Maggie McKay (Host): Hospitals are a well-oiled machine, and every department has to work with the others to make sure everything goes smoothly. But some go above and beyond, like Community Memorial Healthcare, where they've earned a specialty pharmacy designation that we'll hear more about and what it means to patients, from Dr. Jack Tretko and Dr. Keegan Bachelor.

Welcome to Wise and Well presented by Community Memorial Healthcare. I'm your host, Maggie McKay. Welcome, Dr. Tretko and Dr. Bachelor. Thank you so much for making the time to be here. Would you please introduce yourselves and explain your roles at Community Memorial? Dr. Tretko, let's start with you.

Dr. Jack Tretko: Thanks, Maggie. My name is Dr. Jack Tretko. And I'm the Director of Outpatient Pharmacy and Purchasing here at Community Memorial Healthcare. I've been with the organization for 18 years. And my current role includes oversight of the Outpatient Pharmacy and the entire purchasing of the whole Pharmacy Department, both the inpatient and the outpatient side. I've also been involved with the 340B Program here and other roles to support IT and such.

Host: Dr. Bachelor?

Dr. Keegan Bachelor: Yeah. Thanks for having me. This is Dr. Bachelor. I am the Outpatient Pharmacy Operations Manager, which includes overlooking the staffing and also the Meds-To-Beds Program we offer here at the hospital and the new specialty pharmacy .

Host: So, for those who don't know, would you please familiarize our audience with the services the Community Memorial Pharmacy provides at the inpatient and the outpatient levels?

Dr. Jack Tretko: Yes, absolutely. And most people do not know that we actually have two departments. We have an Inpatient Pharmacy Department and an Outpatient Pharmacy Department. Our inpatient pharmacists review all the medications that are prescribed in the hospital. We compound medications. We provide antibiotic consultations. We do recommendations. We review patients' labs and adjust their medications appropriately.

On the outpatient side, once the patient is ready to leave the hospital, the outpatient team receives medications from physicians. We offer a service called Meds-To-Beds, which is unique to our hospital. Patients have the opportunity to opt into this program where they utilize our outpatient pharmacy to fill their discharge prescriptions, and what we do is we deliver those medications directly to the patient bedside. And this, we found, has increased compliance and adherence, because there are statistics out there that about 40% of patients that get prescriptions prescribed for them on discharge, they don't refill those medications. So, a lot of those are missed opportunities, which can cause patients to come back to the hospital, because they are not on these medications to stabilize their condition. So, we're hoping to bridge that gap with the Meds-To-Beds program that we offer.

We also offer a free delivery service. So, anyone that visits our hospital or our clinics has the opportunity to use our pharmacy, and we'll deliver the medications to the patient's home for free. It's been a really great service, and it's helped with barriers that some patients have, especially when they're leaving the hospital. A lot of times if they're leaving after a surgery, they're not able to send someone to the pharmacy and they may not have a caregiver. And so, we're hoping to bridge that gap and provide that continuity of care.

Host: I love those ideas. Not only is it free, but it's convenient. And like you said, if they're already there in the hospital and you give them to them, there's more likelihood that they're going to take them. That's brilliant. Congratulations on the recent Accreditation Commission for Healthcare Specialty Pharmacy . Can you explain what this accreditation means for the pharmacy and its patients?

Dr. Jack Tretko: Absolutely, Maggie. This means that the specialty pharmacy has demonstrated it consistently meets high standards for providing comprehensive, high quality care to patients taking complex specialty medications. And it's a rigorous standard to meet, and there are high expectations. And we really feel that this demonstrates our commitment to excellence here at Community Memorial Health Care.

Host: Has Community Memorials Pharmacy received this or similar designations like it in the past?

Dr. Keegan Bachelor: This is the first time we received a specialty pharmacy license. We are the only hospital in the area that has this type of license, which we're very proud of. And before this, something similar is when we became a contractor with all major insurance plans, which opened us up to the public, which many people still don't realize anyone can come into our pharmacy anyone that lives here locally or in the area can walk in. We're an open door pharmacy, which is very unique compared to other specialty pharmacies. Typically, specialty pharmacies are closed door, meaning patients cannot walk in and talk to their pharmacist in person. It's all done over the phone. Typically, it's a mail order. So, patients have to wait a day or so to receive their medications. So, that's one thing that differentiates us.

Host: And what was the process like for getting this accreditation?

Dr. Jack Tretko: Yeah. Thanks, Maggie. The process was lengthy. It took six months for this whole process from start to finish. We had to establish policy procedures. We had to establish how many pharmacists we would need and technicians. And we had to do a lot of data gathering and establish processes for quality control and how we ship medications and doing testing on storage containers. And this took several months to complete. And once we had that completed, we submitted all that documentation to the accrediting body, and at which point they reviewed it and came on site for a visit to inspect us to make sure that what we say we're doing in our policies procedures we're actually doing. And so, they also asked additional questions of our staff and of all the metrics that they require in order to make sure that we are fulfilling their rigorous standards for accreditation. And we have to maintain these standards. We were approved on April 18th, 2024, and this accreditation is good for three years, at which point, you know, we have to demonstrate that we continue to provide this high level of care for our patients.

