With ever-changing coronavirus guidelines, on-edge patients peppering the overworked staff with questions, and more phones ringing than bodies to answer them, burnout has peaked in community pharmacies throughout the country. However, Dana Sadowski, PharmD, believed that community-based pharmacy practice could (and should) be different. She was brought to ClearSpring Pharmacy to spearhead its practice transformation effort. Now, she serves as the pharmacy’s Flip the Pharmacy Champion and directs the clinical programs among its staff, who has been reenergized with the newfound potential of community pharmacy. “Flip the Pharmacy reminds us why we do what we do,” Dana reflects.

Known for its compounding services, ClearSpring Pharmacy has served Denver, Colorado and the surrounding communities of for over 20 years. ClearSpring Pharmacy participates in CPESN® Colorado and CPESN USA.

As the Pharmacy Manager at ClearSpring Pharmacy, Dana leads the implementation of enhanced clinical services. ClearSpring Pharmacy started the Flip the Pharmacy program in October 2020, along with 800+ other pharmacies across the country. Flip the Pharmacy is a 5-year pharmacy transformation program aiming to re-work community-based pharmacy practice beyond filling prescriptions and toward an ongoing focus on a patient's health.

Dana acknowledges that ClearSpring Pharmacy’s participation in Flip the Pharmacy has enabled 

her team to reach more patients and provide higher quality patient care.

Using monthly change packages, Flip the Pharmacy coaches work with local pharmacy teams to implement the six key transformation domains with an emphasis on continuing patient care planning with documentation in various eCare Plan platforms.

Dana shares, “During the pandemic, patients saw firsthand all the services we offered and came to know us as an active health care hub when others closed their doors.” Among the many innovative clinical services offered by ClearSpring Pharmacy, it houses machines that automatically check A1C and cholesterol in a convenient way. The ClearSpring Pharmacy team has also ramped up its medication synchronization, adherence packaging, immunization, and delivery programs. “With so many unknowns at that time, we remained a constant for our patients in our local community.”

In addition to implementing these clinical services, Dana plans to enhance the engagement of nonpharmacist staff in creative ways. Two full-time pharmacy technicians will perform regular patient outreach calls for blood pressure check-ins, medication synchronization fills, and immunization screenings. Student pharmacists would perform blood pressure readings as patients waited during ClearSpring Pharmacy’s COVID-19 immunization clinics.

“When I precept APPE students, they are amazed at how this advanced community pharmacy rotation mimics more of an ambulatory care setting. I love showing students a different side of community pharmacy that they might not see in the classroom.”

Dana owes much of ClearSpring Pharmacy’s success to its coaches, Wesley Nuffer, PharmD, BCPS, CDCES and Whitney Osborn, PharmD. They have been instrumental in helping Dana track the pharmacy’s progress, dissect monthly change packages, and answer questions at a moment’s notice. Flip the Pharmacy coaches are funded by the Community Pharmacy Foundation and national and local team sponsors. ClearSpring Pharmacy is a member of Team Colorado, which is funded in part by a team sponsorship donation from RxPlus Pharmacies. The pharmacy also receives grant funding from the Colorado Department of Public Health.

What’s next for ClearSpring Pharmacy? When asked about the pharmacy’s future plans, Dana shares that her team will be participating in the EngageDr. Program and the NCPA Innovation Center/ CPESN Community Pharmacy Fellowship. She is confident that these opportunities will provide her staff with the skills needed to continue increasing their patient base, building relationships with local health care providers, and growing their presence on social media. She also plans to start enrolling patients in their newly accredited Diabetes Self-Management Education and Support program.

“When you have to work the bench, it’s easy to feel like there aren’t enough hours in the day. We’re all used to our routines and old habits are hard to break,” Dana admits. “Flip the Pharmacy is what keeps us motivated and on track. It’s given us more opportunities than we could have imagined and we’re excited to keep exploring them.”

The Flip the Pharmacy program hopes to directly support 1,000 pharmacies, just like ClearSpring Pharmacy, with coaches like Wesley and Whitney, and impact thousands more. To date, over 800 pharmacies are receiving direct coaching and implementation support. Learn more at 

Articles

Burnout has peaked in community pharmacies across the country. Dana Sadowski, PharmD, is combatting burnout by helping independents reach more patients and provide higher quality care. 

Flip the Pharmacy Champion Fights Burnout by Transforming Patient Care

Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.

This article originally appeared on Contemporary Pediatrics.

It’s a tale as old as time. You write a prescription for a patient with a chronic condition such as asthma and later on the patient reluctantly tells you that he or she has only being taking it a quarter of the time. 

