Dispensing Software

I wrote this post nearly two years ago:

We frequently receive calls from physicians considering pharmaceutical dispensing.  A common theme among these calls is frustration with what it is often described as "a lack of professionalism and responsiveness" from various companies offering physician dispensing options.  Quite often, websites for groups offering to help implement dispensing systems for physicians are merely fronts for individuals selling part-time with no organization behind them.  I often hear folks say that Northwind Pharmaceuticals was one of the only companies to respond in a timely fashion.  There are a number of things a clinic/physician can do to avoid upfront difficulties:

1. Recognize that many websites are posted by brokers who are actually selling products for other suppliers.  These "firms" are often ran part-time by one individual who simply makes commission by marketing others' products.  Look for additional substance on the site geared to helping customers with the dispensing process.

2. Ask the firm if they distribute products from their own facility or just sell for a repackager.  As in any business, if there is a middleman, you are paying more.

3. Verify that they are licensed to distribute in your state. Many state pharmacy boards allow you to verify wholesaler license numbers online.  The DEA also verifies licensure for wholesalers.

4. On their website, look for an indication of how long they've been in business. There are a few repackagers that have been around for 20+ years and are proud to say it.  Northwind Pharmaceuticals has been around since 1981.

5. When you talk to the supplier, ask them about their business. How do they go about helping their customers? Do they offer software?  How do their labels work?  Do they make recommendations for a start up formulary?  You want to find a supplier that can get you the products you need but will also be a good fit for you and your practice.  Talking to them is the only sure way to make sure there is a fit.

Medication dispensing offers wonderful possibilities to a clinic and does not have to be rocket science.  Focus on finding a good partner, asking basic questions and getting a "feel" for the company before you buy.  A little diligence goes a long way.  Good luck!

The information is still relevant today.  I wanted to update it with a few more suggestions:

6. Ask about tracking dispenses.  Reputable repackagers/distributors will offer manual and electronic options for tracking the medications you dispense.  Northwind offers a logbook and a system called RxTracker.  Some other organizations pay a third party to manage their software and require you to purchase it.  Make sure their model fits your needs.  Northwind does not charge for our software.

7. How easy is it to order?  Your supplier should offer email, phone, fax, online and smoke signal as options for you to submit your order.  The point is, they need to make it easy for you to order.

8. What else do they offer?  Some organization don't have the buying power to get all medications or get them at the best prices.  You should be able to get prepackaged medications but what about lotions, creams, ointments, liquids, injectables, supplies?  Your supplier should be able to offer one-stop shopping if that's what you want.

9. What are some of the flags?  Start with their website.  Do they clearly explain what they do, who they are and provide additional information if you need it?  Do they offer insurance or other financial products?  These companies are often brokers that are trying to leverage relationships; they may be a good partner but you will pay more - make sure they are worth it.  Working with a sales person?  Are they are a direct employee or a broker?  Once again, more cost in the system.  How long have they been in business?

10. Who owns the company?  I like to know who I'm doing business with.  Is it a big corporation or a family-owned business?  How important is my business to them?  Thought: the bigger the company, the less important you are.  These questions will lead to fulfilling your preferences and ultimately help meet your expectations.

No worries, nothing a little due diligence won't uncover.  Sometimes it just comes down to what type of company do you want to deal with.  Do you like corporate?  Do you prefer small business?  Do you want to work through the call center or do you want to talk to the owner?  These are cultural questions that can only be answered by you.  Regardless, give medication dispensing a try - it is still one of the easiest add-on services you can find and the returns can be very good.

Call it what you will: physician dispensing, clinic dispensing, point of care dispensing etc.  A clinic that inventories medications and provides them to patients as part of their care is engaging in dispensing.  This activity is legal in most states and has long been considered a part of the physicians tool bag in the quest to care for patients.  Now, you can find it in nurse practitioner and physician assistant tool kits as well.

