-Rx combines a team members. “This is the future next-generation IVR with of community-based pharmacy advanced digital and mobile practice,” says Trygstad. capabilities to successfully extend your patient value in making extensive use of the business relationships beyond the coaching Good Neighbor Pharmacy offers. “The coaching helps us really focus on areas we can four walls of the pharmacy. work on to see the most improvement,” says Snyder. The coach typically reviews key data with Snyder at each session. “You can learn an awful lot about your business in a short period of time from the data,” she notes. But just as important as learning about your business is

omnisys.com continued on page 20

18 may/june 2018 computertalk Watch the video at www.LynnsQS1story.com

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qs1.com 866.925.0538 continued on page 20 ©2018 J M SMITH CORPORATION. QS/1, SharpRx and the QS/1 logo are registered trademarks of the J M Smith Corporation. may/june 2018 computertalk 19 cover story: making a difference continued from page 18

getting an outside perspective and motivation. “You can talk about what you know you need to do in your pharmacy,” says TYOH… What’s That? Snyder, “but when you know your coach is going to follow up, It stands for Toot Your Own Horn, and it’s the you’re so much more motivated to get to work.” motto at Drug World Pharmacies. It means do The coaching can motivate across the business, too. “There’s something good for the business and its cus- something for everyone — from the cashier, to the pharma- tomers, and don’t be shy about letting everyone cist, to the technician, to me and Mark,” she says. know. “It’s part of our bonus plan for our phar- macists and managers,” says Snyder. “And it’s For example, Snyder called an all-hands meeting for one of also something that we encourage all our team the business coach’s visits, which motivated all of Drug World members to do.” For example, a team member Pharmacies’ team members to think about a part of the busi- received a gift card as a reward when she took ness they wanted to tackle. “Somebody picked up social me- the initiative to put together chocolate roses dia, somebody picked up antibiotic calls, somebody picked with tissue paper and a piece of string, with up taking pictures and posting them,” says Snyder. “Somebody the idea that they’d sell better in a bundle. If picked up doctor detailing. There are really so many different you aren’t encouraging your team members to parts of the pharmacy that can benefit from the attention of a TYOH, why not? motivated team member.” Just one more good example from that meeting with the Good Neighbor Pharmacy business coach: Team members came away understanding how valu- ties to add a complementary OTC (over the counter) product able it is to the pharmacy’s bottom line to look for opportuni- to a customer’s purchase. And then there’s the built-in networking effect of bringing in the business coach, who sees and shares what’s working Smart Pharmacies at other GNP pharmacies. Snyder herself is always ready to use Speed Script. share where she’s having success, too. “We don’t have to run our stores alone,” she says. “There are so many resources out there for you, whether it’s what a PSAO like Elevate Provider Re-imagined. Re-engineered. Re-de ned. Network can bring, or a conversation you have with your fel- low pharmacy owners. Why reinvent the wheel when you can Speed Script provides a fl exible pharmacy learn from other pharmacists and other owners?” management system and adaptable technology services that enable pharmacies to effectively achieve their business goals. PRIORITY ONE: EFFICIENCY Featured products include Speed Script, Have you ever timed how long it takes your staff to enter a an all-inclusive pharmacy management system and Speed Script LTC, an electronic prescription into your pharmacy system? Cliff Holt sure has. facility-to-pharmacy communication portal, He learned that it took Hurricane Family Pharmacy technicians fully equipped with drug pass and eMAR between three and a half to four minutes to do the data entry, technology for long-term care providers. with phones ringing and people asking questions. How long can this take without interruptions? Holt knows this, too: Make your pharmacy smarter. about 35 seconds. The obvious solution was to put the data Ask about Speed Script today. entry technician in a space without distractions. At the same time that Holt was considering how best to do this, two of 800.569.1175 his technicians left. One had a baby and the other moved 120 [email protected] miles away. www.speedscript.com ® continued on page 24

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PrintSolutions_CompTalksMagaz_FullPg_Final.indd 1 4/27/18 4:38 PM cover story: making a difference Improving Adult Immunization Rates: Empowering Pharmacies and Patients with Information

Every year, millions of “Why don’t you just tell me what movie you want to see!” adults are hospitalized and thousands of adults die from During the 2017–2018 immuniza- vaccine-preventable diseases. tion season, OmniSYS proved the Improving immunization rates is a efficacy of personalized, targeted critical public health issue, and it recommendations from the phar- begins with helping patients un- macist for flu companion vaccines. derstand which vaccinations they Pneumococcal vaccination rates need in order to be immunized increased from an industry aver- from life-threatening diseases. JOHN KING age of only 3% to over 23% when pharmacists were provided with The pharmacy is a logical setting influenza, and pharmacists need accurate, actionable information for educating patients on recom- reliable, actionable data in order that was both patient and vaccine mended vaccines and improving to educate patients appropriately specific. 20,000 pharmacies utilized immunization rates. Patients visit on these opportunities. our vaccine management service, their pharmacy five times more Historically, determining patient which identified 800,000-plus often than they visit other health- indication for a particular vaccine companion vaccine opportuni- care providers, and pharmacists required accessing data from ties and resulted in over 180,000 consistently rank among the most multiple sources — confirming pneumococcal vaccines being trusted professionals in the United ACIP (Advisory Committee on Im- successfully administered. And for States. This combination of patient munization Practices) guidelines, patients who chose not to receive access and patient trust perfectly validating a patient’s immunization the companion vaccine during the positions pharmacists to make a history, and verifying eligibility initial encounter, the pharmacy was positive impact on immunization based on the payer’s requirements able to follow up with targeted rates. In addition, proposed merg- — which was time-consuming and educational outreach. ers like CVS and Aetna will start disruptive to the pharmacy’s work- to drive even more people to the flow. The entire process is reminis- The role of the pharmacy is evolv- pharmacy for immunizations and cent of the Seinfeld episode where ing. Pharmacies that are able to other clinical services, as risk-bear- George Costanza believes he’s embrace this evolution will not ing entities look for convenient, calling a “movie phone” service only grow their business, but also lower-cost settings of care for their to inquire about upcoming show make a positive impact on adult membership. times, which in actuality is nothing immunization rates and overall Although 25% of all influenza more than his friend Kramer on the population health. CT vaccinations are now administered other end trying to guess which John King is the chief executive officer of in the pharmacy, less than 3% of movie a caller wants information OmniSYS. He focuses on driving innovation patients who receive a flu shot also on. A better solution is to harness and delivering high-impact solutions that receive an appropriate compan- the power of technology in order enable customers to grow their businesses. ion vaccine. Improving outcomes to synthesize the data and simply With over 25 years of sales and operational begins by empowering people tell the pharmacist, when appro- expertise in healthcare and information with information — patients need priate, what vaccine is required. Or technology, John has devoted his career to to understand which addition- as Kramer famously blurts out at advancing health through the creation and al vaccines they need beyond the end of the movie phone scene, adoption of innovative solutions.

22 may/june 2018 computertalk may/june 2018 computertalk 23 cover story: making a difference continued from page 20

Rather than seeing these departures as a problem, Holt saw a solution. Why not GETTING CONNECTED use his VoIP phone system to its utmost As Cliff Holt shows, you can achieve and route calls to these two technicians some impressive results by taking working remotely? And why not con- advantage of the connectivity available nect them to the PioneerRx pharmacy these days. Getting the 14 Best Value system over a VPN? Now one technician Pharmacies locations that are spread

TM

working remotely answers calls from over 200 square miles connected has

M E opening until 4 p.m., and the other han- A N been a big challenge, according to X I I L M M dles the calls until closing. When you IZ O Carter High. But it’s a challenge that the IN T G Y BOT OUR call, there’s no indication that you aren’t group has met. Over time the group’s reaching the pharmacy itself. The tech- CTO, Jason Carter, has been able to use nician on duty typically concludes 80% the pharmacy management system of the calls that get routed to a person and the pharmacy’s workflow software by the IVR (interactive voice response), to build a centralized flow of data on DYNAMIC MARKETPLACE and can easily transfer the rest. And Best market pricing available everything from fills and prescription exclusively to Pharmsaver users she’s otherwise in a distraction-free en- inventory to clinical intervention oppor- vironment that allows her quickly to en- tunities and financials. ter prescriptions that are called in and TRANSPARENT & INDEPENDENT High offers several good examples of work e-prescribing, fax, and refill queues No wholesaler affiliations the impact of this connectivity. First, guaranteeing an unbiased marketplace on the inventory side, the centralized data means that Best Value Pharmacies PROSPECTIVE REIMBURSEMENT has group-level insight via reports and SOLUTIONS can task one manager with, for exam- Users are alerted to potential ple, finding out what’s not moving in reimbursement issues and offered solutions prior to purchase one store but may actually be in high demand at another location.

