ROUNDTABLE: Pharmacy’s future in sync with technology
Where is pharmacy technology headed, and how will it be put to use by pharmacists and the companies that employ them?
In the era of health reform, evidence-based medicine and health information technology, those questions have become fundamental for pharmacy leaders. How retail pharmacies invest in technology and harness the flood of patient and drug utilization data it generates will determine, in large part, the future of the profession and its relevance to a fast-changing health system seeking new cost-saving solutions and more effective approaches to patient care and disease prevention.
Technology vendors continue to boost the power, ease of use and connectivity of hardware and software. To get a better sense of how technology is enabling community pharmacy to play a greater role in health care in the age of reform, DSN invited some leading healthcare technology executives to share their opinions on the evolution of pharmacy technology and what the next few years should bring.
What are the most significant technological developments that you forsee being used in retail pharmacy organizations in the coming years, and will these technologies enhance or replace what exists today and why?
Frank Sheppard, CEO of Ateb
Making data more available and actionable for retail pharmacy teams will be the biggest technological development in the coming years for retail pharmacy. Pharmacy already uses data every day for multiple dispensing related tasks, but the ability to use that data in new and innovative ways that bring value to a broader set of constituents will be the key in how pharmacy evolves over the next few years. IMS reported that 2012 was the first year that prescription dollars declined year over year; this sets the stage that everyone already knows, pharmacy must find new ways to create and provide value to patients. The good news is pharmacy is in the best position to help solve the growing problem of access and affordability in health care. Using the data pharmacy already has and potentially integrating in new sources of information allows pharmacy to proactively assist patients to achieve their healthcare objectives. Solutions like Ateb’s Time My Meds medication synchronization solution and our Patient Management Access Portal organize pharmacy data in a clear and actionable manner that facilitates the pharmacy team to make a dramatic, positive impact on adherence and improve patients’ health. Ateb is actively working with our pharmacy partners to develop new paths (e.g. payers, employers, hospitals and third party administrators) for the pharmacy to be remunerated for these incredible results.
Doyle Jensen, executive VP global business development at Innovation
Retail pharmacy will continue to implement technologies that help to unburden pharmacists from their traditional tasks, enabling them to be “front-and-center” in their patient-centric wellness programs. To support this, we currently see an evolution in the production areas to virtualize pharmacist prescription verification steps. Pharmacies can use technology to balance the verification workload and to centralize this task, helping streamline workflows and increase efficiencies. We also see aggressive development of will call technologies for patient pickup, which will help reduce patient wait times, improve customer service and free up staff for other revenue generating activities. And lastly, with patient adherence a huge part of the Affordable Care Act, we’re seeing the introduction of all sorts of technologies to help drive compliance and increase positive treatment outcomes. We need to continue to find the most effective ways to engage patients and empower them to take an active role in their own care.
Christopher Thomsen, VP business development for Kirby Lester
There are a lot of technologies that handle pieces of the pharmacy’s workflow, but not all are properly and completely connected. In short, we lack uniformity and integration. Several systems handle order entry, DUR, adjudication and patient information; one system prints labels; one system runs the IVR; a different system controls the robotic dispenser; and yet another handles will call and then POS. Technology providers use the term “plug and play” a bit too loosely and flippantly, but the reality is that all technology providers strive to differentiate their products — different applications, benefits and results. And, the situation is further complicated by the continual release of new operating systems, updates and versions. I think we are facing an inevitability; we need universal technology standards, and it’s going to take time and common ground from everyone. But, when this does happen, we will find that it will be a much easier task to interface, integrate and communicate between all of the different software and hardware solutions. At some point, technology vendors will write code with an ability to be more adaptable, yet still differentiated, but better and safer for the end user and the patient. It is in everyone’s best interest. So in a few years, pharmacy management will be able to take inventory: if they have systems that don’t interoperate, throw them out and bring aboard technologies that are truly connected.
Michael A. Ziegler, senior manager marketing and analysts at QS/1
I think an important issue in the near future is medication synchronization and other adherence tools. Synchronization enables the customer and the pharmacist to coordinate the refill dates of all of the customer’s medication to the same day, so the customer doesn’t have multiple pickup dates. The customer should have the ability to select a due date that fits his or her individual schedule. In addition to aiding adherence, the tool should help pharmacies maintain great star ratings in the future.
David M. Williams, VP RxMedic Systems
Pharmacists will continue to move to automation that will improve prescription workflow and overall operations. As reimbursement rates are reevaluated by the various payers, pharmacists will focus on controlling their costs in part by maintaining existing staff levels. Automation, primarily robotics, handles the inventory, counting and labeling as well as photo verification for the prescription. Automating these parts of prescription processing frees staff for interaction with patients and other tasks. An investment in automation, properly implemented, can result in hundreds of hours of time saved every year.
Mike Coughlin, president and CEO of ScriptPro
Medicine is rapidly moving from a "product" industry to a "knowledge" industry. We are moving from the era of test tube medicine to knowledge-based medicine. The new era involves limited distribution drugs, specialty pharmacy, REMS, pharmacogenomics and personalized medicine. In this new era we have at least three "customers" — or stakeholders — to deal with. First, of course, are the patients. They need help and expect us to provide it. Then there are the payers. They need to be assured that we have the knowledge to properly match expensive medications to the patient’s need. If we cannot demonstrate this, the payers will not pay. Finally there are the manufacturers who are conducting research and producing these powerful and expensive drugs. They need to be assured that their drugs are being used properly and that side effects are being dealt with. They want to see competence, and they want feedback and validation. We must provide these things, or they will not give us access to these drugs.