Nonadherence for medication is an issue that many clinicians will have a number of frustrating anecdotes to share. In her presentation at the virtual 2021 American Academy of Pediatrics National Conference & Exhibition, Heather De Keyser, MD, MS, assistant professor of pediatric pulmonology at the Breathing Institute, University of Colorado School of Medicine and Children’s Hospital in Aurora, discussed the impact and scope of non adherence, what may impact adherence, and ways to improve adherence.

Nonadherence to medication is a frustrating problem, with the worldwide average adherence for chronic diseases being around 50%. This nonadherence is costly with 1 study of 43,156 children who used Medicaid and asthma found that if high adherence to inhaled steroids rose from the 33.35% seen in the participants to just 40%, it would result in $8 million per year in cost savings and increasing adherence to 80% would result in $57 million per year in savings. 

Even with serious medical issues, adherence can be low with 58% nonadherence seen in the 6 months followed newly diagnosed epilepsy and rates of poor adherence for solid organ transplant ranging from 30% to 76%, with the poorest adherence in adolescent patients.

A variety of factors can influence adherence to medication including poor access to care, poor provider knowledge of formulary, patient/provider relationship, social determinants of health, stigma, medical beliefs that lead to intentional nonadherence, forgetfulness, poor technique, and medication administration responsibility. De Keyser noted that when you take into account primary nonadherence, meaning getting the prescription filled, which is 14% to 20% with the first fill and 24% to 40% for subsequent fills; secondary nonadherence, meaning the prescription have been filled but the medication hasn’t been use, accounting for 30% to 70%; and poor device technique, which accounts for 43% to 100%, true adherence with asthma medication is likely very little.

Ask any provider why a patient isn’t taking a medication and the answer is likely going to be “if only they knew how important it was.” However, De Keyser emphasized that the reasons behind nonadherence are complex. It can range from a prescription not being filled because it requires frequent refills to parents being unsure of the proper dose to the child or parent simply forgetting the dose. 

She also shared a study that looked at HIV medication adherence. Barriers related to habit were far more commonly reported by children and parents than barriers tied to education. Habit is indeed a strong driver of an action, thanks to the loop of cue, routine, and reward. The habit loop was used to improve oral care when a toothpaste company, wanting to sell more product, encouraged people via an ad to run their tongue along their teeth and if they felt a film to brush their teeth, which resulted the reward of no more film.

To improve adherence, she recommended asking all patients on chronic medications about adherence and verify with objective data, particularly when the condition is not well-controlled. When talking with patients and parents, it’s best to speak clearly, use data, and be non-judgmental. 

Using a personal anecdote about how you don’t always adhere to something related to good health, De Keyser mentioned lack of flossing for instance, can help put patients at ease and help them know that they aren’t alone. Then she recommended 

 - The patient puts the medication in a place where he or she will regularly see it throughout the day, such as the kitchen table or the sink in the bathroom.

 - The patient uses the medication at certain times of day like right before going to school or at morning and evening meal times.

 - The patient connects using the medication to another established habit, such as right after waking up or right before brushing his or her teeth.

 - The patient uses timers on his or her smartphone, other smartphone apps, or electronic health monitors. De Keyser recommends using smartphone times and reminders for medications that require only a short course because notifications can become easy to ignore.

1. De Keyser H. It won’t work if you don’t take it: ways to improve medication adherence. American Academy of Pediatrics 2021 National Conference & Exhibition; virtual. Accessed October 10, 2021.

A session at the virtual 2021 American Academy of Pediatrics National Conference & Exhibition offers insight into the common causes of medication nonadherence and how to improve adherence.

The Cause of Medication Nonadherence and Prevention

Increase revenue from clinical services including immunizations and point-of-care testing with STC|ONE Pharmacy Clinical Services. Leverage vaccine intelligence and real-time decision support to better serve patients and scale your business.

Learn how you can better serve patients and generate more clinical services revenue with real-time decision support and vaccine intelligence from STChealth

Closing Vaccination Gaps: The ROI of Real-Time Clinical Decision Support

Today, October 19, is National Pharmacy Technician Day! Thank a Pharmacy Technician when you see them. Pharmacy technicians are vital to the community and deserve celebration for their hard work. #RxTechDay

to thank a pharmacy technician, comment your favorite technician, and discuss the role they play in your community. 

Today, October 19, is National Pharmacy Technician Day! Thank a Pharmacy Technician when you see them. Pharmacy technicians are vital to the community and deserve celebration for all their hard work. #RxTechDay

Today is Pharmacy Technician Day #RxTechDay

Sean Slovenski Expert Interview Part 1 

Drug Topics® sits down with Asteres® Chairman and BioIQ CEO, Sean Slovenski to discuss 24/7 automated pharmacy pickup. Asteres® develops ScriptCenter kiosks and lockers for secure and safe pickup of prescriptions and healthcare products.

