Supermarket pharmacies navigate clinical roles through partnerships
Supermarket pharmacies are having a moment. Once relegated to obscured locations in the store, they now are no longer hidden from customers’ sight, nor thought of as merely an added convenience. Moving away from the staid count, pour, lick and stick role they once had, supermarket pharmacists increasingly play an important clinical role with a focus on patient outcomes.
Indeed, supermarket pharmacies and their pharmacists have taken their rightful place, alongside pharmacy chain behemoths in terms of volume and services, simultaneously fulfilling scores of prescriptions and providing a host of services that range from disease state management and immunizations to medication therapy management and home delivery.
What’s more, many supermarket pharmacies are managing the prior authorization process and are getting more involved with high touch specialty drugs, enabling clinical interventions and better patient outcomes.
In 2018, supermarkets with pharmacies accounted for 7.2% of U.S. prescription revenues and 12.4% of 30 day equivalent prescriptions dispensed, according to The 2019 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. For 2018, the report estimated that prescription revenues at supermarkets declined by 4.4%, but 30-day prescriptions dispensed increased by 1.6%, said Adam Fein of Pembroke Consulting, an author of the report.
Yet, supermarket pharmacies also are facing the same headwinds that the entire pharmacy industry is. That means companies have to get smart about their offerings by finding partners whose solutions can help them handle increased prescription volume while expanding their clinical roles to boost outcomes and improve profitability.
At the center of Johnson City, N.Y.-based Innovation’s pharmacy automation offerings is its PharmASSIST systems, which provides flexibility in fulfillment and higher levels of efficiency. The Model 4 is a self-calibrating dispenser, which allows immediate on-site auto calibration of medicines. The PharmASSIST RDSx is a robotic dispensing technology designed for high volume industrial applications and high throughput, as well as reliability. Each RDSx fills up to 300 prescriptions an hour.
“In fulfillment, our operators today are looking for ways to make the actual production of the prescriptions as safe and as efficient as possible,” Doyle Jensen, executive vice president at Innovation, said. “We’re seeing that accomplished through a shift to a highly evolved central fill model, where the most amount of technology can be deployed to drive the lowest product cost per prescription. It also gives them the flexibility from that same central fill as a point for home delivery or mail. We see people in the supermarket space adding both of those services into their models.”
Pharmacists spend between 80% and 90% of their time filling prescriptions, Jensen said. “By moving that production to a centralized automated facility creates the time for them to provide patient services,” he said.
One supermarket pharmacy that looks to Innovation to enable clinical interventions is Pittsburgh-based Giant Eagle, a $10 billion company with pharmacy representing some $1.4-to-$1.5 billion in sales. The chain operates 213 pharmacies across western Pennsylvania, Ohio, West Virginia, Maryland and Indiana. Each store averages more than 2,000 prescriptions a week, and roughly 40% of the chain’s volume is filled via Giant Eagle’s central fill facility.
“Innovation provides the technology for us to take the filling process out of the store and bring it into the robots in the central facility, and the communication to move that data back and forth, Jim Tsipakis, Giant Eagle’s senior vice president of pharmacy, said. “More importantly, it allows us to concentrate our valuable pharmacists’ and pharmacy technicians’ resources for services. The real value is the human interaction and the high touch that we want to be able to provide to our patients,” he said, noting that it also serves as a differentiator for the chain by ensuring a pharmacist is available to handle patients’ health-and-wellness needs.”
Schnuck Markets, which has 107 retail pharmacies located across Missouri, Illinois, Wisconsin and Iowa, also relies on central fill for enabling patient engagement.
“Central fill allows the majority of maintenance prescription refills to be processed off-site in order to allow our pharmacy teammates to spend more time with their patients at the store,” Brigid Elam, the chain’s director of retail pharmacy, said. “In addition to improving service levels, utilizing the central fill process decreases the cost to fill and helps optimize overall inventory levels. Also, our stores and patients are supported by a call center and central processing center.” Elam said that Schnucks is offering a plethora of clinical services that focus on a total health-and-wellness offering that also includes nutrition. “We have partnered with Strand platform to improve efficiencies with offering more clinical services, including diabetes self-management education, smoking cessation counseling and blood pressure checks within our current retail workflow,” she said. “This is in addition to the robust full-service immunization program we offer that includes travel health and our MTM programs,” she said.
