AUTOMATED RX DISPENSING CONSIDERED RETAIL THREAT

MICHAEL SLEZAK

McLEAN, Va. -- New, automated pharmacy dispensing plants may turn retail pharmacies into an endangered species.

That was the prediction made by John Ogden, director of pharmacy service at the Veterans Health Administration, U.S. Department of Veterans Affairs, Washington, at the American Managed Care Pharmacy Association's annual conference here Oct. 10 to 12. Ogden's presentation included a video tape detailing the V.A.'s high-tech, automated dispensing facility in Leavenworth, Kan., known as a consolidated mail-order pharmacy, or CMOP.

Ogden said the Leavenworth facility reported it processes an average of 4,000 to 5,000 prescriptions per day and expects to fill 4 million to 4.5 million prescriptions per year once it reaches full capacity. The facility counts 7.8 full-time equivalent pharmacists among its 28 full-time equivalent employees.

Interviewed by Supermarket Pharmacy after the speech as to whether operations like the V.A.'s could eventually eliminate the need for retail pharmacies, Ogden, who is a pharmacist, responded, "The answer is still on the table. Is there room for a pharmacy where patients can get medication promptly if they have an acute episode? Yes, there will probably be something. Whether it's a retail or an access facility or a combo thereof," remains to be seen, he said.

"All you see today is integration," Ogden continued. "Most staff model type HMOs do not farm out their pharmacy services. They keep the services in-house for control, quality, cost and management. So is that where we're going? It looks like it. There'll be a lot of it. "

Instead of despairing about how the profession of pharmacy will survive in the coming decades, at both retail and mail-order pharmacies, Ogden warned, pharmacists should instead be looking for ways to draw themselves more closely into patient care.

The pharmacist's new role, Ogden continued, "is back at the medical center or access point, managing pharmacotherapy and working as part of an interdisciplinary team.

"What value do pharmacists bring to the table that will help patients and enrollees deal with health care issues?" asked Ogden. "And not just to keep these patients well, but when they get sick, where can the pharmacist fit in the equation to help them recover?"

Because pharmacy services can "prevent, not cause, an invasive procedure," there's a good chance they will survive, and not just be seen as a "big piece of the cost" of health care, said Ogden.

The V.A.'s Leavenworth facility is only one of its CMOP locales. Others exist in Bedford, Mass., and Los Angeles, and a fourth is due to be on line by the end of the year in Dallas, said Ogden. In addition, facilities are in the planning stages in Hines, Ill., and Murfreesboro, Tenn. A location in Orlando, Fla., is "likely" to be bid on in the next 24 months, Ogden added. The tape Ogden showed described the automated dispensing at the Leavenworth facility.

"Over 3,000 products can be dispensed, including prepackaged medicines, capsules and tablets, and over-the-counter products. A single computer software system controls all automated equipment, writes orders, prints labels and records patient information. Pharmacists provide quality control," according to the video tape.

The tape went on to describe the process for fulfilling one patient's drug needs through the V.A.'s automated system:

Pharmaceutical products arriving at the Leavenworth warehouse are logged into an order management control system using a portable radio frequency computer terminal and a bar-code scanner. The system, designed and built by Electrocom Automation, Arlington, Texas, and the V.A., controls warehouse inventory.

Pharmacy orders are transmitted electronically to the facility on the CMOP computer, where a tote is assigned to the individual patient order and released onto the conveyor system. A bar-coded license plate identifies each tote.

The tote travels to the first order-filling area, where products that are prescribed infrequently or cannot be dispensed from one of the automated machines are dispensed manually.

The next station automatically dispenses prepackaged products. When the tote arrives here, its license plate is scanned and the computer dispenses the ordered prepackaged products onto a belt. Each order is then transported to a chute and deposited into the tote.

At the next station, two machines dispense oral solid medication into 120-cc or 250-cc vials. Here, the tote is scanned to determine the needed medication and a label containing both patient and medication information is printed and applied to an appropriate-sized vial. The machine then fills each vial with the number of tablets or capsules required. It is capable of filling a number of vials simultaneously.

After filling the vial, the machine applies a cap. But before the vial is released, the computer verifies the tablet count, cap integrity and label placement. Bottles are then dropped into the designated tote.

The conveyor system then transports the totes to the final stage, the pharmacist check area, where completed orders are verified and prepared for shipping by a pharmacist, who compares the items in the tote with the prescription.