ScriptCenter allows your pharmacy staff to maintain control of filling and checking prescriptions, while ScriptCenter takes care of the secure storage, tracking, pickup, and payment of your pharmacist-filled prescriptions.

Sean was named Healthcare Leader of The Year by the US Chamber of Commerce in 2015 and in 2019 as the 7th most influential person in healthcare out of the top 100 by Modern Health Magazine.

 Today I am joined by Sean Slovenski, Chairman of Asteres® Inc. and CEO of BioIQ. Thank you for joining me today. I'd love to jump into today's topic.

 Can you start by telling me a little bit about your background?

Sure, I've been in the healthcare space for about 30 years, been a serial entrepreneur in that timeframe, small companies and large.

So, I started my first business on my own and sold that about 10 years ago to Humana, a large insurer in the Medicare space. And then just before jumping into BioIQ to help with this pandemic, I was the President of Healthcare for Walmart.

 Wow. How is your experience in behavioral health and being at home diagnostics? And in these various industries, sort of driven to the work that you do today with Asteres? And have you seen any, like gaps in the field? And what sort of led you to where you are now?

 Yeah, yeah. So yes, it'd be a few things. But part of the issue with most things in health care is access, affordability, and access. Yeah, there's 1000 other things that go around it, but those are the two that tend to be the biggest barriers.

And with what we do, bringing these, in essence, prescription ATM machines, to remote locations out in the military, out in rural settings, you know, even at grocery stores and places like that, that need extra support, because their pharmacies are not open as long as they used to be pre pandemic. Or in some cases, many pharmacies and retail locations have closed, because they couldn't find workers to keep them open.

So, having access to your medication is pretty primary, to keep your health where it needs to go, whether it's behavioral health related medications or physical health related medication. So that's the interesting thing, we can mail stuff to people's homes.

And that's a great option. But people do like to go out kind of tired of being in their houses. So having a pickup destination where you can get your prescription filled, and then head on to the rest of your day is really quite convenient for people.

 Right, that makes a lot of sense. Going off of that, you mentioned accessibility, can you kind of explain what the script center kiosk is and go into that?

 You know, this simplest way to understand it, maybe two analogies. We've all used ATM machines, alright, automatic teller machines. Well, again, showing my age back in the 80s and 90s. That was a weird thing. You know, banks were like, no one's ever going to use that, because they want to come to the bank.

Now who goes to a bank anymore, right? They're all hitting an ATM machine somewhere. So, this works the same way very much. different laws in different states decide how you can dispense the medications and the process of doing that. But essentially, it's an ATM machine. Instead of spitting out dollar bills it will spit out your prescription prescribed by your doctor as a pickup location.

The other option with our machine is more like an Amazon locker system where the medication your prescription actually would get delivered to a locker within a bank of lockers at a store or community center.

And just like picking up a package at an apartment complex you get a little code, and you type in your name, and it verifies you know, you through, your face recognition or a code that you have and hey, locker 32 a. There's your penicillin for you today is your blood pressure medicine and the locker pops open for you. So, an ATM machine and Amazon locker machine kind of combined into one.

Photo retrieved from https://asteres.com/

Expert Interviews

Drug Topics® sits down with Asteres® Chairman and BioIQ CEO, Sean Slovenski to discuss 24/7 automated pharmacy pickup for secure and safe pickup of prescriptions and healthcare products. 

The Benefits of ScriptCenter Kiosks for Pharmacies, Part 1 

Actions taken by the CDC and FDA this week are paving the way for the rollout of COVID-19 vaccine boosters for eligible Americans.

The CDC recommended Pfizer-BioNTech and Moderna COVID-19 booster shots for certain populations, and the FDA has expanded its emergency use authorization (EUA) for COVID-19 vaccines to include a single booster dose.

Both steps are important to protect the American public and stay ahead of the virus and its variants. The CDC endorsed the following groups as eligible for their booster shots as early as 6 months following their initial series:

Age 18+ who live in long-term care settings

Age 18+ who have underlying medical conditions

Age 18+ who live or work in high-risk settings, including first responders, education staff, and food and agricultural workers

The FDA’s updated EUA now allows for a single dose booster of the Pfizer-BioNTech vaccine at least 6 months following the initial series in individuals 18 to 64 years with “frequent institutional or occupations exposure to SARS-CoV-2,” according to the agency’s news release published on Wednesday. Moderna booster shots can also be administered 6 months after a patient’s initial vaccination in those 65 years and older; those between 18 and 64 years at high risk of severe COVID-19; and those between 18 and 64 years with frequent exposure to the virus. A single dose booster of the Johnson & Johnson COVID-19 vaccine can be administered as soon as 2 months after the first single dose regimen.

