Keith Loria is a contributing writer to Medical Economics.

Keith Loria

Although pharmacists understand that all of a patient’s medical information is confidential and access to that information is protected by the Health Insurance Portability and Accountability Act (HIPPA) of 1996, some still have challenges staying 100% compliant. That is why independent pharmacy owners should establish a compliance checklist and ensure their staff does annual HIPPA training.

“Pharmacy staff need to be aware of who they are providing health information to over the phone, in person, or via mail,” said Chirag Patel, PharmD, MBA, chief operating officer and brand ambassador for Carolina Pharmacy Group in Charlotte, North Carolina “The staff also need to ensure all health information at the pharmacy—prescription vials, labels, print outs, handouts, etc—is properly disposed of. That disposal source is most often an information security company that disposes of personal health information via shred boxes.”

Arielle T. Miliambro, Esq, a partner at Pine Brook, New Jersey-based health care law firm Frier Levitt, outlined the components of HIPAA:

The HIPAA Privacy Rule protects the privacy of individually identifiable health information.

The HIPAA Security Rule sets standards for the security of electronic protected health information (PHI).

The HIPAA Breach Notification Rule requires covered entities and business associates to provide notification following a breach of unsecured PHI.

Each HIPPA rule may have different requirements and exceptions. Miliambro explained that the Privacy Rule contains certain limited exceptions for which PHI may be disclosed without authorization, such as to coordinate care among health care providers or to obtain reimbursement from a patient’s health insurer or payer.

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What independent pharmacists need to know. 

A Guide to HIPAA Compliance in the Pharmacy

Demands on pharmacists are increasing, yet all the tasks historically part of a pharmacist’s day-to-day routine are still required. Aside from COVID-19 vaccinations and responding to overall increase in volume, medication adherence is a top concern for patients and pharmacists. Using technology solutions enables pharmacists to enhance patient safety both effectively and efficiently. 

According to Gerald Finken, RPh, CEO of RxE2 Inc and a 40-year veteran pharmacist, technology-driven medication packaging is a tangible reminder for patients to take their medication as prescribed.

“Additionally, health plans, prescribers, and pharmacies are held accountable through adherence-driven quality metrics [such as proportion of days covered and medication possession ratio], and pharmacists can use packaging to improve these quality metrics,” Finken said. 

Joann Seigel, RPh, vice president of pharmacy services for Masonic Villages in Elizabethtown, Pennsylvania, noted that with automated packing technology, pharmacists can confidently handle increased volume in the pharmacy without an increase in errors.

“It allows you to service a volume you could never manage manually,” she said. “Smart technologies streamline the med packing process.”

For the pharmacist, smart technology ensures that all a patient’s medications are synced up and billed at the same time, explained Donald Brindisi, RPh, pharmacy manager of Masonic Villages.

“It saves headaches around the concern that a patient is taking their medications as they are prescribed,” he said. “Without technology, supporting a patient that could have 10-plus medications in a single blister would be nearly impossible to do efficiently. We feel much more confident because of our automation.”

Thomas E. Hanzel, PharmD, MBA, national vice president of long-term care/nutraceutical at Parata Systems in Durham, North Carolina, said pharmacies are starting to be held accountable and, to some level, rewarded for improving adherence. 

“The right technology can provide customizable adherence packaging that is flexible enough to be adopted by all customer types and, therefore, improve medication management,” he said. “Pharmacists can verify compliance, as the customer receives notice in a cyclical calendar format where the medications are automatically refilled. This can be on a weekly, monthly, or whatever cycle is best for the customer—therefore, decreasing the chance of missing a dose.”

Sapna Patel, RPh, director of clinical services at Mosaic Pharmacy Service in Sterling, Virginia, explained that previously, pharmacists had to spend a lot of time manually counting, filling, and labeling medications. With the automation of these tasks, pharmacists have additional time for patient interaction, including counseling patients on harmful drug-drug interactions, educating patients on disease states, and reiterating the importance of staying adherent to their medication.

“Pharmacy automation has also decreased medication errors made by pharmacists,” Patel said. “Many automation systems have a pill verification system that increases patient safety while decreasing human error.”

