In order to get 2,500 packages containing 5,000 time-sensitive prescription medications out the door every day, Central Fill Inc. (CFI) looks to its vendors to do their part. So, to get a running start on the workday, the company gets some help from the local branch of the post office. At 6:00 AM six days a week, CFI picks up the thousands of prescriptions arriving there daily. Most of those prescriptions will be filled and shipped that day.

The first thing a visitor notices about CFI that is different from most businesses who ship 2,500 packages a day is that it's hard to locate the shipping room. The Harrisburg, Pennsylvania location of CFI is a pharmacy first and foremost, albeit a big one with offices, 250 employees and a large shipping operation. In this pharmacy, attention is paid to both process design and housekeeping. The three shipping stations are located on the pharmacy floor rather than aggregated in a separate shipping room, so there is little visually-discernible difference between the pharmacy operations and the shipping operations. The only telltale signs are a few discrete walls of shipping supplies and carts of processed and ready-to-ship packages that will later be wheeled from the pharmacy floor to the loading dock for pickup.

CFI is a subsidiary of National Prescription Administrators (NPA), a prescription benefit plan manager. NPA contracts with unions, governments and businesses to offer prescription benefits to members, employees and retirees. CFI delivers those prescriptions.

The 250 Harrisburg associates (as well as 150 more in another facility in East Hanover, New Jersey) speed the prescriptions to the patients who depend on them. As soon as a prescription is received, data technicians scan both the envelope and the prescription. After multiple quality control checks, the medications are then dispensed.

For some high-volume medications, this process is automated. Using proprietary software created by IT Manager Kent Robinson's department, dispensers read a packing label and release the right medications in the right amount to the waiting associate. The next step is a quality control check by an exceptions-and-resolutions associate to resolve any questions. Finally, one of the 45 pharmacists on staff visually verifies that the pills in the package are those prescribed. Available for reference on the computer screen in front of the pharmacist is a scan of the prescription, a picture of the medication as well as the prescription history of the patient. Most prescriptions come down a central conveyor belt. After being checked by a pharmacist, the package is sealed and prepared for shipping. All liquids, creams, sprays and temperature-sensitive medications are shipped either in Mylar bags or, if necessary, in cold-pack Styrofoam. Labels are printed for all carriers except FedEx from a Zebra label printer. For security purposes, controlled substances are kept in an entirely separate mini-pharmacy enclosed within the building, with its own dispensers and manifest station.

Working with the Postal Service

Since patients can't be without their medications, prompt delivery and confirmation is an essential part of CFI's service. And while efficient delivery is essential, so is cost-effective delivery. The company is responsible to its client organizations for keeping down the costs of doing business. Where possible, CFI aggressively negotiates price and service with the drug companies, the carriers and all service providers. For instance, it looks to replace more expensive brand-name medications with generic or less expensive formulas that do the same job.

In 1999, the company initiated an intensive review of all its processes including shipping and mailing. The company chose to acquire three Aristo (now part of Kewill) shipping systems, in no small part because of the least-cost-routing features of that system. And, after closely examining the speed at which their package shipments had to be delivered versus the cost of getting them to their destinations, CFI chose a combination of First Class, Priority and Express Mail to handle 85% of package shipments. According to Adam Martin, assistant director of Information Systems, that percentage will go up even further as soon as electronic delivery confirmation is bundled into the USPS' Priority mail service package. "The post office works with us," explains Martin. "Our local rep visits us at least once a month."

Finding the Right Carrier

As part of those same cost-containment methods issued from the study, CFI chose Parcel Insurance Plan (PIP) as the insurance carrier for all of its insured package shipments. "PIP helps keep our costs down, and that helps us keep prices competitive for our clients," notes CFI Senior Vice President and General Manager Wayne D. Zehr, who is both a registered pharmacist and a lawyer. "We save thousands of dollars every month by using PIP."

Those sentiments are echoed throughout the company. "Once we found out about PIP, we definitely wanted them to be part of our manifesting system," says Robinson, who oversaw the review of all software-operated systems. "PIP is very easy for us to use with the USPS or any of our carriers." Assistant Shipping Manager Wendy Cassell, who uses PIP every day, says, "We don't have to do anything new or different [with PIP]. It's all programmed into our Kewill manifest on whatever carrier we choose for an individual package." Customer Service Rep Johanna Oviedo, who handles claims for the company, comments, "PIP is very, very prompt to pay claims. I like that there is always someone available to talk to. Our broker at PIP is easy to get a hold of. They really come through for us."

The bulk of CFI's prescriptions are long-term, maintenance medications for chronic illnesses like high blood pressure, diabetes and arthritis. But the company has recently branched into over-the-counter medications. And CFI is using the Internet to allow patients to order refills. Patients can search the site for a specific brand, product or product ingredient, review their orders online and find a participating local pharmacy for the delivery of acute medications. "We'll be doing more and more over the Internet, as the technology becomes more widespread and security issues are resolved," explains Robinson. "The company is working on ways to bring prescribing doctors directly into the prescription delivery loop to save time and effort for patients. Our goal is to make it as convenient as possible for patients to get their prescriptions, while being as cost-effective as possible for our client organizations. Having vendors like the USPS, Kewill and Parcel Insurance Plan helps us do that."

For more information, please visit www.pipinsure.com or www.usps.com.