Moreover, the EUA stipulates that booster shots do not have to “match;” that is, individuals can choose any of the 3 vaccines—Pfizer-BioNTech, Moderna, or Johnson & Johnson—as their booster vaccine.

As these additional doses become available, the CDC highlighted the critical importance for those who remain unvaccinated to start the process of protecting themselves against the virus and its variants. “More than 65 million Americans remain unvaccinated, leaving themselves—and their children, families, loved ones, and communities—vulnerable,” the CDC news release stated.

“The evidence shows that all 3 COVID-19 vaccines authorized in the United States are safe—as demonstrated by the over 400 million vaccine doses already given,” said CDC Director Rochelle P. Walensky, MD, PhD, MPH. “And, they are all highly effective in reducing the risk of severe disease, hospitalization, and death, even in the midst of the widely circulating Delta variant.”

Coronavirus (COVID-19) Update: FDA Takes Additional Actions on the Use of a Booster Dose for COVID-19 Vaccines. News Release. FDA; October 20, 2021. Accessed October 21, 2021. 

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-takes-additional-actions-use-booster-dose-covid-19-vaccines

CDC Expands Eligibility for COVID-19 Booster Shots. News Release. CDC; October 21, 2021. Accessed October 22, 2021. 

https://www.cdc.gov/media/releases/2021/p1021-covid-booster.html

The FDA and CDC have both issued their respective recommendations for the rollout of Pfizer-BioNTech and Moderna COVID-19 vaccine boosters. 

Americans Gear Up to Receive COVID-19 Boosters 

The Biologics Price Competition and Innovation Act (BPCI Act) of 2009 created an abbreviated licensure pathway for biological products that are demonstrated to be interchangeable with an FDA approved biological product.

 Biosimilars provide patients with additional treatment options at lower costs.

 Typically, biosimilars marketed in the United States have initial list prices that are 15% to 35% lower than the existing FDA-approved biologic (reference product).

Biosimilar products have no clinically meaningful differences from their reference product, and they undergo safety, ecacy, and quality evaluations.

Pharmacists can play an important role in educating health care professionals and patients about biosimilars to improve access to and enhance their knowledge about these medications.

As of August 21, 2021, the FDA approved 30 biosimilars, with the most recent being the first interchangeable biosimilar insulin product in the United States, Semglee (insulin glargine-yfgn).

The reference product for Semglee is Lantus, a long-acting insulin. Semglee is approved for the treatment of type 1 diabetes in children and adults and for type 2 diabetes in adult patients.

 “This is a momentous day for people who rely daily on insulin for treatment of diabetes, as biosimilar and interchangeable biosimilar products have the potential to greatly reduce health care costs,” said FDA Acting Commissioner Janet Woodcock, MD, in a press release.

 This will help to make insulin more affordable for patients as the cost has skyrocketed.

Semglee is administered subcutaneously once daily at the same time each day.

 In patients with type 1 diabetes, Semglee must be used with short-acting insulin.

 The recommended starting dose in patients with type 2 diabetes who are not currently treated with insulin is 0.2 units/ kg or up to 10 units once daily.

 In patients switching from once-daily insulin glargine injection 300 units/mL to once-daily Semglee, the recommended initial dose is 80% of the insulin dose being discontinued.

As with Lantus, the most common adverse effects reported with Semglee include hypoglycemia, edema, weight gain, allergic reactions, and injection site reactions.

Riabni (rituximab-arrx) received FDA approval in December 2020 as a biosimilar to Rituxan for the treatment of adult patients with non-Hodgkin lymphoma, chronic lymphocytic leukemia, granulomatosis with polyangiitis (inflammation of the blood vessels), and microscopic polyangiitis.

Riabni is administered as an intravenous infusion by a health care professional.6 Prior to initiating treatment with Riabni, patients should be screened for hepatitis B infection.

 Riabni carries a boxed warning for fatal infusion-related reactions and it is critical to monitor patients closely as fatalities within 24 hours of infusion have occurred.

Riabni infusions should be discontinued for severe reactions.

 Other boxed warnings include severe mucocutaneous reactions, hepatitis B virus reactivation, and progressive multifocal leukoencephalopathy.

The FDA approved Hulio (adalimumab-fkjp), the sixth biosimilar to Humira, in July 2020; it is expected to launch in July 2023 in the United States.

Hulio is approved for the treatment of rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis, adult Crohn disease, ulcerative colitis, and plaque psoriasis.7 The agent is administered as a subcutaneous injection, and it carries a boxed warning for serious infections (eg, active tuberculosis [TB] and invasive fungal, bacterial, and viral infections) and malignancies (eg, lymphoma).

