Pharmacy Edge

Pharmacy Edge Magazin

Issue

Sixteen

e

October/2017

Gold

Sponsor

Blair Thielemier PharmD

10 Breakthroughs from Pharmacy’s First Virtual Conference

Jimmy Neil Preserving the Future of Independent Pharmacy Eight Tips to Improve Productivity in the Community Pharmacy

Pharmacy Edge 2017

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Pharmacy Edge 2017

Contents - October 2017

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24

12 04

A message from Founder

22

Feds Unravel Multimillion Dollar Health Care Fraud Scheme Targeting New Jersey State

07

A message from our President

08

10 Breakthroughs from Pharmacy’s First Virtual Conference

24

Preserving the Future of Independent Pharmacy

12

Jimmy Neil

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16

How Medicare Fraud Schemes Are Perpetrated by Pharmacies

Eight Tips to Improve Productivity in the Community Pharmacy

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ThoughtSpot 2017

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The Other 80/20 Rule

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Pharmacy Edge 2017

Joshua Pirestani

A message from Founder The month of July was an exciting time for the field of Pharmacy. It was the month when Good Neighbor Pharmacy’s Thoughtspot held their annual tradeshow and conference in Las Vegas, NV. With much thanks going out to Lauren Moyer from AmerisourceBergen Director of External Communications for making arrangements for us to cover ThoughtSpot 2017 for our Pharmacy Edge readers and APPA members. I would also like to give a special thanks to Courtney Dysart with Tierney Agency for her assistance during the show.

Brandon Welch, APPA President and I had the opportunity to attend this year’s ThoughtSpot in Las Vegas, Nevada on July 21st & 22nd. One of the highlights for myself was attending the Advocacy in Action events.

Representative Doug Collins, 9th District of Georgia and NCPA CEO Doug Hoey, RPh, MBA were joined by AmerisourceBergen panelists to discuss current issues regarding independent pharmacy and what we can do to advocate policy change in issues like Provider Status and DIR transparency. We also heard from pharmacist Danny Cross, the owner of Southwest Pharmacy and Advanced Medication and also the Chairman of the New Mexico Pharmacy Business Council. He shared his experience with a successful advocacy initiative he had in New Mexico and Texas. ThoughtSpot 2017 provided a great forum to network and provide exclusive deals on product purchases.

In closing, I would like to say thank you to all of our members, corporate members and sponsors for supporting the American Pharmacy Purchasing Alliance. Thank you and please take a moment to view our new corporate members below who have joined APPA within the last 90 days.

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Gold Sponsor Republic Pharmaceuticals www.republicpharma.com New Corporate Members Repeat Rewards www.repeatrewards.com Advocate www.advocatemeters.com EzriRx www.ezrirx.com Sterre Health www.sterrehealth.com Numed Pharma www.numedpharma.com Shepard Medical Products www.shepard-medical.com Winslow Profiles & Reports www.winslowreport.com The American Journal of Pharmacy Benefits www.ajpb.com Endeavor Search endeavorsearch.com See more www.joinappa.com/sponsors

Sincerely, Joshua Pirestani | Founding Member American Pharmacy Purchasing Alliance

Pharmacy Edge 2017

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Pharmacy Edge 2017

Suzette DiMascio, CHE, CMCE, CPC, President & CEO of CSI Specialty Group, Rebecca Shanahan, JD, President of NASP and Sheila Arquette, RPh, Executive Director of NASP, invite you to the

Networking Luncheon Tuesday, September 19 11:45 am - 1:15 pm • Network with industry thought-leaders.

• Develop relationships amoungst your peers • Discuss tactics to navigate the workplace by sharing experiences and best practices.

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Visit WSPRX.net to Reserve Your Seat

Pharmacy Edge 2017

Brandon Welch

A message from our President As the new President of APPA, I am humbled and honored to have the opportunity to build on a phenomenal foundation we have here at the American Pharmacy Purchasing Alliance.

We have built up a strong alliance over the years and my vision is to continue to push it forward. Not only has our membership grown exponentially since our initiation in 2014, but we have also expanded our relationships with key stakeholders in the pharmaceutical industry. This has all resulted into a stronger presence in our industry and more value to our members.

First off, we want to truly thank AmerisourceBergen and their welcoming staff for inviting us to attend “ThoughtSpot 2017”. ThoughtSpot, is an annual conference and trade show by Good Neighbor Pharmacy that offers independent community pharmacies practical and clinical education to help you diversify your revenue streams and optimize your core business.

ThoughtSpot turned out to be another opening success with great pharmacy advocacy meetings and clinical education forums. I was delighted to be able to take this information and share this with you all. I hold myself accountable for keeping this organization abreast of the new changes and challenges we face in our industry, so we know how to successfully position ourselves and become adaptable. We must keep up the great fight and continue to show our value in the market place of healthcare. Let’s continue to emerge in the healthcare ecosystem.

I believe we are at a critical juncture to advance our services by recruiting more diverse audiences. Our world’s changing demographics, demand for greater flexibility, and advancing technology are factors that play a key role

in today’s Industry. Our members need us now more than ever. Our values are built on advocacy, education, networking, purchasing solutions, and being able to adapt to the ever changing needs of our members.

2016 year was an exciting time for APPA as we continued to build on work that began in the previous year. We finally completed the development of our strategic plan. This will help guide the alliance over the next five years.

The plan includes specific action items that will support the achievement of our strategic priorities. Our three strategic plans include the following: »» Operational Practices for the Alliance: APPA is committed to the principles and practices of sustainability in its management and operational strategies. The Alliance listens to and consults with its members to be sure that actions are in line with the needs of its members. This way, we could simultaneously work on advancing the organization toward a shared vision in changing times. »» Professional development: APPA offers timely professional development opportunities for continuing education and learning through webinars, meetings, seminars and industry partners. It also fosters the development of leadership within the student pharmacist community. »» Partnerships: APPA engages with educational partners who provide learning opportunities for APPA.

