On June 12, ProxsysRx opened its pharmacy in Holyoke Medical Center — a 198-bed independent community hospital in Holyoke, Massachusetts. The pharmacy is currently offering full retail service, and some patient-discharge prescription support (Meds To Beds), but the Employee Prescription plan still has a few hurdles to overcome. It’s a still-unfinished process that began when we reached our agreement with HMC in March, 2022.

Below is a brief (yes, brief) overview of the process we’ve undertaken between then and this post’s Publish date — as well as a step-by-step primer on the challenges involved in building a hospital outpatient pharmacy from scratch.

Pharmacy Site- And Needs-Analysis

From a purely practical perspective, we needed to map-out the pharmacy space to begin pharmacy space planning: IE ordering shelving that would fit — not to mention countertops, carpeting, file cabinets and all the other physical equipment needed to create a retail pharmacy environment. Those pharmacy space planning considerations are among the responsibilities of ProxsysRx’s Director of Facilities & Implementation Eric Teer, who’s become something of a Site Construction authority since he joined us.

Meds To Beds program planning

Around the same time, ProxsysRx’s Corporate Trainer Becky Clark began planning the pharmacy’s Meds To Beds program for COO Billy Calhoun. “ProxsysRx believes very strongly that ever hospital outpatient pharmacy should have a well-run Meds To Beds program. My initial involvement with Holyoke was to give Billy a timeline of how long I thought it would take to get the Discharge Program going.

“I then went to Holyoke myself — to check-out the facility, and to assess the number of people we’d need, once build-out was complete. I had my first meeting with the hospital’s department heads. I introduced our process to them. I answered their questions, and asked a lot of my own — particularly about their patient discharge processes, and how our hospital outpatient pharmacy could work well with their existing processes. And, of course, I talked to staff on all the units we’d likely be serving.

“I was also there to determine the number of units we’d be serving, as well as their average number of inpatients and outpatients.”

Pharmacy staff recruitment

Fast forward six months. We’re now ready to begin recruiting pharmacists and staff. Toward that end, the first hire ProxsysRx makes for the pharmacies we build-and-own is a Pharmacist In Charge. For the Holyoke pharmacy, we struck gold with Phil Goncalves — an experienced professional who owned his own pharmacy before joining ProxsysRx. That said, with all his experience, we still had to familiarize Phil with our hospital pharmacy operations — and our company culture.

Altogether, the process of hiring and onboarding a PIC typically takes four to six weeks.

An unexpected expansion of our pharmacy operations

After we hired Phil in October, he started immediately as a full-time, salaried ProxsysRx pharmacist.

At this point, our Holyoke story added another plot twist — in addition to the twists and turns we’d experienced in the regulatory licensing process (much more on that shortly). While we’d signed on with the hospital to build and manage their outpatient pharmacy, our working relationship progressed so well that they asked if we would also manage their inpatient pharmacy. Which was, frankly, a welcome request — both ProxsysRx and Phil, given the time we were now seeing it would take to get the retail pharmacy open & generating income, and Phil into the job he’d signed-on for.

Pharmacy Licensing And Credentialing

Richard Thomas, Director of Managed Accounts and Operations Support, has been one of our team leaders in licensing and credentialing. Here’s his overview of the pharmacy licensing and credentialing process:

Licensing and credentialing entities involved

  • Board of Pharmacy License (includes onsite inspection)
  • DEA
  • NPI
  • Third-Party Payers (private and government)

Once all the licensure has been completed and obtained, we move onto the wholesaler.

Once the wholesaler account is approved, we move forward with the PSAO. This takes around two-three weeks to complete as there are multiple steps for approval.

Once our final approval is received, we then move forward with individual third parties to contract with — as we must obtain our affiliation letters to provide to the third parties.

The PSAO go-live date is dependent upon them to add you into the go-live effective dates that have in their calendar process.

During this time, we’re getting ProxsysRx’s MedServRx prescription-savings program active and live in the network for any cash paying patients — so that we can accept patients, despite not having any active payors if a go-live is needed, per the Board of Pharmacy.

From here we start the credentialing process with all the direct payors: CVS Caremark, Express Scripts, Humana and State Medicaid. It can take anywhere from 4 weeks to 6 months to get these plans live and active in the network, which means we’re constantly following-up with the payors to check our status.

Getting all of the payors live and active is the most important part of a go-live, because if you don’t have payors, you don’t have the patient-volume necessary to ensure the prescription volume you need — from a retail, discharge delivery and employee perspective.

Regulatory hurdles and delays

One of the significant initial delays in meeting all the necessary legal requirements to open was with the Massachusetts pharmacy board — which took four months.

Our next regulatory challenge was gaining approval from Cardinal CSMP (Controlled Substance Monitoring Program) — which can’t even start until a Board of Pharmacy permit is received. Until recently, that process (given ProxsysRx’s history and record) was close to a Rubber Stamp matter. However, given the nationwide (and, in our opinion, long-overdue) crackdown on opioids, it’s become significantly more involved. Wholesalers have added a new set of complications for “new accounts” — which is what we were considered, in the state of Massachusetts.

