The shift toward centralized pharmacy fulfillment is accelerating — and for health systems willing to invest, the returns are substantial. At a featured session during Becker’s Spring Chief Pharmacy Officer Summit, three pharmacy executives who have built and scaled central fill operations shared what they’ve learned, what they’d do differently and what others should know before they break ground.
The session was moderated by Annalise Barnette, PhD, Marketing Manager of Pharmacy Automation at BD. Panelists included:
- Ryan Mezinger, Senior Vice President and Chief Pharmacy Officer at MetroHealth (Cleveland)
- Joshua Weber, PharmD, Senior Director of Ambulatory, Retail and Specialty Pharmacy Services at St. Luke’s Health System (Boise, Idaho)
- Nilesh Desai, Chief Pharmacy Officer at University of Miami Health System
Here are four key takeaways from the session.
Note: Quotes have been edited lightly for length and clarity.
1. Frame central fill as a strategic revenue engine, not an operational upgrade
All three panelists emphasized that the business case for central fill only lands when it’s framed beyond cost savings.
“You don’t want to build a central fill facility just to automate,” Dr. Weber said. “You want to build it because you want to own the entire prescription journey for the patients in your health system.”
Dr. Weber offered a starting point for building that case: each 1% improvement in prescription capture rate translates to roughly $6.5 million in additional gross margin opportunity, with payback periods typically running five to fifteen months and a three-year ROI of four to 20 times the initial investment — heavily dependent on 340B mix, labor savings and starting capture rate.
2. Engineering Central Fill with scalability in mind
A consistent theme across all three organizations — the leaders who built for where they wanted to be, not where they were, were glad they did. Mr. Mezinger offered a vivid illustration of why planning for scale matters. When his team designed their central fill facility, they built for a capacity of 12,000 scripts per 10-hour shift, a figure that initially drew skepticism.
Two and a half years later, they’ve grown from 1,000 to 4,000 scripts per shift and are already adding robots. “Once you build this, it grows much faster than you anticipate,” he said.
Mr. Desai echoed the point on space specifically. “Ask for adequate space, because there is never enough space in pharmacy, and I can assure you you’re going to need more space,” he said.
Dr. Weber added that the facility layout, conveyance system and IT infrastructure should all be designed with expansion points built in — and that servers should be located on-site when possible, rather than in a virtualized data center, given the low-latency requirements of automation systems.
3. Refill retention is where the financial performance compounds
The panelists were clear: capturing the first fill is table stakes. The real financial leverage is in keeping the refill.
Mr. Mezinger grew MetroHealth’s refill retention rate from 30% to 83% by redesigning the patient outreach workflow. Automated messages go out seven days before a refill is due, and call center staff are scripted to offer a specific pick-up time rather than ask an open-ended question.
“If you’re waiting for the patient to contact for refills, it’s too late,” he said — a philosophy that has helped MetroHealth grow from 2.3 million scripts filled last year to a projected 2.8 million this year.
Dr. Weber recommended targeting 90-day fills, auto-refill enrollment for at least 20% of active scripts and syncing multiple medications into a single package to reduce shipping costs and improve adherence.
4. A few operational details can make or break the program
The panelists shared several watch-outs that separate smooth launches from costly ones. Going paperless from day one was Mr. Mezinger’s top recommendation: “If you’re doing paper, it’s going to be a bottleneck.”
Dr. Weber urged involving IT as early as the RFP stage, noting that the integration layer extends well beyond the EHR into shipping, manifesting and adjudication systems.
Mr. Desai emphasized the importance of holding vendors accountable for end-to-end automation — not a partial solution. “Make sure you partner with them to say this is a complete autonomous workflow that you want,” he said. “It is doable. It’s just that you have to put your minds together.”
To learn more about BD’s centralized filling pharmacy solutions, visit the BD Parata Central Fill website:https://parata.com/solutions/centralized-filling-pharmacy-solutions/
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