Never Say Never



Never say never.  I still remember when I looked at the pharmacy director in the eye & said “I will never work for the IHS.”

Those were the days when my commute was walking down the hill to the Whiteriver hospital from the government trailers just 2 minutes away. The thing I looked forward to the most was walking back up the hill at the end of the day.  I had just finished an FDA rotation and couldn’t imagine myself working anywhere else.
I couldn’t wait to start my job there.  I wanted to work there after I graduated from pharmacy school, and they were excited about hiring me.  I was ready to just be finished & moved to D.C., but I had to go to Whiteriver first for another rotation.  Prior to being in D.C., I had just started to fall in love with having adventures and traveling while studying at Oxford University, and could not imagine living in the middle of nowhere where people thought I was a foreign exchange student  (On a softball field after a day at the Whiteriver hospital, I was asked if I was a foreign exchange student).

Whiteriver Indian Hospital: My first IHS home…would it be my last?

And then there was the pharmacy director at Whiteriver. He used to grill me.  I thought about how much I didn’t know, and that I really didn’t want to be working in a pharmacy anyway.  As much as I liked working with the patients at Whiteriver, talking on the phone all day long at the FDA Drug Information Branch was a much better fit for me.  At least I’d be able to look things up when people had questions.  I remember saying adamantly to the pharmacy director at Whiteriver, “I will never work for the IHS…I’m going to work for the FDA.”

He said to me, “Never say never” and I rolled my eyes to myself.

But my path took an unexpected turn when I was offered to cover an Indian Health Service travel assignment the summer before starting at the FDA. I thought what a great opportunity that was.  I could go have an adventure at a less remote IHS site and make money to travel in Europe.

Ok, I admit it.  It grew on me.  I ended up liking it. And I unexpectedly ended up meeting my now husband in Europe after that IHS travel assignment, and the rest is something I wish I didn’t have to admit to the pharmacy director at Whiteriver–he was right.  Never say never.  I ended up working at IHS/tribal sites instead of working for the FDA, because it allowed me the flexibility of doing my external PharmD and travel to see my now husband who was living in Europe at the time.

After contracting at IHS sites for a few years, I decided to start & grow RPh Temp Service because I noticed pharmacy directors would complain about being sent just a “warm body” by temp agencies. I wanted to raise the bar of of contract pharmacists available to the IHS, so pharmacy directors didn’t have to settle for warm bodies.

I wanted the pharmacy directors to feel as if their temp staff seemed like part of their permanent staff— pharmacists who would jump in wherever needed, knew what they were doing, had strong work ethic, and who appreciated Native American culture.

RPh Temp Service started out by connecting recently retired IHS pharmacists (and people who made IHS contracting a career) with IHS travel assignments. It evolved to include pharmacists with IHS experience who were in-between job situations, including those who recently finished residencies.  It gave them the opportunity to travel and have time off when they wanted to, while they figured out their next career move.

It’s been very rewarding to offer IHS-experienced pharmacists access to assignments they aren’t able to access through other agencies.

Now, are you ready to hear the kicker to the “Never say never”? Now the previous pharmacy director at Whiteriver where I did my rotation works with our company.  Who would have thought?

Will My IHS Pharmacy Have to offer mail-order services?



Last month you read about how using the VA Consolidated Mail Outpatient Pharmacy (CMOP) for mail-order prescription services in IHS may affect pharmacy staff size. From what we learned during our interview with CAPT Pam Schweitzer, IHS-VA National CMOP Coordinator, the plan is for most sites to stay at the same staff size or to even increase. We asked you what you thought in our poll, and 70% thought that it wouldn’t increase.

Phoenix Indian Medical Center staff visiting the VA CMOP Leavenworth

Another frequently asked question about the program is “Will my pharmacy HAVE to offer mail-order services & use CMOP?” We discussed this with CAPT Schweitzer, and she took the time to address some of thse important and valid concerns:

Q: Will IHS require every site to get on board with CMOP?