Patients should be tested for TB prior to starting Hulio and monitored closely for any signs of infection during treatment.

Nyvepria (pegfilgrastim-apgf) received FDA approval in June 2020 as a Biosimilar Update and the Pharmacist’s Role in Education Pharmacists can play an important role in managing patients on biosimilars and increasing uptake of these products.

It is a leukocyte growth factor indicated to decrease the incidence of infection in patients with nonmyeloid malignancies who are receiving myelosuppressive anticancer drugs associated with an increased incidence of febrile neutropenia.

 Nyvepria is administered as a subcutaneous injection. Serious adverse eects can include spleen rupture, acute respiratory distress syndrome (ARDS), serious allergic reactions, sickle cell crises in patients with sickle cell disorders, kidney injury, capillary leak syndrome, leukocytosis, malignancies, and inflammation of the aorta.

 Nyvepria should be discontinued in patients experiencing ARDS, serious allergic reactions, sickle cell crises, or inflammation of the aorta.

Biosimilar Forecast and the Pharmacist’s Role in Education

According to an IQVIA report, biosimilar medications are expected to lower drug costs by $100 billion over the next 5 years.

 The development and approval of biosimilars has increased over the past 2 years.

 Since the passage of the BPCI Act, $17 billion in biosimilar spending has been associated with a savings of $37 billion.

 The following biosimilars launched in 2019 achieved significant uptake within their first year: bevacizumab (42%), trastuzumab (38%), and rituximab (20%).

There are 108 biosimilars across 22 molecules in development, with some in the pipeline for the near future.

President Biden is working to improve access to biosimilar medications by promoting drug competition to drive down costs and facilitate the development and approval of biosimilar and interchangeable products.

Pharmacists can assist in educating health care professionals and patients about biosimilars and the approval process to improve uptake. The FDA determines biosimilarity based on the “totality of evidence” provided in the marketing application submission.

 Animal, human pharmacologic, immunologic, and additional clinical data are added in a stepwise approach.

 Semglee being the first approved interchangeable biosimilar product provides further opportunities for education.

An interchangeable biosimilar meets additional requirements and may be substituted for the reference product at the pharmacy, which can help increase patient access to these medications.

 The process is similar to the manner in which generic drugs are routinely substituted for brand products. For approval of an interchangeable biosimilar, manufacturers must provide additional data that reflect how the product can be used in clinical practice with patients.

Studies generally evaluate the safety of patients’ alternating between the reference product and interchangeable biosimilar compared with those being treated with the reference product alone.

 Additionally, the results must reveal that there is no decrease in efficacy or increase in adverse effects with switching.

Pharmacists can inform patients that biosimilars are safe and effective medications used to treat a variety of conditions, such as psoriasis, irritable bowel syndrome, Crohn disease, arthritis, kidney conditions, and cancer.

The same benefits and adverse effects are expected with biosimilars compared with their original biologic product because they are made with the same types of natural resources and have the same strength and dosage recommendations. In addition, biosimilar medications can be used regardless of whether patients were first treated with the reference product. Emphasize to patients that biosimilars may provide them with more access to important treatments at lower costs.

Further, the FDA monitors the safety and effectiveness of all biosimilar medications after their approval.

 Explain that there are similarities and differences between biosimilars and generic drugs. For example, both are compared to a reference (original) product for approval,

 and both are versions of previously FDA-approved medications. Biosimilars and generics go through a thorough review process and receive FDA approval through different abbreviated pathways.

 One difference is that biosimilars are made from natural and living ingredients, whereas generics are generally made from chemical ingredients.

As biologic medications cannot be replicated exactly, more information is required to show that a biologic is biosimilar to another biologic than that required for a generic drug.

Pharmacists can play an important role in managing patients on
biosimilars and increasing uptake of these products. 

Biosimilar Update and the Pharmacist’s Role in Education

Keith Loria is a contributing writer to Medical Economics.

Today’s pharmacies must install diverse or alternative revenue opportunities to boost profits. This can mean revamping their front end, expanding on services such as specialty pharmacy medications, or partnering with health care providers or hospitals in the area. It can even entail offering tailored services to their patients such as smoking cessation, weight-loss counseling, or nutrition guidance.

“In the changing landscape accentuated by pharmacy benefit managers, the profit margins that have previously supported pharmacists’ salaries and the cost of running independent retail pharmacies have been borne on the spread of the product,” says Paige Clark, RPh, vice president of pharmacy programs and policy at Prescryptive Health. “That reimbursement model, in many cases, can no longer support independent pharmacies.”

