elements magazine - june 2012 vol.1 iss.1

EELEMENTS

SELLiNg CarERed Cross Pharmacy knows its marketing

THE NEW WaY TO OrDEriNVENTOrY

3WaYSTO iMprOVE Ca$H FLOW

How To Fight Back

MaNagED CarE & pBMS

Don Raby, PBA Health CFO, explains

VOL. 1 ISS. 1 | PBAHEALTH.COM

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ELEMEnTS | pbahealth.com 3

Contents

departments

features

24 | Red Cross Pharmacy knows its marketing. The right branding, marketing strategies and trend spotting keep patients coming back to Red Cross fill after fill.

18 | A steady cash flow means you will be able to pay your vendors, wholesal-ers and employees. Boost your cash flow by applying these three strategies.

NEWS: The latest industry updates that matter to your community pharmacy.

TECHNOLOgY: Successful Negotiation Supplement your inventory with the new negotiator ordering solution.

BriCkS & MOrTar: Smartly DressedWhat your pharmacy staff wears can affect your business.

aCTiVE iNgrEDiENTS: generic Wave Continuesnewly released generics not set to slow down in the third quarter.

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redefining Managed CarePharmacists need to take back control of the term ‘Managed Care’ and their role in this healthcare model.

Cash FlowImprove your money management in three (easy!) steps. Don Raby, PBA Health CFO, explains how.

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5 reasons To Launch ScriptCard at Your pharmacyPatients who pay cash mean more profits for your pharmacy. Discover how a ScriptCard prescription discount card program can increase your cash claim revenue. Find the article at www.pbahealth.com/pba-scriptcard.aspx in the “Related news” section.

Don’t know What To include in Your pharmacy E-Newsletter? Try These ideas.Stuck on what to write in your pharmacy’s e-newsletter? Use these ideas to create e-newsletters that your patients will actually want to read. Find the article at www.pbahealth.com/pba-marketing.aspx in the “Related news” section.

You Don’t Need an accounting Degree to reconcile Your ClaimsReconcile your pharmacy’s third party claims the easy way. no accounting degree required. Find the article at www.pbahealth.com/pba-ensurepay-electronic-pharmacy-claims-reconciliation.aspx in the “Related news” section.

On THE WEB // Explore exclusive online content to improve your business at www.pbahealth.com.

MOrE FOr YOur MONEY: i.O.u.Collecting money when patients won’t pay up.

COMMuNiTY: Selling CareAid your pharmacy with marketing tips from Red Cross Pharmacy.

OuTLOOk: patient-Centered pharmacyHear from the new generation of pharmacists.

NOTES: Cii Ordering–Simplified Free your business from the inconvenience of CII paperwork.

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EELEMENTS

Better business. Better pharmacy.

ELEMEnTS is published by PBA Health © 2012 PBA Health

nEWS

Text Message Reminders Improve Adherence RatesText messages have their place in pharmacy. The first large-scale U.S. study linking medication adher-ence and text message reminders displayed improved adherence rates for patients with diabetes and heart conditions. The study, which included 580 employer-sponsored and Medicare members of a national PBM, con-cluded that patients who opt into a text message reminder program have significantly higher chronic oral medication adherence, and that the use of a text message reminder program assists in preserving higher rates of adherence over time. The study was published in the May 2012 issue of Clinical Therapeutics.

Generic Drug User Fee Act (GDUFA) Helps Ensure Quality and AccessibilityThe U.S. Senate has recently passed an act that will allow the Food and Drug Administration (FDA) to collect hundreds of millions of dollars in fees from pharmaceutical manufac-turing companies with the inten-tion of accelerating the review and release process of generic drugs. The act will also help enforce

FDA quality standards for both for-eign and domestic drug manufactur-ers while ensuring public access to generic products in a timely man-ner. The FDA estimates collecting $299 million in fees annually to hire additional generic drug review-ers starting in 2013 and hopes to evaluate 90 percent of generic drug applications.

Patient Blood Pressure Control a Team EffortHealthcare teams that include physicians, nurses, dieticians, social workers and especially pharmacists have been recommended by the Community Preventative Services Task Force (CPSTF). According to the CPSTF website, “team members provide process support and share responsibilities of hypertension care to complement the activities of the primary care provider.” Pharmacist involvement in medication manage-ment and adherence helps engage patients in their own blood pressure supervision and treatment plans. Thomas R. Frieden, M.D., M.P.H., Director of the Centers for Disease Control and Prevention said, “Adop-tion of this model throughout the United States would improve blood pressure control for the 68 million American adults who have high blood pressure and reduce their risk of heart attack, stroke, and other health problems.”

The Prescription Drug User Fee Act (PDUFA) Creates Concern Among PharmacistsA letter sent to the U.S. Senators and Congressmen, and signed by the American Pharmacists Associa-tion, Food Marketing Institute, Inter-national Academy of Compounding Pharmacists, National Association of Chain Drug Stores and National Community Pharmacists Association opposed the legislative reclassifica-tion of the drug ingredient hydro-

codone. The possible reclassification is due to fears that patients are too commonly abusing the drug, which can cause dependence. Opposition to the amendment, which is attached to the PDUFA bill, stands on the grounds that hydro-codone is commonly used to supple-ment or in combination with other ingredients, which in turns sets hydrocodone as a Schedule-III drug. This classification of drugs can be phoned in and refilled without a physician writing a new pre-scription, two procedures that are restricted for Schedule-II drugs. The opposing pharmacy groups wrote, “While we share your con-cerns regarding the abuse and diver-sion of these prescription drugs…these concerns must be balanced with the impact on patients who legitimately need access to these products.” Reclassification of hydro-codone also creates cost, inventory and record-keeping issues for phar-macies carrying the drug.

Find Pharmacy Products and Services in Online DirectoryThe PBA Health online product directory, which is fully searchable and categorized, was designed for community pharmacies to easily locate the products and services you need to expand or improve your business operations. With more than 65 pharmacy-re-lated vendors and organizations you can find everything from billing man-agement services to OTC products to credit card processing services. Locate the right products and services to grow your business today. Start searching our handy online directory at www.pbahealth.com/pba–directory.aspx.

Text message alerts have shown to increase chronic oral medication adherence in a recent study.


TECHnOLOGY

Since launching in January 2012, the Negotiator service has been used to create more than 2,300 orders. During the month of April alone, nearly 1,400 orders were filled and shipped. Even better, this market offering has also saved customers more than $24,000. The success of this ordering service is no surprise; it was created to enable pharmacies to meet their invento-ry needs—from primary wholesale to back-up or supple-mentary products and supplies—using the PBA Health Warehouse. When pharmacists don’t have to worry about flagging inventories or exorbitant shipping costs, they can focus on what really matters—their patients. WHAT IS NEGOTIATOR?PBA Health’s Negotiator is an online purchasing service that provides pharmacies like yours with a substantial brand and generic discount on an order-by-order basis to meet inventory needs as they arise. After minimum qualifications are met, the discount percentages start to rise. Negotiator even calculates and rewards you with an increasing discount percentage as you add additional items to your cart. Depending on your product mix, your discount can range 6%–8% or higher, and that’s on the total order of your brand and generic items. Negotiator not only gives you the power to control your discount, the service also offers you different options for payment as well. If your account has credit available, you can decide if you want to use a purchase order. You can also use your Visa or MasterCard and earn miles or re-wards, while giving yourself extended dating. The choice of a P.O. code or number is available for both options.

