Section 29.1: Organizational Chart & FTE Modeling

29.1.1 The “Why”: An Org Chart is a Blueprint for Information Flow

As an experienced pharmacist, your world has been defined by clinical pathways, dispensing workflows, and patient interactions. The concept of an “organizational chart” may seem like abstract corporate bureaucracy—something for the MBA graduates, not the PharmDs. This is the first and most critical mindset shift you must make when moving into a leadership or startup role. An organizational chart is not a ‘who’s the boss’ diagram; it’s a workflow schematic. It is the blueprint for how information, work, and accountability flow through your pharmacy. A bad org chart creates information blockages, duplicates work, and diffuses responsibility. A good org chart creates speed, clarity, and scalability.

Think about your experience in different settings:

• Traditional Retail Pharmacy: The structure is typically flat and simple. You have a Pharmacy Manager, Staff Pharmacists, Technicians, and Clerks. The workflow is linear: Drop-off -> Data Entry -> Verification -> Dispensing -> Counseling. Accountability is centralized with the Pharmacy Manager. This model is built for high-volume, low-complexity transactions.
• Large Hospital Pharmacy: The structure is typically deep and siloed. You have a Director, Assistant Directors, Clinical Managers, Operations Managers, Clinical Specialists (for ED, ICU, Oncology, etc.), Central Pharmacy Staff, and Decentralized Floor Staff. The workflow is highly specialized, and it can be difficult for one department to see what another is doing. This model is built for high-acuity, high-complexity inpatient care.

A startup specialty pharmacy (SP) requires a hybrid of both. It must be flat and agile like a retail store to respond to patient and provider needs quickly. But it must also be deeply specialized like a hospital to manage complex disease states and billion-dollar medications. The org chart for an SP is not a simple hierarchy; it is a workflow-driven matrix. It is built around the patient’s journey, from the moment the referral arrives to the moment the medication is delivered and beyond.

In this section, we are not just drawing boxes. We are designing the “circulatory system” for your business. We will define the key “organs” (departments) that every SP must have to survive, and then we will apply your core pharmacy skill—dosing—to determine exactly how to staff them. This is how you move from being a pharmacist who participates in a workflow to a leader who designs it.

29.1.2 The Startup Specialty Pharmacy Org Chart: A Visual Deep Dive

Let’s build the blueprint. A successful startup SP is not built around individuals; it is built around functions. We will design the chart based on the four core functions required to process a specialty prescription. This structure creates clear hand-offs and specialized “centers of excellence.”

Below is a common, effective organizational structure. We are building “swim lanes” for the workflow. Work flows from left to right, from referral to delivery, with the clinical and leadership teams providing oversight.

This “functional” or “workflow-based” model is the industry standard for a reason. It creates specialization. Your PA specialists become masters of navigating payer portals. Your clinical pharmacists become experts in their disease states. Your intake team becomes incredibly fast at triaging referrals. You are creating “centers of excellence” from day one. In the next section, we will do a masterclass deep dive into the precise role of each of these four pillars.

29.1.3 Masterclass on the Four Pillars of the SP Org Chart

To build an FTE model, you must first understand the work being done. You cannot “dose” a staff member if you don’t know what their “target” is. Let’s dissect the precise functions, responsibilities, and key metrics for each of the four pillars. This is the granular detail that accreditation bodies like URAC and ACHC will audit.

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Pillar 1: The Intake Department (The “Front Door”)

Core Mandate: Triage, Triage, Triage. This department is the emergency room of your pharmacy. Their job is to receive all new referrals—via e-portal, fax, or phone—and perform an immediate triage. Their goal is to create a complete, accurate, and “ready-to-work” case for the Access department in the shortest possible time. Every minute spent in Intake is a minute added to your Time-to-Therapy (TTT).