Therefore, building a robust and significant clinical services provision is essential to the success of all community pharmacies. Jennifer Donovan, PharmD, vice president of clinical services at Shields Health Solutions in Stoughton, Massachusetts, notes there is a need to balance how to deliver high-quality care while o setting the costs of caring for patients who are underinsured or not insured.

“Finding alternative ways to generate revenue is necessary to ensure all patients, regardless of ability to pay, have access to high-quality health care,” Donovan says.

JoAnn Sanborn, BSPharm, owner and vice president of operations for Hudson Pharmacy in Hudson, Michigan, notes that due to decreasing profits for prescription drugs, which are the main source of business, she often looks to outside sources to help stay in business. These include point-of-care testing, immunizations, hormone replacement therapy consultations, medication therapy management, and complimentary medicine consultations.

Shelley Roberts, PharmD, owner of Grassroots Pharmacy in Lexington, Kentucky, shares that during the first part of the COVID-19 pandemic, the pharmacy’s front-end sales were severely depressed, although prescription sales went up.

“The reduction in cash flow that resulted really drove home the point of how important those sales truly are,” Roberts says.

“We have a thriving smoothie business and gift shop that bring in cash daily versus waiting on insurance reimbursement checks. It is so important to diversify all aspects of your business to account for when one piece is affected.” In Kentucky, there are numerous board-approved protocols that the pharmacy is beginning to delve into to create multiple revenue streams.

“From the beginning, we have looked for ways to be different—the look of our store, the offerings, the atmosphere,” Roberts says. “To be successful, you either have to be unique or do the same thing better than everyone else. With the big boxes’ hold on the market, it is hard to beat them on price, so we don’t try to.” In many states, public health departments are highlighting the fact that community pharmacists are trusted and highly accessible resources. Under the crisis of COVID-19 and the Public Readiness and Emergency Preparedness Act, all pharmacists can provide testing services to detect COVID-19. Additionally, as of September, pharmacists are empowered to provide monoclonal antibody treatment to patients who are positive for or have been exposed to the disease.

“So, we now truly have…testing, treatment, and immunization services that are comprehensive for serving our communities in the fight against COVID19,” Clark says. “This is a great revenue opportunity to look into right now.” “The state of Oregon was among the early adopters of the concept of pharmacists being enabled to provide subcutaneous injections of REGEN-COV [casirivimab and imdevimab] to COVID19–positive patients,” Clark continues.

“As such, the Oregon Board of Pharmacy with leading subject matter experts built a comprehensive clinical protocol to guide pharmacists through patient care. We have incorporated that resource into our turnkey solution at Prescryptive. Not only is the protocol available for utilization, Prescryptive has then built the model policies and procedures needed for independent retail pharmacies to operationalize this...service.”

Among other revenue opportunities, 15 states have extended pharmacists’ ability to provide birth control services to patients in some form. Other states have allowed pharmacists to provide services for tobacco cessation and postexposure and pre-exposure prophylaxis for HIV prevention. “In all cases, expanding clinical services and pharmacist scope of practice relate to meeting unmet public health needs,” Clark explained.

“My tendency is to advise pharmacists to move into areas that are directly reimbursable at a state level by Medicaid, such as birth control prescribing.” Trieu Bao, PharmD, of Soleil Pharmacy in Glen Burnie, Maryland, notes that pharmacists have excellent training that goes beyond filling prescriptions.

“As clinicians, we are driven to provide many other services for the overall health of our clients, thus improving patient outcomes,” he says. “As [many of us are] immigrants, we understand the unique needs of those from a multitude of cultures and provide culturally competent care. Then, we want to be sure they know where and how to get access to other elements of their health care.” As a Clinical Laboratory Improvement Amendments–certified pharmacy, Soleil Pharmacy offers COVID-19 testing.

They also provide international normalized ratio and glycated hemaglobin tests when appropriate for the patient and their care plan. “We o er and deliver in our pharmacy—or in other locations—many types of vaccines,” Bao says. “We are currently finalizing a plan to have primary care telehealth available in our pharmacy or in the homes of the uninsured population in our community.” As recent recipients of the National Community Pharmacists Association Diabetes Prevention Program grant, the pharmacy is also expanding its diabetes services in 3 languages.

“We have found if you focus on the unmet needs in your community and the unique strengths of your staff, you can create something pertinent and of great value,” Bao says. Soleil Pharmacy focuses on vaccinations, common medications, and supplies that support hospital discharge and make the discharge process easier for patients and caregivers.

“We have reconsidered the products we carry and removed the feeling of being crowded in the front of our store,” Bao says. “We are intentionally making it easier for the pharmacist or technician to acknowledge the patient upon entry and for patients to have access to items that will benefit their health journey.”