Practices of all flavors dispense to their patients:

1. Urgent Care
2. General Practice
3. Weight Management
4. Occupational Health
5. Employer Clinics
6. Dermatology
7. Pediatrics
8. Dental
9. Student Health
10. Internal Medicine
11. Podiatry

Clinics often purchase prepackaged medications from companies like Northwind Pharmaceuticals.  Prepackaged medications are also known as repackaged medications because the repackager purchases them in bulk, counts out the pills into smaller groupings and then repackages them into unit-of-use sizes.  In other words, that bottle of amoxicillin with 1000 pills is broken down into a bottle with 30 pills so the clinic can put it on the shelf and provide it to their patient without breaking the seal or counting pills.  Repackagers are regulated by the FDA and are required to maintain the same quality procedures as original pharmaceutical manufacturers.  Packaging, labeling and quality are all critical to this process.

After prepackaged medications are put on the shelf, the clinic must have a tracking and labeling system.  Most suppliers offer their clinic customers a manual logbook or dispensing software.  A few, like Northwind, do not charge for these systems.  The logbook system is a handwritten system with peel-off labels to place on the bottles.  Dispensing software systems typically track inventory and dispenses plus add a label printing function.  RxTracker, the Northwind system, prints a label and drug information sheet that mirrors what a patient would receive from the pharmacy. 

The medication formulary will vary from clinic to clinic and really depends on your patient base.  More generalized practices will have a broader number of medications on the shelf while specialists typically narrow their formularies.  In addition to bottles of pills, clinics also offer lotions, creams, ointments, OTC products, liquids and medical supply items.  Your supplier will be happy to help you figure out the best mix for your practice.

Medication dispensing is not complete without the financial element.  Dispensing clinics typically focus on generic medications  and cash-paying customers.  A few offer branded medications and tread in the insurance reimbursement world but this is only a fit for certain, higher volume clinics.  A cash-focused clinic typically charges about $15 per dispense depending on the product, practice and location.  With the average of 40 scripts per day, this approach will typically yield 25-30 dispenses per practitioner.

Some things to consider when looking for a supplier:

1. Do they offer the medications you need in the size you require?
2. Are they licensed in your state?  Are they VAWD accredited?
3. Does their medication tracking system work for your practice?  Make sure it fits your process and doesn't limit your flexibility in your care flow.  Also make sure it doesn't require much duplication of effort - some labeling systems can be cumbersome.
4. How are their prices?  Some organizations maintain sizeable overhead.  Make sure you're not carrying too much of that in your prices.
5. Do they require a contract?  This may work in some instances but normally limits your flexibility.  For example, Northwind does not require a contract or minimum order.
6. What other terms or deals do they offer?  It never hurts to ask, they might say yes!
7. How is the cultural fit?  In other words, do you like the people you've met/spoken with?  Often, the soft-side becomes the most critical element.
8. Do they warehouse products or are they a marketing company?  There are numerous marketing companies now offering office medication dispensing solutions that are shipped from another company's warehouse.  Typically, layers of people add cost to the product.  Service may also come from different places.  This may work for your clinic but you should be aware of it upfront.

Ok, that is a good start.  Good luck!

Interest in clinic dispensing has never been greater. Practitioners of all varieties are looking for ways to enhance their practices and pharmaceutical dispensing is one of a number of simple-to-implement options.

How easy is it?  For Northwind Pharmaceuticals, the process looks like this:

1. Develop formulary (new clinics normally select 15-25 medications to begin with)
2. Complete new clinic startup forms
3. Submit forms and copies of licensure.
4. Place order for medications (call, email, fax or online)

Once you receive your order (usually in a few days), you can implement as quickly as you like.

1. Unpack and store medications.
2. If you are using our dispensing logbook, simply enter the patient name, instructions and sign.  The carbon label is peeled and place on the bottle; the record of the dispense is left on your logbook.
3. If you are using RxTracker (our web-based dispensing application), you will need to enter the patient name (once), scan the medication and print the label.  The software is accessed through a web-browser.

That's it!  No extra staff. No need for more space.  No need for counting pills; we provide prepackaged medications that are ready to be handed to the patient.  Any questions?

Happy dispensing!