SOPHISTICATED ANALYSIS Then on the clinical side, the group Users have many options when it comes to can gain a unified view of medication GPI generic searches, package size therapy management (MTM) activity opportunities, & short dated parameters all fully integrated with at the different locations. “We use both Medispan datapoints Mirixa and OutcomesMTM,” says High, “and we’ve established a centralized, Cliff Holt, R.Ph., CEO at HIPAA-compliant feed of all the local Hurricane Family Pharmacy data from these platforms. Our stores in Hurricane, Utah. do have some patient overlap, and so we can see all of our MTM opportunities when she’s not handling a phone call. across the pharmacies and make sure “It is crazy how silent the pharmacy is that just one pharmacist is managing the MTM, rather than a patient getting 516.374.0920 and how much more efficient we are,” says Holt. “We’re also keeping trusted calls from different pharmacies that WWW.PHARMSAVER.NET and valued employees working for us both have him in their systems.” Much remotely and saving a technician FTE in of this data flow is facilitated by the the pharmacy at the same time.” continued on page 27

24 may/june 2018 computertalk MORE PHARMACISTS CHOOSE PIONEERRX.

Almost 40% of independent pharmacies who converted pharmacy software in the last year chose PioneerRx. That’s nearly double the sales of any other pharmacy system.*

*Based on 2017 National Survey

SCHEDULE A DEMO TODAY

PioneerRx.com | [email protected]/june 2018 computertalk | (866) 201-8958 25 cover story: making a difference Know Your Options: Printing in Pharmacy Don’t overlook the valuable role your printer plays in your pharmacy workflow. WES MOFFETT

When we think of ny — Lexmark. Lexmark was the only pharmacy technology, company willing to modify its lasers to work with dual-web labels. So why add we typically think of improvements to a second (thermal) printer, when lasers robotics, pill counters, or IVR (interactive can technically handle all of a pharmacy’s voice response). Printers are simply a printing needs? For two reasons. First, means to an end, and not thought of lasers are far more expensive to run and much until there is a problem with one in maintain than thermal. Ever hear anyone your pharmacy. And most people in our say how much they enjoy paying for the industry think of printing as something toner cartridges? Thermal has no con- the shelf talker displays, which are changed done only for prescription labels and pa- sumables. And when you need mainte- frequently. But even when we come to these tient advisory leaflets. Certainly these are nance on a laser, it is far more expensive. secondary uses, it turns out that you have the most important uses, but additional A new drum and the service to install it options. requirements often drive how printers are are very expensive and require a techni- used. Some pharmacies choose to print shelf labels cian. The primary part you replace on a with their lasers. This works fine, but puts First, a little history. In the early years, print- thermal printer is the print head. But this added use on these expensive printers and ers were dot matrix. Then the introduction is a fraction of the cost of the laser drum, wastes labels. The labels come in sheets, and of laser printers brought fast, quiet, flexible and can be accomplished in two minutes quite often you only print part of a sheet, printing to our industry. Yet dot matrix without a technician. Plus, the printer then have to throw out the remaining labels. had one advantage over laser — it was far head lasts longer than a laser drum. Other stores choose to print the shelf labels less expensive. I mention this because it One big advantage of bringing thermal at each store, but using different, portable is worth noting that we are willing to pay printers into a pharmacy is that, quite thermal printers than the ones in their phar- more in certain instances if the benefits are simply, the less you use a laser printer, macies. This may cost more in the short run, strong enough. the better for your bottom line. However, but provides for immediate label changes the primary reason that most pharma- Today, almost all pharmacies use a combi- when needed, and is highly efficient. Finally, cies use thermal printers is because it nation of laser printers and thermal print- some stores contract out this printing job, improves the workflow. With thermals, ers. Until thermal printers were introduced, and have a service bureau do it for them you can separate out the printing tasks laser printed everything in pharmacy, and with very high volume printers. still could today if needed (CVS is the lone and move your lasers from the beginning As you can see, there are more choices than holdout that continues to use laser exclu- of the fill process to the end. Think of most people think of when it comes to print- sively). So why the addition of thermal? If how many times you must reprint a vial ers in pharmacies, and that is why my com- you print everything on a laser, then you label. Now you don’t need to reprint all pany is often asked to study an individual need to use what are known as dual-web of the patient advisory information along chain’s needs and suggest what combination label sheets that marry plain paper with with it. of printers and methods would work best for labels. These are very expensive and also These are the primary benefits behind them. Technology continues to change, and very difficult to run through a laser printer. pharmacies using laser and thermal pharmacies need to change with it. CT If you try to run these through a typical printing. But what about the other uses Wes Moffett is president of Printed Solutions, which off-the-shelf laser printer, you will have for pharmacy printers? Lasers are still the specializes in helping pharmacies deploy printers and more paper jams than are worth putting best solution for printing in-store admin- labels that improve workflow and save money. He up with. That is why 100% of the pharmacy istrative reports. And they are often used can be reached at [email protected]. laser printer market went to one compa- for the shelf labels, and sometimes for

26 may/june 2018 computertalk cover story: making a difference continued from page 24 pharmacy’s workflow software, which reconciliation, and pricing services from gives CTO Jason Carter the ability to Pharm Assess to be invaluable for keep- build customized flows without the ing an eye on his entire enterprise. “I use need for a lot of IT infrastructure. these services more as the owner, than High notes that another service that my staff does at store level,” says Holt. Best Value Pharmacies has found in- “But it really does help me to be able to valuable for facilitating its multilocation have a weekly snapshot of everything model is HIPAA-compliant email and that’s going on.” cloud storage from Entrvst. The phar- macies use these services for quickly USING SPACE WISELY and securely communicating about Running out of space is often a good clinical and operational issues, and for problem for a pharmacy to have. It usu- uploading documents such as invoices ally means it’s growing. But that doesn’t and receipts to the cloud. “This makes a make it any easier to solve, with typical wide range of documents easily acces- Carter High, R.Ph., solutions being a move or a remodel. sible for our central office,” says High. “It director of legislative affairs, Cliff Holt has been fortunate enough keeps everyone on the same page.” owner Best Value Pharmacies, to have this issue at Hurricane Family Staying on the same page while oper- Rhome, Texas. Pharmacy, and was planning to do a ating multiple locations is a top priority continued on next page for Cliff Holt, too. He’s found reporting,

may/june 2018 computertalk 27 cover story: making a difference continued from previous page major remodel before he had a chance encounter with technology that offered Work Smarter, Not Harder him a different course. “I was out at TCGRx’s home office For Al Roberts, Pharm.D., and Travis Hale, Pharm.D., in Wisconsin,” says Holt. “I was there co-owners of Remington Drug in Remington, Va., looking for new packaging automation, it’s not easy to identify a sin- but kept looking over at this model gle change that has had an pharmacy setup they had with this shelving system that I thought was overwhelming effect on their so cool.” This was Beacon, a modular, success. But they certainly see high-density storage system that uses connecting with new technol- pick- and put-to-light technology to ogies that allow them to “work manage prescription inventory. “We brought this in about a year and a half smarter, not harder” as a real game changer. They’ve been ago, instead of doing a remodel,” says able to help their pharmacy grow, benefit their patients, and Holt. “We installed over the weekend add a new revenue stream opportunity by using Amplicare’s and immediately reduced our footprint for drug storage by 50%, with a lower iMedicare tool to compare Medicare Part D plans in seconds, cost than construction and no dust.” and Amplicare Restore to recommend over-the-counter sup- Beacon didn’t just impact prescription plements that can help their patients with the common side storage either. It has a direct effect on effects of nutrient depletion, eliminating discomfort filling efficiency as well, according to that can often be a barrier to adherence. Holt, by ensuring that a product that isn’t handled by automation is just Read more at www.computertalk.com/remington-drug. steps from the filling counter. “We have 50% of our scripts coming out of our robot,” he says. “The next 25% to 30% ry is now assigned to shelf locations by with the shortest expiration dates. are within reach of the filling stations computer logic, which means that he can let software do the work of figuring because we have storage drawers be- KEYING ON INVENTORY neath the counter. And then everything out the best, most efficient location for else is simply three steps away in the each bottle. The system then simply While Cliff Holt has seen a big impact Beacon shelving.” While on the theme directs the staff to the correct bottle from this new way of organizing his of efficiency, Holt made a point to for filling each prescription by lighting physical inventory, he has also found mention that what isn’t counted by the up an LED, of which there are seven tools for managing ordering to be robot goes through an Eyecon tabletop different colors allowing for up to seven important. Hurricane Family Pharmacy counter. “I would never have a pharma- technicians to be at work at the same has recently started using OrderInsite cy without one,” he says. “We have three time — plus, there’s a mobile unit. as part of a set of services offered by its Eyecons in Hurricane, and I’ve got at This system means that there’s no strug- new buying group. “We can seamlessly least one in all the rest of my stores.” gling to keep things alphabetized and order from three different wholesalers, no dealing with issues such as opening not just our primary,” says Holt. The pro- LET YOUR TECHNOLOGY a second bottle of an expensive drug cess begins with the suggested order DO THE THINKING because the staff didn’t see the one that generated by PioneerRx, which is then was already open. And the software brought into OrderInsite and divvied There’s another big change that comes directs the staff to the best bottles to fill up into three buckets that optimize for from using Beacon, notes Holt. Invento- from, such as return-to-stock or those availability, pricing, and other parame-