Clark adds that pharmacies that have not carved in private patient care spaces need to consider doing so, as soon as possible.

Making changes to the layout or design of the pharmacy could also attract new customers. This has been key to many older pharmacies bringing in people and getting them interested in new services. Because Grassroots Pharmacy has been open for less than 5 years, Roberts feels fortunate that the store does not need a facelift yet.

However, the pharmacy does consistently change the merchandise and store layout. “Keeping things fresh is important,” she says.

Partnering With Hospitals and Health Care Facilities

In some cases where collaborative practice agreements (CPAs) are required, partnering with other providers or organizations can be helpful in bringing in new revenue. “Partnering with health care providers and health systems allows for the best patient care,” Donovan says.

“The patient stays integrated within the health system and information is accessible by all health professionals in the multidisciplinary team. Integrating pharmacy services into care is necessary to drive meaningful changes in patient outcomes.” One strategy Donovan has found to be successful is aligning specialty pharmacy programs with the health system’s accountable care organization and at-risk populations to further drive quality and value.

“Developing programs and strategies to help the at-risk population has [been] shown to improve patient care and lower total medical cost,” she says. Hudson Pharmacy has a practice agreement and offers point-of-care testing with a local physician. “Early on in the pandemic, before we were able to obtain product, both the local health department and hospitals offered vaccines for us to vaccinate the elderly in long-term care facilities [who had been] missed, as part of a federal initiative,” Sanborn says.

“We have been partnering with the health departments in both counties to schedule and run clinics and obtain vaccines. We’re basically on call whenever they need help and it’s been very profitable; there’s administration money available from insurance companies to do this work.” The pharmacy has also worked with hospitals to o er a continuum of care for when patients leave the hospital and transfer to long-term care facilities or back home. “We’re there making sure there’s a proper coordination of care and to offer counseling,” Sanborn notes.

Pharmacists should also consider helping with things such as smoking cessation and weight-loss counseling. “The pharmacist can play a crucial role in these conditions as there are tremendous short-term and long-term benefits to their health and the health care system,” Donovan says.

“Even within our specialty pharmacy program, we stress the importance of smoking cessation, weight reduction, stress management, and nutrition as part of an overall care plan to ensure we are helping our patient today and in the future.” Hudson Pharmacy once tried offering diabetes management but found that it was very difficult to get insurance companies to pay for the service. In addition, it was something that people weren’t as willing to pay for. “Now we’ve been doing hormone replacement therapy consultations,” Sanborn says.

“And that the patients are happy to pay for directly, so that’s been successful.” According to Roberts, because the pharmacy is located in a city with multiple large hospital settings and a thriving health department, these services are available for free for most individuals, so she hasn’t instituted any programs. “This could definitely work in other locations, though,” she says. “What has been more helpful than anything is doing [adherence] packaging for their patients. This is what we were trained to do, and what we can excel at.”

Pharmacies can take advantage of alternative revenue opportunities to boost their bottom line.

Diversify Your Revenue Streams

Immunization Information Systems: Beyond the Basics

Immunization Information Systems provide confidential, population-based, computerized database that records all immunization doses administered by participating providers within a geographic area.

https://www.drugtopics.com/view/immunization-information-systems-beyond-the-basics

Burnout has peaked in community pharmacies across the country. Dana Sadowski, PharmD, is combatting burnout by helping independents reach more patients and provide higher quality care.

https://www.drugtopics.com/view/flip-the-pharmacy-champion-fights-burnout-by-transforming-patient-care

https://www.drugtopics.com/view/the-cause-of-medication-nonadherence-and-prevention

https://www.drugtopics.com/view/today-is-pharmacy-technician-day-rxtechday

Drug Topics® sits down with Asteres® Chairman and BioIQ CEO, Sean Slovenski to discuss 24/7 automated pharmacy pickup. Asteres® develops ScriptCenter kiosks and lockers for secure and safe pickup of prescriptions and healthcare products. 

https://www.drugtopics.com/view/scriptcenter-pharmacy-pickup-kiosks-asteres-inc-interview-part-1?seriesVid=1 

Pandemic Response, Pharmacists’ Role Among Key Topics at 2021 NACDS Total Store Expo

This year’s Total Store Expo identified opportunities for growth and facilitated collaboration between retailers and manufacturers.

https://www.drugtopics.com/view/pandemic-response-pharmacists-role-among-key-topics-at-2021-nacds-total-store-expo

Shingrix Approved for Immunocompromised AdultsShingrix Approved for Immunocompromised Adults

FDA gives OK to shingles vaccine for those at risk

https://www.drugtopics.com/view/shingrix-approved-for-immunocompromised-adults

Here’s a roundup of the latest news coverage from Drug Topics®.

