The Power of Community: Pharmacists Share Their Experiences With Service Expansion

Drug Topics^®: Thank you so much for joining us today on Drug Topics^®. I'm Lauren Biscaldi, managing editor and I want to start off this conversation by giving everyone a chance to introduce themselves.

Tyler Woods: I'm a pharmacy district manager for the VMC buying group. We have a couple of our members here with us and I'll kick it over to Ryan for his introduction.

Ryan Bane: Hi, my name is Ryan Bane. I'm the director of pharmacy for Riesbeck's Pharmacy. We're a family-owned independent grocery store chain in eastern Ohio and the northern panhandle of West Virginia, with 17 locations, which have 5 pharmacies located inside them and I take care of those.

Philip Wilkins: I'm Philip Wilkins. I'm the owner of Malden Pharmacy & Home Medical Equipment located in Malden, Missouri, which is the bootheel part of Missouri—small town America. Our city has about 5000 people in it, so it’s rural America. So, it's a super exciting area to be a part of.

Drug Topics^®: I want to start off by defining pharmacy service expansions for our viewers. What exactly is that? What does it entail? And why is it important for pharmacists to know about?

Wilkins: So pharmacy expansion, as we know right now, a lot of our patients and staff have a traditional view of pharmacy. That view is that the patient goes to the doctor and then they get a prescription, come to the pharmacist, the pharmacy technician then puts the medication into a bottle. Then the pharmacist checks ‘Is there any drug interaction?’ Is the dose right?’ and then they go over counseling points, of course. And that part is great. We're on the back end and we make a difference that way.

However, what pharmacies expansion is, CPSEN puts it a little bit different, it's focusing on the patient, and not necessarily just a pill. As we know, most pharmacists, if not all, now that graduate with their doctorate degree, so there's a lot of knowledge that we possess that we can really get to our patients, that is going to be beneficial for them. Another way to look at it is the way that pharmacy is now, we're on the back end. As I mentioned, the patient goes to the doctor. They get their prescription for that back end check. Now our knowledge needs to be sprinkled throughout the whole process. If that is initiating a new medication or initiating a vaccine, we think our knowledge can really be beneficial throughout the whole health care process and not just on the end.

Drug Topics^®: Ryan and Philip, I really wanted to give each of you a chance to talk a little bit about these expansion programs and the services that are either currently available in your pharmacies or in process and upcoming. Ryan, I want to start with you. You're the pharmacy director at Riesbeck's Pharmacy. What kind of programs and services is Riesbeck's currently offering and what's coming up in the pipeline for the future?

Bane: Besides your traditional dispensing model, like Phillip mentioned, found in most pharmacies, we offer medication delivery, med sync, vaccine administration with COVID, flu, Shingrix, all available. We also do…multi-dose compliance packaging. We also recently started billing for the over the counter COVID tests that are getting in high demand with the cold and flu season coming. But the real exciting thing is we created a Riesbeck's Pharmacy consulting services and we are actually getting ready to launch on September 12, a collaborative practice agreement with a local physician, where we'll begin to see his diabetes patients via referral, in an effort to educate and manage all the facets of life that diabetes touches for those patients. That's include dosage adjustments and therapy changes for those medications.

Wilkins: We’re similar to Ryan's pharmacy in that area. A lot of pharmacies may consider pharmacy expansion, being the med-synchronization, compliance packaging, the vaccine administration and as Ryan mentioned, that is pretty much day-to-day stuff now. We’ve joined CPSEN and that got our wheels turning, of all the opportunities out there, the operational side of how to handle certain things. Through the pandemic, we actually started testing for COVID-19. What we found was it wasn't just, the patient has COVID and they come to the pharmacy for their nebulizer solution or for their steroid or whatever the medication may be. Our pharmacy got to be a part of that initial encounter: ‘hey, I don't know if I have COVID. I may or may not. What can you tell me, I'm nervous.’ It allowed the pharmacist to be able to tell them, ‘Hey, there's a possibility you're negative today, but based on how the virus acts, you can be positive tomorrow.’ There were a lot of things that pharmacists were able to, especially at our pharmacy, tell the patients. In other words, it's very beneficial for them.

Some other things that we're doing is a self-monitoring blood pressure program, where we teamed up with local health departments. Our patients, if they have hypertension, they qualify for a free blood pressure cuff, we get hooked up with a blood pressure machine and what we noticed is a lot of our patients don't know that a normal blood pressure is 120 over 80. A lot of this stuff that you assume patients know if they're on blood pressure meds, they really have no idea. We were able to actually go one-on-one with them and kind of explain that and based on our data, patients who went through the process with the blood pressure meds, has definitely increased or has been improved through the process. That's kind of what we're doing. In the future, we’re looking at doing flu testing and then possibly lipid panels. As I mentioned, we are small town America, so sometimes our patients have to travel 20 miles or so to go get labs done. So there's definitely an area for our pharmacy to get involved in that and help the community.