Host: Are there any specific changes that the community will notice as a result of this designation?

Dr. Keegan Bachelor: The first thing our community will notice is how accessible we are compared to other specialty pharmacies. As mentioned, patients can easily walk into our pharmacy. Not only will our patients have the advantage, but also the prescribers within our network, the local prescribers prescribing these medications. Our pharmacists and staff are going to have relationships with these individuals and work as a healthcare team to help these patients. It can be a huge benefit to this whole community.

Host: It sounds like it. I wish there was a pharmacy like that near me. How do the specialty pharmacy services differ from traditional pharmacy services?

Dr. Jack Tretko: Yeah. One of the major differences is our accessibility. Specialty pharmacies like ourselves are available 24/7. So, if you have a question, let us know. If you're experiencing a side effect or you're not sure how to really take your medication, you can call us 24/7 and we'll be able to answer those questions for you.

Another differentiator is we look at the whole patient and we want to make sure that the patient understands how to take their medication and that it's accessible to them. So, if there are any barriers such as financial, we go out of our way to look for co-pay assistance programs or any other financial sourcing so that the patient is able to get that medication and not have to worry that they can't afford it.

And then, lastly, a big feature of specialty pharmacies, it's called the Patient Management Program. And what this is, is we do disease state-specific and drug-specific care plans for patients, where we call the patient, speak with them when we first start service, and kind of create goals and expectations for treatment and check in every month to make sure are we meeting those goals? Are there any other questions? Are there any other barriers that are preventing the patient from taking the medication? And we really work together as a partnership in this, and really try to improve the quality of care all of our patients.

Host: It sounds like you've got all the bases covered. That's so great. Can you elaborate on the types of medications that are typically dispensed through a specialty pharmacy ?

Dr. Keegan Bachelor: Yeah. So, within a specialty pharmacy , there's going to be either rare disease states or medications that are very expensive. It could be thousands of dollars. For instance, we have a medication called Taltz, which is about $17,000 for a one-month supply. So, it's very expensive. Some people think of specialty pharmacy , they associate that with compounding, which is another form of pharmacy, making specific medications for specific individuals. But specialty pharmacy is different than just compounding medication.

As Jack mentioned, the steps that we're required to be able to fill specialty medications are very thorough. They're similar to an outpatient pharmacy, but more thorough with the whole process. And then, insurances allow us to fill these very expensive medications, because they know we are doing the proper steps to help the patient and also working along with the prescribers.

Maggie McKay (Host): What are some of the biggest advantages of using a specialty pharmacy for patients with complex conditions?

Dr. Jack Tretko: Yeah. The biggest advantage is that Patient Management Program, and that really is tailored to each patient. It's specific, again, to the disease state, whether a patient may have psoriasis, irritable bowel disease, migraines, osteoporosis. Those are some of the disease states that we focus on. And we also look at the medication that is being prescribed.

We also try to gather, working together with the provider, the physician that prescribed the medication, and obtaining those labs that the patient went to receive from the doctor. And we try to look at some of those labs and see if the therapy is working as it should, and trying to identify, you know, if the medication is not working, whether it be side effect related or the labs are not responding appropriately. We'll reach out to the physician on behalf of the patient and see if there's another plan that we can develop.

So, this is essentially, you know, you have an extension of your physician, you have a pharmacist guiding you step by step and checking in with you month by month to make sure that there are no barriers and that you're constantly improving in your condition if we can.

Host: How does the pharmacy ensure that patients are taking their medications as directed?

Dr. Jack Tretko: Yeah. So, one of the steps that we have is that we check in with the patient every month. So, a pharmacist will reach out and will ask questions, a series of questions, to make sure that the patient, one, is taking the medication appropriately, has their condition changed, and we'll ask questions. Do you have any doses remaining? Do you have one more injection to administer? And we're trying to assess that the patient is compliant with their medications and that they're due for their next refill. We also track in our system on when we dispense a medication, and we look at that to identify if there's any lapse in adherence. If we see that If a patient is slipping five days or six days on their refill request, then we know that maybe there's something going on and we have to dig in a little bit deeper.

But one of the advantages of the specialty pharmacy program is that we are reaching out to the patient. And, most of the times, the pharmacist will be reaching out to the patient even before the patient reaches out to us for a refilll. So, we try to be proactive in that to ensure that the patient is adherent to the medications. There's so many social economic factors to healthcare. You know, a lot of these specialty medications are refrigerated. And one of the questions that sometimes is missed is simply asking the patient, "Do you have a refrigerator to store your medication in?" If they don't, that is going to make the medication ineffective, because there's only a certain amount of hours that a medication can be left at room temperature. So, there are many points that we check in with the patient to kind of identify any issues that may arise that may lead to a medication adherence problem.

Host: Well, thank you both so much for sharing your expertise and joining us today. This has been fascinating. I really learned a lot myself, and I'm sure everyone listening will as well.

Dr. Jack Tretko: Thank you, Maggie. I appreciate the opportunity to describe our program.

Dr. Keegan Bachelor: Thank you so much.

Host: Absolutely. Again, that's Dr. Tretko and Dr. Bachelor. And if you'd like to find out more, please visit mycmh.org. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to Wise and Well, presented by Community Memorial Healthcare.