Overview
According to WHO (World Health Organization),Community pharmacists are the health professionals most accessible to the public. They are professionals who would share counsel and gain the confidence of all their patrons. They supply medicines in accordance with a prescription or, when legally permitted, sell them without a prescription.
Objectives
Understand the role of Community Pharmacists in health care delivery.
Understand the various types of community pharmacy.
Describe the basic management issues of community pharmacy practice, such as, Business aspects, staff and workflow.
Outline the steps in the medication order fulfillment process.
Introduction to Pharmacy Business
In times past, community pharmacy was synonymous with independent pharmacy and the pharmacist was the chemist. The basic setting then was a traditional pharmacist standing behind a counter, compounding an elixir or dispensing medicine from a large stock bottle into patient’s prescription bottle.
Community pharmacy has evolved over the years into different organizations with unique healthcare environments. From the perspective of community pharmacy in the United States,the following are examples of community pharmacy practice:
Chain drug stores,
Supermarket pharmacies,
Mass merchandise pharmacies
Internet pharmacies
Mail-order pharmacies
Independent Pharmacies
Chain Pharmacy/Drug Stores
As a general definition, a community pharmacy is defined as a “chain community pharmacy” if the organization consists of four or more stores. There are two general career paths in chain community pharmacy: staff and management.
This describes an operation with multiple locations similar designs, one primary management/leadership team and an array of merchandise to offer their clients. These organizations come in different sizes from 5 stores to as large as 5000 stores.
Supermarket /Grocery Store Pharmacies
These are pharmacies located within a supermarket or Grocery store. They primarily serve as a loss leader-to draw customers into a store where they are likely to buy other goods. The supermarkets/grocery stores are retail outlets whose main goal is to generate sales of their product lines, mainly grocery and related items.
Mass Merchant
These are very similar to the supermarket stores. Their primary goal is to attract new types of customers to their stores and grow the sales of their established products.. The pharmacy department serves being a loss leader, meaning they are willing to lose money in the pharmacy department because the “losses” are offset by sales in other departments.
Internet Pharmacy
These are companies developed by entrepreneurial and business professionals for processing and dispensing prescriptions using the internet. A prescription may be mailed, faxed, or other electronic means from the prescriber’s office. The prescription is then processed and mailed to the patient. In the United States the National Association of Board of Pharmacy has developed a seal of approval program for Internet pharmacies known as the VIPPS (Verified Internet Pharmacy Practice Sites), identifying the sites with proper processes and procedures.
Mail-Order Pharmacy
This is very similar to Internet Pharmacy. The only difference is Mail-order pharmacies are developed by the larger chain pharmacies and pharmacy benefits managers (PBMs) in order to maximize efficiency, address the insurance companies and third party payer’s demands for less costly prescription processing and to meet customer’s needs.
Independent Pharmacy
These are pharmacist-owned, privately held businesses in varying practice settings. They are the traditional type of community pharmacy with a single store or two having one or two owners, whose primary product line is the prescription department.Generally, a pharmacy is considered as independent if the total count is fewer than four stores. Many independent pharmacies provide other services like compounding, supplying durable medical equipment (DME) and/or other specialty services.
Pharmacy Employees
The pharmacist: This is the licensed professional responsible for the safe, effective, accurate processing and dispensing of prescriptions. In the United States, requirements for licensure vary from state to state, but one common law in every state and most part of the world is that the pharmacist must verify each prescription before it is given to the patient. Oftentimes, pharmacists may hold many titles like preceptor, and have additional responsibilities, such as the pharmacy manager, store or departmental manager or general manager. The pharmacy manager is responsible for inventory, hiring other pharmacy employees, training new staff, addressing customer service issues, maintain pharmacy work flow and serve as the contact person for third-party payers such as auditors.
Pharmacy Technician: In the United States some states requires that the pharmacy technician be certified, by successfully completing a certification exam and maintain continuing education credits in order to work in a pharmacy .The pharmacy technician’s role is to support the pharmacists with order fulfillment, manage tasks not requiring the pharmacist’s direct judgment such as general inventory management, third party reconciliation.
Pharmacy Clerk: This the person that manages transactions, may assist with accepting new prescriptions, handle customer inquiries and directing them to the appropriate department in the store.
A Typical Community Pharmacy Department Setup
The Drop-off window ( Prescription intake workstation): This is where patients present their prescription to the pharmacy technician or pharmacy clerk, who review it for completeness. The patient is informed about the wait time,the availability of the medication prescribed and possibly the cost.
