Automation helps improve outcomes, provides faster, cheaper Rx services

BY Richard Monks

With community pharmacies being called on to provide a wider range of services, drug stores across the country are adapting new technologies to ensure that they can meet the evolving needs of their patients and strengthen their role in the nation’s healthcare system.

Chronic patients may only see their primary care physician a handful of times per year, but they see their pharmacists two to three times a month, on average.

Healthcare experts say that this frequent access to patients creates a huge opportunity for pharmacists to become central players in patients’ care. However, they note, it also creates a need to make pharmacies more efficient.

With a growing number of pharmacists providing such services as medication therapy management and immunizations, and the prescription-filling process becoming increasingly complex, those in the industry say there is a heightened need for speed and the ability to ensure that the various systems employed in a typical community pharmacy work together.

“There’s so many steps in filling a prescription,” said Miranda Rochol, VP product and strategy at Healthcare Data Solutions, a supplier of real-time prescriber verification services. “It can be a challenge to integrate all of the different systems.”

Healthcare Data Solutions is among a handful of technology providers that continues to tweak its offering to meet pharmacies’ changing needs. For instance, Rochol said, the company’s technology runs more than 70 different validations in a matter of milliseconds to ensure that a physician is authorized to prescribe a certain class of drugs.

The system, she said, helps eliminate prescribing errors and the related fines that fall on the backs of pharmacies when these errors occur.

While the changing role of the pharmacist is dictating that community pharmacies employ a wider range of systems, automation and counting technology remains at the heart of most pharmacies’ operations.

According to a report released this spring by the market research group BCC Research, the worldwide market for pharmacy automation is expected to grow by nearly 9% a year over the next five years to nearly $4.9 billion in 2018.

Technology providers say that adding more functionality to automation systems will be crucial in ensuring that these systems continue to play a central role in pharmacies’ technology strategies. Systems to promote adherence and compliance, and those that monitor patients in their ambulatory settings, will continue to become more prominent in pharmacies, with automation also taking on added significance.

Automation, technology providers contend, will continue to improve dispensing safety and efficiency, and will be at the center of pharmacies’ efforts to provide the high-touch and personal care that patients and providers are demanding.

Most suppliers have already embarked on expanding the functionality of their systems to meet the changing needs of pharmacies and patients.

Over the past year, for example, ScriptPro has continued to add functionality to its automation systems, including the use of biometrics to ensure that only authorized pharmacy staff handle prescriptions, as well as QR bar codes on prescription labels that help patients manage refills and make communicating with their pharmacy easier.

For several years, technology proponents and public health officials have touted sophisticated pharmacy technology as a critical component in reining in healthcare spending. Among the most-often mentioned ways to control costs are the increased use of electronic prescribing and electronic health records. Both technologies have been expanding across the healthcare spectrum in recent years, with industry insiders and government regulators saying the technologies hold great promise for driving down healthcare costs going forward.

Surescripts, the nation’s largest health information network, reported that it routed more than 1 billion electronic prescriptions last year. Nearly three-quarters of the nation’s office-based physicians and 9870 of the chain pharmacies across the country have adapted e-prescribing. Usage among independents last year increased by 1170, according to Surescripts.

While slower to become part of pharmacies’ everyday operating routines, electronic health records got a boost earlier this year when Walgreens, CVS Caremark, Kroger, Rite Aid and Safeway pledged to support the Blue Button initiative, a public-private partnership between healthcare providers and the federal government that seeks to give people greater access to their electronic health information in order to help them manage their care.

Technology suppliers also have been working to broaden the use of electronic health records.

Last month, QS/1 rolled out its ESI Rx History interface. The company said the medication reconciliation program enables pharmacies to instantly retrieve a patient’s medication history through QS/1’s PowerLine.

“Using ESI Rx History allows pharmacies to add their patient’s information to the database,” said Michael Ziegler, QS/1’s marketing and analyst senior manager. “If the patient ever is admitted to a hospital, this will give doctors immediate access to the most current medications the patient is taking.”

The debut of the new interface came less than a week after QS/1’s introduction of a new tool to help pharmacists provide better care.

Through a partnership with VUCA Health, QS/1 is offering a variety of services, including on-demand prescription-specific videos, to engage patients and strengthen customer relationships.

The technology allows pharmacies to print QR codes on prescription labels linking patients to VUCA Health videos that review prescription safety, provide alerts to a medication’s possible side effects and detail ways to limit reactions.


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New Rx, policies benefit women’s health

BY Richard Monks

A wave of new drug introductions and healthcare policy changes has had a significant impact on women’s health care over the past year.

The changes — from better therapies to treat a wide range of conditions to new ways of thinking about how to provide certain types of care — have affected every aspect of women’s health.


Nowhere has this been more evident than in the area of contraception, where a provision in the Affordable Care Act mandates that insurers cover the full cost of birth control medications and the removal of restrictions on emergency contraception have increased the number of women visiting community pharmacies.

Great strides also are being made in other areas critical to maintaining women’s health.


In bone health, for instance, there has been a flurry of drug-related activity aimed at helping alleviate osteoporosis in postmenopausal women.

