2014 Visionaries

Change is coming for independent pharmacies. Whether they manage medication adherence programs, undertake collaborative efforts with physicians, or carve out a unique niche in the industry, the trend is for independent pharmacies to adopt new patient care models that benefit both patient and pharmacy.

Across the country, independent pharmacies are finding ways to thrive in an evolving healthcare landscape by demonstrating their value as members of the healthcare team. These are pharmacies led by dynamic, passionate pharmacists unsatisfied with the status quo who continuously search for new ways to improve workflow, enhance patient care, and distinguish their pharmacies from the competition.

Three of these independent pharmacists stand out as leaders in the industry.

Although they are based in different states and their business philosophies and years of experience differ, two things unite these entrepreneurs from Missouri, North Carolina, and Pennsylvania - their belief in the importance of innovation for independent pharmacy owners in today's changing world and their commitment to putting patients first.

Tripp Logan, PharmD

Tripp LoganTripp Logan got his start in pharmacy early. The Missouri-based pharmacist took his very first steps in his father's pharmacy and now helps run the business that was such a formative part of his childhood.

Although Logan's personal history with L&S Pharmacy, Charleston, Mo., runs deep, he knows that for the business to survive, it can’t keep doing things as it did 15 or 20 years ago. Logan has worked hard to find new patient solutions and processes to improve patient care.

One initiative he helped to create and found is MedHere Today, a comprehensive medication adherence consulting company based in Nashville, Tenn., which not only guides L&S Pharmacy's medication adherence program but also offers consulting services to other pharmacies that want to improve their own medication adherence efforts.

Logan, who currently serves as vice president of Logan & Seiler, Inc., a company that owns L&S Pharmacy and two other independent pharmacies in southeast Missouri, returned home to begin his career in pharmacy after graduating from pharmacy school in 2002.

Soon after Logan’s career in pharmacy began, an encounter with a particularly challenging patient triggered his interest in medication adherence programs. An HIV-AIDS patient presented prescriptions for three drugs that the pharmacy didn't have in stock, but ordered for the next day, at a cost of $4,000. Once the drugs arrived, the patient failed to pick them up, so after several weeks, the pharmacy returned the drugs. When the patient eventually returned, the pharmacy was once again out of the medications.

"I mean, it was just a train wreck," Logan said.

A better way

Logan and his father knew there had to be a better way to serve their patients. They enrolled the patient in a monitoring program, which they soon expanded to serve their diabetes patients as well.

"We proactively manage a panel of patients. Their charts are reviewed regularly by pharmacy staff and we make sure that they have refills on their prescriptions and look for different clinical issues and so forth," Logan said. "There's a complete process from the beginning of the week to the end of the week for what we do to help manage these patients."

The pharmacy's adherence program gained the attention of Pfizer, which decided to do a five-year in-depth report on the impact the program had on the pharmacy. The report concluded that once patients at the pharmacy were enrolled in the monitoring program, they were able to significantly increase adherence across all therapeutic categories.

Patients enrolled in the program filled an additional 29 prescriptions per year, compared with those who weren't enrolled, and the pharmacy saw an increase in average prescription margin and average use of generics.  

"What we found was workflow is better. Inventory is going down, but we are able to fill more prescriptions, take better care of people, and do it a lot more efficiently," Logan said.

The effectiveness of the monitoring program was based in part on medication synchronization. For one patient who filled 15 different prescriptions throughout the month, prescription consolidation resulted in pickup visits just once or twice a month.

"By knowing what day that patients are picking up their medications, you can significantly reduce your inventory," Logan said.  "This frees up a ton of time where we can actually work with patients."

Bigger footprint

By 2010, Logan and his father knew they were doing something good at their own store, but they realized they were never going to be able to obtain hospital contracts to serve discharge patients or to secure contracts with insurance companies. Their footprint was too small.

So they decided to find a way to recruit other stores with similar numbers to follow their program.

"That's when we launched our MedHere Today initiative. We hired consultants, and we've got some boots basically on the ground," Logan said.

The consulting company has secured a contract with a wholesaler and works directly with individual pharmacies to help them implement the workflow processes used successfully at L&S Pharmacy. It also assists with staff training.

Logan believes that independent pharmacy owners need to embrace new technology and programs that help improve pharmacy work flow, so that pharmacists are free to spend more time counseling patients.

"The healthcare system now is transitioning from a quantity-based to a quality-based system. This is a perfect example of how we as pharmacy can transition from quantity in prescription volume to quality, but we have to know whom to focus on and how to focus on them," he said.

Ben Briggs, RPh, CNC, IACP

Ben Briggs’ pharmacy isn't like most other pharmacies, but that's just the way he likes it.

His pharmacy, the Lionville Natural Pharmacy, Lionville, Penn., which sells traditional prescription drugs, natural and holistic therapies, and health food, is nestled next to the Lionville Holistic Health Center, a business Briggs also owns that offers patients the services of on-staff therapists, an acupuncture practitioner, a Bach Flower Essence practitioner, a cranio-sacral therapist, massage therapists, and more.

Briggs, who is also a nutritionist, takes a holistic approach to patient care. The store fills only about five or six traditional pharmacy prescriptions a day. Most of the work of the pharmacy involves compounding, the formulation of individualized prescription orders from physicians, dentists, and even veterinarians.