In the 2017 - 2018 year, our work as an association will focus on the following five priorities that support strategic directions: »» Advocacy – finding ways to inform and educate policy and de-

»»

»» »»

»»

cision makers on the importance of provider status to better serve the pharmacy community Communities of Practice – supporting and expanding our communities of practice to serve the many constituents working in the field of continuing education Benchmarking – collecting and disseminating meaningful data to our members Conference Model – re-imagining the conference model to leverage expertise and build capacity through our strategic partnerships.

Relationship building – Expand our network to provide more services and discounts for our members

These accomplishments could not have been possible without the continued service of our valued members, leadership team, advisory board, and sponsors. I would like to give them all a heartfelt thank you for all of their hard-working efforts in striving to make this organization the best it can be.

I also want to give a special thanks to our Gold Sponsor, Republic Pharmaceuticals for the immense amount of support you have given APPA. We have received nothing but great compliments on the services you offer.

Republic Pharmaceuticals is a wholesale distributer of generic pharmaceuticals and medical supplies to pharmacies, hospitals, and physician’s offices throughout the United States.

Our collective work is an important part of the social fabric of our great nation. This is an exciting time to be part of the field of pharmacy, and I look forward to another prosperous year for APPA!

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Pharmacy Edge 2017

10 Breakthroughs from Pharmacy’s First Virtual Conference There’s a shift occurring in the world of pharmacy as the profession is the in process of a rebranding. New ideas are spawning innovations in revenue streams such as preventative and nutritional coaching services.

This rebranding is being lead by a grassroots movement of pharmacy owners seeking to change their patient’s perception of medication use. For years, these ideas have been shared in in-person organization-sponsored pharmacy conferences, but for the first time ever they are available in a brand new way.

The platform is the internet and the Elevate Pharmacy Virtual Summit is the first-ever completely virtual pharmacy conference experience.

In April 2017, over 1,200 pharmacists from across the globe registered and participated in the ElevatePharmacySummit.com As the founder and host, I was able to craft in-depth interviews with innovate pharmacists and experts to share ideas about how you can “Elevate Your Practice of Pharmacy”. I was able to interview pharmacy leaders and innovative entrepreneurs to discuss how they’ve launched and grown successful pharmacy businesses.

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I asked them the questions that you wish you could ask the speakers at the national meetings!

And the deeper I dug, the more insight we were able to uncover for other pharmacist-entrepreneurs.

For me, there were so many “ahha” moments, but there were a few that still stick out in my mind as the key ideas that came from the 2017 Elevate Pharmacy Virtual Summit.

Here are the Top 10 breakthroughs from my own Summit Experience:

As the founder and host, I was able to craft in-depth interviews with innovate pharmacists and experts to share ideas about how you can “Elevate Your Practice of Pharmacy”

1. Less than 5% of pharmacies are utilizing email newsletter as a marketing tool vs. 40% of businesses in other industries.

Think about how many newsletter you are on. Ever wonder why when you buy a new piece of clothing they ask for your email address?

Its because you are worth more as a customer if they can communicate with you via email. Email is cheaper than traditional marketing methods. And because of the ease of purchasing goods online, it is one of the most effective methods of marketing.

A very small number of pharmacies are taking advantage of this effective and very cheap marketing method.

2. Physicians are actively searching for partners.

As expectations change in the healthcare industry, physicians are looking for pharmacists and pharmacies to help them achieve their patient care goals. Payment is being based on performance and therefore, profit is increasingly linked to patient outcomes.

Pharmacy Edge 2017

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Pharmacy Edge 2017

Pharmacists can offer high quality services that focus on physician quality benchmarks, once they understand MACRA and MIPS. 3. Successful entrepreneurs are hiring professional business coaching and help.

The most successful pharmacy owners and consultants are NOT doing it alone. They invest in themselves, their businesses and in hiring professional business coaches.

One of the biggest surprises that came out of the Summit for me was the number of business owners, myself included, who retained business coaches.

4. There are huge opportunities in nutritional consulting and integrative medicine.

As more and more people are looking to prevent chronic disease and 10

find a way to slow the aging process, there is a huge opportunity for integrative medicine. The gap comes in the number of pharmacists and healthcare providers skilled in providing these services. New CLIA-waived lab tests that can be administered by a pharmacist will go a long way in helping move these consulting services forward.

5. Successful entrepreneurs focus on self development and building their “soft skills”.

The big, gaping hole in my own pharmacy education was DEFINITELY in knowing how to build and run a business. Not even to mention the hiring and management knowledge gap.

Pharmacy owners who are successful quickly learn to invest in their own personal development. Many times as a pharmapreneur, your brand IS you.

This is called personal branding and it is very hard to brand yourself as a

successful business if you haven’t gotten your personal development in check.

6. The riches are in the niches.

Don’t try to be everything to everybody.

The most success pharmacy owners that I interviewed on the Elevate Pharmacy Summit understood that they had certain strengths. They started with ONE THING and perfected it. Then, they were able to build in new programs after creating a strong foundation.

One example that comes to mind is in health coaching. One pharmacist I interviewed started with HRT and thyroid consultations.

She was able to really focus on that program and build on the success of those initial patients.

Pharmacy Edge 2017

7. Waiting for permission is a waste of time…

If you are waiting for your state association to provide you a framework for exactly how to do something, you WILL be too late.

Innovate entrepreneurs understand that plans change and you can always adapt, but you can’t wait until you have everything figured out.

My mantra is, “once you begin taking action, your path becomes clear”.

8. Following your curiosity is the best way to find your passion.

I’ve tried many different ‘hobbies’ on for size. I’ve been curious about everything from gardening and canning to online business and personal finance. The way that I came to my current business is from following my curiosity about MTM services. I learned as much as I could about MTM and started sharing that information. Soon, I unexpectedly became “the person to ask” about MTM services.

It was something that I didn’t expect, but something I am now deeply passionate about. Whether it is your pharmacy or a side hustle, if you haven’t found your passion, try a few ‘hobbies’ on for size and see where your curiosity will lead.

9. Continually educate yourself. Not just for CE, but again by following your curiosity and continuing a path of self-development.

This goes back to investing in yourself. There is a fine line to walk when deciding to pursue expensive pharmacy certifications versus just obtaining the required knowl-

edge. You really must think about return on investment. Luckily there are many, many free resources to have at your disposal. Blogs, podcasts, webinars, e-courses, virtual summits; there are so many options that will give you an idea of what opportunities to pursue.