WHO IS IT FOR?Not everyone should use Negotiator. The service was created for pharmacies that need back-up or supplemen-tary products and aren’t on a preferred wholesaler PBA Health ProfitGuard contract. For continual savings and to take full advantage of smart purchasing techniques, consider joining Profit-Guard. “Far too often pharmacies fail to maximize the

power of information and volume. They approach the wholesalers without even knowing what a good deal is,” said Clark Balcom, Senior Vice President and Chief Operating Officer at PBA Health. “What happens after a negotiation is what matters most,” Balcom said. “That is where the real money is. Entering into wholesaler buying arrangements without the capabilities of PBA Health or ProfitGuard services is like getting on an airplane with no gauges. You can do it, but there are serious consequences.”

SECRETS TO SUCCESS• You save time by purchasing brand and generic products from one place and in one order. • You get the discount without a commitment. You won’t sign any contracts and sign-up is free. • Negotiator calculates and awards you with increasing discounts as you choose to add additional items to each individual order.• Get total order discounts on brand and generic products within one order.

WANT TO kNOW MORE?By contacting PBA Health, you can find out if Negotia-tor is the right program for your business. If so, you’ll be able to log in to Negotiator 24/7 and access our low catalog pricing, great discounts, popular items and PBA Health specials following a short, simple demonstra-tion. Don’t hesitate. Call PBA Health today at 816-245-5700 to learn more!

SuccessfulNegotiation

To sign up for Negotiator, you will need to provide the following: • Store Name• NCPDP Provider Identification Number• DEA Number• Address

• Callback Number• Contact Person• Email Address

You determine the size of your discount

6 ELEMEnTS | pbahealth.com

We all know clothing sends social signals. You would probably feel uncomfortable with a banker wearing a scruffy T-shirt and jeans handling your mortgage. And, you’d likely pass on any houses showed by a real estate agent dressed like a teenager. Wouldn’t it make sense then that clothing could also influence how patients view your pharmacy and your staff? Countless studies have demonstrated that clothing can shape people’s perceptions. What you wear can determine whether or not others view you as competent, friendly, and trustworthy—all of which are important characteristics for pharmacists to represent. Just like patients make certain assumptions about a punk rocker with tattoos or a man in a business suit, they also form opinions based on the clothing their community pharmacist wears. Except these assump-tions can affect their healthcare. Patients’ observations about their pharmacists can determine whether or not they feel comfortable communicating with them. As such, pharmacists and pharmacy owners should consider the function of work wear in best meeting patients’ needs.

THE REAl DEAl Building positive relationships with patients starts with making a good impression. The moment a patient steps up to the pharmacy counter—before you ever coun-

sel her or answer her health questions—she will have already made assumptions based on your appearance. What does it say about you? Darran Alberty, owner and pharmacist at D&H Drug-store in Columbia, Missouri, expects his pharmacy staff to dress professionally. The pharmacy techs wear dark navy scrubs, which add to the clinical atmosphere of the pharmacy. While, the pharmacists typically wear more business casual style clothes and white lab coats.

“As a retail pharmacy, it’s important for us to try to protect our professional image,” he said. “We also want to balance staff comfort at the same time. As a close working environment where you have to be on your feet all day, we want our employees to be comfortable.” Lori Bartlett, owner and pharmacist at Community Pharmacy in Nevada, Missouri, describes her pharma-cy’s dress code as “dress casual.” Besides their stan-

BRICKS & MORTAR Your Physical Pharmacy

“It’s important that we portray a professional appearance so that we’re being acknowledged for our advice.” - Lori Bartlett, Community Pharmacy

Successful pharmacies don’t underrate the importance of staff appearance

Smartly Dressed

By Kirsten Hudson


dard Friday work wear of jeans and polo shirts with the pharmacy’s logo on them, she expects her staff to look professional the rest of the week, wearing items such as khakis and professional shirts. “It’s important that we portray a professional appear-ance so that we’re being acknowledged for our advice,” Bartlett said. “We want patients to recognize the services we provide, not just associate our knowledge with pills in a bottle.”

DRESS FOR BUSINESS SUCCESSEverything in the physical environment of your pharmacy can affect how customers view your business. You know that a store with boxes in the middle of the aisles looks bad, but sometimes pharmacy owners fail to consider the role of employees’ appearances in shaping custom-ers’ perceptions. In the highly competitive retail pharmacy market to-day, consumers are bombarded with choices. When your pharmacy portrays a professional image, you can help consumers narrow down those choices, so that they will

view your pharmacy as the best choice for them. “How your team dresses says a lot about how different you are from the ‘typical’ business in your industry,” said John DiJulius, customer service expert, author and consultant. In an age of slacking dress codes, set a standard of service for your business that exceeds customers’ expec-tations. Establish a standard dress code for your phar-macists, pharmacy techs and other staff. And, remember to keep the feel of your business in mind. “Your dress code should reflect the personality of your culture. Look at the icons of their industry: Starbucks, The Ritz-Carlton, Southwest Airlines, Chick-fil-A and Apple. You know who works there and you get a certain feeling about their culture,” DiJulius said. When you set your business apart from the indepen-dent pharmacy next door or the big box store down the block by establishing a professional dress code, it gives your business added value. Pharmacy owners who promote their business’s unique values are more likely to thrive in the future healthcare environment.

Since the late 19th century, healthcare providers have commonly worn a white coat. While the white coat start-ed as a way to maintain a sterile environment (dirt and grime easily show up on white) it has come to symbolize clinical service and healthcare. Today, the white coat represents the education and credentials that come with being a medical professional. Many pharmacy schools recognize the importance of the white coat as a symbol of the responsibility and pride of the pharmacy profession by holding White Coat Ceremo-nies. In actual practice, however, wearing the white coat seems at issue in community pharmacies today. “I’ve struggled with whether we should wear the white coat or whether we shouldn’t,” said Lori Bartlett, owner and pharmacist at Community Pharmacy in Nevada, Missouri. Proponents of the white coat suggest that the white coat makes the pharmacist more easily identifiable from other staff. Darran Alberty, owner and pharmacist at D&H Drug-store in Columbia, Missouri, agrees. “If you’re in a set-ting where you’re the only one wearing the white coat, it’s pretty easy for patients to figure out who they’re talking with,” he said.

At her pharmacy, Bartlett chooses to forgo the white coat because most of her patients already know her pharmacists well and don’t need that identifying factor.

