The race to develop the first oral version of popular weight-loss drugs
TRENDS | Big Pharma Companies and the Threat of Expired Patents
How lower prices will affect patients and pharma companies
RETAIL | Your In-Store Event
Preparation is key to a successful outcome
SOLUTIONS | Taking Charge of Obesity
How clinical practice can offset DIR losses
SPOTLIGHT | Drug-Induced Nutrient Deficiencies
Recommend OTC products and increase your front-end sales
MONEY | Protect Your Pharmacy
How to choose the right insurance policies
OUTLOOK | The Art of Apologizing
How and when to tell patients you’re sorry
ON THE WEB
VOLUME 13, ISSUE 2
JUNE 2024
PUBLISHER & EDITORIAL DIRECTOR
Matthew Shamet
EDITOR Gina Klein
GRAPHIC DESIGNER
Logan Whetzal
CONTRIBUTING WRITER
Cecilia Vigliaturo
INTERESTED IN ADVERTISING? elements@pbahealth.com
Catering to Family Caregivers
Many of your patients need assistance from a caregiver, and some are caregivers themselves without any previous healthcare training. Your pharmacy can help ease their minds and help them through the transition.
Common Accounting Errors
An essential part of your business is accounting, and it can easily make you feel in over your head. Mistakes happen, but if you catch those mistakes, you’ll be able to avoid them next time.
When Disaster Strikes
Emergencies are bound to happen in your community, but you don’t want to be caught unprepared when one strikes. With the proper planning, you can protect your pharmacy from the unexpected.
NEEDLE-FREE WEIGHT LOSS
The race to develop the first oral version of popular weight-loss drugs
Drugmakers are scurrying about hoping to be the first to develop an oral version of the newest class of weightloss drugs, Eli Lilly’s Mounjaro and Novo Nordisk’s Ozempic and Wegovy. While both can produce significant weight loss, they’re given as weekly injections. The goal now is to push for individualized treatment.
Since nearly everyone takes a pill for something, a daily pill will be much easier for those who aren’t fond of needles. However, an oral pill won’t likely be on the market this year.
According to estimates by the World Health Organization (WHO), adult obesity has more than doubled since 1990 worldwide, and adolescent obesity has quadrupled. In 2022, 2.5 billion adults (18 years and older) were overweight, and of these, 890 million were living with obesity. With weight problems around the globe, companies need to look beyond injectable drugs that treat Type 2 diabetes.
Novo Nordisk recently presented findings of a pill version of semaglutide (the active ingredient in Ozempic and Wegovy) for weight loss in those who are overweight or obese and don’t have Type 2 diabetes. The findings showed participants in the phase 3 clinical trial lost, on average, 15% of their body weight after 68 weeks. The number was consistent with what Novo Nordisk previously reported in clinical trials with patients taking the weekly injection of semaglutide over the same time period.
In March 2024, Novo Nordisk shared the data from an earlystage clinical trial of an experimental weight-loss drug called amycretin. Amycretin is a treatment taken orally, and trial results convey it could be more powerful than Wegovy, the company’s popular weight-loss drug.
Taken once a day, the pill helped patients in the trial lose 13% of their weight over a 12-week period. Patients on Wegovy, however, only lost around 6% at 12 weeks. Side effects of amycretin, according to Novo Nordisk, are in line with its other GLP-1 drugs: nausea, vomiting, constipation, and diarrhea.
Amycretin effectively combines the performance of two different drugs—GLP-1 and amylin—into a single molecule, targeting two hormones involved in regulating blood sugar levels and hunger. In fact, companies like Novo Nordisk and Zealand Pharma would like to build the next generation of weight-loss drugs around amylin.
Data from the mid-stage trial won’t be available until approximately 2026, at the earliest. Therefore, amycretin won’t hit pharmacy shelves anytime soon.
Novo Nordisk also has a lower-dose version of oral semaglutide called Rybelsus that’s already approved for type 2 diabetes. In the clinical trial, the dose tested for weight loss was higher. Basically, it’s similar to how Ozempic is approved for diabetes while Wegovy is approved for weight loss. However, patients who take Rybelsus tend to get more side effects, such as nausea, compared with the injection.