 

 

Considering dispensing medicaiton from your clinic?  Physician dispensing could be a great complement to the services your already provide to your patients.

Here are three reason offering pharmaceuticals from your clinic is a win/win for you and your patients:

1. Extra income - dependingn on the size and patient mix within your practice, clinic dispensing can generate $20,000 - $50,000 of extra income annually.  Done properly, you won't need to add staff or change much in your care flow.

2. Patient satisfaction - it can be a real hassle for a patient to make another stop after leaving the clinic. Giving the patient her prescription before you she leaves simplifies her life and gets her on the path to feeling better even faster.

3. Clinic appeal - Let's face it, competition is intense.  Attracting new patients and keeping the ones you have can be a challenge.  Obviously, job one is great care for your patient.  However, offering complementary products or services can be a great way to attract new patients and keep your current ones coming back.

Still hesitant?  Consider this: providers are implementing clinic dispensing at a rapid rate.  Specialists and general practitioners are providing medications to patients more and more to provide a complete solution.  If you don't have medical dispensing on your radar, just remember, your competition does.

This post continues my discussion of the economics of physician dispensing. If you take a general practice physician and look at his/her prescribing patterns, you will notice similar trends among practices.  As an example, I will use a mature family practice with a single physician.  We tracked his prescriptions and medication dispensing over a five day period.  He averaged 19 prescriptions a day.  About 53% of his scripts are items that can be dispensed from his office.  So, every day he is dispensing about 10 items to his patients.

In this case, the physician's average price per prescription is $15.  The average cost to the physician for each medication dispensed is $3.25.  The clinic is generating $11.75 per script of gross profit; $117.50 per day.  Let's assume that the practice is operating 45 weeks of the year, this makes the physician's annual profit $26,438.  In this case, the physician did not need to add any additional head count and most of these items are less expensive to the patient than going to a pharmacy and using their health insurance.

Conclusion: medication dispensing is not a "get rich quick" program but a viable supplement to a responsible practice.  With virtually no additional overhead cost, medication dispensing can add enough cash to help offset costs in other areas and increase the physician's net revenue from the practice.  In addition, pharmaceutical dispensing helps save the patient money and adds value through convenience.  Sounds like a win-win to me.

One of the major drivers for doctors considering dispensing pharmaceuticals from their clinics is the potential revenue.  There are many patient benefits but this post will focus on the economic impact to a medical clinic.

First of all, the facts.  The U.S. Bureau of Labor Statistics shows about 633,000 working doctors in the United States.  About half of them work in physician offices and 12% of them are self-employed.  Of all working physicians, about 40% are internal medicine, family practice and pediatrics; the average primary care physician earns about $186,000 per year.

With reimbursements dropping (Bluecross cutting reimbursements...), all types of physicians are forced to look for creative ways to cut costs (ex: reduce the price of medical supplies) as well as increase revenues.  Enter physician dispensing.  Medication dispensing involves offering prepackaged pharmaceuticals to patients before they leave the office.  It is estimated that just under 10,000 physicians dispense from their practices.  One study shows that general practice physicians see just 18 patients per day.  General practice docs are seeing a variety of conditions and many of them require a prescription.

My next post will focus on discussing the numbers and economic impact of pharmaceutical dispensing.