“I think by us being so approachable to our customers that they pretty much know us,” she said. “They call us by name almost 100 percent of the time.” Alberty also chooses not to wear the white coat, but he makes sure to wear his nametag to identify himself as the pharmacist. However, the other pharmacists at D&H Drugstore, (except one) do choose to wear the white coat. “I think the white coat is mostly about personal preference,” Alberty said. It’s worth noting, though, that the public has certain expectations from healthcare professionals—and that includes seeing their healthcare providers wearing the white coat. According to a 2011 study published in the Pharmacy Practice journal, which surveyed patients in independent and chain pharmacies in the Alabama area, patients overwhelmingly preferred that pharmacists wear white coats. How do you feel about wearing the white coat? Share your opinion on our poll on Facebook at www.facebook.com/PBAHealth.

The great debate: White coat or no white coat?


BRICKS & MORTAR

For community pharmacists, Managed Care is a loaded term. While the idea of Managed Care inarguably looks good on paper, it has repeatedly failed to meet its own marks in practice. It’s hard to argue with the idea of organizing the process; of bringing accountability and a case for financial liability to a healthcare delivery system that operates for the majority of people. However, there are several ‘strings attached’ to Managed Care organizations that don’t fit the proposed model for better healthcare. These ‘strings’ include inflated administra-tive costs, self-serving formularies, and most importantly, the increasing affect of Pharmacy Benefit Managers on provider-patient relationships. Concerns about Managed Care organizations can be seen on all levels and within almost all professions in the realm of healthcare. For example, the University of Wash-ington School of Medicine’s Ethics in Medicine Topic and Research guide recognizes and teaches that “man-aged care is structured around a variety of incentives to

encourage the practice of cost-effective medicine, and to minimize variation in clinical practice patterns. Mon-etary and nonmonetary incentives raise the ethical con-cern that physicians may compromise patient advocacy in order to achieve cost savings.” In effect, the Managed Care model may threaten to rush patients through their examinations, which may negate the farther-reaching healthcare goals of fewer treatments and better care. Pharmacists deal with these concerns frequently, and typically on a more frank basis than their prescribing physician counterparts. Patients don’t blame their doctor when they’re told that their prescriptions either can’t be filled or aren’t covered by their insurance. They blame the pharmacist, even if they’re informed that they need to contact their insurance companies or their employer’s Human Resources officer about their concerns. There’s still hope for the idea of Managed Care and pharmacists’ function in it. As an industry, pharmacy is changing. By adapting to new opportunities and making

By Kelsea Nore

RedefiningManaged Care

No one is better positioned to changed the meaning of Managed Care than

community pharmacists


a group effort toward revitalization, pharmacists can not only help re-define Managed Care, they can also more clearly define their role as the healthcare providers they trained to be and are—not just people who can “count to 30”, in the words of Express Script CEO, George Paz. WHAT IS MANAGED CARE?The definition of Managed Care changes according to who uses it and how. The meaning is differ-ent when corporate purchasers or directors of healthcare apply it than when pharmacists and physicians use it. Managed Care has one mean-ing to government regulators and another one entirely to patients on the receiving end. For many Ameri-cans, the term ‘Managed Care’ is simply one among many that they associate with their health insurance plans. But what does it mean, exactly? Even the United States Depart-ment of Health and Human Services (HHS) recognizes the malleability of the term in Peter R. Kongstvedt’s HHS-approved book The Managed Health Care Handbook, saying that

“managed care is discussed more of-ten than it is defined. Perhaps this is because managed care is used vari-ously and eludes clear definitions.” However, Kongstvedt (and the HHS) surmise that “managed care refers, in general, to efforts to coordinate, rationalize, and channel the use of services to achieve desired access, service, and outcomes while control-ling costs.” But is that all? Using the most common present day method to investigate, and the one most likely to be used by your patients, one of the first and most credible definitions to come from a Google search is courtesy of The United States National Library of Medicine (NLM), a division of the National Institutes of Health (NIH). The lengthy but encompassing ex-planation from the NLM states that Managed Care programs are:

“…intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical ne-cessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive manage-ment of high-cost health care cases.”

What is clearly missing from the various definitions and explana-tions of Managed Care is the most commonly agreed upon principle

of pharmacuetical healthcare management: If patients correctly take their prescribed medications for their particular disease state(s) and if they adhere to the proper medication therapy protocol and if they have their medication therapy monitored correctly, then patients have a much greater probability of avoiding the need for acute and/or palliative care. In other words, if patients take the right medicine and take it properly then they will stay out of the hospital, which will, in turn, cut down on both short-term and long-term medical costs. Community pharmacists are an integral part of that process, and

Community pharmacists are a fundamental part of the healthcare process, which is why you must be active in redefining the term Managed Care to create a better future for your profession–and your patients.


By adapting to new opportunities and making a group effort toward revitalization, pharmacists can not only help redefine Managed Care, they can more clearly define their role as healthcare providers…

that is why they must be active in redefining the term Managed Care. No one is better trained to actively engage these practices into their profession, or has more to gain from their inclusion, than commu-nity pharmacists.

HISTORy OF MANAGED CAREHistorically, the idea of Managed Care dates back to the early 20th century. Early programs operated as a sort of co-op health plan for vari-ous unions across the United States. Henry J. Kaiser, a notable early user of a Managed Care program of his own devising, created a program for the workers building the Grand Coulee Dam in Washington State. Mr. Kaiser saw the potential of providing prepaid healthcare programs for his employees and opened his popular plans to the general public. Conversely, the American Medical Association (AMA) was opposed to these plans and the control they had over people’s choice of providers. The AMA’s efforts during the 1930s and 1940s were mostly success-ful. Many states created laws that banned plans run by consumers or plans that restricted physician choice, effectively halting the cre-ation of new plans. It was not until the late 1970s and 1980s that Man-aged Care organizations came back into the national spotlight when the HMO Act of 1973 was signed. The act put millions of federal dollars toward the creation of HMOs and employers soon followed suit with their own programs.