Key Functions of Intake:

• Referral Receipt & Logging: All referrals are received and time-stamped in the pharmacy software. This starts the clock for all accreditation metrics.
• Referral Triage (The “Completeness Check”): This is the most critical function. The Intake Specialist acts like a triage nurse, asking:
  • Is this a specialty drug we can fill?
  • Is the patient and provider information complete?
  • Is there a valid, legible prescription?
  • Is the clinical information (diagnosis code, chart notes, labs) attached?
• Initial Data Entry: Accurately building the patient’s profile in the system (demographics, insurance, provider, drug). Your retail pharmacy data entry skills are directly transferable here, but the stakes are higher. A typo in a Group Number can mean a 2-day delay.
• Outreach for Missing Information: If a referral is incomplete (e.g., no diagnosis code), the Intake team is responsible for contacting the provider’s office immediately to get the missing data. They do not pass this “broken” referral to the next department.
• Initial “Soft” Benefit Check: A quick, preliminary check to see if the patient’s insurance is active and if the drug is on formulary. This is a “sniff test” before the deep dive done by the Access team.

Key Roles & Required Skills:

• Intake Specialist / Coordinator: Often a certified pharmacy technician (CPhT). This role requires exceptional attention to detail, a professional phone manner, and a sense of urgency. They are the “quarterbacks” of the new patient workflow.
• Data Entry Technician: Pure speed and accuracy. This role is often measured in “referrals processed per hour” and “data accuracy rate.”

Key Performance Indicators (KPIs) for Intake:

• Time-to-Triage: Time from referral receipt to when it’s triaged as “complete” or “incomplete.” (Goal: < 1-2 hours)
• Data Accuracy Rate: Percentage of profiles with zero demographic or insurance errors. (Goal: > 99%)
• Referral Completion Rate: Percentage of incomplete referrals that are “fixed” by Intake within 24 hours.

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Pillar 2: The Access Department (The “Financial Engineers”)

Core Mandate: Secure Coverage, Eliminate Financial Barriers. This is the department that defines specialty pharmacy. The drugs you handle cost $5,000, $15,000, or even $100,000+ per month. No one can afford this out-of-pocket. The Access team’s job is to be forensic accountants and legal navigators. They ensure that every single script is covered, authorized, and affordable to the patient before it ever gets near the Clinical or Dispensing teams.

This department’s work is split into three main functions: Benefit Verification (BV), Prior Authorization (PA), and Financial Assistance.

Function A: The Benefit Verification (BV) Masterclass

This is not the simple “REJECT – 01 – COVERAGE TERMINATED” you see in retail. A specialty BV is a deep, investigative phone call and portal search to understand the full picture of the patient’s liability. The specialist must determine:

• Is it a Pharmacy Benefit (Part D) or Medical Benefit (Part B/Major Medical)? This is the most important question.
  • Pharmacy Benefit: Processed via the pharmacy switch. Uses copays ($10, $50, $100).
  • Medical Benefit: Billed like a doctor’s visit. Uses deductibles and coinsurance (e.g., patient pays 20% of the drug’s cost).

The BV specialist must get a human on the phone at the payer and ask a specific script of questions: 1) What is the patient’s remaining deductible? 2) What is their out-of-pocket maximum? 3) What is their coinsurance percentage? 4) Is a PA required? 5) Are there step-therapy requirements? 6) Is this the payer’s preferred drug, or is there a non-preferred copay?

Function B: The Prior Authorization (PA) Tutorial

This is the core skill of the Access department. A PA is not “filling out a form.” It is building a clinical case to prove medical necessity. Your team is acting as the patient’s lawyer, using the provider’s chart notes as evidence.

A Step-by-Step Tutorial for Submitting a Winning PA:

