With some 3,300 stores with pharmacies, $15.6 billion in U.S. pharmacy sales last year and prescription volumes that eclipse those of all but the largest drug chains, Wal-Mart Stores has become an international pharmacy powerhouse. But its future in pharmacy still revolves around the point of contact between its 10,000 pharmacists and the millions of patients they counsel, explained two of the company's top pharmacy managers.

"Simply dispensing a product in today's world is not good enough, said Frank Segrave, Wal-Mart vice president of pharmacy. "Pharmacists also have to provide the valid, pertinent information customers need. And they have to do that while respecting both the customers' time and their own work needs."

Ron Chomiuk, Wal-Mart's vice president of pharmacy operations, acknowledged the difficulty of communicating with thousands of pharmacists and coordinating patient education and pharmacy procedures "when you have an organization as large as this." Nevertheless, he said, "We try to stay focused on what's really important to the customer, and that's providing value. I think our reputation tells the patient that were giving them a safe, quality product, dispensed in a safe, controlled environment."

In a recent interview at the company's Bentonville, Ark., headquarters, Chomiuk and Segrave agreed that pharmacists today face a heavy burden as third party administrators, medication experts, disease management specialists and patient counselors. To help them cope, the chain has built a powerful interactive pharmacy system, redesigned layout and work flow and upgraded its technician training programs to relieve pharmacists from much of the manual dispensing process.

Those efforts underscore the importance of customer service, including quick prescription fills and refills and personalized counseling at the prescription counter, the two-executives told Drug Store News. Increasingly, the chain is promoting service in a broad-based bid to elevate the Wal-Mart pharmacy above simply a one-stop customer convenience--and differentiate it invitingly from smaller, easier-to-access neighborhood drug stores.

"In an environment so heavily influenced by third party, one of the issues we know wins is if you can give great customer service," noted Chomiuk, who was vice president of pharmacy for Kmart Corp. before joining Wal-Mart in October 2001. "You can get people from the corner drug store ... if you have that."

According to Segrave, the company has identified two mind-sets among its pharmacy customers. "One is the customer who wants to park close, jump out and run in the store," he said. "The other customer wants one-stop shopping. But in our studies, the interesting thing ... is that some customers will perceive it to be more convenient to park close to a corner drug store so they can walk right in, then wait three hours to get a prescription filled.

"Is that more convenient than having a pharmacy as part of a big box, and having your script quickly so you can be in and out of there in 20 minutes?

Segrave has seen both sides of retail pharmacy, having worked as a pharmacy manager for Eckerd Corp. before joining Wal-Mart as a pharmacy/manager in 1986. He has since risen through the ranks as district manager, regional manager, divisional manager and divisional merchandise manager before becoming a vice president in 1999.

Now he and Chomiuk, along with Jim Martin, senior vice president of pharmacy, are pushing to upgrade all facets of prescription dispensing and health care at the world's largest retailer. Those efforts soon will be apparent to customers, if they aren't already.

In terms of in-store presentation, Wal-Mart historically lagged many of its competitors in pharmacy design. But that's about to change, according to its pharmacy leaders. Wal-Mart's newest supercenter prototype shifts the pharmacy into a more prominent front-store location and gives it a more open and visible look. The goal: to make it easier for patients to drop off and pick up prescriptions and talk with their pharmacist.

The chain's store designers also have expanded the space between the pharmacy counter and the gondolas for OTC products and other drug store merchandise out front. "We created that customer space between the gondola and pharmacy so people can move around and interact more easily with our pharmacists," said Chomiuk.

Leveraging its relationships with suppliers, Wal-Mart also is trying to make it easier for patients to take their medications. The chain is working now with drug makers to
help revolutionize the packaging of pharmaceuticals, moving away from bulk bottles of pills and tablets to what Segrave and Chomiuk call "consumerized prescription packaging."

Such packaging is "beyond unit-of-use," Segrave said. It offers patients the convenience of blister packs that contain individual daily or periodic doses of a medication, along with detailed and easy-to-understand instructions on when and how to take the product.

The new type of package, now in limited use by Pfizer and a few other drug companies, eliminates additional handling of product and the confusion many patients--particularly seniors--feel when dealing with multiple daily medications. It also can boost patients' therapeutic compliance.

Manufacturers, Segrave noted, "have been very receptive to this." It's unlikely, he added, that drug makers would overhaul-packaging on existing drugs already on the market, "but for drugs in the pipeline, they're investigating it. A lot of them are patenting their packaging, as well. It's gaining a lot of momentum in the industry, and I think you'll see more and more drugs coming to market this way."

It almost goes without saying that Wal-Mart's active encouragement of "consumerized prescription packaging" among its suppliers could speed up the process. The chain's ability to move massive amounts of product, leverage its customer relationships and negotiate from a position of strength with all its vendors has become legendary, and it gives the company the opportunity to shift the way manufacturers develop and package their products--including pharmaceuticals.

