Going Above and Beyond as Pharmacists

AUGUST 31, 2016
Julie Kelly, 2017 PharmD Candidate; Nga Ho, 2017 PharmD Candidate; and Christopher Casale RPh, BA, BS, AAHIVS
Learn more about what it’s like to work for a Walgreens specialty pharmacy.
The minute you walk through the doors of Community, a Walgreens pharmacy, there is a sense of uniqueness, something different.

You find yourself thinking, “This doesn’t seem like a traditional retail pharmacy.” Well, we have certainly come to see that when you are different, you can make a difference. That’s what you, as a pharmacist working in the specialty pharmacy area, experience at Community.

Pharmacists are the most accessible health care professionals, yet they are arguably the most underutilized by patients. Community, a Walgreens specialty pharmacy, is a setting where there is opportunity for pharmacists to reach their highest potential serving patients and to at their highest potential and be the health care providers we are trained to be.

Community is especially focused on direct patient care and disease state management. Our pharmacy serves a diverse patient population with chronic complex disease states such as HIV, hepatitis C, cystic fibrosis, cancer, and transplant. It is critical that our patients with these conditions have guaranteed access and links to care, and that they achieve optimal clinical outcomes through better adherence to their medications.

A large responsibility lies with the pharmacy team to help service their diverse and specific needs. Limited distribution drugs and other specialty medications are dispensed through our specialty network of pharmacies, and our teams assist in the triage and fulfillment of these orders to make sure these prescription orders get into our patients’ hands.

Through the years, we’ve come to realize that people don’t always care about what you know; they want to know that you care. Our model has always embraced the premise that success, happiness, and fulfillment are achieved when you put people before profitability. People will forget your name, but they will never forget how you made them feel.

In our industry, that is such an important concept to remember. Our model has proven to work, and Walgreens has invested time and resources to help build upon and expand that model. We’ve taken what we learned from primarily servicing HIV/AIDS patients and applied similar approaches and practices to care for other complex chronic disease states. As a pharmacist, nothing can be more rewarding.

We’ve created many diverse initiatives and business models that our pharmacists are involved with and find professionally and personally rewarding.

Committed to Community Outreach
It’s important to be directly involved in the community of the patients we serve as pharmacists so that we can better anticipate and understand their needs. Community is located next to the Boston Living Center (BLC), which is one of Massachusetts’ largest organizations providing direct services to the HIV/AIDs community.

Pharmacists and pharmacy students coordinate the medication adherence table at the BLC once a week. At this table, they set up current HIV/ AIDS medication resource materials and answer any questions the patients at the living center may have about their current regimens. Blood pressure and pulse readings are also conducted at these medication adherence tables, as well as immunization assessments and other health screenings.

Every Wednesday, there is a Bridges support group for our more vulnerable members at the BLC. This group is for some of the more marginalized members of the HIV/AIDS community like those who may be homeless, have mental health disorders, are actively using or in recovery, or have unique and diverse challenges. Our pharmacists and pharmacy students are there to help support and provide them with valuable resources.

Community’s pharmacy students attend and present on different health topics at these meetings. This allows the members to gain insight from the students and also allows the students to gain insight to the barriers patients with HIV face. Pharmacists and students also attend and conduct meetings for other HIV-positive community organizations such as the Healing Our Community Collaborative, an organization for women infected with HIV.

A subset of our patients have active intravenous substance abuse disorders. To better serve these patients, Community works closely with several substance abuse and transitional care facilities, including the Living and Recovery Community, a 3-month stabilization community for patients co-infected with HIV or AIDs; Woman’s Hope, a 28-day inpatient facility serving women; and High Point Treat Center, a 21-day detox facility for women.

Community fills and couriers all medications for the patients in these facilities, so they have active relationships with nursing and medical staff. Community pharmacists and students also facilitate Narcan training and dispensing, as well as Vivitrol education and dispensing at several of these sites. This allows us the opportunity to round with clinicians there and be more involved in their care and recovery process.

Pharmacists and pharmacy students from Community also attend Grand Rounds at Massachusetts General Hospital (MGH) once a week. When it comes to specialty disease states, it is important to stay updated on current medical literature and treatment. MGH Grand Rounds provides an educational opportunity that is crucial for the pharmacy team.

While at MGH, team members of Community can also visit the infectious disease department where many of our patients are seen. This gives us an opportunity to check in with physicians and care nurses to see if our patients need anything, or if there are going to be any changes in our patients’ medications. Putting in this extra effort for our patients really makes a difference in their quality of care.

Committed to Medication Access
Community offers a variety of free delivery options so that transportation to the pharmacy will never be a barrier to adherence for these patients. This allows the pharmacy to service a wide geographic population of patients. Delivery options include standard 2-day FedEx shipping, priority next-day FedEx shipping, as well as a courier service to local patients. Bedside delivery to patients who are waiting to be discharged from the hospital is also provided. There are several pharmacy staff members who are dedicated to the proper and complete shipping of medications. Before any shipment is placed, a pharmacist verifies that the patient’s regimen is complete.

Community also ensures that financial hardships will never be a barrier to patient adherence. We have a third-party specialist on the pharmacy team dedicated solely to communicating with insurance companies, dealing with third-party rejections, and often times handling patients that may have 3 or more insurance companies. A certain diligence and expertise is needed to guarantee patients’ medications can be billed properly each month to ensure the lowest copay possible. There are many government assistance programs, such as the Massachusetts HIV Drug Assistance Program, that we need to be aware of so that we are making sure patients are utilizing all resources possible.

Specialty medications such as HIV, cystic fibrosis, or hepatitis C drugs are usually very costly and may not be in stock at many pharmacies. Here at Community, we have these medications ready and available for our patients. We have pharmacists dedicated to compounding many specialty medications that may not be available elsewhere, such as transplant medications or certain pediatric suspensions.

Our Community pharmacy team communicates closely with prescribers to assure there are always refills available when needed. Pharmacists or pharmacy students complete physician calls for each patient in need of a refill every morning. While these calls are being conducted, the patient’s medication profile is being examined to see if his or her medication regimens are cohesive, and if he or she is refilling all of the medications on time. Any red flags can then be addressed with the patient or prescriber.

Committed to Medication Adherence
As pharmacists, we learn that 80% adherence is considered optimal in most standards of care. However, we know that in the specialty arena, where we are treating HIV, hepatitis C, cancer, or transplant patients, 80% adherence can lead to viral resistance, organ rejection, and suboptimal care.

Our goal as a specialty pharmacy has been to do everything possible to assure patients are at a 95% adherence rate, and therefore, many of our initiatives and community outreach programs are a direct reflection of that. This is the foundation we have built our business on, and it is how we have managed to care for the diversified disease states we service.

Blister packaging is a successful tool to help patients achieve this 95% goal. There is a team within the pharmacy staff dedicated to blister packaging procedures. Pharmacists and pharmacy students conduct medication reconciliation before filling each pack to examine exactly what medications the patients are taking, and to assure they receive their complete regimens. Pharmacists create personalized medication charts identifying all medications and dosing instructions and review these with all blister pack patients. The pharmacy staff is also dedicated to prescription alignment so that they receive all of their medications together.

When our pharmacists are on the phone with our patients, we conduct medication reviews and treatment assessments. We look for opportunities to do script alignment, medication reconciliation, and treatment simplification. Through the years, we’ve trained ourselves to look for any red flags that may surface for our patients and immediately address them.

Whether patients are having issues with adverse effects associated with their medications or looking for newer, more tolerable regimens, our pharmacists are prepared to answer their questions and provide answers to their questions.

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