1. Triage the PA: Is this a simple “New Start” PA, or is it a “Continuation of Therapy” PA? Or is it a “Non-Formulary Appeal”? Each has a different path.
2. Download the Payer’s Specific PA Form: Never use a generic form. Go to the payer’s portal (e.g., CoverMyMeds, Surescripts, or the payer’s own) and get the *exact* form for that drug and plan.
3. Analyze the Criteria (The “Rubric”): Read the form. It is a “test” that tells you the answers. It will say: “Patient must have tried and failed Humira OR have a contraindication.” This is your rubric.
4. Gather the Evidence: Call the provider’s office and say, “I am working on the PA for Mrs. Smith’s Skyrizi. The insurance requires chart notes showing she has tried and failed Humira. Can you please fax or e-portal me her last 6 months of notes, specifically mentioning the Humira failure?”
5. Build the Case: Fill out the form, checking all the boxes. Attach the chart notes, lab results, and any other evidence. Write a clear, concise Letter of Medical Necessity (LMN) that summarizes the case. (e.g., “Patient is a 45 y/o female with severe plaque psoriasis who failed a 6-month trial of Humira (see attached notes), resulting in continued 30% BSA involvement. Per plan criteria, we are requesting approval for Skyrizi.”).
6. Submit and Track: Submit via the fastest portal and set a calendar reminder. The law requires a response in a set time (e.g., 24-72 hours).
7. Handle the Denial (The Appeals Process): If it’s denied, you read the denial reason (“Patient has not tried Otezla”). You then initiate an appeal, which often involves a “Peer-to-Peer” review between the provider and the insurance company’s medical director. Your team facilitates and schedules this.

Function C: Financial Assistance Navigation

After the PA is approved, the patient may still have a $500 copay. The Access team’s final job is to make it $0.

• Manufacturer Copay Cards: The first-line tool. The specialist enrolls the patient in the manufacturer’s program to cover their copay (e.g., “Pay as little as $5”).
• Charitable Foundations (Grants): For Medicare patients (who cannot use copay cards) or high-coinsurance patients. The specialist monitors funds like the PAN Foundation, GoodDays, LLS, or HealthWell Foundation. When a fund opens, they immediately enroll their patients to secure a grant.
• Bridge Programs: For when the PA is delayed, and the patient needs the drug *now*. The specialist works with the manufacturer’s “hub” to get a 1-2 week free supply shipped from the manufacturer to “bridge” the patient.

Key Performance Indicators (KPIs) for Access:

• Time-to-PA Submission: Time from complete referral to PA submission. (Goal: < 24 hours)
• PA Approval Rate: Percentage of PAs approved on first submission. (Goal: > 90%)
• Average Patient Out-of-Pocket (OOP): The average copay for your patients. (Goal: < $25)

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Pillar 3: The Clinical Services Department (The “Therapeutic Hub”)

Core Mandate: Optimize Outcomes, Prove Value. This is the department where you, the CASP-certified pharmacist, live. Once a script is 100% “clean” (Intake = Complete, Access = PA Approved & Financially Cleared), the case is handed to the Clinical team. Your job is no longer “gatekeeping”; it is patient management. This department is what justifies your pharmacy’s existence to payers. You prove your value by keeping patients adherent, healthy, and out of the hospital.

Function A: The Clinical Pharmacist’s Role (Beyond Verification)

In an SP, the verification step is a deep, clinical review. It is the synthesis of all your clinical knowledge.

• Initial Clinical Assessment: This is a mandatory, accredited call for every new patient. You are not just “counseling.” You are performing a comprehensive assessment.
  Initial Assessment Script/Checklist:
  1. “Hello, this is [Name], one of the clinical pharmacists at ABC Specialty. I’m calling to review your new prescription for [Drug].”
  2. Confirm Identity & Diagnosis: “I see this is for your [Rheumatoid Arthritis]. Can you tell me what other medications you’ve tried for this?”
  3. Review Co-morbidities & Allergies: “To make sure this drug is safe, I need to review your other health conditions and all medications you take, including vitamins and supplements.”
  4. Review Baseline Labs (The “Super-DUR”): “Your doctor (e-prescriber) has ordered [Ocaliva], which requires liver monitoring. I am looking at your baseline LFTs from [Date] and they look appropriate to start. We will need to check these again in 1 month.”
  5. Identify Social/Financial Barriers: “This medication needs to be refrigerated. Do you have a safe, reliable place to store it? Do you have a sharps container for the injections?”
• Care Planning: You create a longitudinal “Care Plan” for the patient, which is a key accreditation document. It outlines the therapeutic goals, monitoring parameters (labs, side effects), and your schedule for follow-up calls.
• DUR & Interventions: This is the “super-DUR.” You are not just checking for a drug interaction. You are evaluating the entire clinical picture.
  Example: A patient is on Xeljanz (tofacitinib). You see a new e-script for fluconazole from a different doctor. Your retail system might flag this as a “moderate” interaction. Your CASP brain knows that fluconazole is a strong CYP3A4/2C19 inhibitor and can dangerously increase Xeljanz levels, leading to immunosuppression or toxicity. You stop the script, call the prescriber, and recommend a topical antifungal instead. This is a high-level, billable intervention.

