Community Pharmacy
Overview
According to WHO (World Health Organization), Community
pharmacists are the health professionals most accessible to the
public. They are professionals who would share counsel and
gain the confidence of all their patrons. They supply medicines
in accordance with a prescription or, when legally permitted,
sell them without a prescription.
Objectives
Understand the role of Community Pharmacists in health care
delivery.
Understand the various types of community pharmacy.
Describe the basic management issues of community pharmacy
practice, such as, Business aspects, staff and workflow.
Outline the steps in the medication order fulfillment process.
Introduction to Pharmacy Business
In times past, community pharmacy was synonymous with
independent pharmacy and the pharmacist was the chemist.
The basic setting then was a traditional pharmacist standing
behind a counter, compounding an elixir or dispensing
medicine from a large stock bottle into patient’s prescription
bottle.
Community pharmacy has evolved over the years into different
organizations with unique healthcare environments. From the
perspective of community pharmacy in the United States,the
following are examples of community pharmacy practice:
Materials
Pharmacy Student Survival Guide
2nd Edition.Ruth E. Nemire and
Karen L.Kier.
Chain drug stores,
Supermarket pharmacies,
Mass merchandise pharmacies
Internet pharmacies
Mail-order pharmacies
Independent Pharmacies
Chain Pharmacy/Drug Stores
As a general definition, a community pharmacy is defined as a
“chain community pharmacy” if the organization consists of
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four or more stores. There are two general career paths in chain
community pharmacy: staff and management.
This describes an operation with multiple locations similar
designs, one primary management/leadership team and an
array of merchandise to offer their clients. These organizations
come in different sizes from 5 stores to as large as 5000 stores.
Supermarket /Grocery Store Pharmacies
These are pharmacies located within a supermarket or Grocery
store. They primarily serve as a loss leader-to draw customers
into a store where they are likely to buy other goods. The
supermarkets/grocery stores are retail outlets whose main goal
is to generate sales of their product lines, mainly grocery and
related items.
Mass Merchant
These are very similar to the supermarket stores. Their primary
goal is to attract new types of customers to their stores and
grow the sales of their established products.. The pharmacy
department serves being a loss leader, meaning they are willing
to lose money in the pharmacy department because the “losses”
are offset by sales in other departments.
Internet Pharmacy
These are companies developed by entrepreneurial and business
professionals for processing and dispensing prescriptions using
the internet. A prescription may be mailed, faxed, or other
electronic means from the prescriber’s office. The prescription
is then processed and mailed to the patient. In the United States
the National Association of Board of Pharmacy has developed a
seal of approval program for Internet pharmacies known as the
VIPPS (Verified Internet Pharmacy Practice Sites), identifying
the sites with proper processes and procedures.
Mail-Order Pharmacy
This is very similar to Internet Pharmacy. The only difference
is Mail-order pharmacies are developed by the larger chain
pharmacies and pharmacy benefits managers (PBMs) in order to
maximize efficiency, address the insurance companies and third
party payer’s demands for less costly prescription processing
and to meet customer’s needs.
Independent Pharmacy
These are pharmacist-owned, privately held businesses in
varying practice settings. They are the traditional type of
community pharmacy with a single store or two having one or
two owners, whose primary product line is the prescription
department. Generally, a pharmacy is considered as
independent if the total count is fewer than four stores. Many
independent pharmacies provide other services like
compounding, supplying durable medical equipment (DME)
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and/or other specialty services.
Pharmacy Employees
The pharmacist: This is the licensed professional responsible
for the safe, effective, accurate processing and dispensing of
prescriptions. In the United States, requirements for licensure
vary from state to state, but one common law in every state and
most part of the world is that the pharmacist must verify each
prescription before it is given to the patient. Oftentimes,
pharmacists may hold many titles like preceptor, and have
additional responsibilities, such as the pharmacy manager,
store or departmental manager or general manager. The
pharmacy manager is responsible for inventory, hiring other
pharmacy employees, training new staff, addressing customer
service issues, maintain pharmacy work flow and serve as the
contact person for third-party payers such as auditors.
Pharmacy Technician: In the United States some states requires
that the pharmacy technician be certified, by successfully
completing a certification exam and maintain continuing
education credits in order to work in a pharmacy .The
pharmacy technician’s role is to support the pharmacists with
order fulfillment, manage tasks not requiring the pharmacist’s
direct judgment such as general inventory management, third
party reconciliation.
Pharmacy Clerk: This the person that manages transactions,
may assist with accepting new prescriptions, handle customer
inquiries and directing them to the appropriate department in
the store.
A Typical Community Pharmacy Department Setup
The Drop-off window ( Prescription intake workstation): This
is where patients present their prescription to the pharmacy
technician or pharmacy clerk, who review it for completeness.
The patient is informed about the wait time, the availability of