"The thing about custom compounding is that one size doesn't fit all, so we can make it for that person. We read their blood work, their saliva testing, and their whole overall picture of their health," Briggs said.

The road to integrated services

Briggs was drawn to a more holistic approach to patient care after graduating from pharmacy school and receiving his license in 1971. He got his start in more traditional pharmacies, but he was discouraged, he said, that often the focus turned to volume and money rather than to patient care.

"I went to pharmacy school to help people. All that knowledge I had of biochemistry, pharmacology, physiology - all of that went by the wayside when I got stuck behind a pharmacy counter," he said.

He decided to open his own small apothecary shop in 1979. Eventually, after several location changes, the Lionville Natural Pharmacy and Holistic Health Center was born.

Briggs' specialty is endocrinology, and he often works with patients on thyroid issues and hormone replacement for women and men.

The way he sees fit

As co-owner of the store along with his son, who became a partner in 1999, Briggs is able to run his pharmacy as he sees fit. Frustrated with shrinking reimbursements, he stopped working with insurance companies in 1986, but his business continues to thrive, he said.  

"People have accepted the fact that they pay for the service, and we make sure they get a complete claim form to recoup whatever money they deserve," he said.

Instead of lengthy engagement with insurance companies, Briggs, who once hosted a radio show about holistic therapies, invests his time in patient counseling. A first visit typically lasts about two hours, during which time Briggs thoroughly investigates the patient’s history.

His unique understanding of minerals and the role they play in body came in handy when Briggs was working with a young girl who had recently begun attending college and was complaining of terrible aches, pains, and fatigue.

Doctors had told her she had fibromyalgia, but when her mother took her in to see Briggs, he noticed that when she wiped her hands with a paper towel, the towel turned blue. Briggs gave the patient a zinc test in the store and then asked her general practitioner to check her zinc and copper levels. His suspicions were confirmed.  

"As it turned out, she had Wilson disease, which is a copper toxicity. It manifests as rheumatoid arthritis," he said.

This is just one example, he said, of the effect of trace minerals in the body and the importance of maintaining their delicate balance.

"There's always a balance in nature," he said.

While chain pharmacies has sprung up around Briggs’ store over the years, the niche he has carved out and and the reputation in the community he has worked to achieve are solid, he said, and the chain stores have never been much competition.

Steve Adkins, PharmD

When Steve Adkins, PharmD, the owner of Health Park Pharmacy in Raleigh, N.C., saw the same mental health patient shuttling through the healthcare system over and over again, he knew there had to be a better way.

After being hospitalized three times within a six-month period, the patient was bouncing between the hospital, group homes, and his mother's house, using a different pharmacy at each location, which resulted in inconsistent care and poor adherence to his medications.  

Determined to find a more effective way to serve his patient, Adkins offered to enroll him in an adherence program that included medication synchronization.

"He has not been hospitalized since," Adkins said.

Adherence and collaboration

Adkins began his career in long-term-care pharmacy after graduating from pharmacy school in 2001. It was that background, he said, that helped him realize the importance of adherence programs and the role they could play in ending trips though the revolving door into and out of the hospital for many patients with chronic or long-term illnesses.

At Health Park Pharmacy, he has helped to institute a comprehensive adherence program using Pioneer Rx, which enables his staff to do a mini-MTM and medication reconciliation session with each patient upon initial signup. The pharmacy uses this opportunity to contact each patient’s primary care provider, make known the pharmacy’s connection to the patient, and request a comparison of the medication list created by the pharmacy with the drugs noted in the patient’s medical record.

Physicians are asked to alert the pharmacy to dosage increases or discontinuation of a medication, as well as any other drug changes.

Collaboration with physicians is an important part of the pharmacy's philosophy, which is made easier by its location: The pharmacy is located within a 200,000-square-foot healthcare facility that is home to primary care physicians and practitioners with specialties ranging from general surgery and sports medicine to dentistry and plastic surgery.

The pharmacy has cell phone numbers for most of the physicians, Adkins said, and is able to text them with patient questions or concerns, often receiving a response in a matter of minutes.

"We can expedite patient care so much faster than a traditional pharmacy can," he said.

Good for business

A thorough adherence program is good for business as well. Adkins said that pharmacy staffers were able to significantly reduce inventory and improve their workflow by spending less time putting medication back in stock from will call, reducing phone calls from patients worried about running out of refills, and cutting down on the length of time patients have to wait in the pharmacy to get prescriptions refilled.

For the program to be successful however, Adkins said, it must be a team effort.

"I think we have approximately 1,200 patients in our adherence group. If you really want to go down the path of adherence, everyone on the team has to be using that same mindset, from the person at the point of sale, to the order-entry tech, to the fill techs, to the clinical pharmacist," he said.  

Aside from its adherence program, the Health Park Pharmacy has also embraced technology, whether it's through use of videos to help train patients new to using insulin or use of the iMedicare platform to help Medicare patients find the best plan for them.

"Last year we were able to save one community business across the street from us more than $200,000 by just making sure that patients were on the right medication and the least expensive medication, and on the right prescription plan," he said.

Jill Sederstrom is a freelance writer based in Kansas City.