Drug Topics^®: What are some of the biggest challenges that you faced while you're trying to implement these expansion efforts in your pharmacy?

Wilkins: Absolutely, thanks so much for that question. The number one thing that has kind of hindered this is workflow. Because you're still expected to do the traditional pharmacy stuff and you're still expected to get prescriptions out in a timely manner. With that comes some difficulties as far as workflow goes. One thing that we did at Malden Pharmacy was about once a month, we really sit down and we looked at things, it definitely made it a lot easier. My number one advice when you're starting something like this, is to really utilize the people around you.

Bane: With us, it was trying to get the consulting services off the ground. It was just logistics. How? Where do you start? How do you do it? How do you get paid? Where do you go from just the thought of the idea? So, the biggest hurdle was those, which is trying to figure out where to start with this. And really, it was utilize your resources. It was contact that your state pharmacy, contact CPSEN, and contact your colleagues and your networking. We use VMC as our as our buying group, when we contact them and they give us good direction. Just use your resources. Ask those questions. Everybody's usually more than willing to help. The hardest part was ‘What now? Where do I start?’

Drug Topics^®: You've mentioned your communities that you practice in and work in. Ryan, I'll start with you. In that community, what impacts have you seen or do you anticipate seeing as pharmacy services continue to expand?

Bane: We're actually one of the few independent pharmacies left in a lot of our communities. I feel like we're already viewed as an extension of their health care team, at this point. So even when they leave us for whatever reason, whether they're forced to mail order, they're forced to a certain chain, they still call us with all their questions and all their problems, and we still try to help them. I think just offering more and seeing that we can do more will just strengthen our foothold more with the services available. It will just strengthen our role in the communities.

Wilkins: In our community, as I mentioned, there aren’t as many resources as there are in some of the bigger cities. We see the point-of-care testing really taking off our pharmacy. And then eventually, if there's situations where we can get on protocol, to kind of follow Ryan's lead and on a couple of things that he's doing and maybe get a protocol to prescribe Tamiflu or something like that because especially with patients having to travel 30 minutes that they really don't want to, especially if they're sick. I think our pharmacy and the location that it’s in could really help those types of patients.

Drug Topics^®: I'm going to shift gears a little bit and just talk about VMC and how being a part of VMC has helped with your pharmacy expansion efforts.

Bane: If I get an idea in my head, I usually call Tyler right away. And ask “hey, what do you think about this? Or you know anybody that's done this before?” So a lot of it is just taking it to somebody at the VMC team and seeing ‘hey, is this possible? Have you heard of this before? Or am I crazy?’ for things like that. They have a vendor that we never thought of that they introduced to us and say, ‘hey, maybe you should look at this.’ There's just a lot of opportunities that we've come across since we switched over to VMC a few years ago, and it's been really beneficial.

Wilkins: I was just going to echo it really. Being a part of a group like that, a lot of the members and the leadership team, they all have 2 main goals: to further the profession and help your patients. When we come up to Tyler, to the leadership team, something also to point out is that the leadership team is full of pharmacists or pharmacy technicians, so they know what we're going through, they have been in the field before, and they've seen a lot of things because they're a part of a lot of these different organizations. So yeah, I definitely agree with Ryan. It's really nice to be able to call Tyler or call somebody on the team and say, ‘this is what I'm thinking, Is there any immediate red flags? Or is this something that you've seen, that you can kind of help me out with?’ Being part of a bigger team definitely makes life easier.

Woods: We do pride ourselves in being more than a primary GPO or a buying group, as most people know it. It's cost of goods and while we focus on that very heavily, we pride ourselves, that it isn't just our sole focus. When we sign a new pharmacy, we kind of joke, but we get another boss. We work for these guys. They need to trust us, understand that we're here for them. We're a reference point for anything that they're working through whether it's simple to program expansions. It's important. Support is key in any business and pharmacy is no different.

Drug Topics^®: That wraps up all the questions that I had. If there's any sort of final thoughts or key takeaways that you wanted to leave the viewer with, I want to open the floor to you.

Woods: We appreciate the opportunity to showcase some of the incredible efforts we've seen in our group. Thank you, Lauren and Drug Topics^®. We’ve been told for a long time pharmacy is changing, and what we've started to see is it has changed. I think the challenge from here is to expect more from your pharmacy. We talked a little bit about the iceberg of opportunities that are out there. They're endless, but you have to be open and looking for them. So dig in, reach out, whether that's locally, into your peers, whether it's national organizations. See what's out there. Learn more about it and help us improve as a profession what our patients expected a pharmacy visit.