Central fill... For or against?

[PharmD RPh]

Looking for anyone's opinion that currently uses central fill locations.

1. How do they help out companies because it seems like the work has to get done by somebody, why not just let the store do it?
2. Does it cut payroll and make the stores more efficient?
3. Does it really free up more time for the pharmacist to do clinical activities in the pharmacy such as counseling, MTM etc?

Please only post if you have experience and know what you're talking about.

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[All4MyDaughter]

My employer uses a refill center (known as a CMOP) for most refills through the mail. New scripts can come from there too if the provider assigns them "Mail" status (vs. "Window" for pickup). Things like wound care, ostomy supplies and C-II's are filled locally for pickup or for mail. I think it's efficient for routine refills. I think it's inefficient for new fills on things like antibiotics. Mail time is a week to 10 days.

The first chain I worked for had a refill center (central fill). RXs were automatically cued to be filled there if the patient indicated (via the phone refill system) that they were going to pick up their RX after a certain time. It required a bit of patient education b/c patients would tell the system they were coming later in the day and then change their mind, show up at 9 a.m. and we wouldn't have their stuff ready b/c we hadn't gotten our delivery.

 

[PharmD RPh]

The first chain I worked for had a refill center (central fill). RXs were automatically cued to be filled there if the patient indicated (via the phone refill system) that they were going to pick up their RX after a certain time. It required a bit of patient education b/c patients would tell the system they were coming later in the day and then change their mind, show up at 9 a.m. and we wouldn't have their stuff ready b/c we hadn't gotten our delivery.

I'm kinda thinking that in idea it seems efficient, but actual follow thru might be tough. I could see it causing more problems than it helps, but I haven't worked central fill yet, but I see that some chains continue to roll it out in large metropolitan cities.

 

[All4MyDaughter]

I'm kinda thinking that in idea it seems efficient, but actual follow thru might be tough. I could see it causing more problems than it helps, but I haven't worked central fill yet, but I see that some chains continue to roll it out in large metropolitan cities.

Kroger in my city has had one for 5 or 6 years (that I know of, maybe longer). Walgreens didn't have one when I worked there, but I think they might now.

 

[PharmD RPh]

Kroger in my city has had one for 5 or 6 years (that I know of, maybe longer). Walgreens didn't have one when I worked there, but I think they might now.

I've heard of a few Kroger pharmacists not liking it when I've spoken to them over the phone while getting copies.... not sure how many Walgreens have them, but did hear of the POWER initiative walgreens did in Florida and supposedly they didn't see great things with it and kinda put the idea on the shelf.

 

[owlegrad]

I've heard of a few Kroger pharmacists not liking it when I've spoken to them over the phone while getting copies.... not sure how many Walgreens have them, but did hear of the POWER initiative walgreens did in Florida and supposedly they didn't see great things with it and kinda put the idea on the shelf.

One of the things I hear from my friends who work at Walgreens is that the central place makes too many mistakes when typing prescriptions. For instance she will scan a prescription that is written for two medications on it. Only one will be typed in. So she will rescan it, this time circling and indicating that the second item also needs to be filled. Instead they will flag it for the pharmacist to review. Apparently it is an all too common problem.

I also do not understand how the facilities are cost effective. Not only do you still need a pharmacist in the store (as well as at least SOME staff) you also have all the staff at the central site. I guess you eliminate enough hours in the store to make it worth it?

 

[PharmD RPh]

I also do not understand how the facilities are cost effective. Not only do you still need a pharmacist in the store (as well as at least SOME staff) you also have all the staff at the central site. I guess you eliminate enough hours in the store to make it worth it?

That's my question too. Not only are there staff at another site that you have to pay (assuming they take staff away from the store to offsite central fill site). The other thing is wherever this site is has to probably be built, or pay a lease on the property, it needs equipment etc. I hear some of the central fill sites take phone calls away from the stores too and I know a lot of patients want to call up and speak to "their pharmacist" meaning me, not some random guy that picks up in central fill.

 

[R2pharmD2]

I've seen some pretty egregious errors by central fill. I saw first hand where they mis-filled an amlodipine 2.5 with a metformin 850. If you're familiar with what those two pills look like, then you know that there's no way a (competent) human being ever looked at this fill before it went out.

 

[pandapharmer]

I've seen some pretty egregious errors by central fill. I saw first hand where they mis-filled an amlodipine 2.5 with a metformin 850. If you're familiar with what those two pills look like, then you know that there's no way a (competent) human being ever looked at this fill before it went out.

That's pretty scary! I've never seen anything like that from my central fill before. On our patients who request easy-open caps we have to open their bags and replace the caps bc they come standard with the regular safety caps and from looking at the bottles they all have rph initials on them still so I am under the belief that a human being checked them after they were filled by the machine.

I love our central fill. Definitely helps a ton with our workload and I would say that my store isn't even terribly busy (300-400 per day). Refills come the next business day and we can send everything there except for BC, CIII-CV, and bottles/creams. If we get a new rx we can reassign the old one as long as the strength/directions are the same and send them there too.

The only thing is training the customers, like All4MyDaughter said, to let them know that when it says tomorrow on the IVR, it really means tomorrow. And they only have one size bottle so some of our customers complain that they don't want the big bottles so we always have to fill their scripts local. All in all it's really convenient though.

 

[rph3664]

One size of bottle - so that explains metformin 850 in a bottle labeled amlodipine 2.5.

When I worked at a mail order place and we still had manual Baker cells, customer service once got a call from someone who said they took Pepcid but got Coumadin instead. We told them to destroy those tablets immediately, and drop-shipped their Pepcid.

 

[R2pharmD2]

One size of bottle - so that explains metformin 850 in a bottle labeled amlodipine 2.5.

When I worked at a mail order place and we still had manual Baker cells, customer service once got a call from someone who said they took Pepcid but got Coumadin instead. We told them to destroy those tablets immediately, and drop-shipped their Pepcid.

Now that's scary. These types of mistakes can happen anywhere I guess, but in either instance you would think that if a pharmacist had looked at the pills in question for half a second they would have known something was up. Hell, if they'd gone so far as to open the bottle, they could have checked the metformin with their eyes closed and known it was wrong!

 

[All4MyDaughter]

One size of bottle - so that explains metformin 850 in a bottle labeled amlodipine 2.5.

When I worked at a mail order place and we still had manual Baker cells, customer service once got a call from someone who said they took Pepcid but got Coumadin instead. We told them to destroy those tablets immediately, and drop-shipped their Pepcid.

You had Pepcid sent from the manufacturer to the customer?

 

[rph3664]

You had Pepcid sent from the manufacturer to the customer?

That was the phrase we used when something was sent by any kind of next-day service. I don't remember if we used UPS or if FedEx existed at that time. In other words, we filled it immediately and made sure the patient got it the next day.