PLYMOUTH, Minn. — Thrifty White Pharmacy is reinventing the essential component of chain drug retailing by recasting pharmacists as patient counselors and practitioners of medication therapy management. For seeking to end the long-standing limitations on pharmacists from the rote demands of dispensing prescriptions, Thrifty White has been recognized as Chain Drug Review’s Pharmacy Innovator of the Year for 2012.

Bob Narveson

Programs rolled out by Thrifty White over the past two years give pharmacists responsibilities befitting their education. The initiatives recognize that boosting adherence and managing medication therapy will make pharmacists central to efforts to improve patient outcomes and revamp the entire health care system for the better. Nonadherence is estimated to cost the system as much as $290 billion annually.

Thrifty White has transferred about two-thirds of its maintenance prescription dispensing from its 89 stores to state-of-the-art, robotically dependent central-fill facilities in Fargo, N.D. Scripts are filled faster and more economically than at store level, with no diminishment of accuracy.

Prescriptions are then shipped daily by courier to stores for pickup by patients. If the patient prefers, scripts may be delivered to their home or office, or mailed. (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.)

Also, under the chain’s Ready Refill program maintenance scripts 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.

Arguably the most noteworthy of Thrifty White’s initiatives is Medication Synchronization (Med Sync), which encourages patients to pick up all their monthly prescriptions at the same predesignated day each month. An automated call notifies the patient a week and half before pickup is scheduled, both to report any change in drug regimen and to confirm the pickup date. Two additional calls are made to ensure the patient picks up the prescription as scheduled.

Studies have revealed that patients enrolled in Med Sync are three to eight times more likely to take their medication, according to Thrifty White president Bob Narveson.

These signature programs are complemented by other initiatives designed to increase compliance. There is, for example, HealthyPackRx compliance packaging for multidose prescriptions. Individual packets are labeled with the medication, day, date and time to be taken, with the goal of boosting adherence through greater convenience while reducing confusion and the risk of medication errors. HealthyPackRx packages can be mailed for a monthly $5 fee; they can be picked up at the store at no charge.

And patients on maintenance medications can get Rx Timer caps, prescription drug vial caps that track the time since the vial was last opened, showing the patient when the medication was last taken.

These programs share a goal — encouraging the pharmacist to manage the patient’s medication therapy, a service that the retailer offers at no charge. MTM helps hold down health care costs by helping people adhere to their medication regimen, which keeps them out of the hospital, says Thrifty White executive vice president of pharmacy Tim Weippert. The chain’s pharmacists have been trained to monitor dosing, watch out for duplications of therapy, and be alert to lower-cost options and the value of other medical services, such as immunizations and medication compliance monitoring, he notes.

These services have been proven to rapidly and sharply raise prescription drug compliance. While the average community pharmacy adherence rate in the country is around 40%, Med Sync, Ready Refill and the supplementary programs at Thrifty White have combined to drive it beyond 80%, according to a six-month study conducted by Virginia Commonwealth ­University.

The number of people benefiting is far from insignificant. The retailer has enrolled more than 16,700 patients in Med Sync, and they use an average of more than four maintenance drugs. The program has transferred about 900,000 maintenance prescriptions to the central-fill facilities.

The upshot is healthier patients. Patient outcomes have improved significantly, Narveson notes. Thrifty White pharmacists have new opportunities to practice their profession, ones that didn’t exist five years ago, he said. The programs can cut total medical costs, which can save insurers, employers, and Medicare and Medicaid “significant dollars,” he adds.
Narveson also reports that drug inventory levels have been cut even as the practice of medication synchronization has been dramatically stepped up, resulting in the more effective and prudent use of prescription drugs.

Furthermore, pharmacists’ job satisfaction has dramatically increased, making Thrifty White a coveted employer for pharmacy school graduates. Favorable publicity from the programs and internships taken by North Dakota State University School of Pharmacy students led to half of last year’s graduates from the school applying for jobs at Thrifty White.

*To read the full 11-page Retailer of the Year report on Walgreens and Alliance Boots, as well as the Pharmacy Executive of the Year, please see the Jan. 7, 2013, print issue of Chain Drug Review.