Last Week we wrote about the new addition to our pharmacy, baby Maximus (a Parata Max). Today, I wanted to discuss our experience with inventory as we adapt to life with our new robotic child.
An Appetite of Inventory
The Parata Max, as it came configured for our pharmacy, has the capacity to hold 186 different medications. It has two different sizes of canisters; regular, and the “super cell.” A regular size canister can accommodate:
- 300-500 larger tablets (e.g. atorvastatin 80 mg) or
- 1000-1300 regular size tablets (e.g. metoprolol 50 mg) or
- 2000-4000 small size tablets (e.g. levothyroxine or atenolol 25 mg)
The super cells, on the other hand are really best suited for larger tablets and capsules or very, very high volume drugs. Super cells hold roughly twice the capacity of the normal cell.
If it is not apparent, using an average cell capacity of more than 1000, the robotic dispensing apparatus has a capacity of more than 170,000 tablets or capsules, with a ceiling much, much higher than that. Even if the machine is filled entirely with inexpensive generics averaging $0.05 per dose, the inventory capacity is about $10,000. In our case, the actual inventory value is likely going to be higher.
Dual Edged Inventory Sword
One of our learning experiences has been with the re-stocking of the robot. The goal it to find a balance between too much stock (several months worth of inventory) and too little stock (requiring regular re-loads) in the robot. Our goal is to keep 2-3 weeks worth of inventory in the machine at any given time. For fast-moving drugs (e.g. gabapentin 300 mg capsules), a single super cell only lasts a couple of days, using a second super cell with the same drug in it might be warranted.
The goal of restocking any given medication every 2 to 3 weeks is a significant change in our inventory patterns. In the past, we used a JIT (Just In Time) inventory model, keeping only several days worth of inventory on the shelves, and ordering each time a bottle was consumed. Because we receive deliveries 5 days a week, this model worked well to keep overall inventory down and to maximize the number of “turns” of our inventory every year. The new model, with the robot, is going to require additional inventory for many items, meaning that for medications in the robot, we will turn our inventory much less frequently.
As we learn how much stock to keep in the robot, we have decided to keep the same level of stock on our shelves (several days of inventory). This has essentially doubled our inventory of these drugs. Until we have a better understanding of how much inventory to keep in the robot, we want to keep a safety net of inventory on hand. Fortunately, only a few of the medications we have chosen to put in the machine are costly.
Smarter Inventory?
With time, the Parata Max is supposed to get a feel for our inventory usage. The reports generated by the replenishment wizard are designed to give us notice of when it is time to re-order inventory, and then how much stock to put in the machine. This has the promise to help minimize the added inventory required to leverage the robot in our workflow.
The one difficulty, though, is the nature of today’s pharmaceuticals market. On any given day, it is a challenge to get several generic medications due to supply chain issues. If we depend on the replenishment reports to order stock, we risk not being able to get the product in a timely fashion and running our supply completely out.
The other side of this is the frequent substitution that occurs in the market today. Even though the cells in the Parata are not NDC specific, each change of product requires the cell to be re-configured and calibrated. The also means that the cell must be completely empty before replenishing it. Frequent changes in generic products are certainly not ideal.
Substitution Confusion
In our practice, we place a small warning sticker on the prescription vial letting the patient know that a change in generic occurred (and that the product looks different). We generally add these notices for up to 90 days after changing a product in order to alert all customers at least once. When the product was filled off of the shelf, knowing when a product was changed was a matter of a small label or note on the bottle. When coming out of the robot, however, this is much more difficult to track, and we have not yet determined a work-around for this.
Closing
Like any new program, the inclusion of a robot into our workflow is a learning experience. With some time, we hope to minimize the impact of this change on our overall inventory levels. Next week, we will discuss the impact the robotics are making on our workflow, especially as it relates to medication synchronization.