When dispensing, clinics typically have two options for tracking medications and printing labels for dispensed medications: 1) a manual system that uses a handwritten label and a logbook or 2) software that tracks the medications and automates the printing of the label.  Northwind Pharmaceuticals has clinics using both methods.  This post will discuss the pros and cons of both approaches. Manual Labeling With the manual labeling approach, clinics are given a three ring binder with carbon label sheets.  These labels are pre-printed with the clinic or doctor's name and have blank spaces for the patient's name, instructions and the physician's signature.  When the medication is dispensed, the provider writes the patient's name and instructions on the label then signs it.  The label is peeled off of the sheet and placed on the bottle.  The carbon impression is left on the sheet in the logbook for tracking.  Most prepackaged medications also have peel-off labels on the bottle with the drug name, lot # and expiration date so the clinic can document the dispense on a patient chart or receipt.  This method of labeling is very quick, requiring the same amount of time it takes to write a script.  The logbook makes tracking dispenses slightly more difficult and also requires more space to store.  The DEA requires that dispensing records for controlled substances are kept for 2 years; state pharmacy board requirements may vary.  Computer Generated Labels If the clinic chooses to use software to manage the dispensing process, the provider will scan the bottle, select the patient, select instructions and print the label.  The software will track inventory and dispenses thereby allowing the clinic to easily pull information and determine when to reorder medications.  The biggest downfall to the software approach is that, by design, it cannot be as fast as completing a couple of lines on a pre-printed label.  For high-volume clinics, this is a huge challenge.  From a tracking and reporting perspective, software is the ideal choice.   Electronic Medical Records Adding to the challenge of selecting the best approach is the prevalence of electronic medical records (EMR).  As EMR systems become the norm, clinics become more hesitant to use additional software to manage dispensing.  Most EMR packages will track inventory and many also track dispenses.  Until the time when most EMR's also print labels for medication dispensing, the best solution will likely be the manual labeling approach.  If your EMR is tracking inventory and dispenses, then handwriting a few pieces of information on a patient label is a very easy, and very fast, approach. Keep It Simple We have been approached by a number of clinics debating direction with regard to labeling.  My recommendation has been to focus on priorities.  If you are implementing an EMR solution, get the best application for your practice.  We will work with you to make the dispensing side as easy as possible.  Over time, these solutions will evolve to accommodate pharmaceutical dispensing within the clinic.  The Northwind dispensing system, RxTracker, makes it easy to import or export data.  However, we've found we can be of much greater value by working with the clinic to fit in with their processes.  Less is more when it comes to systems and we recommend that you keep your processes as simple as possible.

 

Northwind Pharmaceuticals provides pharmaceuticals to clinics for in-office dispensing.  Founded in 1981, Northwind offers a variety of products to physicians interested in providing medication dispensing services to patients.  Based in Indianapolis, Indiana, Northwind is centrally located for quick shipping to locations across the United States.

Here is a summary of our offerings:

• Prepackaged pharmaceuticals - bulk product repackaged into unit-of-use sizes for physician dispensing.
• Injectables
• Lotions, creams, ointments
• Liquids
• Medical Supplies

You can view a complete list of our pharmaceuticals and medical supplies in our online catalog.

Northwind offers two dispensing systems to clinics interested in pharmaceutical dispensing.  Our manual system uses carbon labels to capture patient information and medication instructions.  The labels are kept in a logbook for accurate record keeping.  We also offer RxTracker, a web-based system which allows clinics to track inventory, print patient labels and reorder electronically.  Both systems are offered at no-charge to Northwind Pharmaceuticals customers.

We make ordering easy.  Clinics can order through our online catalog, send us an email, fax their order or call our toll free number.  We accept orders 24 hours a day and most products are shipped the same day the order is received.

For more information, please visit us at www.nwpharma.com.  You can also call us at 800.722.0772 or email info@nwpharma.com.

The New Year is here.  With it come the hopes, dreams and resolutions.  Weight loss remains at the top of many lists and 2012 will be no exception.  Many of us are able to adjust eating and exercise to achieve these goals.   Unfortunately, there are many who suffer from chronic obesity and require additional help to address their weight loss challenges.  Some qualify for bariatric surgery but many do not.  For the chronically obese who are not good candidates for surgery, prescription medications remain an important part of an overall program to address this disease.

There are many practices that specialize in physician-directed weight management.  Often, doctors choose to simplify the process by offering prepackaged medications from their office.  This saves patients the inconvenience of going to the pharmacy.  Clinic dispensing is legal in most states and physicians have been dispensing medications to patients for hundreds of years.

The primary dispensed medications for weight management are phentermine, phendimetrazine and diethylpropion.  These appetite suppressants are important parts of the process and can aid in weight reduction.  Physicians offering medication dispensing along with their medical consultations provide significant value to these patients.  Many patients are seeking support from their primary care providers and physicians are playing an increasingly important role in helping patients manage obesity.  Offering the right clinical pharmaceuticals gives the practice an edge in helping patients combat this disease.

