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Telepharmacy for Pharmacists

My pharmacy friends tell me that it’s increasingly harder to own and operate a private pharmacy but that working a retail pharmacy job sucks. Some seem to enjoy working for larger medical groups but they get destroyed because of the number of consults they have to do during each shift.

A pharmacist doesn’t need diagnostic tools and doesn’t have to lay their hands on the patient. In fact, a pharmacist is someone who performs higher level tasks based on a decision tree. Not only could they perform the work remotely but they can be more efficient in their role. Telepharmacy for pharmacists could also be a way for the pharmacist to have their own business.

 

Underutilized Pharmacists

Pharmacy is the cornerstone of conventional US medicine. It also happens to be a pain-point for many clinicians. Similar to physical therapy, the physician wants to farm out the pharmaceutical decision to the pharmacist.

Back to the physical therapy example. When I worked at Kaiser Permanente placing a PT/OT referral required that I also suggest what the patient should have done. But…. uh…. I don’t do PT so how do I know what you’re gonna find in your initial PT eval. Outside of KP this concept is rather obvious to everyone. The PT prefers to perform their own assessment, make suggestions to the physician, and together a great therapy plan is established.

I would love to interact with a pharmacist who can figure out the dosages for me and tell me what the next-line medication should be. I used to give the wrong medication for acute sinusitis for nearly 2 years. The IDSA had changed their recommendation to Augmentin as first line therapy and not once did a pharmacist call me out on it even though the diagnosis and medication were associated.

This gap in care was recognized and already addressed in the EHR. Instead of expanding the breadth of pharmacists each drug now comes with a reference link and the dosages are prepopulated. I even see flags in the chart when there are interactions or better options available.

There is even a GoodRx API which can be used with compatible EHR’s so that I can shop for the best price medication for my patients. Now I don’t have any reason to consult a pharmacist. I now only call a pharmacist when there seems to be a medication error such as quantity or because something didn’t get properly transmitted.

Medication Management

I’m probably wrong but these words are free so I’ll wield them as irresponsibly as possible. I suspect that many pharmacists will end up in call centers or will have to settle for a supervisory role at a retail pharmacy often with far lower pay. It’s not much different from how telemedicine is going more and more towards APP’s instead of MD/DO’s – it’s cost-cutting.

From this feculence will bloom clinical pharmacists who will help patients manage their medications. They will consult on complicated cases or on titration routines. They will take into account lab values and even direct further testing in order to manage the patient’s blood pressure, cholesterol, diabetes, thyroid, and lupus medication.

For this to happen the AMA would have to be willing to step aside and they won’t give up that right easily. A pharmacist can be a much bigger resource than a pill counter or someone who runs insurance authorizations. I hope we see more clinical pharmacy integration as EHR’s become more sophisticated and easier to use.

 

Telepharmacy Jobs

I didn’t think I’d find any telepharmacy jobs online but there are a few listed on indeed.com. None of them advertised that the pharmacist could work from home but that’s usually the next iteration of telehealth. No company wants to deal with real estate and workplace injuries when they can have their employees work from home. This allows them to offload the risk and costs onto their employees.

PipelineRx seems to have figured the telepharmacy game out. They sell their services to health groups and have their own telepharmacists staff. They can go into a healthcare system and deliver an entire pharmacy infrastructure for their client.

Pharmacist Tasks

Here are a few things I know and found in regards to what pharmacist do. I’m not a pharmacist so reserve your hate comments or send them to [email protected]

  • drug therapy monitoring
  • patient counseling (med recon)
  • prior authorization
  • refill auth
  • discuss medication with prescribing clinician
  • IV medication stuff (no idea what they actually do, they mix them?)

From what I see a lot of this can be done remotely. The argument that patients prefer or that it’s better for patients to deal with a health professional in-person would only be valid if patient volumes allowed for it. Most pharmacies are slammed and so are the pharmacists.

 

Future of the Physical Pharmacy

Medication prescribing will only grow. Most clinicians recognize how ineffective medications can be when compared to lifestyle modification. But the latter is just information which is already available for free online, from the doctor, from the CDC, FDA, and even from grandma. Medications is what many are after because we have gotten accustomed to buying solutions rather than building them.