A: No. It is optional. One aim of this project is to improve the efficiency of the prescription filling process. This may involve combining automation and mailing prescriptions locally. Many times, adding more staff is not an option.  Some of the sites have long wait times or health through adherence.  CMOP provides an additional/alternative method, which makes sense for improving the quality of health care.
As you can see from the CMOP flow chart below, the programs allows for flexibility for the patient to choose the plan that works best for them, as well as for the IHS site to customize the program to their own specifications:
Q: Will the tribes have an opportunity to get on board with CMOP?
A.  Quite a few tribes are interested. It is expected that they will have the opportunity to get on board.  In fact, three large tribes in Oklahoma have been mailing prescriptions from their facility for quite some time.  Their experiences and challenges were incorporated into the planning of the CMOP project.

Ken Siehr, National CMOP Director snapped this photo of the staff when he stopped by Phoenix Indian Medical Center

Q: Which IHS sites are already implementing CMOP services?

Rapid City Indian Hospital (South Dakota), Phoenix Indian Medical Center (Arizona), Claremore IHS Hospital (Oklahoma), and the Yakama Indian Health Center (Washington), to name a few. Eleven sites are actively using CMOP with at least eight more scheduled for activation by the end of the year.
From our discussions with IHS and Tribal Pharmacy Directors, it is clear that this have been a hot topic of discussion in the IHS pharmacy world. Our goal of part 1 and part 2 of this special IHS and mail-order services series was to help you get answers to some of the FAQs that you were wondering about.  Special thanks again to CAPT Pam Schweitzer for answering questions about this new program.
If you are going to go through the transition to using CMOP in your pharmacy and have pharmacy staffing needs during the transition, click here for your options.

IHS Pharmacy Directors: Pharmacy staff to decrease with CMOP implementation?



I promised you an update on concerns about IHS pharmacies starting to offer central fill mail-order prescription refills through the Veteran’s Affairs Consolidated Mail Outpatient Pharmacy (CMOP) in Leavenworth, KS.

Some concerns I heard from IHS/tribal pharmacy directors were: How would mailing prescriptions impact the current pharmacy staff? Will mailing prescriptions really be in the interest of patient care, and will every site be required to provide mail service? What about tribal pharmacies-can they get involved? Click here to find out the answers

I spoke to CAPT Pam Schweitzer, IHS-VA National CMOP Coordinator, to ask her these and other common questions about IHS mailing prescriptions and using the VA CMOP.

Read on to find out answers to some FAQs about the program and how the goals above will be met:

Q: Is pharmacy staff expected to increase, decrease, or stay the same?

A: The IHS sites where CMOP has been implemented so far have kept their pharmacy staff, and in some cases have increased pharmacy staff. These sites are fortunate to have good CEO support of the pharmacy department. The pharmacists will be able to spend more time reviewing a patient’s records when processing refills, performing medication reconciliation, and/or fulfilling Improving Patient Care (IPC) objectives that allow pharmacists more time to do clinical work.

Q. Wouldn’t mail-order services be worse off for patient care because the patients don’t get as frequent personal interaction, and our work may become less clinical?

A: Mailing prescriptions can increase patient compliance, especially for patients who live in remote areas and may have transportation barriers that prevent access to the pharmacy. Studies have shown that mailing prescriptions can increase patient adherence. Yet if a patient chooses to go to your pharmacy to pick up medications instead, he/she can still choose to do so. The pharmacists’ time will likely be freed up to provide more clinical services for patients, because pharmacists won’t need to be involved with filling nor verifying the prescriptions.

Q: What are the less known features of VA CMOP that will be beneficial to patient care?

A: Patients can be provided with a 30-day supply of medications at each fill, increasing the possibility for billing and reimbursement for drug costs (especially if a site is currently dispensing 90 day supplies).

Patients are able to request their medication early
(before the next fill is due) using a new feature in RPMS called Suspense.
Example: patient picked up medication today. He/she can request refill right now for their next fill.