McKesson High Volume Solutions, based in Malvern, Pa., is making headway with central fill services to free up pharmacists. HVS vice president Joe Tammaro said the company is seeing that supermarket pharmacies’ per-store prescription volume is typically higher than in the traditional drug store industry. “The needs for some solutions to take that volume away and free up pharmacists’ time to do value-added services is even more pronounced in the supermarket industry than in the traditional drug store industry,” he said, noting that HVS provides automation to supermarket pharmacies for centralized off-site prescription filling that can be purchased or offered as a service a per-prescription fee.
“One of the biggest advantages of HVS is that we are a systems integrator. We select the best technology from a number of other vendors, and integrate and implement that together so it’s the best of the best, not just one technology that we own and you have to use,” Tammaro said.
Robotics not only are used for central fill, though. Some supermarkets prefer to have in-store automation that can work alongside the staff to streamline the process of filling prescriptions. Kansas City, Mo.-based ScriptPro has a compact line of three robots — CRS 75, CRS 150 and CRS 225 — aimed at supermarket pharmacies. “The CRS 150 is the most popular among supermarket pharmacies. It can easily fit into a grocery store pharmacy, and 150 tends to be the sweet spot for the number of [drug] cells that you need in a grocery store,” ScriptPro CEO Mike Coughlin said.
In addition to filling the prescription, the robot labels the prescription and puts auxiliary messages on the label, such as certain foods patients should avoid or any issues regarding driving that might be affected by the medication.
“The robot will go to the drug cell and do some verification check. It will activate the drug cell to drop the pill into the bottle and then it will print and apply a label, and then bring it out on a conveyer,” Coughlin said “There are about 10 steps required to manually perform this process that are eliminated by the robot. The pharmacist then can interact with the patient and coordinate their other prescriptions that should be refiled at the same time.” Time-saving tools aren’t limited to robots, either. Such administrative tasks as prior authorization can be automated to make the patient’s experience better and remove a time-
consuming process from pharmacists’ workflow. McKesson Prescription Technology Solutions offers CoverMyMeds, an electronic prior authorization platform that can automate the process of getting insurer approval for certain medications and help track requests.
“Our IntelligentPA solution expedites the process within pharmacy systems by initiating a request automatically when a prior authorization is most likely to be required based on historical data,” Caitlin Graham, CoverMyMeds vice president of pharmacy, said. “This helps reduce manual prior authorization reviews through auto-determination;
eliminates the need for phone calls and faxes; and creates a consistent, electronic process for all pharmacists and techs across the pharmacy chain, providing the opportunity to spend more time with patients and less time with administrative tasks.”
While automation provides supermarket pharmacists with the time to offer more services to patients, there is a need to identify patients who might benefit from interactions while offering services that set stores apart.
New York-based Amplicare’s Medicare plan comparison software, Amplicare Match, offers a touchpoint that makes the supermarket pharmacy into a resource at an already frequented destination.
“[Medicare plan comparison] is a really useful way for pharmacies not only to acquire new patients that are in these grocery settings, but also retain consumers who are also pharmacy patients,” Amplicare CEO Matt Johnson said. “It also opens up the opportunity to address other interventions with patients.”
Among the interventions available are immunizations, which Johnson said Amplicare Restore helps manage.
“We can tie [immunizations] into Amplicare Assist, the notification system, so that pharmacies are prompted at the right time and place in workflow for an intervention like vaccination,” he said, noting the open enrollment period is a good time to suggest a flu vaccine to patients. “This ensures seniors are getting their flu vaccine while coming in to get their plan comparison done or to get their refill.”
Amplicare Restore also assists with managing drug-induced nutrient depletion, which Johnson said drives patient adherence and increases OTC sales for the supermarket.
Patient intervention tools are of particular interest to such distributors as Cardinal Health, which recently acquired mscripts, a tool that offers patient adherence and engagement solutions through a mobile- and web-based health management platform. “Cardinal Health is excited to broaden the capabilities we deliver to our customers that serve to strengthen the relationship between healthcare providers, payers, pharmacies and patients,” Debbie Weitzman, the company’s U.S. pharmaceutical distribution president, said.
Ensuring patients are aware of pharmacy sevices is an essential component of making them available, and also is something supermarkets tend to have difficulty with, according to Claire Biermaas, group vice president of strategic health at Conshohocken, Pa.-based AmerisourceBergen.