Beginning tomorrow, Pfizer's blockbuster treatment for high cholesterol comes off patent paving the way for less expensive generics.  The generic name for Lipitor is Atorvastatin Calcium and it presents another option for dispensing clinics to better serve their patients.  How big a deal is this?  There are currently 8.7 million Americans taking Lipitor.  Lipitor has been on the market since 1997.  Pfizer sold $10.7 billion of this drug last year.

Wholesale pharmaceutical distributors like Northwind Pharmaceuticals will have Atorvastatin Calcium available beginning Wednesday, November 30.  For the first 180 days, rules limiting generic competition will limit price decreases but significant price decreases should hit after that point.  Drug plans as well as Pfizer are offering incentives to stay with Lipitor or switch but it is difficult to say how long those incentives will be offered.  For physicians offering office medication dispensing, it is interesting to note that the average co-pay for Lipitor is $49 and the average co-pay for generic medications is $10.

As prices come down, Northwind will offer prepackaged versions of Atorvastatin Calcium to make it easier to dispense within clinics.  For more information on the change, check out this article in today's Wall Street Journal.

Laura Landro had an interesting article in the Wall Street Journal this morning talking about the growth of alternative clinics: retail, work, urgent care.   She quotes a study by Renee Hsia that shows patients seeking emergency care rose by 43% from 2000-2009 while hospital emergency room visits declined 27% over the same period.

The trend is compelling for clinic operators interested in bringing services closer to patients.  Wal-Mart recently announced plans to re-expand into this space.   Currently, much of the expansion has been into retail locations (pharmacies, department stores) that see a stream of customers for other products.  However, this article also says that about 300 new urgent care clinics are opening each year.

These developments present opportunities and challenges for clinics seeking to compete for patients.  Patient acceptance of the "quick care" model in lieu of scheduled office visits or ER visits opens the potential for more patients in clinics that adopt new models for serving these customers.  As competition increases, pressure on pricing and available services will also increase.  Maintaining a broad suite of services, like medication dispensing, as well as adjustments in hours, scheduling and staffing will help clinics remain competitive.

Though these trends aren't new, they may be accelerating.  The health care law and growing price pressures will continue to push patients and payers to creative solutions to today's complex healthcare challenges.

Medications remain an important part of a clinical weight loss solution.  Northwind Pharmaceuticals works with many medically supervised weight loss clinics that offer medications as part of their solution.  Physician dispensing in a bariatric practice is a great fit for several reasons:

1. Many patients are not good candidates for gastric bypass surgery and must therefore look for other alternatives to help them manage the disease called obesity.
   
2. Physicians typically prescribe a narrow range of medications for weight-loss management.  A smaller, targeted formulary is easier to manage from a clinic perspective.
3. Because weight management is an ongoing battle, physician-directed weight management often requires that patients be on medications for extended periods.  This increases the practice's opportunity to dispense medications and provide convenient service to patients.
4. The nature of obesity is complex from a psychological as well as a physiological perspective.  Allowing the patient to receive treatment and products in the safe environment of the clinic avoids extra trips to the pharmacy and long waits for medications.

Depending on the number of patients, medication dispensing in a bariatric clinic can be overwhelming.  Clinics sometimes purchase bulk bottles and count out pills for patient prescriptions.  This is incredibly time consuming and completely unnecessary.  Northwind Pharmaceuticals offers prepackaged medications; this means that we package the bulk medications into smaller, unit-of-use bottles.  For example, some of our clinics will dispense Phentermine 37.5mg in 30 count, 45 count and 60 count bottles.  Prepackaged bottles are labeled according to FDA and state pharmacy board guidelines; the clinic will need to place a label with the patient's name, instructions and clinic name on the bottle to make it a legal prescription.

To help manage the dispensing process, Northwind offers dispensing systems that comprise a manual labeling approach as well as software (RxTracker) to print labels and track inventory.  Our goal is to make it quick and easy to provide the medications to your patients.