Q: How will staff pharmacists’ & pharmacy technicians’ roles change due to CMOP implementation?

Staff pharmacists will still be involved with processing the refill prescriptions and will likely have more time to review the patient’s electronic record and manage medication therapy.

The pharmacy technicians’ workload of filling prescriptions will decrease, allowing more time for monitoring point-of-sale billing and inventory management. One additional duty the technicians have with CMOP is answering the phone and looking up tracking information if the patient didn’t receive their medication.

Stay tuned in a future issue to find out the rest of the answers to FAQs like whether every site will be required to use VA CMOP and what may be in store for tribal facilities. You’ll also see how CMOP would work if integrated with your pharmacy services.

Expecting pharmacy staffing needs in your IHS/tribal pharmacy?  Not looking for just a warm body?  Get options – select IHS-experienced pharmacists for your pharmacy

Mail-Order Pharmacy for IHS?



Last year, someone I know who works at the VA told me that as a pilot program, a VA mail-order facility started filling prescriptions for an IHS site around June/July in South Dakota. And that a site in Oklahoma was thinking about coming on board too.  The idea, my friend said, was to get IHS on board with the VA filling their prescriptions through mail-order.   My first reaction was that of being completely surprised.  Then I tucked the thought away to revisit it after hearing more.  Now we are beyond Valentine’s Day in 2012 and to my understanding, this idea may be further along than a pilot idea.

Mail-order for the IHS—what do you think?

My first reaction was wow–this new implementation feels opposite to what the praised IHS pharmacy model of patient care stands for.  If mail-order were implemented, patients may miss out on an important opportunity for a timely medication intervention or to get their medication-related questions answered by a pharmacist.

There have been many times while working at an IHS/tribal pharmacy, I remember sharing something important with a patient that had an impact on their medication adherence & health (translating to healthcare cost savings), which would never have come up if I had not interacted with them in person.  It’s like talking to your personal trainer on the phone and getting some basic tips vs. seeing your personal trainer through a full workout.  He or she gets to hold you accountable in a more impactful way in person.  The level of personalized care jumps exponentially.

Then I wondered what the plus side would be. Perhaps there would be easier access to medication for patients.  Workload can be taken off current pharmacists’ plate for more clinical work.

But is it realistic to hope that budgets would allow pharmacists to do more clinical work, or will sites end up having a reason to cut the budgets even more when mail-order is implemented?

Comment below (and feel free to post anonymously) about what you think the pros & cons are. Share your opinion and be heard.  You’ll get updates in an upcoming issue about the status of this concept and its implementation in IHS, what IHS/tribal pharmacy directors throughout the country think about its impact on our patients & practice, and ideas on how best to make it work.

Are you an IHS-experienced pharmacist and interested in temporary IHS jobs?  For access to IHS travel assignment options, click here.

Temporary IHS Pharmacy Jobs – Indian Health Service – Selecting Travel Assignments

If your career path has crossed working with the Indian Health Service at some point in time, whether as a pharmacist or student completing a rotation, chances are that you will work with the IHS at another point in your career in some capacity down the road.

For pharmacists who are waiting for their Commissioned Corps call to active duty right now, an option available to you is working temporary pharmacist assignments through a pharmacist staffing agency that offers Indian Health Service assignments.  This allows you to work in the IHS setting without losing out on experience and pay, while waiting for your paperwork to come through.

If you are recently retired from the Indian Health Service and wanting to do some relief work, travel assignments can be a great way for you to stay connected with the IHS, make money to supplement your retirement, and work when you want to.

If you are currently working for a relief agency and working in the IHS setting, but want to have more desirable work environments and locations to choose from, do research on how you can get the opportunity to do IHS assignments in desirable settings.

If you have worked for the Indian Health Service at some point in time, whether as a pharmacist or had exposure as a JRCOSTEP or during a rotation, doing contract pharmacist work in between jobs or as a career can be options to consider.  One IHS-experienced pharmacist Read more