Here is a representative process and timeline for typical in-house pharmacy buildout and launch with Alchemy. Some of the drivers impacting the timelines include the level of physical buildout required and the location of your pharmacy which drives Board of Pharmacy approval, PBM and Health Plan network enrollment timelines
Week 1: Introductory Virtual Meeting
Virtual meeting where we introduce ourselves, what we do, and learn what your needs are. During this meeting we also create a plan to retrieve your prescription data so that we can complete an Rx analysis
Week 1 - Week 2: Rx Analysis
We ingest all your EMR, contract pharmacy, and third party administrator data to build a 360 degree view of your existing program. We utilize this data to then apply in-house pharmacy capture rates to compare and contrast. We recommend moving forward with an in-house pharmacy if the return on investment (or ROI) and ongoing economics make financial sense for all parties involved. We perform this analysis completely free of charge while some consultant groups charge anywhere from $20-40K for this analysis
Week 3: MSA and Contract Redlines and completion of Paperwork
Our legal and leadership teams work together to review and complete the Master Service Agreement (or MSA) with Alchemy, and any other necessary paperwork before the project kickoff
Week 4: On-site Visit and Site Readiness Evaluation
We will spend a day with you at your location to familiarize ourselves with your business, team and vision. You will also get to meet our entire team. We will also evaluate the readiness of your designated space to understand if it meets the Board of Pharmacy requirements specific to your State.
Weeks 4 - Week 5: Plan for Pharmacy Design
We will provide necessary design support and recommendations for the physical build-out. We engage with your contractor and handhold your team throughout the process if additional support is needed. The pharmacy build-out completion date will be important for determining the date of the board of pharmacy visit (usually 4-6 weeks after the board of pharmacy application is submitted)
Week 5: Kickoff, Data gathering and Process Walkthrough
Alchemy will begin the project with a kickoff walking your team through the next steps as well as gathering upfront data required to begin Board of Pharmacy and DEA applications. We will also discuss other upcoming applications, including NPI, NCPDP, MPN, and PTAN. Other needs, including updated liability insurance limits, and surety bond will be discussed as well. Finally- we discuss a plan for who will act as your Pharmacist in Charge (or PIC) throughout the application process.
Week 5 - Week 6: Board of Pharmacy and CSR Applications
We complete the Board of pharmacy (or BoP) and Controlled Substance Registration (or CSR) applications (if required by your State). In some states these happen in a sequence and in others simultaneously. Note that licensing and approval timelines vary depending on your state’s board of pharmacy. Submission of these applications will need to coincide with the date of construction completion
Week 6 - Week 12: Readiness for Board of Pharmacy inspection
We track the BoP application after submission, and schedule a date for the BoP inspection, which is typically 4-6 weeks after the application was submitted. We also help you prepare for the pharmacy inspection, which includes actual site buildout that meets state specifications, establishing necessary policies & procedures and developing training materials. We will also be present with you during the inspection and provide support throughout the process
Week 12 - Week 16: DEA Application Submission and Inspection
Once the BoP issues a permit, we can now apply for the DEA license. We complete the application on your behalf, track the progress of the application, and then prepare you for the DEA inspection visit which occurs approximately 1 month after submission. We will also be present with you during the inspection and provide support throughout the process
Week 12 - Week 16: Other regulatory Licenses
While we wait for the DEA inspection we will complete applications for other regulatory licenses, including the National Provider Number (or NPI), the (National Council for Prescription Drug Programs (or NCPDP) number, the Medicare/Medicaid Provider number (or MPN), and the Provider Transaction Access Number (or PTAN)
Week 16 - Week 19: Establish PSAO and Wholesaler Accounts
We establish necessary Pharmacy Services Administrative Organization (or PSAO) and wholesaler contracts. We establish 340B account and a non-340B account with the wholesaler. This enables inventory purchase as well as network enrollment for any participating PBMs
Week 16 - Week 18: Hiring, Training and Launch Readiness
Pharmacist in Charge hires the technician, begins training together with the clinic staff and the prescribers. At this point the teams iron out the final details
Week 18 - Week 19: Kickoff PBM network enrollment
For any PBMs requiring direct enrollment (not through the PSAO), we kickoff the enrollment process by submitting individual applications. Some example PBMs include ESI, Humana, Optum, Caremark, MedImpact, Prime and other Medicare/Medicaid plans. There are also timeline specifications for certain PBMs requiring applications be submitted 'X' days/ months from the day of BOP approval. Other PBMs may take 6 months or more for approval (e.g. Caremark). If your pharmacy is located in a HEAT zone, the PBM process takes longer, and can last up to a year
Week 20: PioneerRx Installation and Training
The PioneerRx team will come on-site to install your computers and provide training on how to use the program. The Alchemy team will also be present to provide support
Week 21: Equipment, Supplies and Inventory Purchase
PIC and Technician place final orders for equipment and supplies, which include Pharmacy Point of Sale (or POS), printers, phone/fax, Rx labels, vials, caps etc. First purchase orders are placed for drug inventory to the wholesaler
Week 22: Pharmacy launch and Rx dispense
Qualifying scripts begin to be written directly to the in-house pharmacy for dispense. Patients can start to pick up their prescriptions during the visit or in the days immediately following in the event a PA is required
Week 22 - Onwards: Rx Volume Ramp
This pharmacy dispensing process will be a roll-out as not all PBM contracts will be in place from the very start. During this time, you will ramp up in-house pharmacy volume, re-direct contract pharmacy fills to your in-house pharmacy, optimize first fill and Nth refill capture rates to establish fully ramped steady state pharmacy performance. This is when your pharmacy staff and our software kick into overdrive helping you manage the day-to-day blocking and tackling of running an efficient 340B pharmacy
Week 22 - Onwards: Clinical Pharmacy Program exploration and execution
As pharmacy operations stabilize and volume ramps, we begin to learn, iterate and start discussing ways to further impact the community through clinical programs that will help identify, enroll and treat patients who are in need of care. There are a number of ways to launch and sustain these programs and our clinical research team is well equipped to enable and educate your team
Month 3 – Month 12: ROI Breakeven
As the PBM enrollments are completed and volume ramp reaches steady state, we will continue to monitor cash inflow from the Pharmacy Revenue Cycle Management to build necessary cash reserves to cover ongoing inventory purchase, pharmacy operating expenses and general "Keep the lights on". The in-house pharmacy will become ROI positive in as little as 3 months to 12 months** engaging with Alchemy.
**Note: Most of our clients achieve ROI break even within 3-12-months based on geographic location, patient volume, payor and prescription mix.
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