Therefore, adherence packaging services can increase a patient’s confidence in medication management and improve their overall health by helping them take their medications as prescribed.

If a pharmacy isn’t currently offering an adherence program, it usually is due to a lack of efficient technology. To start an adherence program, it can be helpful to have show-and-tells or introductory meetings with provider offices, discharge planners, short-term rehabilitation centers, and insurance companies, Seigel said.

“Getting key players involved early on to demonstrate the value of engaging with your adherence program is a great way to begin those partnerships,” she said. “Compliance packaging typically comes first and is then supported by the introduction of automation into the pharmacy.”

It will also depend on one’s customer base. For example, although smart cards are great for retail and behavioral health settings, they are not as ideal for long-term care settings.

“Knowing which patient populations you’re looking to support will dramatically change the type of adherence program and the way it is implemented,” Seigel said.

More and more seniors are staying in their own homes rather than going to a nursing home. A recent article in the 

 reported a 15% drop in nursing home occupancy since 2019—mainly due to concerns around the COVID-19 pandemic.1 Seniors who live on their own may need additional support from their care providers when it comes to medication adherence.

“Adherence packaging has allowed pharmacists to help manage patients’ medications better by spending less time filling and more time managing their overall health,” Patel said.

For example, Patel cited a recent case study on a 70-year-old man on 25 medications. The patient has an extensive medical history, which includes diabetes, hypertension, overactive bladder, hyperlipidemia, gastroesophageal reflux disease, and neuropathy. He lives alone and has a hard time remembering to take some of his medications. He became nonadherent due to cost and medication overload.

“Mosaic Pharmacy Service leverages a comprehensive care model that includes filling medications in adherence packaging to help our medically complex patients stay adherent to multiple medications,” she explained. “I switched this patient to more cost-effective medications organized by date and time of dose in adherence packaging, which helped to simplify his routine and ultimately made it easier to stay adherent.”

COVID-19 has disrupted daily processes and routines for many patients, leading to medication adherence concerns. Pharmacists have had to implement strategies to help their patients stay adherent amid a variety of logistical challenges; this includes services like curbside pickup, home delivery, and—of course—adherence packaging.

“[COVID-19] has allowed pharmacists to see the importance of adherence packaging to help manage patient’s medication regimens,” Patel said. “Having all their medication synchronized to fill once a month allows for better adherence and more time for pharmacists to focus on helping patients manage their chronic conditions.”

Adherence packaging is good for any patient managing multiple chronic conditions that require them to take medications multiple times per day. It is also good for patients who have a caregiver helping them manage their medication because adherence packaging makes it easy to see if the medications have been taken at the scheduled time.

The patients most likely to benefit from adherence packaging are those whose caregivers may be far too busy to manage family members’ medications.

“Home health agencies really value compliance packaging for their facilities,” Seigel said. “Patients who may be very far away from their loved ones or a power of attorney can rest easier knowing their medications are being managed safely—which provides peace of mind for both the patient and those responsible for their care.”

The senior population is also at high risk of nonadherence, which is why Patel believes seniors who are on 5 or more medications would benefit most from adherence packaging.

“A recent report put out by the Lown Institute indicates that seniors on 5 or more medications are 88% more likely to seek care for an adverse drug reaction versus those taking 1 or 2 medications,” she said. “More and more seniors are wanting to age in [their own] place. Adherence packaging allows them to stay independent and adherent to their medication regimens.”

There are plenty of benefits for the pharmacists as well. Automation allows them to better manage workflow, produce more cards, and service a much larger customer base.

“It significantly reduces stress for the pharmacists, which inherently reduces burnout,” Brindisi said. “Because every step along the way is barcoded, there’s confidence that processes are reliable and that patients are in good hands.”

Plus, it allows pharmacists to work with patients to reduce their overall medical spend and ensure the best-possible treatment plan.

“The shift away from simply dispensing medications toward holistic patient care allows for better clinical outcomes,” Patel said.

Adherence pouch packaging also increases prescription fills and results in less audits, less direct and indirect remuneration fees, and higher reimbursement.

“Adherence technology decreases chances of medication errors and increases efficiencies, providing a high level of confidence to the pharmacist,” Hanzel said. “Automation also frees up pharmacist time and allows them to use their unique breadth and depth as experts who can then focus primarily on the patient. As a pharmacist, any way that they can improve adherence will [improve outcomes and, ultimately, reduce] total health care cost.”