Function B: The Adherence & Education Program

This is the other core function, often handled by Patient Care Coordinators (PCCs) or Adherence Nurses under your supervision. This team is responsible for all refill and follow-up contacts.

• Initial Counseling: The pharmacist *must* do the initial counseling (per board of pharmacy rules). This includes injection training (often done via video call or by a visiting nurse), side effect expectations, and storage requirements.
• Refill Adherence Calls: This is not just “Do you need your refill?” This is a structured assessment. “Hi Mrs. Smith, this is [Name], your Care Coordinator. I’m calling to schedule your next refill of Humira.
  • Since our last call, have you had any new side effects?
  • Have you had any flare-ups of your condition?
  • Have there been any changes to your other medications?
  • How many injections do you have left? (This confirms adherence).
• Proportion of Days Covered (PDC) Monitoring: This is the #1 metric payers care about. It is the percentage of days in a period that the patient “possessed” the medication. Your team’s job is to keep every patient’s PDC at > 85-90%.
  The formula is simple:

  $$ \text{PDC} = \frac{\text{Number of Days Covered by Fills}}{\text{Number of Days in Measurement Period}} \times 100 $$

Key Performance Indicators (KPIs) for Clinical:

• PDC Rate (by Payer/Drug): The ultimate measure of your success. (Goal: > 90%)
• Time-to-Therapy (TTT): Time from referral receipt to first dispense. (Goal: < 5-7 days)
• Clinical Intervention Rate: Number of pharmacist interventions documented per 100 scripts.
• Patient Satisfaction / Net Promoter Score (NPS): How happy are your patients?

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Pillar 4: The Dispensing & Operations Department (The “Logistics Engine”)

Core Mandate: 100% Accuracy, 100% of the Time. This department handles the physical “product.” This is not a retail dispensing operation. It is a high-stakes, temperature-controlled, anaudited logistics engine. The final “go” signal from this department is only given after they have confirmed all other pillars have completed their work. The pharmacist in this role is the final guardian of the entire process.

Function A: The Dispensing Workflow (The “Go for Launch”)

The dispensing pharmacist (often the Pharmacist-in-Charge, or PIC) does not just “verify” the script. They perform a final case review. Their queue is not just “prescriptions”; it’s “patients cleared for shipping.” Before they print a label, they check:

1. Intake Status: Complete.
2. Access Status: PA Approved. Financials Cleared.
3. Clinical Status: Initial Assessment Complete. Counseling Done. No outstanding clinical holds.

Only when all three are “green” do they proceed. The technician then picks the correct (and very expensive) drug, and the pharmacist performs the final accuracy check (right drug, right patient, right strength).

Function B: Cold Chain & Logistics Masterclass

This is a zero-failure-rate part of the job. 80% of specialty drugs are refrigerated or frozen.

• Validated Packaging: You cannot just “throw some ice packs” in a box. You must purchase and use thermally-validated shipping containers. These are boxes with specific, engineered foam and gel packs that have been tested to hold a 2-8°C temperature for 48+ hours.
• Seasonal Packing: You must have different packing protocols for summer and winter. In summer, you use more gel packs. In winter (especially in northern climates), you must use fewer gel packs and add “buffer” packs to prevent the drug from freezing, which is just as destructive as heat.
• Temperature Monitors: For ultra-sensitive or high-cost drugs, you will include a small, single-use temperature monitor in the package. The patient can check it upon arrival to confirm the cold chain was not broken.