10. Entrepreneurship takes guts and luckily rejection doesn’t kill.

Failing is inevitably comes with the territory for entrepreneurs. Fortunately the upside is that you realize how thick your skin can be! When I’m feeling fearful, I do a little exercise with myself that has been helpful to many of my clients as well.

I think about the thing I am fearful of, let’s use the example of pitching a collaborative program to a physician.

Now I visualize how completely wrong that meeting could go. I imagine the worst case scenario in which the physician is completely uninterested and cuts the meeting short because they do not understand the value in pharmacy services. Then, I visualize myself driving home to my family and putting the meeting behind me.

I know it isn’t easy to put yourself out there, nor is it easy to agree to be interviewed on video, so I want to especially thank all of the pharmacy leaders who agreed to participate in this year’s Summit.

I continue to be inspired by the speakers on the Elevate Pharmacy Summit and their commitment to elevating the profession of pharmacy.

If you are interested in registering for the 2017 Elevate Pharmacy Virtual Summit Encore, go to ElevatePharmacySummit.com to enter your best email address.

The Summit will be live again September 15-19th, 2017 for those registered, just watch your email for instructions on how to join and participate.

See you on the Summit Encore!

After doing this exercise for your situation, ask yourself, “Was that really so bad?”

ABOUT THE AUTHOR: Blair Green Thielemier, PharmD is an independent consultant pharmacist living in Arkansas with her husband and daughter. She is the founder of Pharmapreneur Academy, an online teaching platform where she guides pharmacist-entrepreneurs through the process and barriers of building a pharmacy consulting business. She is the author of How to Build a Pharmacy Consulting Business and host of the ElevatePharmacySummit.com . More information about Dr. Thielemier can be found on her website BTPharmacyConsulting.com

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Pharmacy Edge 2017

Jimmy Neil 1. What was your journey like to get where you are?

When I was fifteen, my family moved from Dallas, Texas to Haughton, Louisiana and built a mobile home park. I learned a great deal about work ethic for the next few years from my dad, and that I wanted an education.

After business school I moved to Atlanta and worked for the US Small Business Administration as a Commercial Loan Officer lending working capital to businesses impacted by disasters. Four years later, I moved into a finance role with a top 3 Drug Distributor. A year later, I took on a sales leadership role in Hospital sales. My responsibilities grew to managing a team of Retail Independent sales consultants, and I soon realized that independent pharmacies needed help with Exit Strategies. In 2008, I started a Pharmacy Transition team for the drug distributor and soon grew it to 5 people. In 2009, in the midst of the banking crisis, I created a partnership with a start up bank that was focused on Veterinary and Dental lending. Live Oak Bank funded their first pharmacy loan in 2010 after meeting with them at NCPA in the fall of 2009. I joined the bank in 2014 as head of pharmacy lending.

2.How do you see the company changing in two years, and how do you see yourself creating that change?

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Live Oak Bank continues to evolve with broader products and services. We recently launched Equipment Leasing with no money down equipment financing and $1 buy outs, and a complete business banking package is being launched very soon. We are expanding beyond a pharmacy acquisition financing bank only.

3. Can you share a time when you have had to expand a core product or service set through innovation?

Because we understand the pharmacy industry so well, we’ve been able to put together longer leasing terms with some automated packaging equipment. We realize that the typical life cycle of this automation is more than 5 years.

4. How do you see the landscape of the independent pharmacy changing in the next few years with all the consolidation happening?

Community pharmacy needs to combat PBM’s. I’m part of a think tank with industry leaders, and our focus is to educate community pharmacy on a changing payment model. This model will evolve over time, and it’s critical that community pharmacy helps define it. It’s much more than auto refilling cholesterol and hypertension medications. I really like the investment that NCPA is making to help define the new payment model.

5. With several consolidations occurring industry wide, how are you helping your customers to compete

in today’s marketplace?

We’ve made more than nine hundred loans in 8 years, and with several hundred loans still in our portfolio, we have the ability to share best practices among all of them.

We have a team of 6 Relationship Managers that focus on only our Pharmacy portfolio, and they lead our customers to organizations and professionals who can mitigate risks and drive more profits.

6. With the many changes occurring in the industry how do you think it will impact Medicare and Medicaid reimbursements for your customers?

If the past is indicative of the future, we’ll have to continue to innovate as chances are that reimbursements won’t increase.

7. Explain what LiveOak Bank does.

We finance pharmacy acquisitions, commercial real estate, provide working capital, refinance notes, lease automation and equipment, finance expansions and start ups.

However, it doesn’t stop at funding. We stay engaged with Relationship Managers dedicated to your continued success. Soon, you will be able to use Live Oak Bank for all your business banking needs, online and secure, and completely integrating all your accounts.

8. If some of our readers are interested in financing through LiveOak Bank, how should they reach out? Call me directly at 910-212-4951. I’ll put them in touch with one of our 5 Loan Officers, and we’ll work diligently to determine if we can help. www. liveoakbank.com/pharmacy is another easy way to reach out to us.

Pharmacy Edge 2017

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Pharmacy Edge 2017

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Pharmacy Edge 2017

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Pharmacy Edge 2017

How Medicare Fraud Schemes Are Perpetrated

by Pharmacies

down anyone engaged in fraud.

Medicare also provided information and procedures in reporting fraud, outlining the details required to file a report, such as dates and receipts, and which numbers to call. Customers, patients, and employees are urged to report against fraudulent activities if they suspect or when they have been a victim of it.

Fraudulent activities in every sector of health care are nothing new.

In fact, Medicare and Medicaid fraud alone costs taxpayers an estimated billions of dollars annually, according to the Centers for Medicare and Medicaid Services (CMS). No one really knows the actual amount of money lost to fraudulent activities. But that’s not

The Hows of Pharmacy Medicare Fraud Among the many fraudulent activities in the healthcare sector, abuse of pharmacy benefits is the most prevalent. In fact, many pharmacy owners and employees have been arrested for their participation in the pharmacy Medicare fraud schemes. The largest a takedown happened in 36 Federal Districts, including New York where a phar-

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the point. The real problem is cracking down on acts of fraud, which is often difficult considering that both the patients and healthcare organizations contribute to the problem one way or another.