Mathews AW, McGinty T. Covid spurs families to shun nursing homes, a shift that appears long lasting. 

 Updated December 21, 2020. Accessed May 3, 2021. 

https://www.wsj.com/articles/covid-spurs-families-to-shun-nursing-homes-a-shift-that-appears-long-lasting-11608565170

Smart tech improves medication management and workflow.  

Enhancing Medication Adherence With Smart Packaging

To be successful, independent pharmacists must identify the most essential financial key performance indicators (KPIs) for their businesses. For pharmacy owners, having a simple awareness of their pharmacy’s specific KPIs is crucial, according to Christopher Cella, RPh, national vice president for McKesson RxOwnership, a no-fee resource for independent pharmacies seeking financial and ownership transaction guidance.

“Some owners need help identifying what measures are important and what needs to be monitored from a financial standpoint,” he said. “Once that is established, how do their results match up against other owners in similar market areas, demographics, and services? After you know what your financial results are, you need to understand how to interpret these results as well as understand what levers can be or need to be adjusted to change your results.”

Matthew Johnson, PharmD, chief pharmacy officer for FDS, a Fort Worth, Texas-based pharmacy solutions company, said pharmacists must identify critical actions that drive volume and profitability—and then determine which ones are most advantageous. “In an environment with high unit costs and low margins, profit takes precedence over revenue,” he said. “Utilize shorter feedback loops. Use KPIs that can be measured on daily and weekly cadences. A quarterly view is helpful, but it is far too long to wait before correcting the course.”

All pharmacists should ask themselves certain questions. For instance, do you manage your expenses? Or do you consider your store to be operating efficiently if at the end of the month there is money left over in your account after paying expenses?

Examine the most essential financial key performance indicators for pharmacy businesses.

Assess and Manage Your Pharmacy’s Profitability

As the United States surpasses 26 million COVID-19 infections, immunization against the disease is critical. President Biden has pledged to increase the vaccine supply so that 100 million doses can be distributed during his first 100 days in office, and that means that community pharmacies should prepare to do their share.

But pharmacists still need to oer other immunizations as well, so the addition of these expected COVID-19 vaccinations will only add to the pharmacy’s workload. That’s why pharmacists need to think about how to improve workflow eciencies and create a stronger system management. Technology is often the answer.

Technology allows for faster counting and better record keeping, and for those pharmacies that can invest in automation, the impact can be exponential in improving eciencies, both in vial dispensing and in medication adherence packaging.

Peter Saad, PharmD, MBA, director of product strategy at pharmacy automation company Parata Systems, noted that the COVID-19 vaccine efforts will be new waters for retail pharmacy, as much of the process will be dierent, including, but not limited to, billing and tracking.

“Technology and automation will be key in streamlining processes for these pharmacies by freeing up time for pharmacists and technicians to focus on the clinical initiative of vaccine efforts and understanding the new waters,” Saad said.

More than ever, pharmacists are seen as frontline medical providers for the vaccine, and as such, they need to be front of house counseling patients. That’s why we are seeing retail pharmacies invest in technology, whether new to automation, or scaling their existing automation.

“Tactically, there are a variety of ways pharmacists can rely on technology for workflow and system management,” Saad said.

These include syncing patient medication regimens to monthly cycles to limit time to dispense/sell in the pharmacy, allowing more time for vaccine discussion and distribution; using Health Insurance Portability and Accountability Act compliant online form submission and preemptively inputting patients before arrival to streamline the vaccination process; and automating the filling process or hiring an additional pharmacy technician, as at least 1 technician will likely be occupied with receiving and inputting patient and vaccine information.

“If possible, have all refills filled via central fill, which allows for the ability to fill prescriptions quickly without using new resources, as this supports the bottom line and returns pharmacists and techs to activities that support patient care,” Saad said.

Jason Turner, PharmD, owner of Moundsville Pharmacy in Moundsville, West Virginia, said a great way to create a strong foundation of efficiencies in a pharmacy is to initiate a medication synchronization program.

