Medical care changes coming to Fort Knox at the start of 2020 have also necessitated changes to how Binter Street Pharmacy operates.

Set to open in January, the newly constructed Ireland Army Health Clinic's pharmacy, with its much smaller footprint, will focus solely on servicing active duty Soldiers and their Families.

"We're going from nine windows to four windows," said Capt. Travis Weaver, chief of Pharmacy at the Fort Knox Medical Department Activity. "As well, our waiting room space is smaller and shared with Lab and Radiology, so we all have one waiting room versus one dedicated waiting room to pharmacy."

The anticipated opening of the new clinic has prompted he and clinic leaders to reconfigure Binter Street Pharmacy as the dedicated facility for retirees and their families, while the new clinic pharmacy will focus on fills and refills for service members and their Families during the normal workweek. Binter Street will be the only pharmacy open on Saturdays.

"That new work area is what led us to have to move so much of our workload over to Binter, because we're going into a smaller space," said Weaver. "It's been a considerable shift."

Previously, the clinic pharmacy at the legacy building was the main location for medications, with 60% of Fort Knox prescriptions being filled there and 40% filled at Binter Street. All that changed roughly a year ago when pharmacists began downsizing the workload at the clinic in anticipation for the move. Now, about 20% of prescriptions are filled at the clinic with 80% or more filled at Binter Street.

The new focus for Binter has also affected pharmacy staff, according to Col. Amy Roy, deputy commander for nursing services at Ireland Army Health Clinic.

"It puts a strain on the pharmacy staff when you have to change the workload from here at the clinic over to Binter Street because you move them there," said Roy.

Adding to the strain is an adjusted focus on personnel at pharmacies across the Army. Roy noted that they will lose all their military personnel in the pharmacies, leaving only federal civilian employees to fill and refill prescriptions.

Roy acknowledged that the changes have put a strain on retirees and their families as well; patients who have already had to adjust to the network system.

"For the patients who got referred out to the network, the retirees, it is extremely stressful on them because it's a completely new health care system," said Roy. "That's not what they're used to."

Prescription processes have had to change as a result of retirees and their families being moved to the network. Weaver explained how previously, patients would be seen in the clinic, their prescriptions typed electronically into the internal network, and then filled quickly with few issues.

"When you're seen in the network, everything has to be either handwritten, faxed or sent on an electronic prescription, which is essentially a handwritten prescription sent electronically," said Weaver. "Doctors can write for anything they want, so a lot of times it doesn't match up to what TRICARE covers or what we have in stock.

Weaver said mistakes are more frequent with a system reliant on faxes and handwritten prescriptions, which delays the process of filling a prescription even further. That extra effort has doubled the processing time it takes to get the roughly 600 patients they see and 1,200 prescriptions they fill each day.

"There's a lot of room for error that we have to call providers on, and make changes, and get clarification," said Weaver; "a lot of phone calls are made."

As a result, Weaver and Roy are working on ways to alleviate some of the stress on patients.

One way to accomplish this is for patients to look up suggested prescriptions on the TRICARE Formulary Search Tool to ensure they are covered. The site can be found at the link listed below.

"You can look up any drug and see if it's covered by TRICARE, and it also tells you if there's a copay associated with it if you were to go like a Walmart or Walgreens or CVS; or if there's a copay associated with a mail order," said Weaver.

He explained that many network beneficiaries rely on Binter Street for their medications because of copay charges.

"Copays are the driving force, especially since unfortunately they are increasing," said Weaver. "People drive from other states; people make three-hour drives just for their pharmacy service."

Another idea they have implemented is a drop-off window, what Weaver calls an express line, where patients can drop off a form that alerts pharmacists to allergies and what medications they need.

"They can just take that straight to the window, leave, and come back later to pick up their medication," said Weaver. "That is something we're really trying to get folks to realize. Say you drove three hours; you can come on post, stop at the pharmacy, do the drop-off, go to the commissary, and then come back later to pick up your meds and you're not stuck in the waiting room.

Another way to help patients is the text-messaging system they just installed this week.

"It will do two things," said Weaver. "It'll text message patients whenever their refill prescriptions are ready for pickup, and it'll also text message them, if they opt in and do the drop-off, when their medications are in and ready for pickup."

Weaver said pharmacists are currently announcing to patients that it will take about three hours to get prescriptions filled. Utilizing the text-messaging system, patients can find out exactly when their medications are ready.

The last suggestion that Roy and Weaver offered that will help to alleviate stress for patients is something patients can do for themselves -- plan to arrive during slower times. Weaver recommends visiting Binter Street after 10 a.m. on Mondays or between 2 and 6 p.m. Tuesdays-Fridays. With only 45 seats authorized per fire code in the waiting room, patients adjusting the times that they drop off and pick up medications takes a tremendous strain off the staff.

"I get it. During your day you want to just go and get it over with, so you figure your morning time is the best time, and it really honestly isn't," said Roy. "At least not at Binter Street."