Indie pharmacists find Rx for success at McKesson ideaShare

Only a few years ago, Iowa pharmacy owner Randy P. McDonough, PharmD, MS, CGP, BCPS, found himself feeling overwhelmed by the bad news about big declines in reimbursements. “I was scared to death about what the impact would be,” recalled McDonough, who faced a possible 50% reduction in payments from the biggest payer in the state.

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Today, things look quite different. McDonough believes that his independent pharmacy will stay afloat by evolving with the times, and with infectious optimism, he thinks his colleagues can succeed too.

“I had pharmacists in similar situations to mine tell me there’s nothing we could do about it, that we have to accept our fate,” McDonough told an audience at McKesson’s ideaShare 2015 in San Diego. “But I’ve never believed that accepting your fate is the way to go.”

Process and documentation

The key is learning to make an active difference instead of just providing medications to patients, said McDonough, co-owner of Towncrest Pharmacy in Iowa City and Solon Towncrest Pharmacy in Solon, Iowa.

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“Make every encounter count. Half of our inventions now have to do with adherence. For us to have an impact within the profession and the system we have to become interventionists,” said McDonough, who spoke at a session titled “Impacting pharmacy economics in a preferred network environment.”

McDonough has created a pharmacy system he calls “Make Every Encounter Count,” which allows pharmacists to focus on patient and medication management while technicians drive the dispensing system. Through use of his system, McDonough was ready in 2013 to prove to payers that pharmacy interventions were boosting the health of patients.

“Start doing the documentation, so you can show them the interventions you’re making,” he said. “Everybody who’s going to be high-performing needs to have a clinical documentation system and be documenting on a regular basis.”

Timed refills

Greg Paisley, BS Pharm, RPh, found success with a strategy that improves adherence through focus on the timing of medication refills, Ateb’s Time My Meds system for synchronizing the medications of any patient with two or more maintenance medications.

Patients no longer had to fill their prescriptions at different times of the month, said Paisley, vice president and chief operating officer for Shrivers Pharmacies and Coler Long-Term Care. Shrivers Pharmacies has five locat􏰁ions in Southeast Ohio.

Paisley cautions that med synch is not for every patient. “We’re in very rural and poor Ohio. Some patients simply did not have $30 a month, at one time, to pay all their co-pays,” he said. “Med synch didn’t work for them. They stayed with auto-refill.”

OTC solutions

Chris Cornelison, RPh, who owns Iuka Discount Drugs and Saltillo Pharmacy & Solu􏰁tions in Mississippi, advised the ideaShare audience to focus on selling.

“I can solve patient problems by offering them professional over-the-counter solutions,” he said. “The thing I can’t change is third-party reimbursement. I should weigh in on the battle, but I shouldn’t spend all day spinning my wheels.”

Cornelison, who is also owner of owner of Solutions Rx Supplements, believes that every pharmacy in the country should make $10,000 to $20,000 a year in net profits from nutritional supplements sold to patients facing systemic depletion caused by medication use. Pharmacies can make similar net profits - at least $5,000 in each category - from the sale of probiotics, digestive enzymes, and natural products such as fish-oil supplements, as he is doing.

The OTC department as a whole should make six figures a year, he said.

How can pharmacists manage this? Sell products to patients who may not realize they need them, he said.

For example, patients taking metformin may need a vitamin supplement because of dipping vitamin B12 levels, he said. Or a patient may get rid of statin-related muscle aches by taking a crystal-free coenzyme Q10 (CoQ10) supplement. Pharmacists can help by asking patients about symptoms and alerting them to these possibilities.

But isn’t a bottle of vitamins only a small purchase? “Don’t look at this as a one-time $10 interaction,” he said. “Look at it as a $120-a-year opportunity. You take away their side effects, and they’re happy. And it becomes a $120-a-year opportunity.”

Randy Dotingais a medical writer based in San Diego, Calif.