One Pharmacy’s Three-Part Solution to Medication Adherence
Keep patients on track with medication synchronization, compliance packaging and just-in-time delivery
Seven years ago Tyson Drug Co. owner Bob Lomenick started to hate his job. “I didn’t have time to eat lunch or go to the bathroom,” he explained. Today, however, his three pharmacies are filling four times as many prescriptions and are performing well on adherence-focused quality measures, and he has more time. “Now I love what I do,” Lomenick said.
His moment of enlightenment came when he visited another pharmacy during his time as chairman of Mississippi’s independent pharmacy board. During that visit, he saw how efficiently a pharmacy could operate if it synchronized customers’ medication refills.
“The growth we’ve seen over the past five years is proof that this model works,” Lomenick said. Med sync has improved his business and his personal life. “I did it for selfish reasons,” Lomenick said of his decision to start a medication synchronization program. “I was trying to make my life easier.”
But the program did more than free his time. Synchronizing medications:
- Streamlined pharmacy efficiency. Their med sync program alone accounts for 800 patients across three pharmacies, totaling 18,000 prescriptions a month in a rural area of Mississippi with heavy enrollment in Medicare Part D and Medicaid. This allows the staff to better manage their time and frees up time for pharmacists to interact with patients in the store.
- Improved patient adherence. In addition to synchronizing medications, the pharmacy offers free delivery and free strip packaging with the date and time for every dose. “We do everything we can to make sure patients are taking their medications correctly,” Lomenick said.
- Provided better information to doctors. Before filling patients’ prescriptions each month, the pharmacy calls and asks patients whether they are having any problems or have made any medication changes. Synchronizing medications also reveals when patients don’t take their medications as prescribed, because they are out of sync and aren’t ready for a refill on schedule. When the pharmacy finds a patient is not adherent, it sends a letter to that person’s physician. “A lot of times physicians assume patients are taking medications correctly,” Lomenick said. Knowing a patient isn’t fully adherent allows a physician to consider alternative treatments.
- Eased the burden on patients and caregivers. The pharmacy explains how its synchronization and packaging frees patients and their caregivers from sorting out doses into a pill box every week. Afterward, they can see at a glance if they have taken a scheduled medication.
- Boosted the pharmacy’s performance on quality measures. Lomenick’s records show patients at 100% PDC in several categories. And although many of the health plans his pharmacy works with don’t participate in EQuIPP™, which limits the amount of quality measurement data that is available, each of the Tyson Drug pharmacies has scored above the five-star goal level for at least one adherence measure.
Fine-Tuning the Process
“The traditional retail pharmacy model is broken,” Lomenick said, with pharmacies being reactive to patients. Medication synchronization changes that by making a pharmacy proactive.
About a week before prescriptions are due to be refilled, the pharmacy now calls patients to check that they need the medications, resolves any insurance issues and ensures the medications are in inventory. “Synchronization gives me time to handle all of that,” Lomenick said, contrasting that to when a patient walks in the door and wants a prescription refilled right then.
Because of the detailed processes the pharmacy has put in place, it also can conduct medication therapy management with patients over time.
When Lomenick started the med sync program, he put one pharmacy technician in a back room with a computer, phone line and label printer, and the tech used an index-card file to manage the program. Other staff would write down the name and phone number of a customer who was a candidate for synchronization for the tech to call and explain the program.
By the time 60 patients were enrolled, the staff saw the positive impact med sync was having on the pharmacy workflow. One day when Lomenick was working the counter around noon, he thought his pharmacy workload was down so much that he checked his script count. Instead of being down, the pharmacy was filling 250 prescriptions.
Now he is looking at computerized systems that will better enable him to flag customers for intervention and conduct MTM efficiently.
About 95% of the patients in Tyson Drug’s med sync program also receive free delivery. When Lomenick began the program, he divided the region into quadrants, with a vertical line and a horizontal line, to designate four delivery days. The program has grown so much that the pharmacies now have 26 delivery areas with 30 to 40 patients each. When a new person joins the program, the delivery driver knows by the location which group the pharmacy needs to put that person in.
In addition to calling patients before filling their medications, the pharmacies call them just before delivery. Deliveries are then timed so that the patient’s first dose in the compliance package is for that evening. Otherwise, even with compliance packaging some patients might still struggle to stay on track if their new doses arrive a few days early, Lomenick explained.
A staff member told Lomenick one day about a patient who called to thank the pharmacy for the program. Before this program, the woman said, “I worried all day every day if I was taking my medication correctly …. It’s like a cloud has been lifted.”
Lomenick’s family also noticed the difference the program made in the pharmacy owner. “You’re fun again,” Lomenick’s son told him one day. “When we call the pharmacy, you can actually talk to us. You’re a changed person.”
“I went to school a long time to learn how to manage medications,” Lomenick said. With medication synchronization, he now has time to do that, instead of just rushing to fill prescriptions.
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