MANAGED CARE AND PBMSThe term Managed Care has been

snatched up by the pharmaceutical benefit management (PBM) indus-try. The common consensus is that the PBM industry gained a footing in the 1970s when employers used benefits to incentivize employment opportunities. The PBM industry began as a go-between business that devised, negotiated and admin-istered prescription drug benefits for health insurance plans. Today, PBMs make their profits through administration for the plans they manage. Until recently, a sub-stantial portion of their income was made from manufacturer rebates and brand drug discount programs aimed toward prescribers. PBMs promised to pass the savings from manufacturer rebates on to the con-sumer or to the healthcare plan they represented. Too often, this was not the case, which lead to marginally low reimbursement rates for phar-macists and costly formularies (and co-pays) for patients and plan spon-sors. However, since so many brand name drugs have gone generic in recent years, major PBMs are now attempting to wring their profits from the generic drug market. For example, a 30-count bottle of 10mg Bisoprolol costs the phar-macy $14.70 or $0.49/pill and the MAC reimbursement to the phar-macy is $13.50 or $0.45 per pill. By the time the pharmacy includes the cost for a cap, bottle, label, and pay-roll (and to say nothing of overhead costs, such as rent and utilities), the pharmacist has lost well over the $1.20 initial hit he or she took on the product. The best estimates of the total cost to fill a prescription, including overhead and labor are

roughly $10 dollars. Therefore, the true cost to fill this prescription is $24.70, and the pharmacy actually loses $11.20 filling this prescription. Too many PBMs have no obliga-tion, legal or otherwise, toward transparency in their business practices for brand or generic drug spread pricing. Community phar-macies have met recent moves and mergers within the PBM industry with indignation. Organizations, such as the National Community Pharmacists Association (NCPA), state boards and PBA Health, have been heavily involved in different po-litical efforts to create legislation to prevent the overreach of PBMs into the United States healthcare system. “Now, more than ever, we must maintain a strong and unified front to ensure that a high level of patient care remains the trademark of independent pharmacy,” said PBA Health Texas Governmental Affairs Director John Heal. “Attacks to the profession come daily and we must stand together in order to combat those attacks.” PBMs have also been the biggest champions of mail order phar-macy (they stand to make the most money from this practice, after all). PBMs even go so far as to call their backroom Pharm.Ds ‘Managed Care Pharmacists’, which implies that every prescription is monitored, filled and followed up on a case-by-case basis. In actuality, Managed Care pharmacists address drug recommendations from a finance-first stance on the macroeconomic level, meaning that they do not meet or consult with individual patients and instead value the dollar first, the cure or relief of the patient second. Patients and physicians cannot easily reach mail order pharmacists should complications arise. Also, since patients receive their medica-tions in larger amounts, such as 90-day fills, there’s no sure way to monitor adherence. If patients aren’t taking their medication properly, or


If you take the right medicine and take it properly you will stay out of the hospital, which will, in turn, cut down on both short-term and long-term medical costs. Community pharmacists are an integral part of that process…

at all, any therapeutic benefit is lost. The Managed Care ideal of ‘effi-ciency’ is thrown out of the window when the repercussions of mail or-der pharmacy are looked at logically, and from the patient’s point of view. WORkING TOGETHERRetail pharmacists have traditionally provided a multifaceted offering that is unique among healthcare provid-ers. Yet, the fee-for-product (pre-scription drugs) model is no longer a sustainable way to do business for many pharmacies. Pharmacies have strived to make up for lost profits with items such as Durable Medi-cal Equipment or OTC products, yet they still continue to struggle. With the import of PBM and fed-erally defined Managed Care plans and the rise of computerized data and records, reimbursements have been severely reduced. It is im-perative for pharmacists, no matter where they practice their profession, to take action to more carefully—and boldly— define their role in the healthcare spectrum or be relegated to flat rate, zero or even negative re-imbursements for both the products and services they provide. How can pharmacists take back control of

their profession and help redefine Managed Care? Pharmacists must first fight pro-fessional apathy. Absolutely nothing can be done to expand and advocate the pharmacist’s role in outcome-based, total-patient care if those whom the movement is centered on do not prioritize these changes. Every pharmacist should be aware of his or her responsibility to ‘give something back’ to the profession and be not only proud but also will-ing to ‘pay it forward’ for the future of pharmacy. Attending conferences and legis-lative or community events is a good way to stay involved and informed on pending changes and new ideas. There are several state and national organizations that support indepen-dent pharmacy businesses. Pharma-cists should consider their mem-bership in these associations and groups as an opportunity to expand their livelihood both as an individual business and as an industry.

WHAT yOU CAN DO INDIvIDUAlly“I will embrace and advocate chang-es that improve patient care,” is the sixth tenant in the recently revised AACP Pharmacist’s Oath. Large group efforts aren’t the only way that pharmacists can expand on their roles as healthcare providers. The effects of Medication Manage-ment Therapy (MTM) have been widely espoused by pharmacists. In-store wellness classes and dis-ease education forums have also had a growing affect on the growth of independent pharmacy. Community efforts such as The Diabetes Ten City Challenge (DTCC) and the Asheville Project in North Carolina are changing the definition of Managed Care, too. These proj-ects established measurable prac-tices for pharmacists and incentives for patients with varying diabetic disease states to participate. For example, the “average total health care costs were reduced annually

by $1,079 per patient compared to projected costs if the DTCC had not been implemented.” The first rollout of the Asheville Project (which initially focused strictly on diabetics) found that

“positive results were realized by month six and have remained fairly consistent from that point forward. Positive results were definitely seen by the end of year one with every program.” Emulating a similar proj-ect or program within even smaller communities could significantly expand the independent pharma-cist’s role in Managed Care. Pharmacists must then focus on one group. It is the largest, most important, and the potentially loudest group of people anyone in a healthcare profession will interact with: the patients. In turn, the patients can reach out to the payers (their employers and insur-ance companies). Explain the importance of staying connected to one’s own community. This should be deeply stressed to your patients. Large, corporate-run pharmacies have no ties or obligations to the areas they serve. Business decisions are handed down to them from afar and are not made with the best interests of the community in mind. Remind your patients about the community pharmacy’s standards of genuine concern for their family’s health and well-being, the personalized care and the attentive staff, too. Community pharmacists are well positioned to redefine the term Managed Care and make it a con-cept that works in both theory and practice with real, outcome-based results. By taking a firm, united stance against major PBM regula-tions by creating measurable well-ness and prevention services that yield favorable results, and by asking for the voices of patients to chime in for these advocacy movements, there is no reason that pharmacists cannot redefine Managed Care.


ACTIVE InGREDIEnTS Drug news

NDC Description Manufacturer Brand Price Generic Price

00049399060 Geodon® 80mg Cap 60ea Pfizer $604.32 $218.56

00456202001 Lexapro® 20mg Tab 100ea Forest $418.02 $259.95

63653117106 Plavix® 75mg Tab 30ea BMS/Primar $193.33 $4.34

63459020130 Provigil® 200mg Tab 30ea Cephalon $926.00 $539.26

00310027460 Seroquel® 300mg Tab 60ea Astrazeneca $942.36 $29.04

00071015523 Lipitor® 10mg Tab 90ea Pfizer $337.30 $15.24

“It’s been an extraordinary year for generics,” said Rick Mingori, director of Trade Relations at PBA Health, “and there’s plenty more to come.” First and second quarter sales of first time releases for generic drugs have been steep. And, the percentage of use of generic drugs has risen in tune with the dollar amounts. Industry experts believe that more than 80% of all prescriptions will be filled with generic drugs by the end of 2012. A recent IMS Institute for Healthcare Informat-ics study (April 2011) found that last year the top 10 drugs prescribed to consumers are generic, not brand. The first and second quarters of 2012 saw the generic releases of the following brand name drugs:

Geodon® • Lexapro® • Plavix® • Provigil® • Seroquel®

Both new prescriptions and generic switches have boosted the prescription and dispensing rate of these newly released products. Also, since plan sponsors are placing a greater emphasis on members with the highest volume and cost of prescriptions, the implementation of pricing tiers that encourage generic use has increased. With drugs like Cymbalta, Nexium, Copaxone and Celebrex due to lose their prescription patents in the next two to three years, generic growth is undeniable. A recent Morgan Stanley Research study “estimates Big Pharma price increases will average in excess of 15% per year through 2016 in an effort to keep revenues up in the face of multiple waves of patent expirations.” Patients and pharmacists should also expect the continued growth of educational or preventative programs and treatments, such as Medication Therapy Management.