Another concern is adherence. These drugs have a lot of requirements. For example, patients taking oral semaglutide need to take it daily on an empty stomach in the morning.
The oral semaglutide was tolerated well and the side effects were similar to the injection. The side effect most reported was nausea.
Eli Lilly also has an oral weight-loss drug called orforglipron. According to the phase 2 clinical trial results published in the New England Journal of Medicine, participants taking the drug lost an average of 9.4% to 14.7% of their body weight after 36 weeks. This depended on the dose each participant was given.
Orforglipron is taken daily in the morning, just like oral semaglutide. However, orforglipron can be taken within 30 minutes of eating while oral semaglutide cannot. Side effects are also in line with the other GLP-1 drugs.
TRENDS BIG PHARMA COMPANIES AND THE THREAT OF EXPIRED PATENTS
How lower prices will affect patients and pharma companies
You can’t rely on a drug for its success. While a lot of drugs are profitable, no matter how much money they’re bringing in, they’ll eventually fall to generics or biosimilars.
An inevitable threat will be putting billions of dollars in sales at risk between now and 2030 for big pharmaceutical companies. Numerous blockbuster drugs will expire this year. Known as a patent cliff (and an historic one at that), when the door opens for competitors to sell copycats of those drugs, it’s often at a much lower price. This will most likely cause revenue to fall for drugmakers, and in turn, your patients can purchase the drugs at a more affordable price.
Some companies already have replacements ready with a new generation of the same drug, while others have gone to court to fight against generics. Unfortunately, patent cliffs are unavoidable. They must replenish older top-selling drugs with new ones so they will grow sales rather than just sustain them.
When a drug loses its exclusive rights, companies are affected differently. It all depends on how much of their sales they make from the product or the type of treatment.
DRUG TYPE MATTERS
A product could be one of two things. It can be a smallmolecule drug, which means it’s made of chemicals with low molecular weight. Or it can be biologic, a medicine obtained from living sources such as humans or animals.
Quite a few of the biggest drugs facing upcoming patent expirations are biologics, such as Merck’s Keytruda and J&J’s Stelara. Drugs like these won’t likely bring in much revenue. However, biosimilars won’t be a threat anytime soon since they aren’t identical copies of branded biologic drugs like generics.
Biosimilars aren’t interchangeable. They can’t be directly substituted with a branded biosimilar because not all patients will react to a biosimilar in the same way they do to a biologic. This is why physicians are more wary of switching patients to them. It’s also much more costly to research and develop a biosimilar than generics. This is why biosimilar makers are less willing to sell them at discounted prices to branded copies.
PATENT CLIFFS DEEMED MANAGEABLE
As drug pipelines improve, financial company JPMorgan sees the upcoming patent cliffs in the mid-2020s “largely manageable.” They also expect the biopharmaceutical industry’s sales to be “roughly stable” through 2030.
BUYING MORE TIME
So they don’t lose revenue, pharmaceutical companies are shifting to delay competition or extend patent protections on drugs. For instance, Merck is testing a new, more convenient version of Keytruda. This version can be injected under the skin rather than through intravenous infusion. If the new form is approved, it might secure a separate patent. This would extend Keytruda’s market exclusivity by several years.
The current form of Optivo is administered into a patient’s veins. However, Bristol Myers Squibb is testing a version that’s injected beneath the skin, and it showed promise in a late-stage trial in October. This could lead to extended market exclusivity.
An additional threat to companies is Medicare drug price negotiations under the Inflation Reduction Act. However, it depends on how the policy will affect revenues. It could differ depending on when a drug loses exclusivity.
Medicare has begun price talks this year for the first round of 10 prescription medications, which include Stelara and Eliquis. In the fall, the federal government plans to announce the agreed-upon prices for those medications, which will go into effect in 2026.