28 may/june 2018 computertalk cover story: making a difference ters. Holt also uses OrderInsite to track inventory usage across his locations and move underutilized stock to a location Care Plans as Powerful Tools where it’s needed. “We keep our inven- Cliff Holt’s pharmacy system vendor, PioneerRx, has tory fresh,” says Holt, “which is critical, especially with multiple locations.” made an intentional push toward making clinical services an integral and efficient part of the community pharmacist’s prac- Carter High reports that Best Value Phar- macies is also managing stock across tice. A prime example is med sync, which allows for so much its locations, and offers some good more than refills — it becomes the foundation for a pharma- examples of just what they’re looking cy’s clinical services. Aside from a proven adherence boost, for as they do this. “We take a look at a number of data points,” says High. “For med sync helps the pharmacist incorporate chronic disease example, what was the last-use date for management services into the monthly refill call. Care plans a particular item? Is it a brand name? give pharmacists another powerful tool to document clinical Does it exceed a financial threshold?” activities, with the pharmacy gaining the ability in PioneerRx When an item raises one of these flags on an inventory report, it triggers a look to automatically start care goals based on specific criteria and into just what’s going on. Is the inven- longitudinally track patients on their journey to better health. tory actually still on the shelves? Even with the perpetual inventory system Best Value Pharmacies uses, there can shows us the newest products,” she says. still be inaccuracies. If it is there, what Another area where “It also shows us current promotions steps does the location need to take to data is going to be king and has shelf talkers, too.” The advanced address the issue? “These reports can features that Snyder has through Good actually make us notice that there’s an is in patient care and Neighborhood Pharmacy and Elevate issue with a particular store, and then clinical interactions. Provider Network tie in here, since her we can say, ‘Let’s do an inventory and membership comes with an advertising see where we’re really at,’” says High. Once pharmacists budget and support for creating ads — for example, on Facebook. “For instance, take action, the next I know this month we’ll run a 50%-off LEVERAGING RETAILING challenge is to docu- coupon,” explains Snyder. “I’ll promote EXPERTISE that using Facebook, but we don’t have ment it, creating a new to know how to create that Facebook While prescription inventory may be ad ourselves. Elevate has experts who where most of the money is tied up in trove of data that will guide us through the process. I just go many pharmacies, don’t ignore your and share it with the groups I want to front end, advises Heidi Snyder. The be a major asset to reach on Facebook.” This is a smart way freestanding Drug World Pharmacies your pharmacy. to ensure the pharmacy is getting the location is, perhaps, exceptional in that most value out of the discounts it offers. it’s really more of a general store for the finding out what they are looking to town, according to Snyder, offering a buy when they walk in the store.” Snyder wide-ranging shopping experience for also stays on top of retail opportunities DATA, DATA, DATA customers. “We have a very exciting and by reading the Good Neighbor Pharma- There’s so much data available within always-changing front end,” says Snyder. cy-produced Retail Remedy magazine your technology, it takes some thought “We make sure that we are listening every month, of which you can see an to the small community that we’re in, example at abcretailremedy.com. “This continued on next page

may/june 2018 computertalk 29 cover story: making a difference continued from previous page to be sure you are using it effectively. There’s nothing worse than spending your time digging down into the wrong de- tails for your financial reports, for example. According to Is Your Sync Program Carter High, Best Value Pharmacies uses its centralized So Successful It’s flow of data to review a variety of financial metrics both by location and group wide when needed. Among these Overwhelming Your metrics are reimbursement per unit or per prescription and dollar amount spent on payroll to produce a given amount Workflow? has a big med sync of revenue. Hurricane Family Pharmacy program. According to Cliff Holt, the program At Drug World Pharmacies, Heidi Snyder is also keeping includes close to 60% of prescription volume, a close eye on the data. “You can improve your business, with the target to reach 75%, ultimately. “A strong whether it be sales, profit, or finding which doctors have med sync program is huge for efficiency and for prescribed the most,” she says. That last example is interest- managing operating costs,” says Holt. But suc- ing, and shows how your pharmacy data can really help set cess here can also create some unexpected head- a strategic direction. Snyder lists several questions you can aches, as Holt discovered when his highly moti- answer through your prescription and prescriber data. Are vated sync tech was firing off so many baskets for you seeing as much prescribing as last year? What’s your filling that the flow was causing anxiety further profit per prescription per doctor? Are there doctors working down the dispensing bench as the orders piled in specialties for which some prescriptions have more profit up. This sync technician happened to be looking than others? for a few more hours, and Holt had a pharmacist who was interested in getting an early start to the DOCUMENTING CARE day. A little creative thinking, and problem solved. Another area where data is going to be king is in patient care “I said, well, what happens if we fill our med sync and clinical interactions. Snyder is already putting technolo- prescriptions an hour and a half before we open gy to work in this area, with the pharmacists at Drug World three days a week?” says Holt. “My technician Pharmacies having access through the Elevate Provider got the extra hours she wanted. We reduced the Network to PrescribeWellness. “We get access to data about distractions, which ended up making the whole our patients’ adherence through this and that enables us to process so much faster that we saved a 40-hour see the best opportunities for med sync, for example” says tech FTE [full-time equivalent].” And right there Snyder. “We can see the people who have missed refills or you can chalk up another big win at Hurricane who meet certain criteria, such as the number of medica- Family Pharmacy for staying focused instead of tions or specific disease states. This kind of real data is one of succumbing to the distractions of multitasking. the reasons that our pharmacies consistently rate with five stars. Our pharmacists see this data and they take action.” MTM or med reconciliation,” says High. “We see the enhanced And once your pharmacists are taking action, the next clinical services networks as central to really solidifying the challenge is to document it, creating a new trove of data good relationships we have with physician offices by creat- that will be a major asset for your pharmacy. Carter High is ing a record of how we’re helping their patients get positive getting out in front of this need by making Rhome Pharma- outcomes.” cy the Best Value Pharmacies pilot location for CPESN USA’s enhanced pharmacy services model using the Pharmacist DO YOUR DOLLARS MAKE SENSE? eCare Plan data standard. “This is the tool that we really need for documenting the care interactions we’ve always had With the wide array of technology out there for better man- with our patients and the advice we’ve always provided to aging such varied aspects of pharmacy operations, there’s prescribers, as well as the more structured interactions like one thing to be careful about, notes Carter High, who is a

30 may/june 2018 computertalk cover story: making a difference member of the National Community Pharmacists Association’s technol- ogy committee. He reports that an Track Order Entry to Eliminate Errors interesting theme has come out of recent conversations in that group. Eliminating distractions and keeping your focus on “There are so many add-on services order entry is a key way to address one of the major chal- these days,” says High. “This is good, lenges to eliminating dispensing errors. That’s because the because if you have a need, there’s probably a solution out there for it. But most common error activity that is tracked happens at the two problems come up when you sign order entry stage, according to data from SoftWriters, whose up for a variety of these. First, you find FrameworkLTC pharmacy management system can record oc- yourself moving out of your pharmacy management software a lot and into currences at all steps an order passes through, broken down another tool, whether it’s software on by employee or error type. Are you tracking internal errors as your servers or a cloud-based product. they happen and getting the valuable insight into where the That disrupts your workflow. Then on errors are occurring in your pharmacy? the financial side, we see our margins getting ground down by all these ancillary fees. You bring these tools on to get a job done, but at the end of the says. “And I’m always ready to pull the month you’ve spent another $2,000 trigger on the next thing. We build a on top of your core platform fees, and piece at a time, but we learn with each that can make it really challenging to step and can apply all that as we open keep your level of service up or even new stores.” As each element of Holt’s keep your doors open. So one thing operation proves itself, he can then to remember is that you really have to package together the right pieces and watch your dollars and cents.” ramp up a new location quickly. “I have the confidence to say, OK, this is the There’s never a good technology suite that goes into one of CONCLUDING THOUGHTS time to stop looking our stores,” he says. There’s never a good time to stop for ways to improve your Keeping an eye on the horizon is looking for ways to improve your phar- important too, notes Carter High. “En- macy operations. As long as you plan pharmacy hanced clinical services networks are on turning the lights on tomorrow, you operations. As long the biggest thing out there for us right now,” he says. “I think this is going to be should be thinking about what to do as you plan on turning next. “It’s very easy to just get to work really interesting. As we gain the ability at 8 a.m. and leave at 6 or 7 and realize the lights on to bill for more services, we’re going to that, well, I didn’t touch my goals at tomorrow, you should be see how we can turn that big wheel all,” says Heidi Snyder. Her Drug World and demonstrate just how effectively Pharmacies offers a great example of thinking about we are complementing physicians and what you can do when you are willing what to do next. other providers in improving care for and eager to bring in an outside per- our patients.” CT spective and find the partners who can Cliff Holt’s advice is to not be afraid Will Lockwood is a VP and senior editor at bring you the services your pharmacy to do things a little differently. “I have ComputerTalk. You can reach him at will@ needs to succeed. a ton of technology in my stores,” he computertalk.com.