“One of the challenges we see a lot of times, especially with any pharmacy that has a footprint within a larger business, is that there’s marketing and branding activity for the entirety of that chain. We help customers make sure they’re connecting the pharmacy marketing to the larger brand,” Biermaas said noting that AmerisourceBergen also offers merchandising programs to help tailor offerings to what operators want to emphasize. “If they want to focus on diabetes or women’s health, we have resources and expertise to help them make decisions about where they want to focus,” she said.
With prescription volumes increasing, inventory management is one of the most challenging areas of pharmacy operations.
“Inventory is their most expensive investment,” said Nathan Chapman, vice president and general manager of Irving, Texas-based Supplylogix, which offers inventory optimization solutions. “Certainly, where the cost of drugs continues to get higher, we can really help these pharmacies optimize the inventory that they have across their entire chain and really align with them on what is their inventory strategy.”
Supplylogix’s Pinpoint Order system can look at demand history, as well as pull in the upcoming refills and help to determine if supermarket pharmacies have the right product available at the right time. “We take care of the algorithms behind the scenes so that within your pharmacy, you can focus on the patient. We are focused on ensuring that our solutions and our tools help free up some of that time you may be spending on trying to order, when to order and how much to order,” Chapman said.
Supplylogix’s Pinpoint Transfer provides the ability to balance inventory across stores.
With generics making up roughly 9-in-10 prescriptions filled in the United States, per the Association for Accessible Medicines and IQVIA, supermarkets also need an effective generics purchasing tool, according to AmerisourceBergen’s Biermaas.
She said the company’s PRXO Generics program looks to simplify the purchasing process while helping contain costs. “If they order from this program, they reach certain tiers and they get certain rebates. We’re helping them buy better through the platform,” Biermaas said. “The platform educates the pharmacist as you are building your order to make sure you’re optimizing based on your contract.”
Monitoring the pharmacy’s financial performance also is critical when juggling reimbursements both from prescription drugs and an expanding suite of clinical services, said Christopher Smith, director of product strategy, pharmacy at Winston-Salem, N.C.-based Inmar.
“We endeavor to simplify the back-end transactions and help our clients understand the finances in a variety of ways, whether it’s on transactional-based products, or analytics products and services that help amplify and help them understand those transactions,” Smith said.
Later this year, Inmar is launching Pharmacy Analytics On Demand, a dashboard-enabled product that will allow pharmacies to be better informed about their business and see how they are performing against other pharmacies in the landscape.
Broader scope, connected store
Many supermarket pharmacies are branching out into specialty pharmacy, further broadening their pharmacists’ clinical roles.
Schnucks has six stand-alone specialty pharmacies and three in-store specialty pharmacies. It also has a Specialty Care Center, staffed with a pharmacist during food pantry hours, which serves as a resource to discuss medication challenges with patients and support the community.
Noah Tennyson, Schnucks director of specialty pharmacy, said as specialty drug approvals rise and become more self-
manageable for patients, the need for specialty pharmacies is growing. “It is important to offer specialty pharmacy services to our patients in order to best achieve therapy goals,” Tennyson said. “Specialty drug therapies are often very expensive and require extensive monitoring and patient support.”
Giant Eagle has a specialty pharmacy in Ohio and in Pennsylvania, concentrating on such conditions as hepatitis C, Crohn’s disease, oncology, HIV and neurology. The chain also employs a nurse and dietitian — the latter of which can help tie in the store’s food offerings. “These disease states are really complex and require a higher level of attention to detail and a higher level of patient interaction, and we make sure that we go over the top in service,” Tsipakis said.
So, what does the future hold for supermarket pharmacies?
“Supermarket pharmacies are becoming a destination for nutrition, health and wellness,” Schnucks’ Elam said. “Consumers are becoming more aware of their food options and how they impact their overall health. Our pharmacies are positioned well for this change in destination for pharmacy customers.”
Innovation’s Jensen envisions a bright future. “Those supermarkets that are embracing technology and alternative delivery models for the prescriptions have lots of future growth opportunities as opposed to those who don’t,” he said.
Tsipakis also is optimistic. “It’s an exciting time for pharmacy. Certainly, there are some headwinds we’re all facing as an industry and profession, but the ability to take care of patients and make a difference in a patients’ lives has not changed,” he said. “If anything, it’s gotten more important. As pharmacists and pharmacies, we play a very important role in make sure that therapy medication prescriptions are dispensed, administered and executed flawlessly, and we are helping curb healthcare costs.”
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