Telepharmacy takes pharmacists online off-site – Pharmacy Annual Report

Telepharmacy takes pharmacists online off-site – Pharmacy Annual Report – Some pharmacies are piloting telepharmacy systems

A new type of delivery system is emerging within pharmacy, and it has the potential to both enhance patient care and provide a new revenue stream for pharmacy operators.

In what are being described as advanced stages of pilots, pharmacy operators in retail and clinical-settings, as well as health care professionals working in urgent care facilities, emergency rooms and doctor’s offices, are testing the automated delivery of prescription medications to patients.

In addition, some pharmacies are piloting telepharmacy systems that make it possible for registered pharmacy technicians working in stores in remote or rural locations to deliver medications to customers after the prescription has been processed and adjudicated by a pharmacist working from a home or central pharmacy location.

Thrifty-White currently has two telepharmacies in operation (see Drug Store News July 21); Jody Doe, an independent pharmacist who owns Killdeer Pharmacy has two telepharmacies in operation in North Dakota; and Larry Larsen, who operates a pharmacy in Watford City, N.D., is about to open a telepharmacy on the Fort Berthold Indian reservation in Newtown, N.D.

Howard Anderson, the executive director of the North Dakota Board of Pharmacy, said that under the definition the board has adopted for dispensing prescriptions a registered technician at a remote pharmacy can manually prepare the medications to deliver to the patient. The technician has to be, supervised by a pharmacist in a “home” pharmacy who monitors the filling process via an Internet connection and a video camera and only permits the medications to be dispensed after the patient has been counseled.

The remote location also must be linked to a pharmacy management software system.

Anderson said the North Dakota Pharmacy Board has a list of about 10 retailers who hope to offer additional telepharmacy services by September of next year.

“We have lots of requests from retailers to open telepharmacies,” said Anderson, who said they meet the needs of consumers living in remote locations that are not able economically to support a full pharmacy. “Thrifty-White had the vision of opening telepharmacies three years ago.”

Two companies that make automated prescription dispensing systems, Telepharmacy Solutions, a division of AmeriSource Bergen, and Mendota Healthcare say they have a system that would work within that model, and both are talking to chain and independent pharmacy retailers about putting the technology into stores.

According to Ken Rosenblum, the chief executive officer of Minnetonka, Minn.-based Mendota Healthcare, which makes an automated prescription dispensing system called InstyMeds, two chains with pharmacies, a mass merchandiser and a food store, both in the top five slots in their industries in terms of sales volume, are in discussions with Mendota to test InstyMeds in pilots that could start within the next six months.

And according to Carl Geberbauer, director of sales and marketing for North Billerica, Mass.-based Telepharmacy Solutions, an AmeriSourceBergen company that markets a proprietary automated prescription dispenser under the brand name ADDS, the company is talking with numerous independent pharmacy operators about installing ADDS units in clinics, physician offices and retail stores within the next three to four months.

Jody Doe, who opened his first telepharmacy in Beach, N.D., last September and his second in New England, N.D., last November, said his decision to try telepharmacy was promoted by the needs of the people living in rural communities.

“There hasn’t been a pharmacy in Beach, N.D., for the past 10 years, and the business there is growing pretty fast,” he noted.

“We’re averaging 30 to 35 scripts a day. In New England, the pharmacist was retiring, and no one wanted to take it over.”

Doe said that through telepharmacy, be can operate the two stores at what is now coming close to break even. “The cost is about one-third of what it would be if I had a pharmacist. If those stores needed a pharmacist to be there, they wouldn’t be in operation.”

Doe said that given the shortage of pharmacists and the economic difficulties of providing pharmacy services in remote area like Beach and New England, he believes telepharmacy as a health care service will continue to grow.

“I think it will take off. I know other states like South Dakota and Montana are looking at this, as well. If I can build the volume to where I can hire another pharmacist in Killdeer, I would certainly, think of opening more telepharmacies,” Doe said.

David Holmstrom, executive director of the Minnesota Pharmacy Board, said that there are about five telepharmacies in operation in Minnesota right now, some open for several years and they seem to be serving a real need for patients in remote locations in the state.