may/june 2018 computertalk 31 pharmacy forward SPONSORED CONTENT

Getting Things Done: Putting Process Automation to Work in LTC Pharmacy Saliba’s Extended Care triggers and steps, either, notes Saliba. Pharmacy, a Guardian pharmacy, is a “I’m very good from an operations per- closed-door long-term care (LTC) oper- spective,” he says. “I know what I want ation that provides pharmacy services to see happen, but I’m not the person to care facilities ranging from assisted who would be able to figure out how living to behavioral health and skilled to set it up. But the nice thing about it nursing. As is typical in LTC pharmacy, is, all we have to do is decide what we documents come in by fax or e-pre- want done. And then Integra works with scribing. Saliba’s Extended Care Pharma- us to build the rules within Logix to run cy uses Integra LTC Solutions’ DocuTrack things.” document management system, which John Saliba, R.Ph. Process automation is taking a central, greatly improves efficiency by creating President strategic role at Saliba’s Extended Care paperless workflow. Still, there are a lot Salibas Extended Care Pharmacy. “We’re looking to automate of time-intensive, repetitive tasks that Pharmacy as many tasks as we can and to aggres- put a real burden on pharmacy staff. When the request is granted, Logix sively reinvent our business,” says Saliba. Take, for example, refill authorizations. alerts the pharmacy staff. If there’s no “Our challenge over the next year or so is response from the prescriber after three In the past the workflow for this at Sali- to make sure that we keep on top of ev- tries, then Logix changes the status to ba’s Extended Care Pharmacy, according erything Logix can do and leverage it to “need to call,” at which point a human to president and owner John Saliba, the greatest level that we possibly can.” steps in. “Our technicians only need to R.Ph., put all prescriptions needing refill focus on those particular prescriptions authorization in a workflow queue. Phar- On the shortlist is automating the phar- that require a call now,” says Saliba. macy protocol required that the staff macy’s prior authorization process and “We’re down to somewhere between fax authorizations to the doctor’s office some of the communications that it has 100 and 200 prescriptions that need a up to three times, with the staff then with its customers — for example, when technician’s attention.” making a phone call if there was no a prescription is not going to be able response. Each action in this protocol That’s process automation making to be refilled for various reasons. “There required a technician’s time: to enter a huge reduction in work, and that are ways for Logix to help us automate the original refill authorization request, means that those people who were these tasks and keep track of them to initiate the faxes, and to update the managing refill authorizations more efficiently,” says Saliba. “We can’t number of faxes sent and the status of before can be deployed to some control certain aspects of the operating the request. The queue could stretch to higher-complexity function. “That’s environment, like reimbursements, but 500 or 600 requests that the staff was better for them, and it’s better for what we can do is focus on maximizing managing, each at its own stage in the the company,” says Saliba. our efficiency so that we’re able to not protocol. You don’t have to be a process automa- only survive but thrive, as we’re tasked tion expert to set up Logix with the right with doing more and more with less.” CT That was the past, though, and John Sal- iba has now put Integra’s Logix process automation to work on this process. So Plus: Integra LTC Solutions’ Louie Foster on the power now, as soon as the pharmacy prints of Logix process automation to address: prescriptions that need refill authori- • High levels of facility-specific complexity better than compiled software. zation, they go right into the queue in • Integration of disparate communications channels, from fax to DocuTrack, and Logix automatically runs DIRECT message to Slack. the protocol, faxing the requests at reg- • The need for a clear ROI from your technology investment. ular intervals until the limit is reached. www.computertalk.com/integra-ltc-logix 32 may/june 2018 computertalk pharmacy forward SPONSORED CONTENT

It Makes Sense: Enhanced Inventory Control with a Counting Machine When the California State Board location performs monthly C-II inventory of Pharmacy revised its regulations to man- counts and quarterly C-III to C-V counts, date a quarterly physical count of Schedule supervised by a pharmacist. Additionally, II medications starting April 1, it raised Kinney pharmacies back-check every eyebrows. And concerns. And awareness. narcotic stock bottle with the counting machine immediately after every Rx fill. “By That’s good, says Virginia Herold, executive maintaining solid control, we are prevent- officer of California’s board. “I can’t say the ing narcotics from getting into the wrong new policy was warmly accepted across the hands. The chances of something being whole state,” she says. “And I acknowledge stolen or lost is dramatically reduced. It’s a that physical counts are a lot of work. But powerful deterrent,” says Adsit. we are strongly concerned that too many pharmacies are estimating — not physically Gordon Wong, owner of Knolls Pharmacy, counting. We are doing this in the interest Pacific Palisades, Calif., knows some of his Gordon Wong using his KL1Plus of public safety, and helping pharmacies colleagues are scrambling with California’s at Knolls Pharmacy for inventory new inventory frequency rule. He’s even keep themselves out of trouble.” count. received calls to borrow his Kirby Lester California used to mandate biennial C-II and spatula? There are three commonly cit- counter. “I don’t know how anyone could counts (the same as the DEA), so the move ed reasons: 1) habit, 2) fear of new technol- do a physical inventory count without a to quarterly was a bold statement. Is the ogy, and 3) cost. All three reasons are feeble tablet counting device,” Wong says. “With- Golden State setting a new standard? Will at best, and dangerous at worst, says David out my Kirby last Saturday when I did my more state boards require more frequent Adsit, director of pharmacy operations for inventory, I would have been one unhappy counts and levy stricter penalties for non- Gouverneur, N.Y.-based Kinney Drugs. guy. Easily it would be double the time, and compliance? That remains to be seen. Says more than double the worry.” Herold, “When it comes to opioid control, “To err is human, and if you’re counting by we are all looking over the fence seeing hand, the chances for error are a lot higher Albertsons-Safeway pharmacies in Califor- what our neighbor is doing.” than a machine,” Adsit says. “You couple nia and across the country know they’re that with the efficiency and time savings, well-situated for inventory accuracy. Since In other words, inventory rules will likely and it just doesn’t make sense to NOT use a 1973, they’ve standardized on Kirby Lester tighten before they relax. What does this counting machine.” counters, now in all 2,100 locations. “The mean for pharmacy managers? More fre- time saved as well as the improved count- quent counts drain staff time, thus impact- Kinney Drugs, which operates 77 pharma- ing accuracy provides our pharmacists ing profitability. Pharmacy management is cies in New York state and 22 in Vermont, more time to counsel and educate patients, tasked with finding the most economical, has used Kirby Lester counters since the late leading to a win-win situation for everyone time-saving method possible, since physical 1980s. The tabletop-sized machines are as involved,” says Dain Rusk, Albertsons group inventory should be done during off-hours vital to Kinney’s inventory strategy as any when prescription filling can’t deplete stock computer software. And their fleet of pill VP of pharmacy operations. CT levels. Hand-counting is more time-con- counters gets plenty of work; every Kinney suming during a physical inventory (taking 2 to 3 times longer) and significantly less New Inventory Management System? accurate than a bench-top counting Mitch Archer, senior systems analyst at device (95% versus 99+%). In an age where PioneerRx, offers eight steps to get the most pharmacies are mired in red tape for being off even one Norco, why would pharmacies out of any perpetual inventory system. consciously opt for the higher risk of a tray www.computertalk.com/archer-inventory