THE THIRD QUARTER TRIOThe third quarter of 2012 will see the generic release of three major pharmaceutical drugs: Actos®, Diovan &

generic Wave Continues into Third Quarter

Diovan® HTC, and Singulair®. Actos®, or Pioglitazone Hydrochloride, was previously manufactured by Takeda Pharmacueticals. The drug is used, in conjunction with changes in diet and regular exercise, to treat Type 2 Diabetes. Diovan® & Diovan® HTC, which will be known generical-ly as Valsartan, was manufactured exclusively by Novar-tis. This drug is used to treat hypertension and has also been used to treat symptoms of congestive heart failure. Lastly, manufacturer Merck’s heavily prescribed brand drug Singulair® will be released under its generic name Montelukast. This drug, taken orally, is used to treat asthma symptoms as well as seasonal allergy symptoms such as wheezing, sneezing and trouble breathing. PBA HEAlTH’S FIRST FIll PROGRAMUnderstanding the value and relative safety of generic drugs, your patients probably request the generic equiva-lents of brand drugs all the time. When you’re a mem-ber of PBA Health’s First Fill program, you can acquire new generic product immediately with guaranteed sale, special discounts and, most importantly, 30-day price protection in a market with rapid price erosion. Pharmacists who opt into the First Fill program will automatically receive shipments of newly released generic (and brand, depending on market potential) pharmaceuticals immediately after the approval date. All of the products in the PBA Health Warehouse, including First Fill products, meet our high safety stan-dards. You’ll receive only top-quality, well-maintained products every time you receive a First Fill shipment through our VAWD-certified warehouse. All it takes to opt into this valuable program is to fill out an application. Call 816-245-5700 today and learn more about becoming a First Fill customer.

First time generic releases add to an already high amount


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Improve your money management in three steps

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>>>>Businesses, like your pharmacy, rise and fall on cash flow. After 20 years working in public and private accounting, I can unequivo-cally tell you that businesses only go bankrupt when they don’t have enough cash to pay their bills—not because they supposedly made or lost money the previous month or last year. I have seen a large manufacturing company run net operating losses for seven years straight but still re-main in good financial shape by gen-erating cash. I have also witnessed profitable companies go under simply because they consumed cash and eventually could not pay their bills. When it comes to business, your banks, vendors and employ-ees don’t care if your accountant told you that your pharmacy made money last month. They’re only con-cerned with one question: “Do you have enough cash to pay me?” You need a steady cash flow to keep cash in the bank to pay your wholesaler, your rent and your other expenses. But, what exactly is cash flow? Simply put, cash flow is the ability of a business to convert sales to cash. All collected sales are even-tually turned into cash, but there are numerous elements that affect the time it takes to convert sales to actual cash in the bank. Most pharmacy owners never stop and contemplate how they can increase their cash flow and cor-respondingly their cash in the bank, but it’s time to take control of this crucial aspect of your business. You can implement the following three strategies at your pharmacy to posi-tively influence your cash flow for future business success.

1. BETTER BANkINGDon’t neglect the importance of establishing and maintaining a good relationship with your local

banker. Your bank can do more for your pharmacy than maintain your business checking accounts. For example, a vital tool your bank offers is a line of credit. Establishing a line of credit can give you peace of mind that you will be able to cover payroll, pay suppli-ers and vendors, pay taxes, and—equally important—pay yourself. A line of credit serves the purpose of providing a short term, low-cost funding mechanism for meeting day-to-day business expenses when your normal cash flow is inadequate to serve the purpose. A line of credit can also be an effective tool to use for paying your wholesale supplier faster and thereby helping you negotiate a bet-ter cost of goods, which translates into additional profitability. Just make sure to establish a line of credit before you need it. Don’t bother calling your banker to estab-lish a line of credit the day before you realize you won’t be able to make payroll. The answer will likely be “no”. Work with your local bank to make sure they’re fully aware of you, your pharmacy business and how you make money. It’s best to over communicate with your bankers and keep them familiar with your phar-macy than to under communicate. It’ll only help you in the future.

2. RETHINk yOUR SUPPlIER RElATIONSHIPI know many pharmacy owners con-sider their wholesaler rep to be their friend. Now, I don’t want to upset any relationships, but you should always remember that you and your wholesaler have an inherent conflict of interest when it comes to your business. Your wholesaler wants to make as much money as possible from your purchases and you want to pay as little as possible for those

same purchases. Hence, the conflict. I have, over the years, found that one of the easiest areas for phar-macies to be taken advantage of is on their generic purchases. Prices fluctuate daily and are hard, or im-possible, for pharmacies to fully and consistently track and reconcile on their own. This is a dangerous com-bination that often leads to pharma-cies over-paying for generics. To provide an illustration, I received a call from a pharmacist who was upset because he had lost money on a prescription due to the acquisition cost of the product be-ing more than the reimbursement. It turns out that the problem wasn’t the MAC (even though it was admit-tedly too low). The problem was that his pharmacy was set up for “auto-substitution” with his wholesaler. He had tried to order the lower priced “contract” product, which would have allowed him to make a profit on this prescription, but it was not available for whatever reason, so the wholesaler automati-cally shipped a substitute, higher priced, non-contract item. In this case, the contract item he ordered normally sold for $39, but the item he actually received cost $127. He was reimbursed $52, so a $13 profit turned into a $75 loss. It doesn’t take too many of those deals to burn up a lot of cash! How do you address this business issue so that you maximize your profitability and therefore your cash flow? I would counsel any pharmacy to immediately get off of auto-substitution. There are few benefits to this option when you can utilize a secondary supply source like PBA Health to help address shortages or out-of-stock situations at your primary supplier instead. I would also advise pharmacies to take advantage of a service called ProfitGuard. PBA Health recently

By Don Raby, CPA, CGMAChief Financial Officer, PBA Health


PBMs have no reason to pay faster or reimburse more–they already have the covered lives and they already have your pharmacy under contract.

developed ProfitGuard for the sole and exclusive purpose of protect-ing a pharmacy’s buy-side margin by monitoring pricing and purchase decisions made by the pharmacy and providing feedback about op-portunities to buy the same product at a lower price. ProfitGuard also provides feedback on cheaper alter-natives in different package sizes or alternate manufacturers. Pharmacies who leverage the ProfitGuard service regularly in-crease their monthly margins by at least 1 to 2%. Since ProfitGuard requires little additional time to manage, this money effectively drops straight to the bottom line.