Function C: Inventory Management (Just-in-Time)

You cannot stock a specialty pharmacy like a retail one. You cannot have 10 boxes of every drug “just in case.” Your inventory is your single biggest cash liability.

• Just-in-Time (JIT) Ordering: This is the rule. You do not order the $50,000 drug from your wholesaler (e.g., McKesson, Cencora) until after the Access team has confirmed the PA is approved and the Clinical team has scheduled the delivery with the patient. The drug arrives at your pharmacy on Monday and is shipped out to the patient on Monday. It never sits on your shelf.
• Drug Pedigree (DSCSA): The Drug Supply Chain Security Act requires you to track the “pedigree” (a history of its ownership) of every single drug package. This is a complex inventory and IT function managed by this department.

Key Performance Indicators (KPIs) for Dispensing:

• Dispensing Error Rate (Wrong Drug/Strength/Patient): (Goal: 0.00%)
• Cold Chain Excursion Rate: Percentage of shipments that arrive outside of temperature. (Goal: < 0.1%)
• On-Time Delivery Rate: Percentage of packages that arrive on the day promised to the patient. (Goal: > 99%)

29.1.4 FTE Modeling Masterclass: A Step-by-Step “Dosing” Tutorial

Now that we understand the work done by each pillar, we can finally answer the question: “How many people do I hire?” We will now build a comprehensive, bottom-up FTE model. This is your “dosing calculation.”

Step 1: Identify Your “Work Units” & Tasks

The “patient” in our dosing analogy is the workload. In an SP, the workload is driven by two main “work units”:

• New Patients (NPs): High-touch, high-workload. Requires work from all four departments.
• Refill Patients (RPs): Lower-touch, but high-volume. Requires work mainly from Clinical and Dispensing.

Every task we detailed in the “Four Pillars” section is a “task” that consumes time.

Step 2: Establish “Time-per-Task” Benchmarks (The “Time-Motion Study”)

This is the most critical part of your calculation. You must determine, on average, how many minutes each task takes. These are your “dosing parameters.” In a real startup, you would measure this with a stopwatch. For this masterclass, we will use industry-standard benchmarks.

Masterclass Table: Sample Time-Motion Benchmarks (in Minutes)

Work Unit	Task	Intake	Access (PA/Fin)	Clinical (RPh/PCC)	Dispensing (RPh/Tech)
New Patient (NP)	Referral Triage & Data Entry	30 min	–	–	–
	Benefit Verification (BV)	–	45 min	–	–
	Prior Auth (PA) – Simple	–	30 min	–	–
	Financial Assistance Enrollment	–	20 min	–	–
	RPh Initial Clinical Assessment & Counsel	–	–	45 min	–
Refill Patient (RP)	Refill Adherence & Assessment Call	–	–	12 min	–
	RPh Clinical Refill Review	–	–	5 min	–
	PA Re-authorization (Annual)	–	30 min	–	–
All Patients	Tech Pick, Pack, Ship	–	–	–	10 min
All Patients	RPh Final Dispense Check	–	–	–	5 min

Note: These are illustrative. A “Complex PA” (e.g., Oncology appeal) could take 180+ minutes.

Step 3: Define Your “Productivity Factor” (The “Bioavailability”)

You cannot assume a 1.0 FTE (Full-Time Equivalent) gives you 40 hours of productive work. This is the most common and fatal flaw in FTE modeling. This is your “bioavailability” calculation.

• 1.0 FTE = 2,080 hours/year (40 hours/week * 52 weeks)
• Subtract Non-Productive Time:
  • Paid Time Off (PTO): ~120 hours (3 weeks)
  • Holidays: ~64 hours (8 days)
  • Training & Meetings: ~80 hours (1.5 hours/week)
  • Breaks & Unscheduled Time: ~10% of remaining time

Step 4: Worked Example: “ABC Specialty Pharmacy”

Let’s calculate the “dose” of staff needed for a startup pharmacy.