The prescription entry station: This can be located at the drop-off window as well. Prescriptions are entered into the computer system by being scanned into the database for easy retrieval profiles are maintained and updated at the same time.Once the prescriptions are ready for filling, they are classified as “ waiting” (patient is waiting to pick prescription up and requires immediate entry) , “later” (Patient will return at a later time to pick prescription up), or “delivery” (If that service is available)
The assembly workstation: This is the space in the pharmacy where medications are packed and prepared for checking by the pharmacist. The medications are assembled, dispensed from the stock bottle, labeled, along with medication guides and adherence tools like dosing cups/spoons, medication calendar etc). Equipments and resources that may be used in this area include calculators, scales, measuring cylinders, computer, textbooks, auxiliary labels and distilled water dispenser.
The pick-up window (Pick-up station):This is where prescriptions that are filled are stored and ready for pick up by the patients. Patients are also counseled at this window.Prescriptions are usually kept in baskets or bins and arranged in alphabetical order according to patent’s last name. There is usually a designated area located close to the pick-up window where the patients can have confidential conversation with the pharmacist.
The medication storage system: This usually consists of shelving units called bays. They usually located behind the pharmacy counter and medications are arranged in a variety of ways, usually alphabetical order by generic name.A full sized or compact refrigerator is typically kept within the pharmacy to store medications like insulins, some liquids, suppositories and some injectable medications that require refrigeration. Also medications already dispensed that require refrigeration are kept in the same refrigerator.
Information to verify on the prescription
Patient’s name and address
Other patient’s information such as age, date of birth, weight,allergies.
Prescriber’s name and address
Drug indication (whenever possible): critical for patient counseling.
Date of issuance of prescription.
Drug name/strength/dosage form
Total quantity dispensed
Instructions/directions for medication such as the amount or units per dose, frequency, route of administration.
Number of refills
DAW (dispense as written) line: Indicates whether a generic medication may or may not be dispensed.
Prescriber’s signature and address.
Prescriber US DEA (Drug Enforcement Administration) number for controlled substance prescriptions.
Length of therapy and or reason for therapy (Diagnosis code for reimbursement from third party payers (health insurance companies)
Information supplied by auxiliary labels.
How and when to take drug
What to avoid when taking the medication (such as foods other medications)
If the product is a new generic drug for the same medication dispensed previously.
Possible adverse effects
The expiration date, especially if it is a reconstituted medication.
How to store the medicine
Commonly recommended adherence devices
Pill boxes
Dosing spoons/cups for pediatric use
Droppers for small doses of liquids
Dial-a-dose containers
Medication calendars
Beeping devices
Telephone call reminders
Internet/e-mail reminders
Prescription Costs
Community pharmacies are usually reimbursed a percentage of the Average Wholesale price (AWP) as an estimate of the drug cost, plus a dispensing fee for pharmacy services.
The difference between the actual acquisition cost of the medication and the drug cost estimate typically offsets operational cost of the medication.
There are three main factors involved in the increasing cost of prescription medication:
Utilization: As the population ages, more precriptions will be written and dispensed for ailments and conditions of this age group.
Availability of new medications: As new medications are being developed, manufacturer research and development (R&D) continues to rise, thus affecting the cost of medications.
Development of formularies: The federal ,state ,local and private companies create formularies – a list of medications deemed cost effective as per respective insurance company. Medication not on the formularies are considered non-formulary drugs and are usually more expensive.
Patient Encounter
A 52 year old man presents to your pharmacy with a new prescription.
Peter Williams
9876 Highway Road
Anytown, USA 33333
Name: Barry John Date 08/02/13
Diazepam 5mg #30
One tablet by mouth at bedtime
Refull: 2 P.William MD
When entering the prescription data, you noticed his current prescription profile as follows:
Medication / Direction / Qty / Last refill
Metformin 500mg tab / One tab p.o bid with food / 60 / 07/01/13
Lisinopril 10mg tab / One tab p.o daily / 30 / 07/01/13
Simvastatin 10mg tab / One tab p.o qhs / 30 / 07/01/13
Levothyroxine 112mcg tab / One tab p.o daily / 30 / 06/01/13
Temazepam 30mg cap / One cap po prn sleep / 30 / 07/23/13
Glyburide 5mg tab / One tab po bid AC / 60 / 06/01/13
Discussion question:
- What information should be verified before filling the prescription for diazepam?
- Is the prescription missing any necessary information?
- Are you familiar with all the abbreviations used on the prescription and in the prescription profile.
- What auxiliary labels would likely be placed on the bottle of diazepam.
- List at least 4 counseling points that should be provided to the patient when she picks up her prescription for diazepam.
- What open-ended questions should be asked when counseling the patient on the new prescription.
Pharmacy Student Survival Guide 2nd Edition.Ruth E. Nemire and Karen L.Kier.
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