3. GET RID OF CENTRAl PAyOften pharmacies don’t understand how central pay can negatively affect their businesses, especially their cash flow. In a central pay system, the PBM sends the money due to your pharmacy in a lump sum, along with money owed to other pharmacies, to a third party contracting entity also known as a central pay proces-

sor. The PBM sends this money in one big check to the entity, along with a remittance detailing what money goes to what pharmacy. The contracting entity then passes the money along to each pharmacy. Pharmacies may incorrectly as-sume that central pay speeds up their payments, but how could this be true? Instead of the money go-ing straight from the PBM to your pharmacy, the money goes to a third party, who then processes it, cuts checks or stages ACH transfers, and then finally transfers the money to your pharmacy. This is also assum-ing they don’t sit on the money to earn interest in the meantime. Those extra steps slow down the time it takes for your money to go from the PBM to your pharmacy. Don’t believe the marketing hype for central pay models that state that the PBM pays faster through central pay or that the PBM reim-burses more if your pharmacy’s on central pay. PBMs have no reason to pay faster or reimburse more—they already have the covered lives and they already have your pharmacy

under contract. These are myths concocted by central pay processors so they can use pharmacies’ money to create profits for themselves. You may wonder how central pay processors can make money on the float with interest rates on interest-bearing accounts at 0%? The answer is in the law of large numbers. Because central pay processors lump money from a large number of pharmacies in one account, they can then sit on that money for about five days and invest a portion of it in government securities to earn quick, but signifi-cant interest. And just think, some pharmacies actually pay extra to be on central pay! The average of five days that central pay processors sit on the pharmacy’s money isn’t an arbitrary number. I drew from our experi-ence at PBA Health. We’ve found that pharmacies that switch from central pay models to TriNet, our non-central pay third party network, see an average pick up of about five additional days of cash flow on their receivables. In other words, pharmacies find that they receive their money directly from the PBM about five days sooner than they did through central pay, which signifi-cantly improves cash flow. Want to get a clear picture of your pharmacy’s cash flow? Find out how to measure your cash flow and learn the basic calculations to positively influence your cash flow in two exclusive white papers written by Don Raby, CPA, CGMA and Chief Financial Officer at PBA Health. Complete with formulas and step-by-step instructions, these informative white papers will give you the tools you need to improve your money man-agement. Download the white papers by going to www.pbahealth.com/pba-profitguard.aspx and clicking on ‘Cash Flow: Improve Your Money Manage-ment In Three Steps’ in the “Related News” section.


Don Raby, CFO at PBA Health and CPA, knows the math behind how to increase your pharmacy’s cash flow. By applying a few simple strategies, you too can take control of this crucial aspect of your business.

MORE FOR YOUR MOnEY

A pharmacy calls to tell you that your patient has re-quested to transfer her prescriptions. While not a situa-tion you want for your business, as part of the nature of the pharmacy industry, you likely have to deal with trans-fers occasionally. Then it gets worse. You realize that the patient still owes you money from previous prescriptions. Occasionally a patient can’t afford a copay and will start a “tab” with your pharmacy. Or, a patient will create a substantial balance on a charge account by only paying off a small portion at a time. Then, patients will transfer their prescriptions to avoid paying their bills. What can you do to make these inconvenient patients pay up? Most state laws forbid withholding a prescription transfer because of monies owed. The Louisiana Board of Pharmacy even states that you can’t hold a patient’s prescription “hostage” just because the patient owes you money (no matter how much you might want to). If, however, your state considers transfers more of a cour-tesy than a requirement, you can refuse to transfer the prescription until the patient pays the bill. In these situations you have few options. Patients can simply contact their physicians for new prescriptions, fill them at another pharmacy and effectively avoid paying their balances to your pharmacy. As a business transac-tion, patients still have a financial obligation to pay for their prescriptions, but going through the costly legal process of filing a lawsuit, hiring a collections agency or going to small claims court to collect the debt likely isn’t worth your time and money. To avoid this situation in the future you should rethink how your pharmacy handles past due bills. Actively work-ing to prevent these situations before they happen will make your pharmacy a more profitable business.

Pick and chooseAs a community pharmacy, you likely know your patients well. If your pharmacy provides charge accounts or “tabs” as a courtesy, only offer the service to patients who you know will pay their bills regularly. Sometimes situations happen where a son or daughter takes over an elderly parent’s affairs and doesn’t pay the parent’s medication bill, but you can avoid most costly situations by only offering the service to your best customers.

Get it in writingCreate a charge account contract for patients to sign. In case you ever do need to go through the legal process of collecting a substantial debt, providing legal docu-mentation is crucial. With documentation on hand you can also use it as leverage to remind patients with over-due bills that they signed a legally binding contract to pay for their prescriptions.

Send reminders and make personal contactOnce a bill hits overdue, send patients consistent invoic-es. If they use email, then regularly send past due email notices to patients with outstanding balances. Or, send the invoices through ‘snail mail’ in a big priority envelope that screams “Important”. If patients with overdue bills come into your pharmacy to pick up refills or to fill new prescriptions, ask them if they would like to add on their past due bill. Face-to-face communication will likely improve the chances of getting a patient to pay a bill in full.

Stop filling their prescriptionsOnce an overdue bill hits a certain amount, refuse to fill the prescription until the patient pays the bill. As a community pharmacist you want to get your patients the medications they need, but you have to find a balance between your role as a pharmacist and your role as a business owner. Continuing to fill prescriptions for pa-tients with overdue bills isn’t profitable for your business.

Rethink the serviceConsider whether the costs of offering charge accounts or “tabs” outweigh the benefits for your business. Even if you set an interest rate for past due bills on your charge accounts, one bad account may create more costs for your business than the entire service is worth. In the long run, paying the fees for processing credit cards may be less expensive than providing charge accounts. No matter how convenient you make it for patients to pay their bills or how diligently you send invoices, some-times patients just don’t pay. It happens. All you can do is implement good business practices—and stick with them—to keep patients’ outstanding bills to a minimum.

Collecting money when patients won’t pay up

i.O.u.


COMMUnITY PHARMACY

When patients go to Red Cross Pharmacy they know they’ll be taken care of. Whether they need to get heal-thy, stay healthy or manage their health, patients think of their local Red Cross Pharmacy as an extension of their healthcare team, not as just a place to fill their prescriptions. “The prescriptions are still an important piece, but we’re really about care,” said Doug Stone, market-ing and merchandising manager at Red Cross Pharmacy.

“We’re about caring for the patient all the way around.” Red Cross Pharmacy wants patients to think of its pharmacies as resources to aid in their overall health and wellness needs, not just as avenues to obtain medi-cations. With a friendly staff, genuinely useful programs, and supplementary services, such as medication therapy management and free blood pressure testing, Red Cross Pharmacy focuses on providing care that goes above and beyond dispensing prescriptions. “We are a healthcare destination,” Stone said. How did Red Cross Pharmacy achieve this reputation? It might not be how you expect.

