FARGO, N.D. — Traditionally, advancements in the practice and professionalism of community pharmacy have come incrementally, one small step at a time. Often, minor gains have been offset by narrowly conceived restrictive barriers advocated or put in place by health care constituencies less interested in advancements in the relevance of pharmacy than in influencing and manipulating the larger health care ­community.

Now comes an innovative initiative from a Minnesota-based 89-store drug chain with outlets across six states in the upper Midwest that shows every initial indication of nudging the practice of pharmacy from a profession dependent on and tied to the dispensing of prescription drugs to one whose success is based on the professional involvement, knowledge, wisdom, judgment and commitment of the pharmacist.

The drug chain in question is Thrifty White Pharmacy, and the series of initiatives it has rolled out over the past two years has succeeded in eliminating many of the mechanical functions that have traditionally defined and limited the role of the pharmacist at store level, replacing them with an expanded role in patient counseling and medication therapy management.

The programs turn on the inarguable premise that the pharmacist’s professional life is tied to doing more than dispensing prescriptions, and indeed that encouraging patient compliance and managing the patient’s medication therapy is the role pharmacists must play going forward if they are to exert a positive influence on health care outcomes.

According to a 2009 New England Health Institute study, poor medication adherence results in over $290 billion annually in avoidable costs to the U.S. health care system.

To that end, the filling of maintenance prescriptions has been largely transferred from the individual stores to state-of-the-art, robotically dependent central-fill facilities located here. Prescriptions are filled more quickly and economically than at store level, with no decline in safety or accuracy. Prescriptons are then shipped daily by courier to the individual stores for delivery to the patients. If the patient prefers, prescriptions may be home- or office-delivered, or sent by mail. (Some 80% of the maintenance prescriptions are picked up at the store, while 15% are mailed and 5% are delivered to a home or business address.)

Utilizing the central-fill options — some 65% of Thrifty White’s total maintenance prescriptions are now filled at these facilities — has led to initiatives that allow the pharmacist the freedom to perform more of the duties community pharmacists have been educated and trained, though not always encouraged, to perform. The initiatives include the following:

• Ready Refill — Maintenance prescriptions are automatically filled ahead of time and are ready for the patient each month. The pharmacy will even call to let the patient know the prescription is ready. The key to the service is the utilization of the central-fill facility to process maintenance prescriptions ahead of time, from which they are shipped overnight to the individual stores or, should the patient prefer, delivered or mailed to his home or office.

• Medication Synchronization (Med Sync) — perhaps the most significant of the Thrifty White initiatives, Med Sync encourages patients to pick up all their monthly prescriptions at the same predesignated day each month. An automated call notifies the patient 10 days before prescription pickup is scheduled, both to determine if the patient’s drug regimen has changed and to confirm the pickup date. Two additional calls are made to insure the patient picks up the prescription as scheduled. “Studies have found that patients are three to eight times more likely to take their medication when they use the Thrifty White Med Sync program” says Thrifty White president Bob Narveson.

These cornerstone programs are supplemented by other initiatives designed to increase compliance. Specifically, Thrifty White offers patients HealthyPackRx Compliance Packaging for multi-dose prescriptions. These individual packets are labeled with the medication, day, date and time to be taken, with the objective of improving convenience while reducing confusion and the risk of medication errors. Thrifty White will mail HealthyPackRx packages to the patient for a monthly $5 fee; they can be picked up at the store at no charge.

As well, Thrifty White Pharmacy offers its maintenance drug patients Rx Timer caps, prescription drug vial closures that track the elapsed time since the vial was last opened, showing the patient when he last took his medication.

These programs share a common objective — encouraging the Thrifty White pharmacist to manage the patient’s medication therapy, a service that the retailer offers at no charge.

Executive vice president of pharmacy Tim Weippert explains: “We’re finding that medication therapy management helps keep health care costs down by helping people adhere to their medication regimen and keeping them out of the hospital. Our pharmacists have been trained to monitor such factors as correct dosing, duplications of therapy, lower-cost options and other medical services such as immunizations and medication compliance monitoring.”

These services have been proven, in a very short time, to sharply increase prescription drug adherence. More specifically, where the average community pharmacy compliance rate in the United States hovers at around 40%, Med Sync, Ready Refill and the supplementary programs put in place at Thrifty White have combined to drive it beyond 80%, according to Thrifty White’s initial six-month study conducted by Virginia Commonwealth ­University.

That’s no small accomplishment when put in context: The retailer has thus far enrolled about 16,700 patients in the Med Sync program. Those patients use an average of over four maintenance drugs. Thus, the program has succeeded in transferring some 900,000 maintenance prescriptions annually to the central-fill facilities. But the advantages both to Thrifty White and its patients go far beyond the success of central fill in freeing up pharmacists to provide more relevant health advice.

According to Narveson: “We’ve significantly improved the healthy outcomes for our patients. We’ve provided pharmacists with new opportunities to practice their profession, opportunities which didn’t exist five years ago. We know we can reduce total medical costs with these programs, which can save insurers, employers and Medicare/Medicaid significant dollars.”

Narveson also points out that prescription drug inventory levels have been reduced even as the practice of medication synchronization has dramatically increased, resulting in the more effective and prudent use of prescription drugs to keep patients healthy.

“Finally,” says Thrifty White’s president, “job satisfaction among pharmacists has dramatically increased. The favorable publicity our programs have received and the opportunity to involve pharmacy interns from the North Dakota State University School of Pharmacy in the program resulted in half of last year’s graduates from that school applying for jobs at Thrifty White.”

The retailer’s medication adherence initiatives have combined to propel the 89-store drug chain to the first ranks of community pharmacy retailers. These initiatives have brought a new recognition of the possibilities and the potential to America’s oldest drug chain.