Problems have become so widespread that there’s now a Medicare Fraud Strike Force tasked to hunt and take

Pharmacy Edge 2017

Auto-refilling pharmacy fraud is one of the reasons that a pharmacist in Janesville, Wisconsin was arrested.

macist was accused of defrauding Medicare and Medicaid by more than $50 million. But how do pharmacists get away with it?

Different Pharmacy Medicare Fraud Schemes Auto-Refilling Pharmacy Fraud This happens when a prescription is automatically filled, even when a patient did not request a refill. Without the patient’s knowledge, the pharmacy will then bill Medicare for the prescriptions that patients never picked up. They do the same with Federal Employees Health Benefits Program (FEHBP), Medicaid, and TRICARE. Because the prescriptions are still in store, they can rinse and repeat and get away with it.

Auto-refilling pharmacy fraud is one of the reasons that a pharmacist in Janesville, Wisconsin

was arrested. He was charged with creating false prescription orders and submitting them for reimbursement, which resulted in Medicare and Medicaid paying him approximately $1 million. The fraudulent activity started between January 2008 and March 2014 and only got caught when the Wisconsin Department of Health Services conducted an audit.

Kickbacks and bribes Violations of the anti-kickback statute are among the alleged crimes that conspirators do to commit health care fraud. But, even when it is illegal, some pharmacies still give patients gift cards or other incentives to transfer their government-paid prescriptions, making it easier for them to use the prescription for fraudulent activities.

Large pharmaceutical companies, on the other hand, bribe pharmacies and pharmacists to switch patients’ medication to a particular drug manufactured by the pharmaceutical company.

One such case happened in California where a physician and pharmacist were charged for allegedly accepting bribes and kickbacks to prescribe expensive pain creams and equipment.

The prescriptions were medically unnecessary and may have been part of the $27-million false claims.

Drug switching fraud As the name suggests, this type of pharmacy Medicare fraud involves filling a patient’s prescription with a medication that is different from what a doctor prescribed. Switching a patient’s FEHBP, Medicare, Medicaid, or TRICARE prescription for tablet meds to capsule, or vice versa, is considered wrongfully taking money from the government.

But many pharmacies commit this fraudulent act to make more money from the government.

Pharmacy benefit managers (PBMs) fraud Pharmacy claims are processed and paid by PBMs or third-party administrators used by insurance companies, especially those that offer Medicare Part D Prescription Drug Plans. The role of PBMs is to help negotiate for better prices on prescription drugs and make a profit by operating their own mail order pharmacy.

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Pharmacy Edge 2017

This makes it easier for them to commit several types of PBM frauds, such as switching drugs, shorting medications, paying kickbacks or offering inducements, dispensing adulterated or expired drugs, recycling or reshipping drugs returned by mail order customers, using lock-in pricing that is undisclosed, and keeping manufacturer’s rebates in their pockets instead of passing on the savings to patients.

But the worst form of fraud that PBMs commit is a failure to negotiate prices, which is a blatant disregard of their responsibilities.

This type of negligence is already a serious violation, which only adds up when other types of PBM fraud are committed along with it.

In 2006, Medco Health Solutions, an American Pharmacy Benefits Management (PBM) company, allegedly solicited and received kickbacks to promote certain drugs.

They received more from insurers and HMOs. But they ended up paying $155 million when whistleblowers blew their cover.

Under the Federal False Claims Act (FCA), all of the fraudulent practices listed above can form the basis for a whistleblower lawsuit. But there should be a whistleblower first.

Medicare Fraud and the False Claim Act The majority of the pharmacy care fraud cases were brought to attention by whistleblowers, most of which are current or former employees. Under FCA, a whistleblower can receive 30% of what the government collects from the companies accused and proven guilty of fraud. And that’s before the damages are tripled, which means the award can add up significantly. This might be the perfect

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time to be aware of what goes on with your own pharmacy transactions and blow the whistle on pharmacy Medicare fraud perpetrators.

Medicare recommends that before you report a fraud, you must collect essential details: • Name of a provider or identifying number • Item or service in question • Date when an item or service was supposedly delivered or given • Amount approved and paid by Medicare • Date on the Medicare Summary Notice (MSN) Then, provide your name and number and the reasons you think Medicare should not have paid for such a transaction, whether for a product or service.

If you meet all five conditions for your report to be eligible for a reward, you can get paid up to $1,000. The conditions include that: • An alleged fraud is specific, not general • A suspected fraud is confirmed by the Medicare Drug Integrity Contractor, the Program Safeguard Contractor, or the Zone Program Integrity Contractor as fraud • A suspected pharmacy, pharmacist or organization isn’t already under investigation • At least $100 of Medicare money will be recovered from the fraud reported It is also important that you are not considered an “excluded individual”.

That is, you’re not part of the fraud scheme or that you don’t qualify for another government program’s reward.

Under the Federal False Claims Act (FCA), all of the fraudulent practices listed above can form the basis for a whistleblower lawsuit. But there should be a whistleblower first.

Pharmacy Edge 2017

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Pharmacy Edge 2017

The Other 80/20 Rule We all know the 80/20 rule that says “80% of your sales come from 20% of your customers”, but did you know that there is a different 80/20 rule?

The other one is this - your pharmacy’s front end (regardless of how big or small it is) represents 80% of your pharmacy’s image. When it comes to what your customers think about your pharmacy, 80% of what they see and interact with is your front end.

So the question to consider is, what kind of image are you portraying?

We all get in our habits when coming to work, and for most of us, that involves going in the back door, drop20

ping off items in their designated spots (coat, purse, etc.) and then diving into work. It is important; however, that you occasionally mix it up. At least once a month, walk into your pharmacy via the front door, and look at it with fresh eyes as a new customer would see it for the first time.

Even before you open the front door, look outside around the pharmacy, to make sure sidewalks are clear and in good shape, any landscaping looks trimmed, and it looks overall inviting.