There are no easy solutions.  Clinics offering weight management services must utilize every available option to help fight obesity and improve the quality of life for patients.

Continuing consolidation among repackagers is creating opportunities and challenges in the clinic dispensing market.  The challenges fall on medical clinics that are experiencing disruptions in their supply chain, changing personnel, higher prices, new processes, discontinued medications and various other issues.  Northwind Pharmaceuticals has received many calls from unhappy clinics looking for better support, steady access to medications and competitive pricing.  In the spirit of sharing, I wanted to put a few bullets from those conversations into this post.

• Why are companies merging?  Money, competitive positioning, aging owners etc.  The pharmaceutical industry is changing rapidly and pressures continue to mount for business owners.  Regulatory scrutiny continues to increase along with downward pressure on pricing.  Its tough out there.
• Why am I having difficulty getting medications?  When it comes to consolidation, many of the repackagers are ending up on the coasts.  For clinics that are located farther away from their supplier's new location, this means increased shipping times.  In addition, when companies merge, the goal is to reduce costs which often means streamlining formularies or eliminating product offerings.  Finally, you have the normal challenges of recalls, manufacturer shortages and regulatory barriers that tend to choke supply.
• How do I know if I should stay with my current supplier?  Everyone tends to stay on their current path unless something pushes them off of it.  If you need better service, better prices, better technology, better delivery times or any of a host of priorities, then it is probably time to do an evaluation of your options.
• I just don't have time to evaluate options...  Actually, looking around doesn't have to take much time.  You usually figure it out in a couple of interactions.  Is the vendor responsive?  Believe it or not, many are not very timely in responding.  Do they offer the technology or labeling that you need?  Do they offer the medications that you dispense?  Are their prices competitive?  Do they make it easy to order?

We all want to buy from people we know and trust.  When a company is bought, often the people you trust are required to follow new dictates.  They may still be trustworthy but it just might not work for your situation anymore. Your supplier needs to provide the dispensing systems that meet your office medication dispensing requirements.  Pricing, availability and service are all part of that equation.  Things are changing fast; don't be afraid to look at a little change yourself.

I recently came across an interesting Brief from the Center for Healthcare Research and Transformation discussing antibiotics.  The Brief is titled Antibiotic Prescribing and Use.

The brief pulls data from a study based on Blue Cross Blue Shield members in Michigan but results are likely reflective of broader US trends.  Northwind clinics that offer medication dispensing will be interested in some of the findings.

Some interesting findings:

• Overall antibiotic prescribing actually decreased from 2007-2009.
• Antibiotic prescribing for children increased in the same period.

Top Ten Antibiotics:

1. Azithromycin
2. Amoxicillin
3. Cephalexin
4. Ciprofloxacin
5. Amoxicillin-Clavulanate
6. SMZ-TMP
7. Doxycycline
8. Levofloxacin
9. Clindamycin
10. Penicillin V

Azithromycin and Amoxicillin were prescribed much more frequently.  The list shifts a little  with children.

The brief also talks about appropriate prescribing habits and the challenges associated with inappropriate antibiotic use.  For clinic dispensing, awareness remains key as practitioners seek to address legitimate health concerns and the sometimes challenging emotional concerns of patients and the parents of patients.

As we head into another school year, antibiotics will again be at the top of the list for many ailments hitting us.  Applying antibiotic prescribing to bacterial infections and avoiding it for viral infections remains the best measure of "appropriate" (at least from the Brief's perspective).  For point-of-care dispensing. the trends remain the same.  Offering the patient convenience while balancing their preferred treatment with the most effective approach remains a challenge.  Pharmaceutical wholesalers like Northwind remain a source of support but the balancing challenge remains with the practitioner.

For more information on this brief and some other interesting topics, check out the CHRT at www.chrt.org.

I am so impressed with the entrepreneurial spirit I see with so many of our clinic customers!  As the pressures mount, the creativity explodes!

