PCA Pharmaceuticals

1. Develop a dispensing protocol, document it and post it.  This particular physician had done extensive research on the legal elements of dispensing in her state, developed a dispensing protocol that worked for her clinic, staff and patients and then documented her dispensing process.  Not only is it good for the clinic, it demonstrates a higher level of professionalism and diligence should anyone ever ask.
2. Train your staff.  Don't assume great nurses or data entry clerks make great mind readers.  This physician documented her protocol and actually spent time training her staff on the process and her expectations.  A little bit of time upfront goes a long way.
3. Go beyond regulation requirements.  What a great idea!  Her goal is best practices.  What are your best practices?  She spent time thinking about dispensing in the context of benefiting patients and her clinic.  I'll devote a later blog to this concept.
4. Anticipate mistakes.  We are all human so mistakes are a given.  What can we do to anticipate and prevent them?  In her case, the physician requires double-checks in at least two points along her dispensing process.  It didn't add much time and has been very effective.
5. Embrace security.  Though it is not required, this physician stores all of her medications in a double-locked cabinet.  Controlled substances require extra security but it doesn't hurt to keep everything locked up.
6. Leverage prepackaged pharmaceuticals.  This physician's original model involved having office staff count pills and package medications for patients.  Even when this isn't expressly forbidden by law, it presents numerous points of error to the clinic.  Most staff are not trained as pharmacy techs and it is difficult to implement and manage pill counting and packaging.  Our friendly physician sought out PCA to help her get out of the pill counting business thereby enhancing her practice and reducing her risks.

• Phentermine
• Phendimetrazine
• Metformin
• Fluoxetine

• Staffing - clinics often fear that office medication dispensing requires a lot more effort on the part of staff members.  This does not have to be the case.  Few clinics are overstaffed and no one is looking for additional work.  A successful dispensing program requires minimal impact to staff.  PCA has been able to help clinics implement physician dispensing without adding staff.  Fast labeling and streamlined processes make this possible. When looking to dispense, narrow your formulary on frequent movers, keep your inventory to a minimum, use the fastest labeling system you can find and limit the steps in the patient check-out process. Handing the patient his/her bottle while delivering medication instructions puts very little overhead in the transaction and emphasizes your directions.
• Processes - A streamlined dispensing process requires one touchpoint for giving the medication to the patient and one for completing the transaction.  If the prescription is dispensed to the patient while they are receiving medication instructions, then payment for the meds should occur when the patient is checking out as he/she normally would.  Requiring patients to pay cash for their medications will make dispensing even more efficient by avoiding submissions for reimbursement.  If you specialize in occupational health and make work comp claims, a limited formulary and understanding of your carriers policies will make dispensing much more viable for your practice.

• Picking the right labeling or dispensing system will impact the time it takes to dispense medications in your office.  Many companies offer manual labeling as well as electronic labeling systems.  Though dispensing software is better at information retrieval, programs tend to be a bit slower than a simple manual system.  If you opt for a manual system, make sure you don't have to duplicate entries on bottles and logbooks; you should be able to write the information once and keep a copy through the miracle of carbon imprints.  PCA offers both systems and we will help you implement whichever makes sense for your clinic.
• Tracking inventory and managing the reorder process can be a challenge.  In this case, electronic systems make it easier.  However, adding another system for a clinic using an EMR doesn't make sense.  The best answer is to keep fewer quantities on hand and let your distributor carry the burden of inventory.  If your pharma distributor is frequently out of products or makes you wait weeks for products then they may not be big enough to meet your ordering requirements.  Once we understand a clinic's ordering pattern, we will adjust our inventory to make sure we have the right products when they are needed.

• Most states allow physician dispensing but a few have limitations.  Check with your Board of Pharmacy or Medical licensing to determine if your state has specific regulations.  Who can handle the medicine, record keeping and reporting are just a few of the possible requirements in your state.
• Many states have separate requirements for controlled substances. Some even regulate controlled substances from different agencies.  Be sure to look closely to make sure you aren't missing something specific to your state.

• How profitable is medical dispensing? This very common question is a variety of responses.  Many clinics earn 80% gross margins on medications and are still able to be very competitive with the local pharmacy.  However, the low overall cost of generic pharmaceuticals requires a sizeable volume to make an impact.  Fifteen to twenty daily dispenses per physician is not unheard of but the doctor must be prepared to offer the option to patients.  It doesn't happen automatically.
• Most distributors do not require a minimum order or contract.  However, the clinic will likely spend several thousand dollars on an initial inventory.  With the right items, this cost can be recouped in 2-3 months.  The physician must be realistic about what will be required in the clinic - look carefully at your prescribing mix and focus on the most frequently prescribed medications.

1. Get back to basics - What is it that your practice, operation, team, etc. does? Who are your customers?  What are the three little things you can do today to focus on them?
2. What is your purpose/mission? Example: PCA helps clinics better serve patients by enabling pharmaceutical dispensing. We provide prepackaged medications and medical supplies. Focus yourself and your staff on the mission not on the economy.
3. Stay tactical - what can we be doing each day to makes things better for staff, for patients etc.
4. Stay upbeat - what have you got to lose?

• Medication dispensing
• Medical supplies
• Dispensing software
• Pharmaceutical warehousing and fulfillment

Blogging technology is so cool!  Having a handy reader allows me to tag blogs in which I am interested and quickly scan them to keep up on our rapidly changing world.

PCA provides medical supplies and enables pharmaceutical dispensing for many types of medical clinics.  I've discussed the importance of one particular group, community health centers (CHC's), in previous blogs.  I came across an interesting study that focuses on the economic impact of community health centers in the State of Washington.  I discovered this study in an update written by Beau Boughamer at the National Association of Community Health Centers (NAHC).

I've talked about the huge impact of these health centers on individuals and their access to care.  CHC's primarily focus on providing care to the poor and uninsured - including medications and other supplies.  The study shows over $1 billion of direct and indirect economic benefit to the State of Washington including 5100 jobs.  Beau also references a broader national study that shows over $12 billion of economic impact from CHC's nationally.  Very cool!

You can look at the Washington study directly at the Community Health Network of Washington.  The national study is available from the NAHC.