may/june 2018 computertalk 33 pharmacy forward SPONSORED CONTENT

Technology-Guided Packaging: Better Med Organization at Masonic Villages

The Masonic Villages of Pennsylva- with the specific NDC that’s being billed nia provide a full continuum of retirement for. After the medication bottle is scanned, living, personal care, and nursing services the lights guide the technician to drop the at five locations across the state. The medication into each blister by illumi- Masonic Villages Pharmacy services its Eliz- nating the appropriate blisters on-screen, abethtown, Lafayette Hill, and Warminster as well as under each patient tray. The locations. The 1,400-acre Elizabethtown pharmacist check is just as smooth, driven campus serves over 1,870 residents in by the same combination of barcode retirement living, personal care, a 453-bed scanning and lights. “At final verification, skilled-nursing and memory support the pharmacist selects the order to be facility that includes a 48-bed transitional When Don Brindisi, R.Ph.,saw TCGRx’s checked, and SmartCardRx visually iden- care for short-term rehab, and a children’s new SmartCardRx packaging technology tifies the type and number of pills that home. Pharmacy manager Don Brindisi, at a trade show last summer, his first re- should be in a blister cell,” says Brindisi. “If R.Ph., is a big proponent of adherence action was, “How soon can we have it?” anything’s not right, then you can’t go any packaging, and the pharmacy has used leaving short-term rehab, and then pro- further. That’s big for preventing errors.” TCGRx’s ATP® and InspectRx® automation vides a full set of medications synced and “The cost justification has been easy to to provide residents with strip packaging packaged for them to take home, easing see,” says Brindisi. “What used to take two for some time now. Until recently, the that transition and supporting their return technicians and a pharmacist an entire pharmacy was still packaging weekly to independent living. day, now takes one tech and a pharmacist plastic pill organizers for 80 to 90 residents just an hour or two.” completely by hand. Multimed blister cards are a big plus for residents, and they’ve become exponen- Masonic Villages’ approach of offering Until, that is, Don Brindisi, R.Ph., pharmacy tially easier and safer for the pharmacy to different adherence packaging to meet manager, saw TCGRx’s new SmartCardRx™ produce, now that the process is driven the needs of different residents illustrates light-guided packaging technology at by SmartCardRx with a sync program an important fact: There isn’t one pack- a trade show last summer. Brindisi’s first layered on top. The staff no longer needs aging methodology that’s going to fit all reaction was, “How soon can we have it?” to manage the average of 12 prescriptions patients. “I think you have to offer multiple per resident as they come due for refills methodologies,” says Brindisi, “but you SmartCardRx enables the pharmacy to fill at different times over the course of the also have to find the ways to do this as up to four cards at a time, whether for one month. “We would spend time refilling the efficiently as you can. The accuracy and patient or multiple patients, using a vari- medications one by one and then have speed of SmartCardRx that comes from ety of multimed blister card styles. At Ma- to have to spend time to fill all the actual barcode scanning and the fill-to-light sonic Villages, this means gaining a level plastic pill organizers,” says Brindisi. process makes a major difference for us. of efficiency and accuracy that allows the When we can take a packaging option like pharmacy to fill and dispense a four-week Brindisi sees the efficiency and accuracy multimed blister cards that we know our supply for residents at one time. Providing of SmartCardRx coming from the bar- residents want, and that we know is vital residents a four-week supply helps them code-driven, fill-to-light technology. First, to their adherence and make the whole stay independent and adherent with just the barcoding: A staff member scans the process around it easier for our pharmacy, one visit to the pharmacy each month. barcodes on the blister trays to assign to that’s a big win for us.” CT Blister cards are also part of Masonic that patient order, then scans the medica- Villages’ meds-to-home program within its tion stock bottle, which ensures the right To learn more about TCGRx transitional-care unit. The pharmacy does drug and right dose for the right patient. and SmartCardRx, visit www.tcgrx.com/ a medication reconciliation for residents This ensures that the technician is filling products/smartcardrx.

34 may/june 2018 computertalk george’s corner

A Pet Peeve George Pennebaker, Pharm.D.

I HAVE A PET PEEVE. I expect watching TV, count the number of drug it is one of your peeves as well. Maybe Our country is famous ads versus ads for other products. When together we can figure out what to do for the “snake oils” reading your favorite magazine, count about it. the number of pages devoted to drug sold from the back of ads versus ads for other things. Most It concerns the public media. We all print prescription drug ads are three see it every day. It is mildly irritating for horse-drawn wagons pages, only one of which is read. TV ads many and very bothersome for some. in the 1800s. Some have a long list of reasons to not take My reaction is frustration and higher the product; these reasons are rapidly blood pressure every time I see it. had dangerous stuff read while people are dancing on the seashore. If you don’t watch TV much, DRUG ADVERTISING! in them. All were sold check out CNN or “60 Minutes.” You will find it everywhere, every day, in using the advertising Why do we have this problem? Money. newspapers, magazines, and especially Follow the money. Drug companies on television. techniques of the spend billions of dollars every year on There are two types of drug ads: those time — printed ads. These ads sell the products very that advertise prescription-only drugs flyers and, especially, well. If they didn’t, billions would not be and those for nonprescription drugs spent. Media companies obviously like and other medical products. testimonials. It worked the income. So the perpetrators (man- ufacturers and media) want to keep it PRESCRIPTION-ONLY then. It still works now. the way it is. They spend another “huge bunch” of dollars making sure it stays the DRUGS way it is. Any politician who even thinks the product or try to talk the patient out Prescription drug ads usually end with out loud about the problem would be of it. If it could cause harm to the pa- happy couples dancing and prancing harming campaign resources ($$). on the seashore or in sylvan meadows, tient, the prescriber will explain that and or holding hands in bathtubs. not prescribe the requested product. I once tried to get a newspaper that If not harmful, even if it does no good, does investigative reporting to investi- The ads claim that the product is some or is more expensive than alternatives, gate the economics of the drug indus- percentage better than its competitors. prescribers will often prescribe it just try. Boy, was that a dead end. Often there is statistical “data” that is to keep the patient happy. A happy pa- difficult to fathom. Statistical claims are tient comes back; an unhappy patient NONPRESCRIPTION easy to manipulate unless subjected to does not. PRODUCTS rigorous criteria coming from scientific Here’s an idea that I have that could methods. Understand that the United States is the only country that allows the advertising make lots of money if the media is used Each ad ends with “Ask your doctor of prescription drugs. well. The product would be called “No- about …” Responsible prescribers are continued on next page faced with a dilemma: Either prescribe The next time you spend an evening

may/june 2018 computertalk 35 george’s corner continued from previous page

Here‘s an idea that I bleed” for people who have nosebleeds. WHAT TO DO? It would be a very small tube of tinted have that could make The first step is education. No one petroleum jelly. The active ingredient should graduate from high school name I would use is “petrolatum” (just lots of money if the without knowing how to analyze pro- different enough to confuse) and the motional materials. That includes some chemical name of the tint chemical. I media is used well. basic understanding of statistics as well would do a mass email-Facebook-Twit- The product would as how to determine the veracity of ter search for people who often have written and oral statements. nosebleeds. Provide the “bleeders” with be called “No-bleed” a sample and require that they tell me A most important change would be to how well it worked. I will acquire a lot of for people who have require that the adverse effects of the testimonials. product receive the same emphasis as nosebleeds. I know the positive aspects. Adverse effects Put those testimonials into an advertis- that sounds silly, but need to be just as bold and included in ing program. Refer people to a website the body of the first page of written ma- that has a video that extols the product take a close look terials and the first paragraphs of verbal values and testimonials. End the video materials. by telling them how to buy it online for at some of the ads However, those two changes are diffi- at least $20 a tube (plus shipping and cult to achieve and have limited impact. handling). in magazines and More effective actions are needed. Do Then get ready to go to the bank. newspapers and on you have any ideas? I would like to see I know that sounds silly, but take a close TV. Things as silly as them. No matter how silly or impractical look at some of the ads in magazines they may seem, please share them with and newspapers and on TV. Things as the above example me. Perhaps we can get something silly as the above example are being going that is beneficial to our country’s promoted. Those ads would not last for are being promoted. people. CT long if they were not successful. George Pennebaker, Pharm.D., is a consultant Our country is famous for the “snake using the advertising techniques of the and past president of the California Pharmacists oils” sold from the back of horse- time — printed flyers and, especially, Association. The author can be reached at george. [email protected]; 916.501.6541; and drawn wagons in the 1800s. Some had testimonials. It worked then. It still PO Box 25, Esparto, CA 95627. dangerous stuff in them. All were sold works now.

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36 may/june 2018 computertalk viewpoints

Tim Kosty R.Ph., M.B.A.

Merger Mania Accelerates Don Dietz R.Ph., M.S.