“Medication synchronization changes your workflow from being ‘on demand’ workflow, meaning when the patient calls in the prescription, you begin to work on it in a way where your pharmacy team is in control of when you process a large percentage of your prescription volume,” he said.

For example, there are 1800 patients enrolled in Moundsville Pharmacy’s SyncRx program—73% of monthly prescription volume.

“We are able to schedule the work with a strategy to be most efficient in our prescription processing and most available to our patients for clinical services, such as immunization,” Turner said.

Jason Ausili, PharmD, chief clinical officer for FDS, a provider of pharmacy technology solutions for independent pharmacists, noted that tech can help drive immunization efficiencies in numerous ways.

“It can be used for billing the medical benefit for vaccine and/or administration fees in a way that is streamlined with workflow, provide automated reporting to state registries for reportable vaccine events, and allow a pharmacist to query state registries for vaccine eligibility at the patient level,” Ausili said. “Tech makes clinical documentation easy and efficient and makes the patient scheduling process a more automated and organized experience.”

At Moundsville Pharmacy, there are 2 Kirby Lester units, a ScriptPro SP 200, and a Parata PASS 300VP to increase efficiencies in the sta, workflow, and programs.

Turner recommends using dierent colored paper for each immunization record, which allows the staff to access and recognize vaccines in the workflow quickly, from billing to vaccinating, documenting, and record storage.

“For larger pharmacy teams, I would create a workflow for your immunization prescriptions,” he said. “This way, if a patient comes in and requests a vaccine, everyone knows how that clipboard is to flow to maximize your eciency and not disrupt existing workflow.”

Because vaccine billing can be challenging, Turner suggests directing vaccine billing to 1 or 2 vaccine specialists to make sure they are processed timely and identify quickly if you are unable to bill a payer through your pharmacy management system.

Maximizing the features of pharmacy software is no longer an option, as many pharmacies continue to use their software the way they did 5 or even 10 years ago, either not detecting the upgrades in their pharmacy management systems or not knowing how to incorporate them into their workflow.

Too often pharmacies invest in automation, counting technology, or a fancy new bell or whistle for their pharmacy management system, only to find that it doesn’t change the outcome.

“Over the years, in working with and training pharmacy owners in medication synchronization, it has become clear that the physical workflow of the pharmacy—how the prescription moves about the pharmacy—and the processes that support pharmacy workflow really dictate the eciency of a pharmacy,” Turner said.

The expense of automation technology and lack of cash flow for retail pharmacies are no question the largest barriers for adoption. But Saad said the best way to increase efficiencies with existing staff is by incorporating automation.

“Not only will it allow pharmacists to move to the front of the pharmacy and practice at the top of their license, but it will allow for value-adding activities for patients, all the while technology is handling routine prescription fills quietly in the back of the pharmacy,” he said. “When pharmacies start to hit 200 scripts a day, there will already be ROI from the technology, helping to fix that cash flow problem and making the cost worth it almost instantaneously.”


In 2021, there will be a lot of buzz around the approved COVID-19 vaccines and their availability, and although these vaccines have given pharmacists opportunities, they also have added pressure.

“The most important first step is to train your staff in how to respond to calls and inquiries about the vaccine,” Turner said. “This will help to keep inquiries consistent, concise, and informative for the patient. Utilize your automated attendant to record a manager’s message at the beginning of every received call and your on-hold system to provide additional information.”

The pharmacy management system will be able to record and bill immunizations. However, understanding what insurance you can and cannot bill will be important, keeping in mind that, even if you cannot bill the insurance, you cannot deny the patient the vaccine.

Additionally, when the vaccine supply increases, retail pharmacies will be busier than ever, which means long lines made even longer with social distancing efforts.

Saad said that although billing will be unified, normal business activities, in combination with vaccine efforts, will be hard to manage without relying on assistance, including technology and automation.

“After the pandemic passes, retail pharmacies need to accept what they have known for a decade: Fee for service is no longer viable,” he said. “If they don’t pivot their pharmacist role to one that is more collaborative and clinical in nature, they will be out of business in the next decade. Free up pharmacist time using automation, work to identify clinical services, and start providing."

Pharmacies can leverage technology for their workflow and system management. Here’s how.