"What we've told the pharma companies is that ... we will stock those packages," said Segrave, even if it means developing three or four different packages for each drug to accommodate different dosage requirements and duration of a patient's prescription therapy. "Our message to them is that we'll dispense all of them, depending on how it's prescribed. If you think about it, we do it today in the OTC department.

"We're certainly on the forefront of RFID in the pharmacy world, as well as the retail world, and that, I think, is going to enhance the logistical process and getting drugs to customers quicker and with more accuracy.

"This is happening today," he added. "We are taking one of our pharmacy warehouses right now and making it RFID-compatible, so that as the drugs start coming RFID-labeled, we'll be ready for it at the distribution center level. It's all part of the Wal-Mart strategy.

We hope to have a few items that are RFID within the next six months," Segrave added. "We already have commitments on a few items, and we will have them labeled in RFID, running through the system at the case level, and on a couple of bottles of [class 2 controlled substances]."

Both the Food and Drug Administration and the Drug Enforcement Agency, said the executive, "are fully supportive of the effort."

In terms of pharmacy technology, of course, RFID is only the tip of the iceberg. Wal-Mart has, by design, proceeded cautiously, in expanding into robotic dispensing or other expensive pharmacy workplace automation, but the chain does provide its pharmacists and techs with a powerful, fully interactive computer system it calls Connexus. We have a terrific ... proprietary system that helps prioritize the work flow based on when a customer is coming in to pick up a product and also provides the checks and balances to deliver accuracy and efficiency in prescription filling," Segrave explained.

"We're really proud of Connexus," added Chomiuk. "If you're not focused on ... robotics, you can spend your time and resources and capital on technology that really helps you redeploy people to get that [prescription and wellness] information to the consumer.

"I like to call Connexus a tech-driven system, because all that ancillary work flow is truly done by technicians, he went on. "And in an environment where pharmacists are getting harder and harder to come by, it really allowed us to redeploy them better across our organization. So that was money well spent in technology that allowed us to make our people resources a lot more valuable."

Added Segrave, "We designed this system with the customer in mind because at the end of the process, we want the pharmacist spending time with the customer."

With the Connexus system, Chomiuk explained, Wal-Mart stepped back and looked at how the prescription could best flow through the dispensing process and designed the pharmacy around that. Thus, in the new pharmacy prototype, he said, We have two drop-off stations ... where technicians talk face to face with customers while they input their information. As the script flows to the fill pod ... radio frequency equipment [identifies] the product" to be filled.

Once the tech fills the prescription, Chomiuk continued, it comes back for visual verification, and the pharmacist is the last person who touches it."

In other words, said Segrave, "It's a non-linear filling process," based on a radio frequency transmission of information within the pharmacy, with products identified by bar code.

"Typically, pharmacists work across the front counter," said Segrave. "Not ours." The prescription moves around the Wal-Mart pharmacy from one station to another, he said, as it goes through the filling and verification process and gets a final review by the pharmacist at the end of the process.

Added Chomiuk, "Once the technician inputs the script, it goes to a controlled-number basket, the tech scans that basket, and it tells the tech what's supposed to be filled. They go to the counter, and if they pick up the prescription and zap that bar code and it's the right medicine, it allows them to print a label ... and fill the script. If it's the wrong item, it beeps and won't allow them to go any further."

Much of that process, of course, is invisible to customers. Much more apparent is the growth of health screenings, brown-bag events and other high-profile events Wal-Mart is bringing to markets throughout the country.

"The pharmacist coming out of school today has a clinical mind-set. They want to do clinical services, diabetes screenings and get involved in the community," said Chomiuk. "The challenge we have is [to] accomplish that in a retail setting ... in such a way that the consumer feels they're being treated [professionally]. And I think we've done a pretty good job."

Among the chain's most successful programs in 2003, said Chomiuk, was a nationwide, one-day glucose- and cholesterol-screening program in Wal-Mart's stores, tied with a diabetic-care theme throughout the stores. "We used the pharmacy as a center point, and spread the event out to all those things that Wal-Mart offers the diabetic in the store."

Last summer, Wal-Mart and some of its suppliers cosponsored brown-bag events for seniors in Arkansas and Virginia. The programs promoted not only drug interaction safety and compliance, but also benefits available to seniors, including Pfizer's Share Card discount program.

"It took a lot of collaborative work with both the manufacturers and Wal-Mart's marketing department," Chomiuk explained. "We needed to get the communities aware of what's happening, and once we'd done that, it was amazing. We had stores where there were a couple of hundred people lined up who wanted to talk about the card, program and find, out if they were eligible.

All these efforts add up to competitive differentiation and a positive image, said Segrave. "It's the total customer experience, and the most important part of that is the service: what we're doing to help that customer feel good about our stores.

"If we fill the prescriptions quickly and accurately and get them on their way, the customers will be back. And if they need to buy some hip waders while they're there, so be it," he added.

- pharmaonline.co.in