MERGER MANIA HAS accelerated in the healthcare market, All sectors of the pharmacy market are and pharmacy is a key factor driving impacted by these proposed mergers. these new alignments. Recent mergers that have caught our eye include: • CVS/Aetna administrative location, headquarters, be created to drive patients into the • CIGNA/Express Scripts etc., there will be millions or billions retailer’s locations to receive primary • Albertsons/ Rite Aid saved by reducing overhead. Let us look care services. The ability to motivate • Walmart/Humana at these mergers in greater detail by patients to seek healthcare at retail grouping these new mega-entities by locations will be an interesting benefit All sectors of the pharmacy market business type and examine the impact design and marketing challenge. are impacted by these proposed on pharmacy. Sharing of data between merger mergers. Whether we are employees partners could drive programs offering of one of these companies, submit VERTICAL INTEGRATION: patients healthy choices, incentives claims to the PBMs (pharmacy benefit RETAILER ACQUIRING AN for healthy lifestyles, monitoring of managers) or health plans, or have our INSURER unhealthy patterns, and even insurance insurance coverage from one of these rates based upon this information. CVS/Aetna and Walmart/ healthcare giants, we will be directly Perhaps loyalty programs could have Humana affected by the new business models crossover activities between the retailer and alliances being created. Three Both CVS and Walmart are purchasing and the insurer. out of four (exception: Albertsons/ a health insurance company with the Finally, in both situations, there is an Rite Aid) of these mergers are vertical expectation that the retailer would gain existing long-term business relationship integration plays that will influence the a preferred pharmacy network position between CVS and Aetna and between supply chain, concentrating power in for patients to obtain their prescriptions. Walmart and Humana. What is the risk larger organizations. As this column is CVS drives 70% of its retail sales via the to CVS and Walmart in these situations? written, the Federal Trade Commission pharmacy department, while Walmart Losing a big client! These mergers (FTC) has not approved or challenged Pharmacy is an estimated 5% of sales. ensure that CVS will not lose Aetna these mergers. A key dynamic, in our The expected increased capture rate for its PBM services, and that Walmart opinion, will be the expanded data pool of prescriptions for the insurance lives and Humana will continue their strong for these organizations to mine and will increase prescription volume for marketing programs, especially in make better, more informed decisions these chains and negatively impact Medicare Part D. for themselves and, hopefully, their the prescription volume for the other patients. chains. Another benefit is that CVS Retail pharmacies should expect and Walmart employ hundreds of All of these mergers forecast more difficult access to Aetna and thousands of people who could now administrative costs savings by Humana patients as preferred have their healthcare insurance directed consolidating office functions — i.e., networks are created and/or expanded. to their new partner. you don’t need two accounting Reimbursement rates will become departments. Assuming these Both sets of merger partners point continued on next page corporate giants can decide on a single to a new healthcare model that will

may/june 2018 computertalk 37 viewpoints continued from previous page

more aggressive, and performance should prove profitable. The number networks that reward positive health The healthcare of pharmacies will be comparable outcomes should become a standard market will continue to Rite Aid before the divestiture of offering. It should be easier for CVS/ 2,000 pharmacies to Walgreens. The Aetna or Walmart/Humana to hit the to undergo access to additional data will not be performance standards, because they dramatic changes, as compelling as the health insurer will have access to medical, pharmacy, mergers, but can still provide insights and front-end utilization data. and pharmacy into changing consumer dynamics. must adapt to the VERTICAL INTEGRATION: IN SUMMARY HEALTH INSURER BUYING A outcome. PBM The FTC is the wild card in these mergers. Will the FTC agree with the CIGNA/Express Scripts HORIZONTAL potential synergies that the merger INTEGRATION: TWO Watching CVS partner with Aetna and partners have identified, or view them RETAILERS MERGING knowing that OptumRx is connected as reducing competition? We are with UnitedHealthcare, it is not Albertsons/Rite Aid actively watching the Department of surprising that CIGNA targeted Express Justice in its review of AT&T’s planned This coming together of a large Scripts (ESI) for acquisition. This will acquisition of Time Warner for insight supermarket operator with pharmacies enable CIGNA to provide comparable into the outcome of the proposed and the remaining 2,000 pharmacies service offerings and access to data, healthcare mergers. If these mergers of Rite Aid has no vertical integration. and level the playing field with its two are all approved, the emergence of Albertsons can use Rite Aid’s PBM, largest competitors. Once CIGNA can a few large players may continue to EnvisionRx, for claims processing or detach from its current PBM, OptumRx drive market consolidation as smaller attempt to sell the business to pay (legacy Catamaran), the company will competitors decide if they can compete down the large debt of the combined leverage operating efficiencies, data in this market or must align with one of organizations. Usually when an sharing and data mining, and enhance the big-three health insurers to survive. acquisition is announced, the shares clinical offerings. Again, retail pharmacy This is the core question the FTC is of the target company rise with the should expect more limited networks, wrestling with, and all stakeholders will expectation that the offer will be a perhaps performance networks, all be lobbying to influence its decision. premium to the current share price. accompanied by more aggressive base Either way, the healthcare market will Unfortunately for Rite Aid shareholders, reimbursement rates, unless you are a continue to undergo dramatic changes, the opposite has occurred, and the “high performer.” and pharmacy must adapt to the stock price is down almost 30% since outcome. What changes are required the merger was announced. Rite ESI has marketed itself as an will be a topic for a future column. CT Aid shareholders continue to suffer “independent” PBM, and that will now financially and may not vote to approve Tim Kosty, R.Ph., M.B.A., is president, and change. It will be interesting to see the merger. Don Dietz, R.Ph., M.S., is VP of Pharmacy how CIGNA competitors that are using Healthcare Solutions (PHSI), which ESI for PBM services will react. Will Reducing administrative overhead by consults with pharmaceutical manufacturers, they keep their business at ESI, or look combining headquarters may prove PBMs, retail pharmacy chains, and for alternatives? No doubt CIGNA/ESI challenging. But the opportunity to software companies on strategic business will insist there is a fire wall between cross-sell Rite Aid private-label items and marketing issues. The authors can be reached at [email protected] and organizations, but direct competitors in Albertsons stores and Albertsons [email protected]. may have a different perspective. private label foods in Rite Aid stores

38 may/june 2018 computertalk technology corner

High-, Low-, and No-Tech Joshua C. Hollingsworth Pharm.D., Ph.D. Approaches to Medication Brent I. Fox Adherence Pharm.D., Ph.D.

“DRUGS DON’T WORK IN adherence, all with varying degrees the American Pharmacists Association patients who don’t take them,” as former of evidence as to their effectiveness. in 2016, they found that such a system U.S. Surgeon General C. Everett Koop, Some approaches are low-tech. Others helped them identify and subsequently M.D., famously said. Medication adher- are bleeding-edge technology. The counsel those patients who were not ence — the extent to which a patient approach chosen depends greatly on achieving adequate blood pressure takes medication as prescribed — is the patient, his or her perceived barriers, control due to nonadherence. As more requisite for their therapeutic effects to and the medication. Seeing as this is a digital pills come to market, we expect be fully realized, including the minimi- column about technology, we’ll start to see more robust studies exploring zation of disease progression and the with the high-tech approaches and their effect on medication adherence. risk of major sequelae. For instance, work our way down. Smart pill bottles. Smart pill bottles adherence to antihypertensive med- Digital pills. A digital pill is a medi- incorporate sensors, either in the bottle ications that properly manage blood cation embedded with a sensor that or the lid, that record actions related to pressure can decrease the risk of heart transmits adherence data (i.e., if and the bottle itself (such as removal of the failure, coronary heart disease, stroke, when the medication was taken) lid) and timestamp each time an action peripheral arterial disease, and renal dis- through a patch worn by the patient is taken. In the case of smart pill bottles ease. Since most medications are given to a mobile app. Patients can use the that record the lid being removed, in oral form, such as pills, capsules, etc., app to access the data themselves. each opening and closing serves as a and are dosed only once or twice daily, They can also allow caregivers and surrogate marker for medication admin- one may think that adherence would healthcare providers access to the in- istration. Smart pill bottles are com- be a nonissue. But as pharmacists and formation through a web-based portal. monly used in research to simply track pharmacy technicians, we know that We discussed digital pills in the previous medication adherence. However, since this could not be further from the truth. installment of this column, including they can provide medication alerts It is estimated that three out of four the first digital pill, Abilify MyCite, which and reminders, and their data can be Americans are nonadherent to their was approved by the FDA in November shared with healthcare providers and prescribed medications, and adherence of 2017. Something we did not mention caregivers, smart pill bottles can also be generally decreases as the pill burden, is that, according to the drug’s labeling, used in efforts to enhance medication or number of prescribed medications, its ability to improve medication adher- adherence. Available products include increases. Medication nonadherence ence has not been shown. Still, one can Medication Event Monitoring System greatly increases mortality and health- easily see the value in such a system. (MEMS) Caps, AdhereTech, and Pillsy, care costs. In the United States, it is And, specific to antihypertensive med- among others. Similar to digital pills, estimated that about 125,000 deaths ications and blood pressure manage- smart pill bottle systems can be used and $100 billion to $289 billion in med- ment, there is evidence of benefit when to identify and subsequently counsel ical costs per year are directly linked to the adherence data from digital pills nonadherent patients. Unlike digital medication nonadherence. is shared with pharmacists. In a small pills, these systems can be used with There are several approaches available study by Kevin Noble and colleagues, any medication dispensed in a vial. that was published in the Journal of that are meant to address medication continued on next page