A few examples:
During a visit to a dispensing clinic in Chicago this week, we discussed pending changes in Illinois law related to workers compensation reimbursement.  The news?  Not good.  Unflinching, the clinic is already working on other avenues of revenue and exploring joint venture opportunities with health services companies in different fields.  For this clinic, medication dispensing is one part of an overall plan to grow their business and continue serving their customer.

At a student health center, I discovered an RN who returned to school to get her APN.  Returning to her clinic, she lobbied to reduce their dependence on contract medical expertise and expand the clinic's capabilities by leveraging her new capabilities.  The result of her initiative?  Cost savings of hundreds of thousands of dollars a year for the clinic.  In addition, she is working to expand services including clinic dispensing to enhance the value they provide and convenience to their patients.  Lower costs and enhanced services!

At a health system-owned group of clinics, we discussed developing an expanded formulary to help secure a contract with an employer group.  The list of medications needed to match a different set of patients than some of their other clinics.  The pharmaceutical fulfillment solution needed to be timely and relevant to their new customer.  As a trusted partner, we also worked to help them identify new practitioners as they continue to expand into new areas.

Northwind clinics around the country are aggressively meeting changes in law, practice, economy and demographics with incredibly creative and entrepreneurial ideas.  The challenges will not disappear and neither will the opportunities.  As a pharmaceutical wholesaler, we distribute medications.  As a trusted business partner, we work to supplement our customer's efforts and expand their business.  Pharmaceutical logistics are easy when compared to the challenges of running a clinic in today's complex environment and we welcome the chance to help our clinics face those challenges head-on.

Our clinics demonstrate that they are not just great medical practitioners, but smart business people.  I would not bet against them!

Has it seemed like there are more and more products that are getting harder to get?  I just read an article in the Indianapolis Recorder talking about critical drug shortages.  It is interesting that a niche Indianapolis periodical has picked up on what is becoming major issue for health care providers and patients.  For clinics that dispense medications to their patients, it can be very disruptive to practice patterns.  Patients with chronic ailments relay on that periodic visit to review their condition and receive their medication at the point of care.  For acute patients, the inability to get the right product at the right time can slow their recovery.

Why are we seeing shortages of pharmaceuticals?  Raw materials shortages, reduced production of less profitable products, FDA recalls (many of these) and the occasional medication that is declared unsafe and removed from the market (like propoxyphene) can affect drug supply.  For dispensing clinics, we are seeing shortages of corticosteroid products, ophthalmic ointments and a host of lotions and creams of varying types.  The shortage of these clinical pharmaceuticals challenges practitioners in resolving ailments.  In some cases, we've seen shortages of injectable drugs but the biggest issues in the world of medication dispensing have been common, prepacked pharmaceuticals.

What can you do?  In some cases, we've been able to identify comparable products or substitutes for our clinic customers.  Of course, those usually don't last long if it is a major shortage.  In the case of FDA recalls, manufacturers typically address the issues and get back into production fairly quickly.  Some of the raw materials shortages we're seeing right now are more challenging because the supply chain has little ability to impact availability of many of the raw materials.  Physicians and nurses are evaluating their use of many of these products and searching for alternatives to solve patient issues.  In some cases, it is simply a matter of paying a higher price for the same product.  More often, practitioner and patient must grin and bear it.

The bottom line?  These shortages are simply a part of the world we live in and will continue to challenge pharmaceutical logistics throughout the country.

Distributors that help clinics dispense pharmaceuticals normally offer a dispensing logbook and/or an electronic tracking and labeling system.  These systems enable the clinic to keep track of medications dispensed to their patients.  Medication tracking software can be simple or complex depending on your vendor.  We encourage our clinics to keep their dispensing system as simple as possible.

Practitioners that dispense to their patients typically offer a combination of pills, lotions, ointments and solutions.  Many of our customers focus on treating acute conditions so we see many orders for antibiotics, analgesics, cough & cold products as well as corticosteroids.  Vaccines are also offered as a complement to the dispensing process.  In the case of Northwind Pharmaceuticals, we will also provide medical supplies to our clinics. 