News Roundup: Immunization Information Systems, Pharmacist Burnout

Russell Libby, MD, is an assistant clinical professor of pediatrics at the University of Virginia School of Medicine in Charlottesville, Virginia, and at the George Washington University School of Medicine in Washington, DC.

Andrew J. Schuman, MD, is a clinical assistant professor of pediatrics at the Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.

The first population-based vaccine registry in the United States launched in Delaware in 1974 and did not begin to flourish until the Robert Wood Johnson Foundation launched their All Kids Count program in 1991. Government funding for immunization registries became available when President Bill Clinton included immunization registries in his Childhood Immunization Initiative in 1993.

There are currently 63 registries, now called immunization information systems (IISs), in the United States. These include state-, island-, and city-based IISs, each operating independently under its respective local and state policies with their own rules around collection and use of data, analysis, and operational routines.

Figure 1 shows the percentage of children under 6 participating in a state-based IIS as of 2019.

An ISS is a confidential, population-based, computerized database that records all immunization doses administered by participating providers within a geographic area. IISs provide a consolidated record of administered vaccines for the benefit of the patient, their family, and the greater public health. An IIS keeps a record of vaccinations given, dates, and manufacturing details, and can identify when a future or missed vaccination should be given.

IISs have many advantages; they can improve immunization rates, reduce vaccination errors, identify opportunities to vaccinate, provide epidemiological insights when there is a community outbreak of a vaccine-preventable disease, and allow access by patients, families, schools, and other health care providers. 

An IIS can also reduce time spent entering data and track vaccine inventory, especially if it is connected through your electronic health record (EHR) system. An IIS can make a child’s immunization portable when the family changes practices, moves from one location to another, or seeks care outside the medical home.

The administering site is credentialed by the individual IIS under licensed providers who can designate access for data entry and/or viewing by staff. Access to view is allowed for the patient, parents, and specified agencies, such as schools, pharmacies, urgent care facilities, and hospitals. 

There are federal requirements for documenting vaccines established by the CDC, which includes the specific vaccine, manufacturer, lot number, the date and location, and that the patient and/or family was given a vaccine information statement (VIS) to review with its publication date.3 Most systems will identify when a dose of a specific vaccine should be given and have specific time intervals that are not forgiven when a sequential dose is given too early.

It is the responsibility of the administering site to enter the required data, and it can be a burden to staff when they need to enter the data in multiple locations, such as the registry, the EHR, and the patient vaccination card. Most pediatric-specific EHRs are certified and connect with a local IIS, requiring only 1 point of data entry that will be shared with the IIS, the medical record, and the patient copy.

There is significant evidence that IISs improve vaccination rates and reduce missed opportunities for administering immunizations. Australia implemented a national IIS in 1996 and demonstrated an increase in full immunization among 2-year-old children from 64% in 1997 to 93% in 2007.4 Australia has a national health care system that facilitates implementation and utilization of IISs. Although the United States has yet to implement a national IIS, studies have repeatedly demonstrated that

IISs improve vaccination rates, reduce missed opportunities for vaccinations, and facilitate responses to community outbreaks of diseases.

The most significant problem with existing vaccine registries in the US is the lack of interoperability between them. Few nonpediatric-specific EHRs can currently extract data from local and state registries, or deposit immunization information directly into them. This necessitates office staff performing double entries of immunizations into the office EHR and the local IIS, which is time-consuming and unwieldly.

One method of speeding up data entry is the integration of barcode scanning into EHRs. After receiving a shipment of vaccine, the shipment form is scanned into a vaccine inventory, which is integrated into the EHR. When vaccines are ordered for a patient, the barcode on the vial is scanned again and screened by the connected IIS. 

Warnings appear if the vaccine is being given too soon, is not age appropriate, is attributed to the wrong funding source (eg, Vaccines for Children Program), or has expired. The staff manually enters the other vaccine administration details into the EHR and the information is electronically sent to the appropriate IIS. Over the next few years, it is anticipated that a growing number of EHRs will have this capability.

There is no uniform rule requiring an administering site to enter that data into the IIS, which further complicates the potential for interoperability. However, the COVID-19 pandemic and the CARES Act may be creating a new opportunity for data sharing between EHRs and the IISs. 

All sites administering COVID-19 vaccines must report all vaccinations into a database that allows for capturing the event and providing reminders for a second dose as indicated by the vaccine given. It may open the opportunity to connect all vaccine registries into a national database, accessible from anywhere.

Immunization Information Systems provide confidential, population-based, computerized database that records all immunization doses administered by participating providers within a geographic area. 