Medication compliance is often an essential part of effective, long-term treatment of serious mental illnesses and a number of substance abuse disorders. Yet, risks to effective medication compliance begin, literally, on the way to the pharmacy. For many reasons-a forgotten preauthorization, a transportation problem, an unexpected financial need, pharmacist questions about a possible drug interaction, or an inability to carefully follow medication instructions-a consumer may never get their prescription filled, or if filled, may never take it as recommended. And, the prescriber at the CMHC may know little or nothing about it until the consumer suffers an acute episode or relapse.
Whatever the case, the obstacles in place between the CMHC and off-site pharmacy are dangerous for clients and costly for providers. So how can a behavioral health organization recognize the right time and place to implement a more personalized pharmacy service that will offer increased convenience and confidence for prescribers, reduced workloads for staff, and boost consumer medication compliance and outcomes?
In general, a center should first consider its population size and prescription volume before deciding on whether or not to pursue a pharmacy services vendor. Genoa Healthcare, which specializes in providing CMHCs with on-site pharmacies, suggests that any center that either supplies more than 100 reimbursable scripts per day, 20 days per month (depending on the state) or at least four medications per client is a good candidate for an on-site pharmacy.
The common problem of medication compliance is another strong argument for the more personalized approach of a pharmacy services vendor. “There was a Wall Street Journal article out not too long ago that stated that after a six-month period, only 33 percent of people who are supposed to be on a maintenance medication continue to take it,” Jim Smith, CEO of QoL meds, another provider of on-site pharmacy services to CMHCs, says. “I don't think there are any solid statistics on how many prescriptions are written and never filled, but that often happens in behavioral health, and the chances of that happening are greatly reduced if you have an on-site pharmacy.”
Because many CMHCs do not have close partnerships with a pharmacy-on or off site-verifying whether or not clients have complied with their medications is extremely difficult, if not impossible. The time and effort that staff would have to spend tracking down every client's activity at various pharmacies is not cost effective or operationally efficient. When such valuable time is wasted on these tedious tasks, both the center and its consumers lose resources.
This waste, when it occurs again and again, can be another indicator of a center's need for an on-site pharmacy services vendor. These vendors can not only track medication compliance rates and instantly report them back to the clinicians, but they also take the helm on clinical time-wasting tasks, such as completing prior authorizations for medications and communicating with clients about refill dates.
“Mental health clinics should be interested in this because it should help them improve the use of their own internal clinic resources and allow people to do what they've been trained to do,” Mark Peterson, Vice President of Sales and Marketing for Genoa Healthcare, says. “I think many mental health clinics are so involved in managing the medications of their clients that I'll walk into a clinic that doesn't have a pharmacy and literally it's almost like they are running a pharmacy in there.”
Finding the right fit
Once a center has evaluated its population size and need for supplemental medication management services, allowing just any pharmacy services vendor to establish itself as part of the center could do more harm than good. “This is a two-way process,” Peterson says. “The organization needs to make a decision about whether or not they want to have a pharmacy on site so they understand the benefits of it, and as a pharmacy business, I have to make sure that I'm going in understanding what it's going to look like as a business for me.”
Peterson notes that the most important responsibility for the center to fulfill during this process is to check a pharmacy services vendor's references. “If you haven't checked references from the places, and they haven't even suggested you check references, you're doing your organization a real disservice,” he adds.
Along with checking references, Peterson suggests that centers ensure that the different personalities from both the center and the pharmacy services vendor work well together before a contract is signed. The vendor is completely integrated into the CMHC, and any potential downfalls that could arise from this close partnership should be identified early on.
The center should also do thorough research to identify all of the potential services that prospective vendors can provide. Both Genoa Healthcare and QoL meds offer medication education and outreach programs, online patient tracking tools, flexible packaging and dosage options, and access to primary care medications outside of their standard prescription-filling services, which allows for a more in-depth, supportive partnership with the CMHC. Typically, these services are provided at no additional cost to the center.
Once the center has identified an appropriate vendor, the vendor will then assess the feasibility of opening a pharmacy at the center. “There's no criteria that would prevent [us from partnering with] them other than are they big enough and do they serve enough clients,” Smith says.