The “Patient” (Projections):

• New Patients (NPs): 100 per month (1,200 per year)
• Refill Patients (RPs): 400 per month (4,800 per year)
• PA Re-authorizations: Assume 1,200 (one for every NP, one year later).

Calculation A: The Intake Department Workload

• Workload: Only NPs generate Intake work.
• Task: Triage & Data Entry (30 min/NP)
• Total Minutes/Year: 1,200 NPs/year * 30 min/NP = 36,000 minutes
• FTE “Dose” Needed: 36,000 min / 99,840 min/FTE = 0.36 FTEs
• Conclusion: You do not need a full-time Intake person yet. This work can be combined with another role. Or, you hire 1.0 FTE, knowing they will be at 36% capacity, and you give them other duties (e.g., helping with phone calls).

Calculation B: The Access Department Workload

• Task 1 (BV): 1,200 NPs/year * 45 min/NP = 54,000 minutes
• Task 2 (Simple PA): 1,200 NPs/year * 30 min/NP = 36,000 minutes
• Task 3 (Financial Asst.): 1,200 NPs/year * 20 min/NP = 24,000 minutes
• Task 4 (PA Re-auths): 1,200 RPs/year * 30 min/RP = 36,000 minutes
• Total Minutes/Year: 54,000 + 36,000 + 24,000 + 36,000 = 150,000 minutes
• FTE “Dose” Needed: 150,000 min / 99,840 min/FTE = 1.50 FTEs
• Conclusion: You need 1.5 PA/Access Specialists. You must hire 2.0 FTEs. You cannot hire half a person. This model shows you will have 2 staff members who will be at 75% capacity, which is a healthy, safe “dose” that allows for sick days and complex cases.

Calculation C: The Clinical Department Workload

• Task 1 (RPh NP Assessment): 1,200 NPs/year * 45 min/NP = 54,000 minutes (Pharmacist Work)
• Task 2 (PCC Refill Call): 4,800 RPs/year * 12 min/RP = 57,600 minutes (PCC/Tech Work)
• Task 3 (RPh Refill Review): 4,800 RPs/year * 5 min/RP = 24,000 minutes (Pharmacist Work)

Pharmacist FTEs:

• Total RPh Minutes: 54,000 (NP) + 24,000 (RP) = 78,000 minutes
• FTE “Dose” Needed: 78,000 min / 99,840 min/FTE = 0.78 FTEs

PCC/Tech FTEs:

• Total PCC Minutes: 57,600 minutes
• FTE “Dose” Needed: 57,600 min / 99,840 min/FTE = 0.58 FTEs

Conclusion: You need 1.0 RPh (who will also be the PIC) and 1.0 PCC. Both will have capacity to help with other tasks, which is perfect for a startup.

Calculation D: The Dispensing Department Workload

• Total Scripts/Year: 1,200 (NP) + 4,800 (RP) = 6,000 scripts
• Task 1 (Tech Pick/Pack): 6,000 scripts/year * 10 min/script = 60,000 minutes (Tech Work)
• Task 2 (RPh Final Check): 6,000 scripts/year * 5 min/script = 30,000 minutes (Pharmacist Work)

Pharmacist FTEs:

• FTE “Dose” Needed: 30,000 min / 99,840 min/FTE = 0.30 FTEs

Dispensing Tech FTEs:

• FTE “Dose” Needed: 60,000 min / 99,840 min/FTE = 0.60 FTEs

Step 5: Final Dosing Summary & Role Consolidation

Now we add up the “doses” by role type.

• Pharmacist FTEs Needed:
  • 0.78 (Clinical) + 0.30 (Dispensing) = 1.08 FTEs
  • Hiring Plan: 2.0 RPhs. One will be the PIC/Operations Manager, the other will be the Clinical Manager. This is a safe, compliant starting dose.
• Technician/Specialist FTEs Needed:
  • 0.36 (Intake) + 1.50 (Access) + 0.58 (PCC) + 0.60 (Dispensing Tech) = 3.04 FTEs
  • Hiring Plan: 3.0 or 4.0 Techs/Specialists. You would hire 4, and “cross-train” them. You’d have 2 dedicated Access Specialists, 1 dedicated Dispensing Tech, and 1 “hybrid” Intake/PCC. This is a robust, flexible team.