may/june 2018 computertalk 39 technology corner continued from previous pages

Mobile apps. Yes, there’s an app rate sections for days of the week and cific barriers is also crucial. Forgetfulness for that. In fact, according to a 2015 times of day. This sorting can be done is a top-cited barrier for many patients. study by the University of Arkansas for by a caregiver, a healthcare provider, or To address this, help patients identify Medical Sciences, there are over 450 patients themselves. Pillboxes simplify appropriate context cues that can be medication adherence apps. And this matters when it comes time to actu- used to remind them to take their med- number has surely increased since ally take the medication. Pillboxes are ication. For instance, if the medication 2015. These medication adherence especially useful for forgetful patients, is to be taken every morning, and your apps offer varying functionality, such as as they can verify whether they have patient drinks coffee every morning, scheduled reminders, drug interaction taken their medication for the day by then mentally anchoring the taking of warnings, refill alerts, health marker visually inspecting their pillbox. Medi- the medication to drinking his or her tracking (e.g., blood glucose, blood cine-On-Time is a similar and effective morning coffee can be helpful. Further, pressure, etc.), and sharing of data with solution, with the added benefit of the medication can be kept near the caregivers and healthcare providers. The having the filling pharmacy prepackage coffee so that it will be seen when the aforementioned study identified the complex medication regimens into coffee is being prepared. Other com- following free apps as being the most calendar cards. The calendar cards re- mon barriers to consider include costs trustworthy: Mango Health, MyMeds semble pillboxes that are clearly labeled and adverse effects or fear thereof. Medication Management, MediSafe and color-coded to indicate the time Meds and Pills Reminder, and Dosecast of day that the medication should be Here we have covered several ap- Medication Reminder. Mobile apps such taken. In addition to low-tech pillboxes, proaches that can be used to improve as these can be used by patients to smart pillboxes are also available. They medication adherence. Some, such as improve their medication adherence. function very similarly to smart pill bot- digital pills, digital pill bottles, and text tles and can be used to remind patients messaging, are generally driven more Text messaging. We covered the use when and how to take their medica- by healthcare providers, while others, of text messaging in pharmacy in a pre- tions, monitor when the medication is such as the use of pillboxes and mobile vious installment of this column. When taken, and generate dashboards and apps, can be driven by patients, provid- used alone, scheduled text messages reports that can be shared with caregiv- ers, or both. No matter the approach can be used to remind patients to take ers and healthcare providers. used, patient counseling is crucial to their medications at the appropriate setting expectations and addressing time. This approach has been shown to Patient counseling. Although there barriers. What approaches do you take significantly improve medication ad- is no technology involved, we would when working with patients to address herence, at least in the short term. Text be remiss if we did not mention the medication adherence? Let us know. messaging could also be combined importance and power of a pharma- We welcome your comments and with digital pills or smart pill bottles, cist talking to his or her patient when questions. CT allowing an approach that targets it comes to medication adherence. In Joshua C. Hollingsworth, Pharm.D, Ph.D., is medication nonadherence as it occurs. order for patients to take a medica- an assistant professor, Pharmacology and Bio- Given that nearly every adult now has tion appropriately, they must be fully medical Sciences, Edward Via College of Osteo- a mobile phone, text messaging is a informed as to what this entails. It is pathic Medicine, Auburn University and Brent wide-reaching and relatively inexpen- common for patients to stop taking a sive approach to enhancing adherence. I. Fox, Pharm.D., Ph.D., is an associate professor medication because they feel that it in the Department of Health Outcomes Research Pillboxes. Although they are low-tech is no longer necessary or that it is not and Policy, Harrison School of Pharmacy. The or no-tech, inexpensive and easy-to-use working. Thus, informing patients as authors can be reached at [email protected] pillbox organizers may improve medi- to expectations in terms of duration and [email protected]. cation adherence. Pillboxes are useful of therapy and signs of effectiveness is for presorting medications into sepa- very important. Addressing patient-spe-

40 may/june 2018 computertalk catalyst corner

Marsha K. Millonig, Mergers and PBM Pricing B.Pharm., M.B.A.

IN THE PAST FEW YEARS, the CVS pharmacies that provide services And what of the new players, like Ama- healthcare industry has seen a tremen- through retail, specialty, long-term care, zon, Berkshire Hathaway, and JPMorgan dous amount of merger and acquisition and mail-order channels, coupled with Chase? There’s no question that the activity. Consider the following proposed convenience clinics, a pharmacy benefit leadership of these organizations is corporate couplings: Anthem and Cigna, manager, and pending approval of the successful, but will that success transfer Aetna and Humana, Walgreens and Rite company’s deal with Aetna, access to to the complex healthcare environ- Aid, Centene and Fidelis, CVS and Target, networks of hospitals and clinics, and ment? Sure, Amazon can likely deliver Catholic Health Initiatives and Dignity insurance provision, are the most signifi- a prescription quickly (the drone will Health. Some of these went through; cant “soup-to-nuts” example the industry always beat the drive-thru window). And others were scuttled due to regulatory has seen. JPMorgan Chase is familiar with elec- constraints. All of these changes are tronic transactions in a highly regulated driven by a desire to increase market BENEFITS? environment. Warren Buffett is, by any presence, revenue, and relevancy. Some accounting, a brilliant businessman who What remains to be seen is what benefits are within a channel, such as CVS’s has seen success across many industries. these megamergers will deliver to acquisition of Target’s pharmacies and Their announcement of the formation patients and purchasers. We all know the Omnicare, and Walgreens’s acquisition of of a new entity that would provide care challenges today — cost transparency, Duane Reade, Boots, and some Rite Aid for their employees sparked speculation affordability, access, quality outcomes, in- locations. Others are what are considered (and some volatility in the stock mar- teroperability — and skepticism abounds vertical integration, such as Centene’s ket). Few details were provided, though as to the realistic solutions these mergers stake in RxAdvance, or Cigna’s proposed leaving industry experts to ponder the might bring. Will networks continue to merger with Express Scripts. Prime options. Would Amazon really open a narrow, offering patients fewer choices, Therapeutics is owned by a number of pharmacy division, and leverage its size perhaps at better costs? Will the pro- Blue Cross Blue Shield plans and has a to negotiate significant discounts from viders in these narrower networks have strategic alliance with Walgreens that manufacturers? Would its technology be the capacity to build relationships with is designed to address both retail and able to be applied to the complexity of patients and provide more optimal care? specialty network needs. Many of these healthcare transactions, with numerous Or will increased coordination and data proposals are starting to generate con- code systems and vocabularies? The sharing result, delivering the desired cern about transparency and consumer three companies employ about one outcomes? Another consideration: If access, and the issues are rearing up in million people; is that large enough to the big payers — Aetna, Cigna, Anthem, legislatures across the country. disrupt the status quo, or will their new Humana, United HealthCare — all own a partnership offer services to others? Health plans, hospitals, pharmacies, and PBM, what options are left for the smaller payers? Can they stay independent? PBMs (pharmacy benefit managers) are IMPACTS all joining forces, hoping that by offering Will they trust that ESI, CVS, Optum, etc., a complete continuum of services, they will protect their data appropriately? These same questions can be asked will be able to leverage their purchasing Anthem must be wondering how quickly from the perspective of independent power and massive amounts of data into it can stand up to its new PBM now that or regional pharmacy chains. How will effective, efficient methods of improving CVS, which is supposed to process claims they differentiate themselves and re- care delivery and outcomes. CVS Health for them when they leave Express Scripts, is likely to be a significant case study. is intending to merge with Aetna. continued on next page