the medication prescribed and possibly the cost.
The prescription entry station: This can be located at the dropoff window as well. Prescriptions are entered into the
computer system by being scanned into the database for easy
retrieval profiles are maintained and updated at the same time.
Once the prescriptions are ready for filling, they are classified
as “ waiting” (patient is waiting to pick prescription up and
requires immediate entry) , “later” (Patient will return at a
later time to pick prescription up), or “delivery” (If that service
is available)
The assembly workstation: This is the space in the pharmacy
where medications are packed and prepared for checking by the
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pharmacist. The medications are assembled, dispensed from the
stock bottle, labeled, along with medication guides and
adherence tools like dosing cups/spoons, medication calendar
etc). Equipments and resources that may be used in this area
include calculators, scales, measuring cylinders, computer,
textbooks, auxiliary labels and distilled water dispenser.
The pick-up window (Pick-up station):This is where
prescriptions that are filled are stored and ready for pick up by
the patients. Patients are also counseled at this window.
Prescriptions are usually kept in baskets or bins and arranged in
alphabetical order according to patent’s last name. There is
usually a designated area located close to the pick-up window
where the patients can have confidential conversation with the
pharmacist.
The medication storage system: This usually consists of
shelving units called bays. They usually located behind the
pharmacy counter and medications are arranged in a variety of
ways, usually alphabetical order by generic name. A full sized
or compact refrigerator is typically kept within the pharmacy to
store medications like insulins, some liquids, suppositories and
some injectable medications that require refrigeration. Also
medications already dispensed that require refrigeration are
kept in the same refrigerator.
 Information to verify on the prescription
Patient’s name and address
Other patient’s information such as age, date of birth, weight,
allergies.
Prescriber’s name and address
Drug indication (whenever possible): critical for patient
counseling.
Date of issuance of prescription.
Drug name/strength/dosage form
Total quantity dispensed
Instructions/directions for medication such as the amount or
units per dose, frequency, route of administration.
Number of refills
DAW (dispense as written) line: Indicates whether a generic
medication may or may not be dispensed.
Prescriber’s signature and address.
Prescriber US DEA (Drug Enforcement Administration)
number for controlled substance prescriptions.
Length of therapy and or reason for therapy (Diagnosis code for
reimbursement from third party payers (health insurance
companies)
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Information supplied by auxiliary labels.
How and when to take drug
What to avoid when taking the medication (such as foods other
medications)
If the product is a new generic drug for the same medication
dispensed previously.
Possible adverse effects
The expiration date, especially if it is a reconstituted
medication.
How to store the medicine
Commonly recommended adherence devices
Pill boxes
Dosing spoons/cups for pediatric use
Droppers for small doses of liquids
Dial-a-dose containers
Medication calendars
Beeping devices
Telephone call reminders
Internet/e-mail reminders
Prescription Costs
Community pharmacies are usually reimbursed a percentage of
the Average Wholesale price (AWP) as an estimate of the drug
cost, plus a dispensing fee for pharmacy services.
The difference between the actual acquisition cost of the
medication and the drug cost estimate typically offsets
operational cost of the medication.
There are three main factors involved in the increasing cost of
prescription medication:
Utilization: As the population ages, more precriptions will be
written and dispensed for ailments and conditions of this age
group.
Availability of new medications: As new medications are being
developed, manufacturer research and development (R&D)
continues to rise, thus affecting the cost of medications.
Development of formularies: The federal ,state ,local and
private companies create formularies – a list of medications
deemed cost effective as per respective insurance company.
Medication not on the formularies are considered nonformulary drugs and are usually more expensive.
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Patient Encounter
A 52 year old man presents to your pharmacy with a new
prescription.
Peter Williams
9876 Highway Road
Anytown, USA 33333
Name: Barry John
Date 08/02/13
Diazepam 5mg #30
One tablet by mouth at bedtime
Refull: 2
P.William MD
When entering the prescription data, you noticed his current
prescription profile as follows:
Medication
Direction
Qty
Last refill
Metformin
500mg tab
One tab p.o
bid with food
60
07/01/13
Lisinopril
10mg tab
One tab p.o
daily
30
07/01/13
Simvastatin
10mg tab
One tab p.o
qhs
30
07/01/13
Levothyroxine One tab p.o
112mcg tab
daily
30
06/01/13
Temazepam
30mg cap
One cap po
prn sleep
30
07/23/13
Glyburide
5mg tab
One tab po
bid AC
60
06/01/13
Discussion question:

What information should be verified before filling the
prescription for diazepam?

Is the prescription missing any necessary information?

Are you familiar with all the abbreviations used on the
prescription and in the prescription profile.

What auxiliary labels would likely be placed on the
bottle of diazepam.

List at least 4 counseling points that should be provided
to the patient when she picks up her prescription for
diazepam.

What open-ended questions should be asked when
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counseling the patient on the new prescription.
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