When you step through the front door, take a few moments to look around, and ask yourself these questions: »» How does the pharmacy smell? »» Is it clean, organized, and well lit? »» Are the marketing pieces hanging up current? »» Any displays need updating? »» Do your windows need washing?

Pharmacy Edge 2017

When looking at your OTC shelves, make sure you have at least three of each product available for purchase. It may be tempting to keep inventory costs down by only having one of each item, but consumers tend to never purchase the last one on the shelf, therefore hurting your chances of anyone buying anything. Also make sure you or one of your staff, regularly check expiration dates to confirm you aren’t selling outdated product.

If your OTC shelves are looking a little dated, consider making a seasonal section, where you regularly switch out new items. Assign a staff member to decorate the area themed with the season. Another idea is to create a “Pharmacist Recommends” section of products you like. To spruce up regular sections, consider making small displays to help showcase products.

For example, get a bowl of fake oranges and set them next to your Vitamin C supplements, or put fake grass in a plant holder next to organic products.

By making sure your front end looks neat, clean, and professional, you can easily and actively shape how people view your business. The last thing you want is someone not using your pharmacy because they didn’t like the way it looked, and you didn’t even have the opportunity to talk to them. By taking just a bit of time each quarter, you can make a big impact on how your community sees your pharmacy.

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Pharmacy Edge 2017

Feds Unravel Multimillion Dollar Health Care Fraud Scheme Targeting New Jersey State

Thus far, five men, including an Atlantic City firefighter and four pharmaceutical sales representatives, have admitted to defrauding two New Jersey state health benefits programs of over $25 million by submitting fraudulent claims for compounded medications. More indictments may follow as the government continues its investigation into the conspiracy.

The alleged ringleader of the group, pharmaceutical sales representative Matthew Tedesco, recruited a number of others, including other pharmaceutical sales representatives, state and local government employees, and doctors, in a scheme to submit fraudulent prescriptions to an as yet unnamed out-of-state compounding pharmacy (or pharmacies) for a

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number of expensive compounded medications. The claims were submitted through the New Jersey State Health Benefits Program and the New Jersey School Employees’ Health Benefits Program.

The fraud took place between January 2015 and April 2016. During that time, Tedesco and his “recruiters” are alleged to have persuaded a number of teachers, firefighters, municipal police officers, State police and other public employees to obtain unnecessary prescriptions in exchange for kickbacks from the conspirators. Tedesco and others persuaded doctors who never saw nor evaluated the “patients” to submit prescriptions for up to a 12-month supply of medications (usually pain, scar, antifungal, and libido creams) to a compounding

pharmacy or pharmacies. The conspirators received a kickback from the compounding pharmacy or pharmacies for each prescription filled. Tedesco and his coconspirators then gave money and other benefits to doctors who signed the prescriptions and the public employees and other individuals who agreed to provide their health insurance information and receive the mail-order drugs.

For a scheme that lasted for a mere 15 months, the kickbacks were impressive.

The compounding pharmacy or pharmacies filled over $50 million in prescriptions mailed to persons in New Jersey. Over $25 million of that sum was for prescriptions arranged by Tedesco and his co-conspirators. Tedesco admitted receiving over $11 million

Pharmacy Edge 2017

for submitting false claims, some of which was paid out to those who had agreed to join the conspiracy.

As a part of their plea agreements, the five known conspirators will forfeit the amount of proceeds each received from the conspiracy and

pay restitution. All are scheduled for sentencing in December and face up to 10 years in prison, along with additional fines.

The FisherBroyles Health Care and Pharmacy Law team offers

complete compliance reviews for pharmacists, pharmacies, and health care providers across the U.S. and can provide counsel regarding both state and federal regulations.

Please contact any of the following attorneys for assistance:

The FisherBroyles Pharmacy and Health Care Law team is pleased to keep you updated on events of interest to those in the healthcare and pharmaceutical industries. Questions may be directed to any of the following attorneys:

Brian E. Dickerson, Esq. brian.dickerson@fisherbroyles.com fisherbroyles.com

Anthony j. Calamunci anthony.calamunci@fisherbroyles.com fisherbroyles.com

Nicole H. Waid nicole.waid@fisherbroyles.com 202-906-9572

Amy L. Butler amy.butler@fisherbroyles.com 419.340.8466

Katy Wane katy.wane@fisherbroyles.com 502.890-5920

ABOUT US

Reliable Pharmaceutical Returns (RP Returns) is a pharmaceutical reverse distribution/disposal company that is licensed by the DEA, State Board of Pharmacy & Tennessee Department of Environment & Conservation to return pharmaceuticals eligible for credit and properly dispose of DEA CII-V Controlled Substances and pharmaceuticals that are not eligible for credit. We provide these services to manufacturers, wholesalers, distributors, contract packagers, hospitals, pharmacies, long term care facilities, doctors, dentists, EMTs, and veterinarians throughout the United States.

High Quality-Low Cost Returns Specialists Ms. Mesha R. Berry 443-454-4676 OR 1-888-361-8856 www.rpreturns.com

Reliable Pharmaceutical Returns was established to provide the most efficient, compliant, and cost effective approach for the destruction of outdated and unwanted pharmaceutical drug products.

RP Returns is committed to the highest standards of quality and customer service. We are fully capable of handling large volumes of returns while providing individual attention to each customer’s specific needs.

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Pharmacy Edge 2017

Preserving the Future of Independent Pharmacy Independent community pharmacists shouldn’t limit their options when thinking about retirement. By tapping into the right resources at the right stage, community pharmacists can plan for their future while preserving the independence the pharmacy was founded on - and that patients have come to rely on. And when it comes to making the right decision about the future of the pharmacy, owners should consider a few key facts that highlight how important a holistic view of succession planning really is: 1. More pharmacy owners are thinking about retirement.

More than 37 percent of pharmacists were 55 or older in 2014.1 The idea of retirement for many pharmacy owners is no longer a distant concept. With every passing year it becomes a more pressing concern, particularly for those who feel they have limited options when it comes to exiting their business and preparing for the next stage of their lives. This is why succession planning is essential. When a succession plan is implemented several years before any anticipat24

ed retirement, the necessary financial and operational processes can be put in place to facilitate a seamless exit strategy without disruption.