Pfizer’s Duavee (conjugated estrogens and bazedoxifene) was approved by the Food and Drug Administration last year for both moderate to severe vasomotor symptoms associated with menopause and prevention of postmenopausal osteoporosis.

In addition, Merck said it will seek approval of odanacatib this year after completing clinical trials in 2013. The drug increases bone mineral density by inhibiting cathepsin K, an enzyme that breaks down bone and cartilage. Researchers say that odanacatib could be a major breakthrough in treating osteoporosis, noting that during the trials, a data safety monitoring committee shut down the study after finding that the drug was so much more effective than a placebo that it should be given to all study participants.

Meanwhile, Amgen and UCB Pharma’s romosozumab, designed to inhibit osteoblast activity, is in the midst of a phase-3 clinical trial that is comparing its efficacy with alendronate, one of the main osteoporosis treatments for the past two decades. The drug is an antibody that targets sclerostin, a protein that inhibits bone formation. Researchers said monthly injections of romosozumab have been shown to increase patients’ spine density by an average of 10%.

Generics also continue to play a central role in the osteoporosis market. Among the latest drugs to join the fray is Mylan’s risedronate sodium tablets USP, 150 mg, the generic version of Warner Chilcott’s Actonel tablets. Indicated for the treatment and prevention of osteoporosis in postmenopausal women, the drug debuted in June 2014.

Community pharmacy advocates and educators say that pharmacists can play an additional role in controlling bone density decay by encouraging patients to use nutritional supplements to increase their calcium and vitamin D intake to the respective 1,000 mg to 1,200 mg and 800 IU to 1,000 IU per day recommended by the National Osteoporosis Foundation earlier this year.


As community pharmacists continue to become more involved in patient care, more people are turning to their neighborhood pharmacy for vaccinations, including immunizations for the human papillomavirus, or HPV. Public health officials say these immunizations are especially critical in helping to control the spread of sexually transmitted infections, or STIs. They note that nearly 80 million of the more than 110 million STIs currently in the United States are caused by HPV, making it the most common STI in the country.

Pharmacists can play a crucial role in curbing the spread of STIs by emphasizing that patients get the full course of HPV treatment. Too many women, experts say, do not get the second or third dose of the vaccine. However, because patients’ immunization records are rarely shared with community pharmacies, pharmacists are often powerless to help increase the adherence rate for completion of HPV immunization.

Hormone replacement therapy

While HPV vaccinations are aimed primarily at younger patients, a fourth pillar of pharmacies’ role in women’s health — hormone replacement therapy, or HRT — caters to older patients.

After years of debate, most healthcare providers agree that women who are not at increased risk for breast cancer or heart disease can benefit from HRT. Therapy, they say, should start before age 60 years, last for up to five years and deliver bioequivalent estrogen and micronized progesterone in the lowest effective dose.

However, research also has shown that women receiving HRT face an increased risk of stroke. Health officials recommend that pharmacists managing a woman’s hormone replacement care stress the importance of additional preventive measures, including taking two low-dose aspirins a day while on hormone therapy and getting between three-and-a-half and five hours of moderate exercise a week to reduce the added stroke risk.

To help women sort through HRT risks and the array of other health issues they face, many retailers are offering detailed educational brochures in their pharmacies and extending pharmacy hours.

“Walgreens female consumers are particularly savvy and many will do research before making health decisions,” said company spokeswoman Markeisha Marshall. “That’s why we make women’s health and family planning information easily accessible through comprehensive in-store brochures and online resources.”


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Generation X — the missing ink?

BY Rob Eder

As we compiled the many research reports that make up our cover feature, “Customer profiling,” I found myself wondering why no one ever talks about Generation X. It’s all about millennials and Latinos, and boomers and seniors; you never see any research on Gen X.

It’s almost like marketers couldn’t give a flying fig about Gen X. And I never really understood why. Until a colleague — another Gen Xer — sent me an article he had recently seen on MarketWatch, “10 things Generation X won’t tell you.”

Now I get it. As target-customers go, we just kind of suck.

First, there really aren’t enough of us to care about — just 49 million versus 75 million baby boomers and 89 million millennials, also known as Generation Y; millennials are so cool, they even get two nicknames.

Second, we’re broke. We went to work in the wake of the market crash of 1987 and the recession of the early ‘90s; we may have made some money during the Clinton years, but we lost it all in the tech bubble, or the housing bubble, or the recessions that followed both.

But let’s face it, it’s not like the economy conspired to punish Gen X exclusively. “The recession hit just as many boomers were about to retire, and many postponed it due to the slump in their portfolios,” Market-Watch noted. Four-out-of-10 boomers don’t expect to retire until they are at least 66, and 10% more say they don’t ever expect to retire, according to a recent Gallup poll.

About half of all Gen Xers say they are behind in saving for retirement, according to a 2013 MetLife survey. “Generation X could be the first [generation] that will have downward mobility in retirement,” Diana Elliott, research officer at The Pew Charitable Trusts, told MarketWatch.

So, if you’re wondering where the Gen X shopper research is in this issue, what can I tell you? Just call us the “Missing Ink.”


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Which area of the industry do you think Amazon's entry would shake up the most?