To be successful in this new era we must assimilate knowledge into our organizations at the exponential rate that it is being created. And we must ask questions that are similar to the marketing of physical products:
- How do we get the knowledge to the right place?
- At the right time?
- At the right price?
- And how are we going to get paid for it?
- How do our stakeholders know we have this knowledge?
- How do they know we are using it properly?
Knowledge is not shipped through supply chains like products. Knowledge is transmitted instantaneously, anywhere through communications. Call it what you want — communications, telematics, telepharmacy. In this new era, we need platforms to systematically assimilate knowledge and manage it like a supply chain. Pharmacy operators who want to participate in this future should begin to view their primary product as knowledge and put systems in place to acquire it, embed it in their organizations and make it available at the right place, at the right time, at the right price and with a plan for how they will be reimbursed for it. I believe telepharmacy will become the system that conveys this information in an affordable and safe way. It will become a platform that enables pharmacies to make the transformation from a product industry to a knowledge industry.
Adam T. Vargulick, director of product management at VoicePort
The technological developments that I foresee being used in retail pharmacy organizations in the coming years will be those that focus on improving pharmacy efficiency to reduce cost while providing tangible metrics of improved patient care and outcomes. External forces, such as the Affordable Care Act and the annually published CMS Star ratings, are two prominent examples of current drivers that are dictating a fundamental change in retail pharmacy operations. Retail pharmacy is asserting itself in the patient-centered care model, providing more value-added services, as well as more consultative engagements with patients. Technology solutions like VoicePort’s medication synchronization program, SynchroScript, are helping to positively impact the coordination of care, providing a “hub” for retail pharmacies by integrating disparate data sources and applications to empower pharmacists with the tools and information they need to manage patient care and subsequently track the outcomes. As well, today’s patient is more informed and eager to take an active role in managing their health so tools like VoicePort’s Appointment Scheduler, integrated with the pharmacy website, provide them a way to self-serve a number of pharmacy related interactions from vaccinations to comprehensive medication reviews and everything in between. Retail pharmacy is continually presented with challenges but within those challenges lies opportunities, and this is where technology like that provided by VoicePort becomes the key.
WSJ: Pills of the future to replace injection as specialty drug delivery mechanism
NEW YORK — The Food and Drug Administration recently approved two "robotic pills," or pills that place an image camera or ingestible sensors into the gastrointestinal tract, according to a report published earlier this week by the Wall Street Journal.
Other robotic pills still in development include one backed by Google — a pill that would replace injectable drugs, the report noted.
Blake Byers, the Google Ventures general partner who spearheaded the investment, told WSJ that inventor Mir Imran may be achieving one of the "holy grails" for biotechnology by figuring out how to deliver such protein-based drugs as basal insulin to the body without the use of a syringe.
Analysis: Exchange plan patients to bear the burden of specialty medicines
WASHINGTON — In most exchange plans, consumers will face paying a percentage of the costs — often called co-insurance — rather than fixed-dollar co-payments for many specialty medications used to treat rare and complex diseases. According to a new Avalere Health analysis, some plans require enrollees to pay 50% of the specialty drug’s cost. If exchange plans use coinsurance for specialty medications, patients may incur several thousands of dollars of cost-sharing for high-cost drugs before reaching the out-of-pocket maximum.
“This latest analysis further underscores that exchange enrollees could face high out-of-pocket costs, particularly for specialty medications,” stated Caroline Pearson, VP Avalere Health. “High prevalence of coinsurance also can make costs unpredictable for patients who struggle to translate cost-sharing percentages into actual dollars.”
Specifically, 59% of Silver plans on exchanges across the nation use co-insurance for consumer cost-sharing on the specialty tier. Among Silver plans, the analysis also found that 23% of plans have co-insurance rates of 30% or more on the highest formulary tier. As many as 60% of lower-premium Bronze plans apply specialty tier co-insurance greater than 30% of the drug price.
By contrast, only 38% of Platinum plans require co-insurance.
“Health plans operating in the exchanges are using significant cost-sharing to meet actuarial values set forth in the law and limit premium costs. However, these formulary designs often result in high costs for patients with chronic illness who need biologics and other products on the specialty tier,” said Dan Mendelson, CEO Avalere Health. “Tracking these patients to ensure that they are getting appropriate care is a critical quality need.”
Avalere Planscape examined 603 different plan designs across metal levels offered by 60 different carriers in 19 states, both federally facilitated marketplaces and state-based exchanges. The distribution of metal level and plan type of the plans included is similar to the distribution of plans offered on the FFM. High-deductible plans are not included in this analysis.
This analysis specifically focuses on drugs dispensed through the pharmacy benefit, which includes self-administered products. Many specialty drugs must be physician-administered and will be covered under the medical benefit, which will have separate cost-sharing requirements from the co-insurance rates described here.