Red Cross Pharmacy is known as the place to go to re-ceive top-notch patient care because of years of diligent and successful marketing.

MARkETING THE COMMUNITy PHARMACyMarketing highlights the benefits that your pharmacy already offers and puts that message in front of current and prospective patients. Red Cross Pharmacy approach-es marketing by taking the exceptional patient care that its pharmacies have already established in practice and promoting that fact to patients. Doing so provides value to patients and gives them a reason to choose Red Cross Pharmacy over the competition. Whether through newspaper ads, radio commercials, promotional signage, or social media, all aspects of Red Cross Pharmacy’s marketing focuses on that message of patient care. All of its marketing centers on building that brand.

DEvElOPING A BRANDMarketing a pharmacy, or any business, starts with

Selling CareHow marketing helps Red Cross Pharmacy improve its business

Red Cross Pharmacy marketing and merchandising manager, Doug Stone, checks product at the Kearney, Missouri location.

By Kirsten Hudson


branding. While a logo, posters, signs and other design elements tend to come to mind when you first think of

“branding,” a business’s brand is simply its reputation in customers’ minds. How do patients view your pharmacy? That’s your brand. Maybe your patients know your pharmacy as the friendliest store in town? Or, perhaps you’ve built a posi-tive image around your store so that patients view your business as warm and friendly rather than clinical? The core message that patients perceive about your business is your brand. You can shape patients’ views of your pharmacy’s brand through marketing, but ultimately your patients drive your brand. For Red Cross Pharmacy, that brand is being a healthcare destination. With 11 retail locations and three long-term care facili-ties across Missouri, Red Cross Pharmacy has to unify its branding throughout all of its stores. “We want to have that consistent message,” Stone said. “That way if patients move to Kearney from Grain Valley, for example, they’ll know that they can receive that same level of care at the Red Cross Pharmacy in Grain Valley as they did at their Red Cross Pharmacy in Kearney,” he said. If your community pharmacy only has one location, that doesn’t mean you should skip out on branding.

“Word of mouth is good and it works to an extent, but branding your name in newspapers, radio commercials and other forms of media just continues to put your name in front of people,” Stone said. With a unique brand, you can build impressions in customers’ minds, so that they remember your phar-macy and want to come back. If you’re the only phar-macy in town that provides pet meds, then you want your patients to think of your business as a specialty pharmacy. Or, if you have a dietician on staff, then you want your patients to think of your pharmacy as the place to go for their nutritional needs. Branding tells your unique story and captures the essence of what makes your pharmacy special.

A UNIQUE BUSINESSIn an increasingly competitive marketplace with other independent pharmacies, big box stores and national chains competing for patients’ business, Red Cross Pharmacy knows the importance of differentiating its businesses from other pharmacies out there. “You have to set yourself apart from the others so you’re not just a ‘me too’,” Stone said. “If you’re a ‘me too’ then you’re not going to gain any ground, especially if you go into a market where you know there’s competition. You have to figure out how to

differentiate yourself from everybody else.” True to the idea of Red Cross Pharmacy as a go-to spot for healthcare needs, Red Cross Pharmacy actively works to distinguish its stores from a ‘typical pharmacy’. Red Cross Pharmacy stays on the cutting edge of phar-macy and keeps up with the latest healthcare trends to provide the best care for patients and further meet their needs. Currently, Red Cross Pharmacy is working on devel-oping and promoting its adherence program, EliteCare, which the pharmacy noted as a major trend across the nation. EliteCare enables pharmacists to work with patients to simplify their lives by syncing up multiple medication refills into one refill date. “We’re way ahead of the curve right now,” Stone said. Red Cross Pharmacy also differentiates its pharma-cies from other community drugstores by offering the technology services that patients are beginning to expect from their pharmacy, such as online refills and text mes-sage and email refill reminders. Red Cross Pharmacy is also working to build its social media presence on

With a friendly staff and useful programs and services, Red Cross Pharmacy focuses on providing care that goes above and beyond dispensing prescriptions.


Facebook and Twitter because that’s where customers are spending a lot of time. Keep in mind that putting unique services or offerings in place at your pharmacy is only one part of the puzzle. You also have to market your pharmacy to let patients know that you offer delivery or that you always give per-sonal attention. Otherwise, how will they know? Red Cross Pharmacy regularly works with the PBA Health marketing department to create and update its brochures, informational leaflets and the promotional signage in its stores. All of Red Cross Pharmacy’s marketing materials are intentionally designed to pro-mote its stores as healthcare destinations for patients because Red Cross Pharmacy wants that message to stick with customers. “Marketing is about telling your story,” Stone said. “That’s how you get impressions built in customers’ minds.”

lOOk TO THE FUTURETo maximize marketing success for your pharmacy, you need to include marketing in all facets of your business. Too often community pharmacy owners think of market-ing as secondary, when it should be a part of everyday operations. Take a cue from Red Cross Pharmacy. Upper management and managers from each of the Red Cross Pharmacy locations get together at regular

meetings to discuss what to promote that month, to pinpoint issues with marketing or branding, to develop marketing opportunities and to get general feedback from the stores. “We want everyone to be on the same page,” Stone said. Red Cross Pharmacy recognizes that every aspect of a business works together. Meaning, marketing and general operations are interrelated. For example, obtain-ing patient information is an important clinical prac-tice, but it can also improve marketing. When you ask patients for their name, date of birth, address, phone number and email address, you protect your pharmacy from audits and also obtain information that you can use for future marketing efforts, such as targeted mailers or special promotions. As a retail pharmacy owner, you have to be both a businessperson and a pharmacist. Luckily, marketing can help you integrate the two. Marketing allows you to promote the best clinical aspects of your practice, such as versatile compounding or diabetes knowledge, while also increasing customer loyalty, obtaining new patients and boosting your business all around. “Marketing asks customers to come to your pharmacy, and your expert service and knowledge keeps them coming back,” Stone said. “Do both and everything will come together.”

Red Cross Pharmacy displays marketing materials, such as brochures, informational leaflets and promotional signage, in its stores to promote its specialized services, like EliteCare, to patients. EliteCare is an adherence program that helps simplify patients’ lives by syncing up multiple medication refills into one refill date.


COMMUnITY PHARMACY

OUTLOOK The Future of Pharmacy

Cassandra Shields knew she wanted a career in the medical field. Shields ruled out getting an M.D. or D.O. on account of the long hours and the very real threat of malpractice that medical doctors can face. She had also considered nursing, the same occupation as her mother. Her path changed when, as an undergrad at Bethany College in Lindsborg, Kansas where she studied Biology, Shields interned at Apotek Pharmacy. It was there that she discovered that the pharmacy profession provided opportunities to develop lasting relationships that led to healthier lives for patients. “It was very obvious that the patients trusted their pharma-cists, and that the pharmacists sincerely wanted to help them,” she said. “That’s when I knew pharmacy was the profession for me.”