2. There’s a new generation of opportunity.

Too often, pharmacy owners feel like the only path for an exit is to accept an offer to sell their prescription files to a major chain instead of first trying to sell their pharmacy whole to another independent owner. What they may not realize is the pool of potential buyers is growing every year. Not only did the total number of practicing pharmacists in the U.S. increase by about 19 percent from 2003 to 2014,2 the number of professional student pharmacist enrollments is also on the rise. In fact, total pharmacy school enrollments have increased every year for the past 14 years,3 proving that the pharmacy profession continues to be a vital career path for future clinicians.

3. The appeal of independence is growing.

In a changing landscape where many chain pharmacies are no longer offering graduates the same lucrative salaries and signing bonuses as they were just five years ago, every grad-

uating pharmacist with an entrepreneurial interest represents a future independent pharmacy owner. In the 2014 National Pharmacist Workforce Study released by the American Association of Colleges of Pharmacy (AACP), surveyors found that independent pharmacists ranked high among pharmacists who noted the highest level of career commitment.4 The same survey showed that when asked about their sense of control in the workplace, those in independent pharmacy settings also reported the highest levels.5 Many independent pharmacists enter the profession because of their commitment to patient care and because they want to be able to personalize that care in an environment they control. Independent pharmacy ownership offers a template and an opportunity to do that, giving a new generation of pharmacy owners a path to career satisfaction.

4. Preserving the legacy is powerful - and possible.

Many independent pharmacies have become local institutions in the communities they serve,

Pharmacy Edge 2017

with long-established patient relationships, as well as loyal employees who are as integral to the overall quality of the care and service delivered as the pharmacist is. Maintaining that legacy is a key consideration for many pharmacy owners as they begin to think about retirement.

It’s also a powerful consideration for a potential buyer. Purchasing an existing pharmacy is a path to immediate stability. Starting a new pharmacy from the ground up is like building any new business.

It requires a significant capital investment, plus licensing and marketing to build a patient base.

In addition, the time it takes to become part of payer networks and get paid by PBMs adds a considerable financial strain for a startup. But through the

acquisition of an existing pharmacy, a new owner can count on a predictable level of operating income that has been benchmarked through actual practice rather than future projections.

Additional Considerations In anticipation of selling, there are several other considerations that should be on the table, including: »» Timeline. What is the proposed timeline for retirement or exiting the business? »» Exit strategy. Is there a transition strategy in place for withdrawing from the business? Will there be a gradual shift or lessening of ownership responsibilities over time?

What employee management considerations need to be implemented in advance of this change? »» Value strategy. What things need

to be done in advance of selling to maximize the value of the pharmacy? And what is the strategy for implementing these improvements? »» Resources. Have resources been identified to assist with retirement guidance and planning?

Better Choices and Broader Opportunities Succession planning is a critical part of an overall financial management plan for the future. With proper guidance and implementation, it can open new doors, offer better choices and provide broader opportunities for selling, allowing pharmacy owners to successfully transition out of their businesses and into retirement while preserving the pharmacy’s legacy in the community it serves.

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Pharmacy Edge 2017

Eight Tips to

Improve Productivity in the Community Pharmacy Here are eight ideas community pharmacies can implement to boost productivity, improve efficiency and help businesses run like a well-oiled machine: 1. Measure more – A pharmacy can only manage what it measures. Without data, a community pharmacy won’t be able to tell whether it’s performing better or worse than industry standards, and progress can’t be tracked to see if efforts to improve efficiency are paying off.

Inefficiency is undesirable in any business sector. But for community pharmacies facing intense competitive pressures and tight margins, operational inefficiency can seriously endanger profitability and viability.

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For example, there are software programs that give pharmacies the ability to track how many scripts employees dispense on an hourly basis. If this reveals that some employees are much more productive than others, a manager can identify the less efficient team members and work with them to raise their performance.

2. Rationalize the physical workflow – Take the time to step back and look at how quickly a script moves through the pharmacist’s

bench. How much do technicians need to move to fill a script? Do the techs have all the materials they need close at hand?

Inefficient pharmacy layouts where technicians have to run halfway across the pharmacy just to pick up a vial can greatly decrease output. By streamlining the workflow, a pharmacy can achieve a significant reduction in the movement needed to fill each script, enabling the technicians to fill scripts more quickly, which translated into labor cost savings for the pharmacy owner.

3. Save time with synchronization – Setting up a med sync (medication synchronization) program can have a major positive impact on productivity and efficiency. Consider that some patients take four or five maintenance medications for chronic conditions. If they can fill all these prescriptions in a single monthly visit, that not only saves the patients the inconvenience of making multiple trips to the pharmacy, it also makes it much simpler and more efficient for the

Pharmacy Edge 2017

pharmacy to fill all these prescriptions at once.

What’s more, by making demand predictable and dependable, med sync programs make it easier for pharmacy owners to plan their staffing needs far in advance. If a pharmacy knows that Mr. Smith, Ms. Jones and 20 other med sync patients will all be visiting the pharmacy on the 10th of the month for all their refills, then a pharmacy can make sure they have all the labor they need on that day to have the scripts ready and waiting before the patients walk through the door.

4. Research robotics – Robots won’t make sense for every pharmacy. The initial outlay can be steep — a state-of-the-art vial-packing robot could cost close to $200,000.1 Nonetheless, high-volume community pharmacies or independent owners with multiple stores should run the numbers to see if robots make sense. A robotic dispensing system can process up to 150 scripts per hour, automatically print and apply prescription and auxiliary warning labels.2 Some industry robot providers report more than 99 percent uptime and counting accuracy rates.

Robotic dispensing systems are especially effective when they are integrated with med sync programs. A pharmacy can give the machine the details on the patients who will be arriving the next day to get their medications, and the robot will take care of filling and preparing all the scripts for pick up.

5. Designate and delegate – Pharmacy owners who try to do everything themselves can resemble a circus performer spinning a dozen plates. Sure, they can keep the plates going for a while, but get distracted for just a moment, and they’ll have a big mess to clean up.