Step 6: The “Masterclass” Dose Adjustment: Disease State Complexity

Our model above is good. But it’s not great. It makes a fatal assumption: that a Psoriasis patient takes the same *work* as an Oncology patient. As a clinician, you know this is false. We must adjust our “dose” for the “co-morbidities” of the workload. We do this by creating a Weighted Workload Unit (WWU), or a “Complexity Factor.”

Masterclass Table: Sample Complexity Factors

Disease State	Complexity Factor (WWU)	Rationale (Why is it more work?)
Psoriasis, Rheumatoid Arthritis	1.0	Baseline. Standard PAs, standard counseling.
Hepatitis C	1.3	Requires extensive lab tracking (genotype, SVR), shorter duration of therapy.
Multiple Sclerosis	1.5	High-cost, complex PAs, high-touch adherence calls due to side effects.
Oncology (Oral)	2.0	Extremely complex PAs (cycle-based), constant lab monitoring (toxicity), frequent dose changes from provider, intense patient counseling.
Cystic Fibrosis, HAE	2.5	Ultra high-cost, 100% case management, deep coordination with care centers.

Step 7: Re-Dosing with Complexity Factors

Let’s re-run our “ABC Pharmacy” scenario. The 100 NPs/month are not all the same. The mix is:

• 50 NPs/month = RA/Psoriasis (Factor: 1.0)
• 50 NPs/month = Oncology (Factor: 2.0)

Your workload is not 100 NPs. Your Weighted Workload (WWU) is:
(50 NPs * 1.0) + (50 NPs * 2.0) = 50 + 100 = 150 Weighted Workload Units.

This complexity doesn’t really change the *Dispensing* or *Intake* work. But it dramatically changes the Access and Clinical work. Let’s re-calculate the FTEs for those departments using 150 WWUs instead of 100 NPs.

Re-Calculation: The Access Department (Adjusted Dose)

• Task 1 (BV): 1,200 (150/mo) WWUs * 45 min = 81,000 minutes
• Task 2 (Simple PA): 600 (50/mo) WWUs * 30 min = 18,000 minutes
• Task 3 (Complex PA): 600 (50/mo) WWUs * 120 min = 72,000 minutes (We adjust this task time for Oncology)
• Task 4 (Financial Asst.): 1,200 (150/mo) WWUs * 20 min = 24,000 minutes
• Task 5 (PA Re-auths): 1,200 (150/mo) WWUs * 45 min = 54,000 minutes (Onc re-auths are harder)
• Total Minutes/Year: 81k + 18k + 72k + 24k + 54k = 249,000 minutes
• Original Model Dose: 1.50 FTEs
• Adjusted Dose Needed: 249,000 min / 99,840 min/FTE = 2.50 FTEs
• Conclusion: By factoring in complexity, you now need 3.0 FTEs in your Access team, not 2.0. Hiring 2.0 would lead to immediate burnout and toxicity.

Step 8: The Final Check – Service Levels & Ratios

Your FTE model is your “calculated dose.” But, just as with a drug, you must check it against “black box warnings.” In SP, these warnings are your accreditation standards and payer contracts.

Your model might say you only need 1.08 Clinical RPhs. But…

• Accreditation (URAC/ACHC): May have “soft” rules about pharmacist-to-patient ratios, and hard rules about pharmacist availability. They *will* audit your phone records to see if a patient could reach a pharmacist 24/7. This may force you to hire 2.0 FTEs just to cover business hours and on-call, regardless of what your minute-by-minute model says.
• Payer Contracts (SLAs): A payer may put a Service Level Agreement (SLA) in your contract that says: “All PA submissions must be attempted within 24 hours of referral.” Your model for 2.5 FTEs might be too lean to guarantee this. You may need to “dose higher” (hire 3.0 FTEs) to ensure you always meet this contractual, financial, and compliance-driven “therapeutic goal.”