REACHING THE COUNTERAs a student in the University of Missouri-Kansas City (UMKC) School of Pharmacy, Shields enjoyed her

studies. Four years of classes, such as medicinal chem-istry and pharmacotherapy, gives future pharmacists a strong foundation in understanding why pharmacists are considered one of the most trusted professions in healthcare. “The first two years can be overwhelming. Everyone is saying ‘How do I retain all of this knowl-edge?!’ However, internships and hands-on experience really showed us how much we already knew and how much we did retain from the classroom,” she said. “Pharmacists are almost considered to be a little obsessive compulsive, because if we do not perform our job to the best of our ability, we are putting our patients at great risk. Our job as pharmacists is to put the pieces of the puzzle together to see the bigger picture,” she said. “To this day, I use those ideas to motivate me to better understand, and further help, my patients.” The 2010 graduate added, “Leaving school doesn’t mean your education is finished. It’s important to stay up-to-date on what’s happening in medicine and in

Cassandra Shields represents one of the new faces of pharmacists focused on the futureBy Kelsea Nore

patient-Centered pharmacy


your community. Utilize the Internet, conferences and communicate with your peers. You’ll be amazed at what happens when people come together to help others.”

STARTING OUTShields worked as a technician at the Olathe Medical Center Pharmacy in Olathe, Kansas throughout her graduate studies. “I actually worked in hospital and compounding settings before considering retail,” Shields said. “It was a valuable experience; working closely with the doctors and seeing the immediate impact of my work was great.” But, Shields reflected on what initially drew her interest to pharmacy, the ability to give con-tinual care to patients by getting to know them well. Independent pharmacy was a better fit for her. Shields said that many national chain pharmacies have a different perspective on the pharmacist-patient rela-tionship. She’s right, too. Many national chain pharma-cies have incorporated strict time limitations on their pharmacists—the infamous promise of ‘Prescriptions in 15 Minutes or Less’ comes to mind—that seriously endangers patient care. A 2011 study released by The Mayo Clinic reported that more than 50% of people take medications improperly. Rushing patients out of the pharmacy does not serve to improve these statistics.

COMMUNITy PHARMACy Regional chain and independent pharmacies do not en-force these kind of stringent guidelines on pharmacists.

“It’s really important that patients understand the signifi-cance of adherence and that we’re able to make time for patient questions and concerns,” Shields said. “The pa-tients here at Key Rexall Health Mart in Salina, Kansas know that they can call or come see us with almost any health-related question.” But not all patients realize this, and nor do their doctors. “One of the biggest surprises for me as a community pharmacist was the disconnect between the doctors and the pharmacists,” she said. “For example, MTM (Medication Therapy Manage-ment) is a requirement of Medicare Part D, and it helps reduce costs. MTM is proven to be effective and it has a positive impact on the ‘big picture’ for our patients,” Shields explained. “I’ve had to explain this development to some physicians and make it clear to them why their involvement is so critical for the success of the patient.” These kinds of team efforts between doctors and phar-macists have been proven as a successful, outcome-based disease-management method. This level of care is not only the most ethical course of action for health care professionals like Cassandra Shields, it’s likely the future of pharmacy, as well.

THE FUTURE OF PHARMACyAll levels and specialties of pharmacy are changing. According to the 2011 Advanced Pharmacy Practice Report to the U.S. Surgeon General: “Current pharmacy practice is considerably more diverse than what has been previously reported in terms of scope of practice and practice setting. Traditional roles of the pharmacist tied solely to medication product and delivery have been greatly expanded.”

Shields agrees. “The days of making a living strictly with dispensing are over. Eventually, we may even see a flat rate for drugs, with reimbursements based on adherence rates or other services instead,” she said.

“In the meantime, the move toward outcome-based care is inevitable, and I believe pharmacists should gladly embrace this change.” Several studies and the forecasted changes dictated by the Federal Healthcare Reform bill point in this direction. Provisions within the Healthcare Reform bill visualize expanded MTM grants with funding for inde-pendent pharmacies and changes to the generic drug reimbursement standards as well. Legislation is not the only driving change within the world of pharmacy; technology has moved the profession into new realms as well. For example, patient adherence ‘scores’ will likely be monitored digitally to calculate outcome-based re-sults. It is not hard to imagine the benefits of medically trained professionals having access to and communicat-ing these results. “Pharmacists have a responsibility to their profes-sion,” Shields said. “We’re often the most approachable and accessible members of our patient’s healthcare team, and we need to let our patients, and their doctors, know this. By working together—with each other, doc-tors, nurses and other medical staff—our patients can have happier and healthier lives.”

Cassie Shields, PharmD, lives in Salina, Kansas with her husband Brad Shields and their two Cavalier Spaniels, Max and Asher.

“Our patients know that they can call or come see us with almost any health-related question.” – Cassandra Shields, Key Rexall Health Mart


OUTLOOK

nOTES

The hassles of ordering CIIs can take valuable time away from your pharmacy—time that could be spent running your business and helping your patients. Free yourself from the inconvenience of CII paperwork with PBA Health’s turnkey CII ordering solution, CSOS Advantage. Built completely by PBA Health, CSOS Advantage is the only DEA-compliant software on the market today created specifically to make CII ordering fast and reliable. We de-signed CSOS Advantage to work with any pharmacy management system, so you can experience the ease of electronic ordering directly on your desktop without any extra obstacles. CSOS Advantage eliminates er-rors, reduces operating expenses and guarantees full DEA compliance. Discover what else this progressive electronic ordering system can do for you.

SAvE TIME AND MONEyWith CSOS Advantage, you no longer need to maintain a paper trail of your CII orders. The automated sys-tem also includes data storage, so you can easily maintain your records electronically. This built-in archiving helps streamline your workflow, which will save you extra hassle and expense. And, you won’t have to wait on your orders. The electronic platform eliminates the shipping delays as-sociated with DEA paperwork. With CSOS Advantage, orders are filled,

CII Ordering – Simplified!

shipped and delivered the next day when we receive your orderby 6 p.m. CST.

ORDER FlExIBIlITy EvERy TIMECSOS Advantage links with the cur-rent PBA Health Warehouse inven-tory so you can see your order con-firmed in real-time as you complete it. Plus, with no line item limit you can order as few or as many CIIs as you need in a single order. Placing smaller, more frequent orders can help improve inventory management, decrease stockpiling and reduce security issues. GAIN FREE SUPPORTBecause PBA Health created the CSOS Advantage software, we en-sure that it works seamlessly with the latest technology and updates. If you ever have any questions or issues, you can contact our techni-cal experts for a timely fix. Want to say goodbye to DEA Form 222 for good? Make the switch to CSOS Advantage. Call PBA Health at 800-333-8097 or email us at [email protected] to learn more.


elements magazine - june 2012 vol.1 iss.1

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