DOING THE REAL JOB&#8212COSTCO LETS PHARMACISTS BE PHARMACISTS

Rich Martinson, RPh

It is a great feeling to knowthat you have not only helped apatient to manage their condition...but that you have also giventhem a good deal.

Such is the benefitof working in wholesalepharmacy, notesRich Martinson, RPh,US Pharmacy Operations,Northern Division,at CostcoWholesale in Issaquah,Washington."We are able to providea high level ofprofessional pharmacy service at thelowest cost to our members," he said."In light of the high health carecosts—especially in pharmaceuticals—it is comforting to know thatwhen you are providing service andcounseling, and having that one-ononeinteraction with the members,you have that knowledge in the backof your mind that you are givingthem this product and service at thebest available cost in the marketplace."

While competitive pricing is themantra of wholesale in general, Martinsonpoints out that, at Costco,pharmacists have ample opportunityto consult with patients—more sothan in a traditional retail setting, hebelieves, highlighting the organization'sbuilt-in, private counselingrooms designed for its medicationtherapy management (MTM) programsand other consulting initiatives.In addition, Martinson underlinesthat pharmacists are providedwith the adequate staffing to carryout the other tasks associated withrunning a pharmacy. "In our setting,we provide enough ancillary help inthe pharmacies that allows our pharmaciststo be pharmacists, and to beavailable to the members," heexplained. "They are not running aregister, they are not calling theinsurance companies, and they arenot counting the medications. Theyare verifying the prescriptions andbeing available to the members andphysicians' offices."

Pharmacists at Costco take advantageof the latest technology, such asworkflow management systems, tofacilitate the processing of prescriptions.To further save its pharmaciststime, the company is in the processof rolling out a central fill program,whereby a centralized Costco pharmacyis responsible for filling prescriptionsonce the on-site pharmacisthas completed the first steps."Our pharmacists receive the prescription,do all of the local fill functions,visit with the patient, call thephysician when necessary, and counselthe patient,"Martinson explained."Once all that is completed, the actualprescription is sent to our centralfill facility, and that facility does thecounting, pouring, and verificationand then ships the prescription backto the pharmacy to be sold to themember." The goal behind this programis to free up the pharmacist'sschedule so that they have more facetime with the patient, or member, asCostco refers to its customers. "Wewant them to be pharmacists and topractice the profession of pharmacy."

Martinson believes that this plays alarge role in setting Costco apartfrom other organizations. "The pharmacistis required to wear so manyhats in this day and age, and we wantto be sure that we do not lose sightthat we are professionals and we wantto provide professional service, evenif it is in a warehouse setting," he says.

With Medicare Part D and the otherchanges that the pharmacy professionis undergoing, Martinson acknowledgesthat increasing salariesand shrinking margins will set thestage for how the industry will dealwith this new set of challenges. "Weneed to bolster this financial modelwith the development, refinement,and the placing in motion of theseadditional services," he says. "Wewant them to have the services forMTM and disease state managementprograms and take these to a pointwhere, perhaps, we start to bill forservices." Insurance companies, henotes, are beginning to realize thatpharmacists play an active part indisease management and, therefore,the reduction of overall health carecosts. "We can help to reduce theoverall cost in the marketplace, andthere is a value to that. We need tostart looking at that and to be compensatedfor something that we havegiven away."