Point-of-care dispensing is not a path to riches.  There are companies that promote practitioner dispensing as a means to generate significant dollars but the simple truth is that it can provide a decent supplemental revenue stream to a healthy clinic.  If dispensing revenues are higher than those from medical treatments, something is very wrong!  A single physician/nurse practitioner can reasonably generate enough to cover one or two office staff members.

Northwind Pharmaceuticals provides prepackaged medications and manufacturer labeled pharmaceuticals for physician dispensing within the clinic. Northwind also provides medical supplies to clinics. We ship nationwide and specialize in working with student health centers, community health centers and independent medical clinics.

Northwind's dispensing system encompasses labeling and tracking tools to make the medication dispensing process as easy as possible for the clinic.  Pre-labeled bottles display all required pharmaceutical information and provide four peel-off labels for use on patient medical records, receipts or insurance documentation.  Our dispensing log enables the clinic to write the patient's name and medication instructions on a label that is placed on the bottle.  The labels are on a carbon sheet that retains an image of the label so the clinic has a record of all dispenses.

Northwind also offers software (RxTracker) that automates the pharmaceutical dispensing process.  RxTracker allows clinics to capture dispensing information electronically and print the prescription label from any office printer.  RxTracker will also track drug inventory and automate reordering.  Northwind offers both of these dispensing solutions at no additional charge.

Clinics seeking to learn more about in-office pharmaceutical dispensing are encouraged to visit the Northwind Pharmaceuticals website or call us at 800.722.0772.

Reimbursements continue to shrink.  Pressure is on to see more patients. Pharmacies begin to offer "quick clinic" services.  The government passes far-reaching health care legislation creating a  host of new certainties and uncertainties.  As an independent practitioner, how do you survive in this crazy environment?

Keep the faith!  Demand for the services of good physicians continue to grow.  The growing aging population is creating the need for more and more care.  New technologies and techniques continue to evolve and present new opportunities for services to patients.  A health system in flux also means new opportunities as niches are created and patients find it more difficult to navigate the landscape.

As financial pressures continue to mount, we see more and more physicians turning to clinic dispensing as a means to supplement practice revenue.  Dispensing pharmaceuticals from your office provides convenience for your patients, revenue for your clinic and another point of differentiation for your practice.  Competitive pricing is possible with access to wholesale medications and using prepackaged medications streamlines the dispensing process.  Simple-to-use dispensing software is readily available as are the tried and true dispensing logbooks.  It is easy to implement, easy to administer and easy to maintain.  A single doctor can easily generate $20-$30k of additional profit; focused efforts can reap much more.

As frustrating as many things are for physicians these days, there are still many opportunities.  A little creativity and a willingness to focus on the business elements of your practice can reap unexpected benefits.  Blending medication dispensing, quality care and new services will continue to set your practice apart and keep your patients, and you, healthy.

Medically-directed weight loss has become a necessity for many people.  One element of a physician-directed program is medication.  Bariatric practices that offer medication dispensing are able to bring another tool to the battle against obesity.  Northwind Pharmaceuticals helps bariatric clinics implement pharmaceutical dispensing by providing prepackaged pharmaceuticals, labeling and tracking systems as well as guidance through the process.   

One mistake clinics often make is feeling that they need to count pills and package them within the clinic.  Our service takes the pill counting risk off of the physician and staff by providing options for medications and packaging.  Some commonly dispensed medications within clinics offering medically-directed weight loss services include: 

• Phentermine
• Phendimetrazine
• Metformin
• Fluoxetine
• Furosemide
• Metoprolol

Northwind Pharmaceuticals offers clinics different packaging options for these products.  For example, some clinics will dispense Phentermine 37.5mg in a 30 count bottle and schedule patient follow ups on a monthly basis while other physician's will extend the count to accommodate a longer interval between visits.  Our clinics view themselves as providing weight management solutions and medications are simply another element of the overall solution.

Clinic business models will vary and we try to be flexible to our client's requirements.  As a wholesale pharmaceutical distributor, Northwind provides a wide variety of medications.  As  dispensing consultants, we help you figure out how best to use them in your practice.  Call us today at 800.722.0772 to learn more about dispensing in your practice.