Brad Puffer: Welcome, everyone, to this episode of Field Notes. I'm Brad Puffer on the Medical Office Communications team at Fresenius Medical Care North America and your host of this discussion today. Here, we interview the experts, researchers, physicians, and caregivers who bring experience, compassion, and insight into the work we do every day.

Headquartered in Franklin, Tennessee, and a business division of Fresenius Medical Care North America, FreseniusRx is a pharmacy focused on renal medications that help patients impacted by kidney disease.

I should say, used to focus on renal medications, because FreseniusRx is expanding its services for our patients, becoming a go-to pharmacy for all their medication needs. The goal is to create efficiency as well as a more focused point of care to improve patient health.

Here to discuss the importance of medication management for patients with kidney disease is Dr. Michelle Nguyen, Senior Director of Pharmacy for FreseniusRx.

Michelle, thanks for being here today. Welcome to Field Notes.

Michelle Nguyen: Thanks, Brad, for having me. It’s great to be here.

Brad Puffer: Well, Michelle, before we really dive into this expansion news, can you help us understand a little bit of the FreseniusRx backstory? How and why was FreseniusRX developed in the first place?

Michelle Nguyen: We started out as a pharmacy, servicing patients who are in need of IV medications for their home dialysis treatment. We offer the service to ship the medications directly to our patients’ homes.

Then in 2011, we recognized that our services can also be beneficial to our patients who are receiving treatment in-center, which prompted, I would say, Phase 1 of our expansion to provide services to all our Fresenius Kidney Care patients.

Fast-forward to today, FreseniusRx is one step closer to becoming a one-stop pharmacy for our patients. FreseniusRx now offers our patients the flexibility to fill their non-renal-related medications in addition to what we’re servicing them already, which is their bundle medications or their renal medications through FreseniusRx.

Brad Puffer: I’m sure that’s going to be really convenient for patients as that offering becomes bigger over the next few months and more patients can take advantage of that. Can you tell me a little bit about how the pharmacy operates today?

Michelle Nguyen: The journey of onboarding our oral-renal medication was challenging. It was very rewarding. We learn a lot through that process, working closely with our clinical team, I believe we have finessed the process of how to coordinate better care for our patients who choose to fill their medications through FreseniusRx.

A little bit of our background about our pharmacy family. So, the FreseniusRx family consists of over 250 team members, and we have a dedicated team for each segment of our patients’ journey within the pharmacy. Just to name a few, we have a customer care team that interacts directly with our patients and clinic staff on a daily basis. They answer any questions, assist with order status, refills, and then our insurance prior authorization specialist team who focuses on troubleshooting the hurdles that the insurance payer puts in front of us as we try to get the prescription filled for the patient, especially when it comes to prior authorization process, which is an approval process that the payer put in place. Our team works closely and greatly appreciates the support and the timely responses of nephrologists in our clinical team in helping us complete this process on behalf of our patient.

With this step completed, our patients can now start their medication timely. We also work closely together with a social worker to find financial assistance for those patients who are in need. Our clinical team continues to be the backbone for our support, working closely with us to get a hold of the patient, adjusting prescriptions, and ensuring our patient receives their medication when they arrive at the clinic.

Brad Puffer: Michelle, it seems like you really do a lot for the patients. It's much more than just filling prescriptions. And it sounds like FreseniusRx was really borne out of this expert need to help our patients fill their complicated medications.

Tell us a little bit more about the pharmacists who are working at FreseniusRx. What makes them specialists in kidney disease?

Michelle Nguyen: Our team consists of 50-plus pharmacists who came from various training, education, and experience backgrounds. Our pharmacists receive special training focused on renal disease, and especially how dialysis impacts the medication their patients are taking. We work closely with a group of experts creating the training module just for our pharmacists on this topic, to keep them abreast on the changes in medications and how medicines and comorbidities impact dialysis. Renal medications in patients with kidney failure make up a small percentage of the general population. Most retail and institutional outlets see a very limited number of these patients. And the pathophysiology of the disease stage is so complicated that failing kidneys can impact your heart, your iron levels, your blood sugar, and your bones. Our pharmacists spend 100 percent of their time caring for this patient and understand the differences between the different types of dialysis and how they impact the timing and the route of each medication that is being administered to our patients.

Brad Puffer: So, Michelle, then, tell me a little more about the medication management for people with kidney disease. Because it really seems like it must be very complicated and I’m sure there are a lot of interactions between all the different medications these patients have to take. So why is it so important to have a pharmacy with specialists in kidney disease?

Michelle Nguyen: It is important to have a pharmacy or a pharmacist team that is dedicated to kidney disease because they need to understand the integral part of how the kidney impacts the medications our patients are taking.

So once a medication is digested and metabolized through the body or broken down into the body, the metabolites need to be removed from our body timely. And the way to remove that – most medications rely on our kidneys to remove those metabolites. And if a medication is not removed from our body timely, which could lead to buildup of these metabolites, and could lead to further complications. It’s important that we have a pharmacist team that focuses on understanding how the renal function impacts the medication that our patients are taking. Once the medication is digested and broken down in our body, the body needs a way to get rid of the excess or the metabolites. And most medications do this through our kidneys, and if the medication is not removed timely from the body it could lead to buildup, which could further create health complications for our patients. For our patients who have minimal to no renal function, they rely solely on dialysis to get rid of these metabolites.