“It seems to be working well. We’ve had no complaints of dispensing errors and we’ll probably see it continue to grow, especially in rural areas.”

Jennifer Livingston, a pharmacist supervising an automated telepharmacy in a franchised Medicap store in Exira, Iowa, said that they have had a telepharmacy since December 1999 and that it has been both a service to the community and a source of incremental revenues for Kimwood, the company that owns the franchise.

Livingston and her staff, working remotely from a host Medicap pharmacy 10 miles away from Exira in Audubon, Iowa, said they use an ADDS machine to help deliver medications to patients in Exira, a town with a population of about 900, including a substantial number of elderly people.

“There wasn’t enough volume to keep the Exira store going as a full service pharmacy when we acquired it,” she said, “but the telepharmacy has allowed us to fill the needs of the people in the community, and it’s added revenue because, in addition to the telepharmacy, we also sell front-end products in Exira.”

Rick Swalwell, vice president of marketing and communications for Medicap, which currently has about 180 stores in operation–all but 12 owned by franchisees–said the telepharmacy was “going great.

“It’s a perfect fit for us because it’s an extension of our existing services without all of the overhead of a full pharmacy,” he explained. “In many small towns and rural communities, pharmacies have had to close because there wasn’t enough volume to support the business.

But this is letting us service the needs of people living in those small communities and rural areas. In effect, it puts a pharmacy back on Main Street.”

Brian Hart, president of Technology Solutions, said that the revenue-generating potential for telepharmacies in retail settings like Exira is based, in large part, on the fact that the automated units allow pharmacists to provide full pharmacy services including remote counseling “at locations too small to economically support a conventional pharmacy.”

Sue Sutter, chairman of the Wisconsin Pharmacy Examining Board, also called the technology interesting and said that under Wisconsin’s current regulations, the technology can be used under the model of a physician being the dispenser of the medications and the pharmacist an assisting agent of the physician.

Carmen Catizone, executive director of the National Association of Boards of Pharmacy, said that the technology has a lot of promise “if all the safety guarantees are in place, if there is a video-monitoring system in place and if the remote pharmacist is able to provide counseling services to the patient. We’ve been watching the pilot programs, and it looks like it’s moving to the next level.”

The NABP has written regulations for its model code to assist state boards dealing with the issue of remote prescription dispensing.

And Catizone emphasized that the state boards of pharmacies are working with those developing and using the technology “to make sure the proper safeguards are in place.”

A federal case

In addition, federal institutions like the Veterans Administration and the Department of Defense are using automated prescription delivery systems to make it easier for patients in their networks to access full pharmacy services and to obtain their first cycle of medications at after-hours urgent care settings within their networks.

According to ScriptPro president and chief executive officer Mike Coughlin, the Veteran’s Administration, in an attempt to prove the viability of telepharmacy as a safe, effective business model for pharmacy, is sponsoring an independent study to measure the effectiveness of a tightly controlled telepharmacy operation.

As part of the study, Coughlin said the VA earlier this summer began field testing SP Auto Center in some of its community-based outpatient clinics.

Coughlin said a number of pharmacy chains are expressing strong interest in seeing the results of the study, which he said should be available in six months to eight months.

ScriptPro, based in Mission, Kan., which has approximately 3,000 robotic dispensing machines installed in retail pharmacies, also has developed a telepharmacy system called SP Automated Center, a combination of an SP 100 robotic dispenser and a mini-SPUD or unit-of-use dispenser. The SP Auto Center is completely under the control of a pharmacist at a remote pharmacy. The pharmacist at the remote pharmacy does all the processing and adjudicating of the prescription and when the prescription is cleared, the pharmacist releases it in the machine, which simultaneously generates a label.

A nurse or technician then gives the medication to the patient and leads them into a counseling room where they are counseled remotely by a pharmacist.

“By this time next year,” said Coughlin, “we should have some stellar examples of how telepharmacy works. And chains will have what they need–a telepharmacy solution that can be readily deployed to remote locations, a way to have a pharmacy without having a pharmacist on the actual premises.”

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COPYRIGHT 2003 Gale Group