The winds of change were transforming the pharmacy industry about 10 years ago. One manifestation of that change was large pharmacy chains acquiring smaller independent pharmacies.1 That forced a pivotal conversation between Joe Moose, PharmD, and his brother, Whit Moose Jr, BPharm. The brothers are co-owners of the 139-year-old Moose Pharmacy in North Carolina.
According to Joe Moose, the Moose brothers looked to the independent pharmacy’s past to develop its mission statement. Moose Pharmacy was started by their great-grandfather A.W. Moose in 1882 and has since expanded to 8 locations in North Carolina. The pharmacy’s mission today: “Take care of the people in the community we serve.”
“When that’s your compass, you practice differently,” Moose said. Two tangible results of that mission are the pharmacy’s Moose Medication Adherence Program (MooseMAP), in which patients with chronic conditions speak with health coaches who help get them oncourse with their treatment plan; and MoosePacks, which allow patients to receive prescriptions in a box with personalized, labeled packets each month. MoosePacks are fulfilled at one of the pharmacy’s locations and delivered to patients. MooseMAP launched in 2010, whereas MoosePacks started in 2013.
Moose offered insights into the success of his pharmacy’s programs and how other pharmacy owners can implement similar services in their store.
Personalization Makes a Difference
At a quick glance, MoosePacks are indistinguishable from Amazon’s PillPacks.
A sample MoosePack on the pharmacy’s website features a clear package imprinted with the patient’s name and details such as day, date, time, and accompanying meal for the package contents. The sample MoosePack contains prescribed medications: glyburide metformin (a yellow tablet), ropinirole HCL (a purple tablet), and a daily vitamin (a red tablet).
But Moose says MoosePacks are different because the personalized packages of medications are connected to the pharmacy’s medication adherence program, so he doesn’t see PillPack as competition.
Another differentiator: Patients receive monthly MoosePacks from a Moose Pharmacy delivery driver. Once in the patient’s home, the delivery driver looks for evidence of loose rugs, which could cause a fall, and unopened MoosePacks and other medications.
Patients also meet face-to-face with a health coach in a consultation room at the pharmacy to discuss gaps in therapy and any changes to their medications after a doctor’s appointment or an emergency room visit. For example, a health coach could discover that a patient has a new prescription for an angiotensin-converting enzyme (ACE) inhibitor, in addition to a previous prescription for the medication and 3 other prescriptions. In this scenario, the patient hadn’t filled the other 3 prescriptions because they didn’t know why the medications were prescribed. That presented an opportunity for the pharmacy’s health coach to call the patient’s physician to determine the appropriate ACE inhibitor and to educate the patient about the reason he was prescribed the other 3 other medications.
Because a health event or a doctor’s visit can change a patient’s prescriptions, Moose Pharmacy can dispense a partial supply of the new medication in a prescription vial until the next month’s MoosePacks delivery; the new medication will be included in subsequent MoosePacks.
When a patient is traveling, Moose Pharmacy can fill their prescriptions for the duration of their travel. MooseMAP and MoosePacks can also cater to the needs of snowbirds who live in North Carolina during the fall and winter and in other parts of the country in spring and summer.
To keep patients on track with their medication adherence plan when they’re not nearby, Moose Pharmacy connects them with a pharmacy in the Community Pharmacy Enhanced Services Network.
Logistics and Quality Control
Although Moose acknowledged that creating personalized packages for each day a patient takes medications seems labor-intensive, he insisted it requires no more work than handing a patient a prescription in a vial.
At one Moose Pharmacy location, a pharmacy technician uses a packaging machine from Durham, North Carolina-based Parata Systems to put the medications in the personal- ized strip packs. A photo is captured of every package and an algorithm looks at the pills in the pouch to make sure it contains the correct prescription for the patient. On a computer in a different room, a pharmacist looks at the photos of each package to validate that medications are dispensed accurately, Moose explained.
About 80% of the referrals for the 2 programs come from 20% of the physicians in the area, he said. Physician practices are typically interested because these programs can help them secure higher reimbursement after meeting quality metrics, Moose said.
Hiring the Right Staff
Hiring the right delivery drivers and health coaches is important, Moose said. When hiring health coaches, he looks for candidates who are willing to invest in connecting with patients on a personal level. Other skills he seeks are efficiency and good judgment; the pharmacy has a high volume of patients to serve and the health coach must make smart decisions about investing their time while effectively transitioning to the next patient who needs help.
Another vital team member at Moose Pharmacy is the delivery driver who brings the MoosePacks to patients’ homes. Moose relies on the delivery driver to spot unused medications in the home; that insight triggers an immediate call to the pharmacy to find out why the patient isn’t taking them.
Moose looks for delivery drivers who not only have a safe driving record but who can also serve as a community health worker. Friendliness and a level of technology savvy are 2 other traits he seeks.
A patient typically meets the delivery driver at least once per month when their MoosePacks are dropped off. But if a patient has more immediate needs, the delivery driver could come by a few times per week, Moose explained.
Metformin, amlodipine, and atorvastatin are the top 3 medications dispensed in MoosePacks. The top 3 conditions treated include blood pressure, diabetes, and behavioral disorders, Moose said.
MooseMAP includes 2800 patients, and 1400 patients get MoosePacks delivered. Moose said 200,000 medications are dispensed in MoosePacks annually. Combined, the 2 programs generate increased revenue for the pharmacy because patients are filling prescriptions 12 times per year, versus 8 times before they’re enrolled, Moose said.
Enrolling complex patients in its medication adherence program and fulfilling medications in personalized packs was not only “the right thing to do” for patients, Moose said, it also resulted in financial benefits for Moose Pharmacy. A 2017 study published in the Journal of the American Pharmacists Association examined the financial impact of attributed patients enrolled in the program.2 According to the results, the yearly profit for each prescription was $10.35 for a combination of chronic, acute, and immunization prescriptions. Further, dispensing the medications strip packaging translated to a mean profit of $1561.82 per year compared with $1208.01 per year with medications dispensed in bottles.2
Pharmacy Today reported in 2014 that one medical group participating in Moose Pharmacy’s programs realized a reduction of inpatient admissions by up to 47% and preventable admissions by 35%.3 That should attract the interest of physician groups and payers alike.
- Appold K. Independent pharmacies: not dead yet. Drug Topics®. Updated January 12, 2019. Accessed February 3, 2021. www.drugtopics.com/view/independent-pharmacies-not-dead-yet
- Clifton CL, Branham AR, Hayes H Jr, Moose JS, Rhodes LA, Marciniak MW. Financial impact of patients enrolled in a medication adherence program at an independent community pharmacy. J Am Pharm Assoc. 2018;(58)4S:S109-S113. doi:10.1016/j.japh.2018.04.022
- Collins S. Community pharmacists at Moose Pharmacies keep high-risk patients out of the hospital. Pharmacy Today. Updated April 30, 2014. Accessed February 3, 2021. www.pharmacist.com/article/community-pharmacists-moose-pharmacies-keep-high-risk-patients-out-hospital