In addition to that, our patients also require special lab monitoring to help prevent disease complication, specifically phosphate and calcium levels. Our pharmacists work closely with our clinical team to help promote medication adherence. In addition to that, Brad, our patients with kidney disease oftentimes live with multiple other diseases, or comorbidities, which will require care from different prescribers. We know today that not all systems link to each other. And in an effort to ensure that our patients have the highest quality of life possible, they may unknowingly prescribe a medication to treat a disease that has already been cared for by a provider. Or they could prescribe a medication that potentially could interact with another medication that the patient’s already taking. Having a pharmacist that understands the patient’s condition, which is kidney failure, and having the ability to see every medication that the patient’s on, or most of the medications that the patient’s on, our pharmacists have the opportunity to help identify these potential interactions, whether there’s duplication of therapy, whether it’s a drug-and-drug interaction or even a drug-disease interaction and we work closely with the providers to make the right intervention.

Brad Puffer: That sounds incredibly important, and something your team has gotten very good at. Now, we’re starting to tease at the fact that there may be more work that you can do to better help patients at other stages of kidney disease. And so, this idea of expanding services to support a patient’s total medication needs and not just those directly related to kidney failure is pretty exciting.

I imagine one of the reasons for doing that is really to help better manage all of the comorbidities that our patients often deal with as well.

Michelle Nguyen: It is indeed very exciting that we are finally here. So, talking about our ability to expand our services beyond our renal medications has been something that we as a company have explored over the last few years, and I’m excited to say that it is finally here.

Being able to offer our patients the option to fill most of their non-renal medications through FreseniusRx. We are one step closer to becoming a one-stop pharmacy for our patients.The convenience serves multiple purposes. First and foremost, keeping it simple for our patients, who already have a complicated life to manage. Comorbidities, dialysis, there’s a lot going on in our patients’ lives today. That’s one way for us to help keep things simple for our patients.

Having most medications filled in one pharmacy, we can provide our pharmacists and our clinical staff better visibility into our patients’ medication regimen.

Brad Puffer: That visibility you get by covering a larger spectrum of diseases and comorbidities by our patients must really also help with assisting medication adherence and ensuring this coordination of care is really efficient.

Michelle Nguyen: The visibility we have with our expanded services allows us to see not only the renal medication that the patients are taking, but also everything that the patients are taking, or if not, most of what the patients are taking. Which helps us to manage our patients’ diseases through promoting medication adherence. As I mentioned, multiple comorbidities mean multiple prescribers and many medications our patients have to take on a daily basis. Patients with high pill burdens have a hard time with medication adherence.

Having the visibility to their complete profile, medication profile, a pharmacist team can identify opportunities to work closely with the providers to find ways that make it easier for our patients to adhere to their medication, which then in turn improves the outcomes for our patients.

Brad Puffer: That’s great, and I’m sure that the management of contra-indications is important. It seems like you’re just creating a really great opportunity to better manage patients and coordinate care, hopefully to improve their outcomes.

Michelle Nguyen: Absolutely, Brad. So, now our team and our pharmacists have better visibility to our patients’ regimen, which will help provide more comprehensive care.

Brad Puffer: So, under this new approach, how will FreseniusRx then work with the care team physicians and other providers? Does anything change? How does it all come together?

Michelle Nguyen: So now that we have a more comprehensive service to offer for our patients, how we collaborate with our care team doesn’t change. It can only get better from here, so we will continue to leverage the process that we already have established and especially technology. So Chairside, which allows our patients to refill their medication at their dialysis chair, leveraging our applications such as Care Team Hub and Patient Track to coordinate care when it comes to medication management for our patients.

This process took us years to build and it’s working, so we can only go up from here.

Brad Puffer: And I assume that there must be other opportunities in the future from a technology perspective to help – you mentioned the Hub. That’s been a huge help to patients over the last several years that we’ve rolled out. Are there some other connected health applications like that that will make a difference for patients?

Michelle Nguyen: Expanding technology capabilities is an ongoing goal for us. How do we leverage technology so we can work smarter and not harder?

A couple of the enhancements that we have in place today is that for our patients we offer text messaging, which is another channel of communication. We are currently exploring to see how FreseniusRx can be more accessible through the PatientHub, to empower our patients to play an active role in their own care plan. For our providers, we currently accept electronic prescriptions today, in addition to – the providers can call or fax the prescription to us. We are looking into how to make FreseniusRx services more accessible through our provider Hub. This will help streamline the communications with our nephrologists. As for our clinical team, we’ve accomplished great milestones in making FreseniusRx more accessible through our Care Team Hub. This coming September, we will enable our care team to order refills directly through the Hub. And, you know, in addition to expanding FreseniusRx beyond our Fresenius Kidney Care world, we are actively exploring digital platforms that will help us best reach patients and providers outside of FKC (Fresenius Kidney Care).

Brad Puffer: So, Michelle, it sounds like all this great integration, expanding to full chronic kidney disease management, helping more patients with more medications, is this just the beginning of a broader expansion of what FreseniusRx can do, perhaps even helping patients outside of Fresenius Kidney Care?

Michelle Nguyen: Our goal is to fine tune our care services that we provide to our current patient population today, and then expand our footprint beyond that. To support that vision of ours, we are exploring digital platforms that will help reach our patient and provider population better.

Brad Puffer: Michelle, everything you’re describing, and the impact you’re going to have on more patients and all their medication needs, it’s really exciting, and it’s certainly something the company is focused on.

It’s been a lot of fun learning about what FreseniusRx has to offer, this really exciting expansion, and I just want to thank you for joining us today. I learned a lot.

Michelle Nguyen: Thank you, Brad. It’s great to be here.

Brad Puffer: And to your audience, thank you for joining us. If you’re new to the Field Notes podcast, you can download past episodes on the Apple Store or Google Play, or right here at FMCNA.com. While you’re there, please subscribe to receive the very latest updates as they happen.

Until next time, I’m Brad Puffer and you’ve been listening to Field Notes by Fresenius Medical Care North America. Take care, everyone.