Embedded Pharmacies: Making a Difference

In the behavioral health clinic, pharmacists do much more than just fill prescriptions.

Tucked in the medical services wing, or off the main patient waiting rooms in many behavioral health centers around the country, you may find a Genoa Healthcare pharmacy.

As a specialty provider for behavioral health services, these embedded pharmacists, in addition to traditional dispensing, perform a variety of activities that help coordinate care for the patients and clinics they serve.

People living with a severe and persistent mental illness have a significantly shortened lifespan compared with the average (13 to 32 years reduction). They often have complicated comorbidities, tend to have poor access to primary care services, are sometimes homeless or indigent, and are high utilizers of health care services such as emergency departments.

Care coordination is an ongoing challenge for this population, and arguably, more complicated and critical than for those without a severe mental illness. Care givers, such as family members, case managers, prescribers, and therapists, both need and welcome the addition of a pharmacist to the care team to facilitate the navigation of medication management and reconciliation.

Care Coordination

In the behavioral health clinic setting, pharmacies and pharmacists are an important part of the care team, fully involved in care coordination and med-reconciliation when patients are discharged to or from inpatient hospital stays to community-based services, group homes, or crisis units. When a patient is discharged from the hospital and comes to the clinic, the pharmacist is sometimes the first person to know, since the patient will present at the pharmacy with discharge prescriptions.

At that point, pharmacy staff goes to work, notifying the care team and working to coordinate the provision of services surrounding medication needs. In addition to simply filling the prescriptions as presented, this triage could involve scheduling blood draws for clozapine management, notifying case managers and clinic prescribers of new medication regimens, working with the clinic and patient to determine payer eligibility, contacting representative payee groups, working with insurance companies to obtain prior authorization for new medications, or any combination of these items. Filling the prescription is only a small fraction of the task at hand when a patient comes in for services.

What happens to that patient and those prescriptions—and how those medications fit into the overall care plan of the patient—really takes on a new meaning and focus in a clinic setting. Being part of the team carries the welcome burden of necessitating a warm handoff between caregivers, and pharmacists embrace that part of the role.

Pharmacy's Proactive Role

Nationally, with the renewed focus on adherence and the medication management challenges that are already present within the behavioral health community, pharmacy’ s proactive role with programs, such as refill reminder calls, specialty adherence packaging, refill coordination and synchronization, and clinic staff education initiatives, seems to fit right in with the broader health system goals. Coordination of refills and services extends well beyond the clinic walls to include primary care and other specialty providers.

Coordination of refills can be an important tool to improve medication persistence. This involves working with multiple prescribers to improve and simplify medication regimens across an entire patient profile. The investment in and use of technology that can help identify adherence challenges through retrospective review of Monthly Prescribing Reference and Global Adherence Project, as well as tools that can identify prescribing patterns within the clinic, has greatly increased prescriber knowledge of the gaps that can occur between what is prescribed and what is actually dispensed to the patient. The ability to identify and communicate adherence-related information can facilitate increased patient education concerning the importance of taking medications as prescribed. It also brings the entire care team into the loop, so that each member of the team can address adherence on a unified front.

Phlebotomy and Laboratory Services

Integrated laboratory services, with phlebotomists working closely with pharmacists and clinic personnel, can be a great accessibility asset to patients with transportation issues or poor follow-through with outside lab providers. Clozapine management, metabolic monitoring, and substance abuse testing are just some of the areas where lab integration can play a role. Having the availability and coordination of phlebotomy and laboratory services helps eliminate barriers to using medications with high monitoring requirements.

Recently, Genoa has partnered with companies that do pharmacogenomics testing, and the pharmacy staff is collecting cheek swabs and providing recommendations for drug therapy based on the results from these tests. Since a significant portion of all FDA-approved medications with genetic information in the labeling are behavioral health medications, this service adds significant value to the care team as the pharmacist reviews therapy options for each patient.

Sometimes, care coordination centers around finances. Patients without the ability to pay still need services and medications. The pharmacist is often called upon to research and assist with facilitating such services as manufacturer patient assistance programs, seeking out sample medications and voucher programs, accessing clinic or community grant programs, and actively and aggressively working with pharmacy payer groups to gain prior authorization for prescribed medications. From a population standpoint, the pharmacist and the pharmacy serve as an educational hub concerning new drug therapies, drug shortages, changes in Medicare and Medicaid, and all things pharmacy or medication related.

Julia Bartlow, RPh, is the regional operations manager for Genoa Healthcare, covering pharmacies in Indiana, Ohio, Kentucky, and Missouri. She is a graduate of Purdue University School of Pharmacy and is currently the District 2 Representative to the Indiana Pharmacists Alliance Board of Directors. She served as a state delegate to the 2012 American Pharmacists Association’s national convention and is active in legislative initiatives that promote improved care for persons living with mental illness. Prior to joining Genoa in 2007, she was co-owner of an independent pharmacy/durable medical equipment business in southwestern Indiana.

Genoa Healthcare, an experienced specialty pharmacy provider for the mental health community, offers integrated phlebotomy and laboratory services. For the past 11 years, Genoa has made adherence related services a cornerstone of the company. With more than 105 on-site, full-service pharmacies in 27 states and the District of Columbia, Genoa is improving patient care and making a positive impact on clinic partners and patients. For more information, please visit www.genoahealthcare.com.