may/june 2018 computertalk 41 catalyst corner continued from previous page main viable in this new megamerger that will address some of the related ac- additional transaction charge, the PBM world? Such pharmacies are perhaps tivities behind these situations, whether loses the clinical data associated with best positioned to present themselves price increases by manufacturers or that claim and can’t accurately perform as community providers and patient ad- contract provisions that prevent phar- drug utilization review for the member vocates, as they long have. Developing macists from sharing information about in the future. new relationships with physicians and less expensive alternatives. Fifteen states have either approved working with payers to demonstrate the Many states are introducing legislation, (Connecticut, Georgia, Maine, North Car- value they deliver through the care they often referred to as the “No Gag Rule olina) or introduced (Arizona, California, provide will be critical to their relevance. on Pharmacists Act” that will prohibit Florida, Minnesota, Missouri, Mississippi, Practicing at the top of their license and health insurance companies and PBMs New Hampshire, New York, Pennsylva- ensuring they can efficiently exchange from contractually preventing pharma- nia, South Carolina, Virginia, Washington) data with physicians and payers will go a cists from telling their customers about legislation that would eliminate these long way in ensuring survivability in this cheaper ways to buy prescription drugs. practices. These states, and others, have merger-manic environment. introduced 80 bills this year that would These bills generally have bipartisan impose regulations on PBMs. Included While this recent spate of merger plans support and would allow pharmacists in these bills are language regard- may seem new or unprecedented, it’s to tell patients when their usual and ing transparency and new standards worth remembering the industry has customary (cash) price is less than the for PBM pharmacy reimbursement, seen some changes like this before. co-pay determined by the patient’s customer charges, rebate revenue, and SmithKline Beecham’s (now GlaxoSmith- insurer. This situation often arises when PBM limitations on pharmacist commu- Kline) $2.3 billion purchase of Diversified the prescription is for a generic drug but nication with customers about costs. Pharmaceutical Services (now Express could also apply to therapeutic alterna- More information can be found on the Scripts); Lilly’s purchase of PCS (now tives. Too many times a less-expensive National Academy for State Health Policy CVS Health, formerly Caremark); and alternative is available, yet patients don’t website (https://nashp.org/state-legisla- Columbia/HCA in the hospital space are know, or aren’t comfortable enough to tive-action-on-pharmaceutical-prices/). just a few of the mergers that rattled the ask their doctor or pharmacist about industry years ago. this. Mainstream media is watching as well. Recent articles in the Detroit Free Press, Pharmacies have been subject to claw- PBM REGULATION The New York Times, The Salt Lake Tribune, backs, when the difference between the But the recent activity is attracting atten- and the Washington Examiner, among actual cost and the co-pay is recouped tion. Concerns are being raised about others, have all helped to educate the by the pharmacy benefit manager. As the impact on consumers, and a rash public about these issues. Personally, an example, if the patient’s co-pay is $20 of PBM-related legislation has been in- I’ve talked with several reporters on the and the pharmacy’s cash price is $10, troduced around the country, including issue. It will be interesting to see the the PBM expects that the $20 would in my home state of Minnesota. Let me outcome of state and federal legislation have been collected and will claw back provide an example. How many times on this and whether the attention may the $10 difference. Multiply that $10 by do pharmacists see a patient pay more impact merger approval. Stay tuned! CT hundreds of patients and thousands of for his or her medication than neces- pharmacies, and it’s easy to understand sary, all because they are prohibited Marsha K. Millonig, B.Pharm., M.B.A., the motivation behind the contract from telling patients about ways to save is president of Catalyst Enterprises in language. What’s the line from Jerry money? This probably happens multi- Eagan, Minn. The firm provides Maguire — “Show me the money”? ple times a day, leaving the pharmacist consulting, research, and writing frustrated and reaching for an antacid or services to the healthcare industry. The Pharmacies need to submit the claim to pain reliever. author can be reached at mmillonig determine the PBM pricing. If they then @catalystenterprises.net. These situations are now being heard reverse the claim, not only does that by legislators, who are introducing bills take extra time and likely result in an

42 may/june 2018 computertalk conference circuit

Idea Exchange 2018

Computer-Rx held its Idea Exchange in April in Oklahoma City.

The event featured more than 20 lab sessions to give customers hands-on experience with system features, and time with exhibitors and Computer-Rx staff. The keynote presentation was given by former head of Disney University Doug Lipp. Attendees and Computer-Rx staff capped off the conference with fun and networking at Computer-Rx customer appreciation night.

Computer-Rx President Lauren Warkentine, left, and Director of Marketing Cara Sharp, discuss the history and future of Idea Attendees learn the “Ins and Outs of the Bob McFarlane, center, discusses the Exchange and Computer-Rx during the Input Process” during one of 23 lab Eyecon packaging from Rx Systems during keynote session. sessions. dedicated exhibitor time in the exhibit hall.

Business Speaker and former Disney University head Doug Lipp delivered an inspiring pre- sentation during Saturday’s key- Pharmacy professionals gain valuable From left, Breynn Sturlaugson, Chantal note session. insights into software and solutions avail- Weisenburger, and Pam Thorton from able to support and improve their pharma- Gateway Pharmacy in Bismarck, N.D. cy operations.

Attendees investigate the RxSafe Exhibitors at Idea Exchange engage with PakMyMeds solution, one of many attendees, sharing how their products and exhibitors. services help pharmacies.

Quality Assurance Tester Kenny Product Support Manager Paul Jacobsen Millemon demon- continues his classroom discussion with strates Computer-Rx interested customers in the customer innovations and success booth. new features to attendees.

may/june 2018 computertalk 43 the back page SPONSORED CONTENT

Beyond Dispensing: The Shift in Pharmacy Practice Ketan Mehta, of Micro Merchant Systems business. They could spend more time of documenting interventions that in Syosset, N.Y., has a clear message for reviewing inventory reports on products demonstrate how their actions are helping independent pharmacy owners: Pharmacists that are selling and move them to a more the patient move toward his or her set goal. need to practice spending less time behind prominent part of the store. They might We helped the pharmacy automate the refill the computer filling scripts and more time on want to spend the extra time reviewing their process and customized workflow for them, patient adherence and outcomes. Here, he most profitable patients, not just the ones enabling more communication and touch shares how he works with his customers to get with the most scripts, or set up a med sync points with the patients through automated the most out of the PrimeRx system to support program for the patients where it makes the text messages for dose alerts, refill reminders, this shift in pharmacy practice. biggest difference. Focus on reconciliation. ready-for-pickup messages, appointment ComputerTalk: Pharmacists feel the Spend time on important decisions that will confirmations — the whole nine yards. This pressures of a changing business. enhance the operations of your pharmacy. increased patient loyalty allowed the owner But you feel they should embrace CT: This is where you are coming to better manage inventory and streamline new practice models. How can they from with “go beyond dispensing?” workflow. Eventually, the pharmacy started do this? seeing an improvement in business, better Mehta: Pharmacists need to adjust their compliance, and reduced penalties through Ketan Mehta: Up until a few years ago, mindsets and look beyond just dispensing. DIR fees and audits. the prevalent pharmacy business model was, Look to what your pharmacy system can more or less, “fill and bill,” with some patient do and combine its features together, CT: Your message is one of being engagement. Now, with more focus on from intake to dispensing, all throughout proactive and innovative. outcomes, pharmacists need to change their the process. Manage your pharmacy as a Mehta: In my opinion, this is the time mindsets and incorporate creative thinking business, and you’ll find the money. When to invest in the right technology for your around how to effectuate desired outcomes you invest in technology, you are adding business. I always tell customers, instead for patient health. This entails embracing a the capacity to optimize your workflow by of focusing on cost, invest in technology pharmacy system that automates routine doing more with less, which will pay huge and automation. The resulting time saved, tasks as much as possible so that the dividends in the long run. Pharmacists play accuracy, and efficiency of operations will pharmacist can concentrate on engaging an important role in the equation for success outweigh the money invested — it is as with patients. For instance, managing by bringing their own creativity in and simple as that. refills is a big part of any pharmacy. Why determining how to spend their valuable The entire healthcare industry is in a flux, not utilize technology to automate the time and focus. which can be daunting, as you have to entire refill process — from monitoring CT: Do you have an example of a constantly change the way you work and due refills, to getting authorization from pharmacist who’s done this? operate. But this disruption can also have patients, to refilling authorized prescriptions Mehta: I have plenty of examples. We have an upside if you are willing to embrace automatically. The idea is not to shy away a pharmacy that had a straightforward goal the change and innovate to stay ahead of from technology, but to take advantage of — to improve its star ratings and reduce the curve. We need to look ahead, beyond its expansive functions that will increase its DIR [direct and indirect remuneration] dispensing. CT efficiency and give you more time to devote fees. We worked with the pharmacist to to running your business and creating review high-risk patients, set up attainable revenue. goals, implement med sync, and apply CT: What sort of time does a more an appointment-based model (ABM). This PrimePharmacy Management System streamlined workflow free up? allowed the pharmacy to counsel patients To learn more about Micro Merchant Mehta: We’re talking about saving between in a more comprehensive manner, leading Systems Inc., visit their 2018 company one to two hours a day that pharmacists to better outcomes for the patients. We profile page at computertalk.com or visit can use and put into managing their also walked them through various methods www.micromerchantsystems.com.

44 may/june 2018 computertalk ANNUAL CONFERENCE // JANUARY 2019

January 23-25, 2019 The Sanctuary Kiawah Island, S.C.

The ASAP conferences keep you in the mainstream of developments impacting pharmacy today.

The schedule allows for plenty of opportunities to network and hold business meetings.

The conferences have the reputation of being both educational and enjoyable, with top-notch speaker programs showcased in unique locations.

If you’ve never attended a conference, make the January conference a priority. You will be glad you did.

VIEW OUR PREVIOUS CONFERENCE SPEAKER TOPICS / / www.asapnet.org

American Society for Automation in Pharmacy ❘ 492 Norristown Road, Suite 160 ❘ Blue Bell, PA 19422 610/825-7783 ❘ Fax: 610/825-7641 ❘ www.asapnet.org

may/june 2018 computertalk 47 PHARMACY SOFTWARE FOR PHARMACY SUCCESS

ENHANCE IMPROVE INCREASE PATIENT CARE PROFITABILITY PATIENT SAFETY

“I love the way Liberty developed a workflow queue system so we can find where a prescription is in the process.” JIM HRNCIR, Owner, Pharmacist, Las Colinas Pharmacy

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“The system is user friendly and because every pharmacy is different, they will customize it to your needs.” JUDY HARRIS, Owner, Pharmacist, All-Care Pharmacy

www.libertysoftware.com or call us at 800-480-9603 48 may/june 2018 computertalk