Delegation is the key to a pharmacy owner’s sanity while simultaneously improving efficiency and productivity. For example, make a trusted staff member an ‘inventory captain’ and put that person in charge of optimizing inventory management. That staff member can develop a process following industry best practices for contacting patients and returning items to stock that have languished too long in the will call bin. Of course, given the sensitivity and costs around keeping track of prescription medicines, a community pharmacy will want to pull those from the bins and have them tracked and shelved as soon as possible.

Similarly, the inventory captain can make sure that daily inventory stocking does not disrupt key pharmacy workflows. There’s no need to disrupt pharmacy operations to stock front-end merchandise as soon as it arrives at the store. A team can wait for a lull in customer activity to stock and get the front-end items onto the shelves.

6. Centralize to capture economies of scale – Owners operating multiple pharmacies can capture efficiencies from centralizing some activities at one location or another. For example, workflow analysis revealed that a pharmacy

owner who operated five stores within 40 miles of one another could improve efficiency by filling all the long-term care scripts from one location, then centralizing all his compounding at another store and so forth.

A community pharmacy could theoretically even centralize their inventory ordering system, as long as they made sure they had total visibility to the stock throughout all their stores.

7. Assign specific employees to dedicated tasks – Imagine a pharmacy where a single staff member performs many roles — one minute she is answering the phone, the next she is pulling a prescription, then she is bottling and labeling the script. Later on, she might call for insurance verification or answer an incoming call. Throughout the day, she is getting pulled in different directions, unable to focus or find a rhythm on any single task.

Now consider an alternate workflow where a dedicated staff member answers the phones, another pulls medicines from stock and puts them in bottles, a third staff member labels the bottles and handles insurance verification, while the pharmacist checks the accuracy of the scripts before the patients pick them up.

This can be more challenging at smaller pharmacies where every staff member wears multiple hats, but particularly at larger volume stores (e.g., those filling more than 250 scripts per day), a pharmacy can often improve workflow by giving specific tasks to individual staff members.

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Pharmacy Edge 2017

With each staff member able to concentrate without interruption on a specific task, the work will proceed faster and more smoothly. As each staff member develops more skill and experience at his or her assigned task, that staff member will become even more efficient and productive.

Bonus tip – If a community pharmacy has enough volume for specialized employees, they should take the time to figure out each staff member’s strengths so they can assign the right people to the right roles. For example, it doesn’t make sense to put an introverted staff member on the cash register. Maybe that person would be

happier handling cycle fills or entering orders. When employees are happier with their roles, they’re often more engaged and productive.

8. Take advantage of technology – Even if a pharmacy can’t justify the investment in robotics, there are other ways to get the benefits of technology at a lower cost. Even an IVR (interactive voice response) phone system can yield major productivity benefits.

IVRs offer very good benefits for the price. It’s possible to purchase a fully-loaded IVR system with all the bells and whistles for less than $10,000.3 With an IVR, patients can call and request refills over the phone simply by keying

in their prescription numbers. The prescription automatically enters a queue and can be filled without engaging the patient in conversation.

The IVR functions 24 hours a day, 7 days a week, so the patient gets the added convenience of being able to request a refill at any time.

By implementing these sorts of initiatives to improve productivity and efficiency, a pharmacy can lower labor costs. And when employees no longer need to scramble just to fill scripts for the patients walking through the door, they can tackle more proactive responsibilities such as marketing and physician detailing that can help grow a pharmacy’s business and increase revenue.

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Pharmacy Edge 2017

What’s Your Fall Marketing Strategy? Not Sure?

Fall is a busy time of year for pharmacies, with flu shots, Medicare Part D Enrollment, and cold & flu season. It’s also a great opportunity to get new customers in the door. Without a plan on how to capitalize on this opportunity, your potential could fall short. Let the dedicated team at GRX Marketing help! We not only create customized marketing materials, but provide ideas and implementation as well! Join our program and we will: • Develop a plan unique to your goals and services • Implement Ideas - giving you time to spend with patients • Use our expertise as fellow pharmacy owners • Proactively reach out to you - we don’t wait for you to call us

Make it Successful!

Contact Nicolle McClure at 515.280.2913 or nicolle.mcclure@grxmarketing.com to get started.

www.pharmacymarketing.com

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Pharmacy Edge 2017

ThoughtSpot 2017 30

Pharmacy Edge 2017

Good Neighbor Pharmacy Launches Estimator Tool to Assist Pharmacists In Managing The Impact of DIR Fees VALLEY FORGE, PA (July 14, 2017) – Good Neighbor Pharmacy, a national independent pharmacy network offered through AmerisourceBergen, has launched a DIR Fee Estimator tool to help independent community pharmacists manage the impact of direct and indirect

remuneration (DIR) fees and the hidden cash flow issues associated with them. The tool is available to members of AmerisourceBergen’s pharmacy services administrative organization (PSAO), Elevate Provider Network, who take advantage of its Advanced Features.

Good Neighbor Pharmacy’s DIR Fee Estimator tool uses the claim detail in combination with the DIR rates from signed contracts between Elevate Provider Network and PBMs. Since DIR fees vary based on Star Rating measures and other performance criteria, the tool generates high and

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Pharmacy Edge 2017

low estimates of DIR fees, as well as a midpoint, or most likely, estimate for the DIR fee. The tool uses real-time, claim-level data and is updated every two hours to ensure the most accurate information is available to help pharmacists better anticipate their monthly fees and plan accordingly.

“For more than 30 years, we have found our greatest successes when we listen to our pharmacists and develop solutions that address the most complicated challenges they face every day,” said Chuck Reed, Group Vice President, Pharmacy Innovation and Solutions at AmerisourceBergen. “Inconsistency and

opacity in how DIR fees are calculated and the delayed timing of DIR fees is a major pain point for pharmacists. Our DIR Fee Estimator tool was created to empower them to plan ahead, give them visibility into the process and ultimately set them up for a more successful business.”

