Rich Martinson, RPh

It is a great feeling to know that you have not only helped a patient to manage their condition...but that you have also given them a good deal.

Such is the benefit of working in wholesale pharmacy, notes Rich Martinson, RPh, US Pharmacy Operations, Northern Division, at Costco Wholesale in Issaquah, Washington. "We are able to provide a high level of professional pharmacy service at the lowest cost to our members," he said. "In light of the high health care costs—especially in pharmaceuticals—it is comforting to know that when you are providing service and counseling, and having that one-onone interaction with the members, you have that knowledge in the back of your mind that you are giving them this product and service at the best available cost in the marketplace."

While competitive pricing is the mantra of wholesale in general, Martinson points out that, at Costco, pharmacists have ample opportunity to consult with patients—more so than in a traditional retail setting, he believes, highlighting the organization's built-in, private counseling rooms designed for its medication therapy management (MTM) programs and other consulting initiatives. In addition, Martinson underlines that pharmacists are provided with the adequate staffing to carry out the other tasks associated with running a pharmacy. "In our setting, we provide enough ancillary help in the pharmacies that allows our pharmacists to be pharmacists, and to be available to the members," he explained. "They are not running a register, they are not calling the insurance companies, and they are not counting the medications. They are verifying the prescriptions and being available to the members and physicians' offices."

Pharmacists at Costco take advantage of the latest technology, such as workflow management systems, to facilitate the processing of prescriptions. To further save its pharmacists time, the company is in the process of rolling out a central fill program, whereby a centralized Costco pharmacy is responsible for filling prescriptions once the on-site pharmacist has completed the first steps. "Our pharmacists receive the prescription, do all of the local fill functions, visit with the patient, call the physician when necessary, and counsel the patient,"Martinson explained. "Once all that is completed, the actual prescription is sent to our central fill facility, and that facility does the counting, pouring, and verification and then ships the prescription back to the pharmacy to be sold to the member." The goal behind this program is to free up the pharmacist's schedule so that they have more face time with the patient, or member, as Costco refers to its customers. "We want them to be pharmacists and to practice the profession of pharmacy."

Martinson believes that this plays a large role in setting Costco apart from other organizations. "The pharmacist is required to wear so many hats in this day and age, and we want to be sure that we do not lose sight that we are professionals and we want to provide professional service, even if it is in a warehouse setting," he says.

With Medicare Part D and the other changes that the pharmacy profession is undergoing, Martinson acknowledges that increasing salaries and shrinking margins will set the stage for how the industry will deal with this new set of challenges. "We need to bolster this financial model with the development, refinement, and the placing in motion of these additional services," he says. "We want them to have the services for MTM and disease state management programs and take these to a point where, perhaps, we start to bill for services." Insurance companies, he notes, are beginning to realize that pharmacists play an active part in disease management and, therefore, the reduction of overall health care costs. "We can help to reduce the overall cost in the marketplace, and there is a value to that. We need to start looking at that and to be compensated for something that we have given away."