As healthcare costs grow we will see technology replace certain tasks. That’s why telehealth has been so widely adopted. Who would have thought that medicine, from all professions, would make room for a computer screen to replace the patient-doctor interaction.

When I started doing telemedicine I remember my colleagues saying that it won’t take off. Even the patients I talked to said that it’s a terrible idea but that they loved the convenience. It’s both fascinating and worrisome but if it means more access then telehealth might be a good thing.

Mail Order Medication

Roman has their own mail order pharmacy and the big name in town for mail order is PillPack. My patients have enjoyed PillPack and their business model makes sense.

In-office Dispensing

Hospitals are familiar with Automated Pharmacy Dispensing systems such as the Pyxis. Many ER’s have these, as well. Even private clinics dispense medication directly from the clinic without a pharmacist.

Though the laws vary from state to state I can dispense a medication to patient as a physician or nurse as long as there is a prescription for it. The markup on such medication is so high in a pharmacy that many clinics make a healthy profit from such systems.

Medication Vending Machine

Will Rx dispensers start showing up? Ya betcha. CVS already has sophisticated vending machines for OTC products. Though we might not see Norco in one of these, it’s not impossible to imagine Narcan or an Epipen showing up. That initial penetration paves the way for Viagra and BCP’s.

 

Telepharmacy in Telemedicine

My buddies who practice in Iran tell me that this is how it goes down. The doctor writes down the name of a medication and the patient takes that to the pharmacist who figure out the dosage and regimen. Imagine how much time that would free up.

I’ve been practicing as a doctor for 13 years and still hate figuring out dosing regimens for griseofulvin or even pediatric ibuprofen dosing. It’s obviously much easier now with EHR but imagine writing a diagnosis of scabies and then doing a warm handoff to the telepharmacist …. whaaaaaat?!

The telepharmacist will figure out the appropriate regimen based on current guidelines and local resistance patterns. They will figure out the dosing, the dispensing, and discuss all the side effects.

 

Telepharmacy in the Urgent Care

We dispense a lot of medication in the Urgent Care but still most Urgent Cares don’t care to take on the responsibility and risk of dispensing medication to the patient. I could see a place for telepharmacy in a busy urgent care.

The medical assistant could handle the dispensing and the pharmacist can go through all the steps necessary to ensure it’s the correct medication. They can counsel the patient and discuss issues with other medications.

The cost for this may not be justified for a tiny Urgent Care but even for a medium UC there could be huge profits. Yes, they would need to give up some real estate to house a computer and medication station but most medium sized UC’s already have their own medication dispensing system.

OnMed has an awesome health station which is unmanned. Meds are dispensed after a patient visit is complete. It’s happening.

A third party vendors (you?) could handle that for them and there could be a profit sharing system.

 

Telepharmacy Business Opportunity

I haven’t been able to price out the systems and services provided by companies like PipilineRx or other vendors but I imagine that it’s prohibitive for many private clinics and urgent cares.

Business Model

Here is a business opportunity for the pharmacist who wants to work from home and do just a little bit of driving around. You can go hit up all of your local private clinics such as endocrinology, GI, primary care, and pediatric offices and tell them that you’ll take over their entire pharmacy and medication dispensing.

You will train their staff to assist you in the process and you’ll handle all the medication ordering and of course the dispensing. You’ll cut them in on the profits and they can get rid of the risk and headache of the entire process.

Logistics

All you need is 4-5 of these clinics and you can handle a high volume from the comfort of your PJ’s. Commonly, many patients waive their consulting and you can either do a video or telephone visit with the patient at a time that’s convenient for them. It doesn’t have to be right during checkout. They can pick up the medicine, go home, and you can call them with instructions.

You can even do it over a HIPAA compliant text messaging service such as Vsee. All you’d need is a laptop and an internet connection.

As for the medication ordering. You could order all the medication to your home address and once a week drive out to stock each clinic. I am not sure if you can order the medication to multiple clinic sites simultaneously. If so, even better.

Herbal Remedies

Herbal remedies are becoming more and more important. Patients expect their doctors to know a lot about this. As the pharmacist you can not only stock alternative medications but also educate your physician clients. This could set you apart from any competition in that space.

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