AmerisourceBergen provides customized solutions to fit customer needs and address the unique challenges faced by independent pharmacists through its Good Neighbor Pharmacy program and PSAO, Elevate Provider Network. This new solution is part of the company’s

multi-faceted approach to managing the impact that DIR fees have on independent pharmacies. AmerisourceBergen works diligently via its PSAO, Elevate Provider Network, to minimize the impact of DIR fees through their approach to managed care contracting–selectively participating in preferred cost-share networks, while continuing to advocate on behalf of all independent and long-term care pharmacies on critical legislative issues that affect daily operations. For more information, please visit OurIndependentVoice. com.

AmerisourceBergen’s Pharmacy Ownership Program What is it?

AmerisourceBergen recognizes that buying or selling a pharmacy business is extremely complex and can be the largest financial transaction of your life, impacting your staff, patients and the community you serve. Our acquisition and ownership group is committed to helping community pharmacists at all stages of your business get to the next one and will walk you through every step of the buying or selling process to ensure you are positioned for success.

Buying a pharmacy?

Our team of Pharmacy Ownership 32

Consultants has years of experience in business valuations, acquiring additional pharmacies, advising on the sale process and industry reach to help you expand your business or make your first pharmacy purchase.

When you’re ready to take the next step in pharmacy ownership, we’ll partner with you at every step of the way. That means: »»Introducing you to our network of qualified buyers and sellers »»Identifying the right opportunity »»Providing financial options and connections to our established banking partners »»Evaluate and analyze the cost of

your pharmacy acquisition from every angle Exiting the industry?

If you’re preparing for retirement or ready to sell your pharmacy, count on AmerisourceBergen to help you find a buyer with the same commitment to your community that brought you where you are today.

We can help: »»Determine how much your pharmacy is worth »»Advise on any improvements and work with you to get them done »»Match you with a qualified buyer

Pharmacy Edge 2017

Testimonials “The experience working with AmerisourceBergen proved to us that they have a better understanding of pharmacy than a business broker. The enthusiasm to help bring the two parties together cannot be compared. I would recommend using AmerisourceBergen’s Pharmacy Ownership Program to anyone.”

John DeMartino, Ira’s Discount Pharmacy, Delray Beach, FL

“AmerisourceBergen’s vast knowledge of the transition process, experience, and professionalism helped create a seamless transition. AHCS hopes to continue to work with AmerisourceBergen’s pharmacy ownership program for future acquisitions.”

Vimal Bhanvadia, Advantage HealthCare Services, Princeton, NJ

A New Ordering Platform from AmerisourceBergen What is it?

ABC Order is a customer-first pharmacy ordering system designed, tested and approved by pharmacists and engineered to fit seamlessly within the pharmacy’s workflow. ABC Order enables pharmacists to order effortlessly, control inventory, access data and information and resolve issues quickly. It’s fast, uncluttered and intuitive, allowing pharmacists to optimize business while spending more time with patients.

ABC Order launched in April, 2017 and is available to all AmerisourceBergen independent pharmacy customers. As of ThoughtSpot 2017, more than 1,200 Good Neighbor Pharmacy customers use ABC Order. ABC Order will continue to evolve to meet the changing needs of the independent pharmacist.

What new features does ABC Order have to help with ordering? »»Digitally track re-order dates for expensive medications »»Get alerted when a product is out of stock »»Receive notifications when backordered or out-of-stock items become available »»Add notes to items in the catalog to alert you to check for cheaper price, change brand, etc. »»The “Watchtower” gives you instant visibility to your orders, support issues and drug notifications »»Ongoing development phases to continually look for new ways to make ordering as easy as possible What does ABC Order help independent pharmacists do? »»Order effortlessly • Robust search functionality

• Filter and sort product easily • Reorder known items quickly »»Control inventory • Monitor NDCs • Proactively identify and react to exceptions • Manage irregular inventory »» Easily reference data & information • Access drug-specific data and history • Reference past orders and invoices »»Resolve issues quickly • Online chat for quick communication and less time spent on phone • Self-service functionality for simple tasks like ordering a cold tote or generating a return 33

Pharmacy Edge 2017

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Pharmacy Edge 2017

American Pharmacy Purchasing Alliance (APPA)

Company Code: APPA877

Your employee benefits just got better!

Welcome to the TicketsatWork benefits program, our new provider for discounts to theme parks, attractions and shows nationwide.

How can I benefit from TicketsatWork?

Through TicketsatWork, you will receive discounts and special access to theme parks and attractions including the Walt Disney World® Resort, Universal Studios®, Las Vegas and New York City shows and performances, Disneyland®, SeaWorld®, Six Flags, and Cirque du Soleil! Also check with TicketsatWork.com for savings on car rental, hotels, tours and attractions across the US. If you’re staying local, save on movie tickets, sporting events, and other special events. And feel free to share the code with friends and family!

How can I order tickets?

There are four ways to access the savings: 1) Visit the company website and select the TicketsatWork.com link. You will be automatically logged into the discount website and have unrestricted access to the savings!

2) Go to www.TicketsatWork.com. Click on the “Become a Member” Box at the top of the homepage. You will then be prompted to create a username and password, and enter our company code. Once enrolled you will have access to discounts on theme parks and attractions nationwide!

3) Place your order over the phone by calling customer service at 800-331-6483. Orders are taken over the phone from 8:30am-12am/7 days a week (holidays included). Eastern Standard Time.

4) Save on shipping costs by picking up your discount tickets at All Access Orlando Vacation Center & Ticket Store, conveniently located on 8472 Palm Parkway, Orlando, FL 32836. Orders can be made in advance by calling 800-331-6483 and walk-ins are always welcome!

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Once a month, TicketsatWork sends a monthly savings bulletin to the administrator. Ask about the bulletin today! You can also check back on TicketsatWork.com whenever you want to find the latest deals.

Enjoy the Savings!

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The latest and the most significant industry-related news and trending stories.

This magazine is produced by APPA - American Pharmacy Purchasing Alliance If you wish to submit an article-to Pharmacy Edge, or would like to request a media kit for sponsorship The latest and thesend most industry-related news opportunities, ansignificant email to info@joinappa.com. and trending stories.

This magazine is produced by APPA - American Pharmacy Purchasing Alliance If you wish to submit an article-to Pharmacy Edge, or would like to request a media kit for sponsorship opportunities, send an email to info@joinappa.com.

18000 Studebaker Road, Cerritos CA, 90703

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