Our CSMP review began shortly after we reached our agreement with Holyoke Medical Center. That process involved their research into ProxsysRx’s processes and prescription-filling practices — as well as a lengthy interview with Phil.

Additional pharmacy recruiting and hiring

Several more months passed before we hired a full-time Director of Pharmacy for Holyoke’s inpatient pharmacy — at which point, Phil transitioned to his role as outpatient pharmacist. By now, it was late March, 2023 — thirteen months into our Holyoke odyssey, but still three months before the pharmacy would open. Nevertheless, we needed to hire additional staff — including two technicians and a front end coordinator. That process took close to four weeks, and was followed by onboarding and training — which meant weeks-at-a-time in Holyoke for Becky and CJ King (also a ProxsysRx trainer), as well as Eric and ProxsysRx Pharmacy Operations Director Drew Holleman.

In addition to Becky & Drew’s onboarding and training efforts, Eric and his two project managers stepped-up their efforts to complete preparation of the pharmacy’s physical operations — as well as the installation of hardware and software systems.

Thankfully, Becky, Drew, Eric and team enjoy traveling to our pharmacy locations — (for the most part) and appreciate ProxsysRx’s policy of getting them home most weekends. “That said,” notes Becky, “It should not take 16 months to build and open a pharmacy. Outside of our hiring and physical build-out work, both of which have gone as well as we could have hoped, everything that could have not gone smoothly went not-smoothly. None of which, I might add, had anything to do with the people at Holyoke — who’ve been great from day one!”

Stocking the pharmacy with prescription medications & retail inventory

Once staff hiring and onboarding was completed (April), we had to order drugs. Which involved, for starters, determining what drugs we needed to buy — in order to best meet the medical needs of Holyoke’s patients and providers.

At the same time, the pharmacy’s front-end coordinator began working on a retail-product mix to meet the additional needs of the hospital’s patients, employees and families — products that typically include anything from toiletries, aspirin and bottled water to snacks, gifts and mobile-phone chargers.

Additional administrative hoops to jump

With everything aforementioned in place, we still had to do credentialing, and get Third Party Payer contracts signed. Third-party contracting is another process that’s grown more time-intensive. Historically, turnaround has typically taken 30 days. Now, that routinely takes much longer. The payers have varying requirements, and one even requires us to be in business for 6 months before they’ll approve an application.

A soft opening for the pharmacy’s retail operations

In mid-June (again, 16 months into the process), Holyoke’s pharmacy initiated retail operations. To ensure as smooth an opening as possible for every every new pharmacy, ProxsysRx’s trainers rotate-through during the first two to three weeks — primarily to lend new teams support with the full range of “real life” situations.

340B Program Implementation

ProxsysRx is also managing Holyoke’s 340B program, which has already enjoyed significant success.

That said, a successful 340B program is the result a health system’s providers and contract pharmacies working cooperatively with its 340B Program managers. Which meant our 340B team also needed to train our new Holyoke Pharmacy team, and the hospital’s providers, in program processes and policies.

NOTE: For more 340B program tips, see our 2023 Guide To Implementing An Effective 340B Program.

Unfinished pharmacy business

For Holyoke’s employee prescription plan, we’re still waiting on the third party — Express Scripts — to finish the plan design. We’ve set-up a “cost plus” plan to help Holyoke save money on insurance expenses for its employees, and we’re still waiting for Express Scripts to build-out the plan on their end — even though we gave them the information months ago.

Credentialing has been so complicated for Holyoke, it’s become something of an all hands-on deck process.

We normally manage that process through Cardinal. On their end, that normally takes a week or two. After that, they have to receive, and update, Payer files from all the third parties with whom we’ll have contracts — and that’s typically taken two weeks to a month per third party. For Holyoke’s pharmacy, the real delay has been with Medicaid — which represents a significant percentage of the health system’s prescriptions.

A broad overview of our investment in the Holyoke pharmacy

In addition to all our already-mentioned costs (full-time pharmacists on board since, respectively, October and April; the physical property; prescription drugs; retail goods and products, on-site time spent by our trainers and Facilities & Operations managers) there have been other investments — including construction. But our primary investment, not surprisingly, has been employee time.

Collectively, ProxsysRx’s corporate-office employees have invested more than 300 hours in preparing Holyoke’s pharmacy to be full-service for the health system’s patients & families, its 340B program and its employees.

Altogether, that’s an up-front investment of well over $500,000 — and yet, not a penny of that has been out-of-pocket for Holyoke. How many vendors claiming to be your “partner” have ever made that kind investment in serving your health system?

ProxsysRx is here to help, if you have questions.

There are so many ways ProxsysRx can help your health system unlock pharmacy’s potential — for better outcomes, and better incomes. To learn more, contact Howard Hall. C: 214.808.2700 | howard.hall@proxsysrx.com