6. Sandostatin LAR (octreotide acetate)
Disease: Acromegaly; severe diarrhea from carcinoid tumors
Disease: Iron deficiency anemia in patients with chronic kidney disease Company: CSL
2023 U.S. sales: $90 million
Expected generic entry: 2024
10. Prolensa (bromfenac)
Disease: Postoperative eye inflammation following cataract surgery
Company: Bausch + Lomb
2023 U.S. sales: $41.5 million
Expected generic entry: January 2024
(Source: fiercepharma.com/special-reports)
YOUR IN-STORE EVENT
Preparation
is key to a successful outcome
Your patients enjoy feeling a part of your community pharmacy. The camaraderie when they walk in to pick up a prescription refill or a tube of toothpaste not only makes them feel at home but keeps them coming back.
While you love all your regulars who frequent your pharmacy and keep it going, don’t forget to find ways to draw in new customers, too. For example, when was the last time you hosted a pharmacy event? If it’s been a couple years, it’s time to plan another. If you’ve never hosted one, what are you waiting for?
Hosting in-store promotional events can:
• Bring new shoppers into your store
• Reward your current customers
• Introduce and educate attendees on new services you offer
• Celebrate notable achievements
In-store events like this keep your pharmacy current and personal, something that national chains and e-commerce vendors can’t do. While your independent pharmacy may not have the pricing advantages, variety, or the versatile hours of operation that the national chain pharmacies do, you have connections with your customers and community that you can grow further through in-store events.
EVENT IDEAS
• Grand opening. If your pharmacy is new in town, host an in-person or virtual grand opening party. Inform them of the products and services you offer.
• Immunization events. Host a week-long vaccination event for flu season or just before the new school year starts.
• Community events. Look for community events such as job fairs or craft shows. Set up a booth or table to meet more prospective customers and generate brand awareness.
• Health awareness events. Offer free blood pressure screenings for American Heart Month or free blood glucose tests for American Diabetes Month.
• Educational webinars. Not every event has to be in person. Webinars are done online in a virtual classroom. So, you can offer a free webinar each month on an important health topic that affects people in your community. It’s a great way to encourage residents to use healthy habits.
• Seasonal events. Participate in your town’s holiday parades with your pharmacy team. Or, host a bake sale with proceeds going to a local charity.
• Birthdays and anniversaries. Host an event to honor someone in your pharmacy who is having a birthday or an anniversary.
Steer clear of hiring outside help to plan and execute your event. Instead, ask your staff if they’d like to volunteer. While you may have to pay employees overtime or give them a special gift of appreciation, those tokens cost far less than hiring an outside firm.
YOUR EVENT BUDGET
Before you set a budget, be sure you know how much you can spend on an event and how you plan to use the money. One area of the event may be quite pricey, so cut back on your spending for that and give yourself more leeway in another area. For example, a virtual venue will be considerably cheaper than an in-person event. Plus, you’ll have virtual event solutions like online registration and web conference rooms. These are less costly than decorations and catering.
TEAM UP WITH LOCAL BUSINESSES
Consider working with other businesses in town. This can cut costs and expand the reach of your pharmacy event.
By teaming up with other businesses, you'll have a lot more reach.
When finding an organization to partner with, choose noncompeting businesses that complement your business and can provide services or entertainment. It’s also wise to look to other area healthcare professionals or social service agencies in your community, such as:
• Optometrists. They can provide eye tests at your eye health event.
• Audiologists. They can provide hearing tests at your hearing health event.
• The American Diabetes Association. If you’re having a diabetes event, your local chapter can pass out literature and oftentimes have personnel who will give a talk on a related subject. Contact a blood glucose manufacturer or a sugar-free candy distributor. They would probably be more than willing to support you with some free product samples to share with your guests.
• A local bakery or florist. Partnering with local businesses provides products to improve the atmosphere and enhance the event experience for your guests.
RECRUIT VOLUNTEERS AND STAFF
Get started early on the event planning process. You’ll need a lot of bodies around to help the day of your event, so plan to either hire employees or solicit volunteers. Make sure there will be enough people to make the event run smoothly. It’s also smart to plan to have a few extra volunteers scheduled on the event day in case someone is sick or doesn’t show up.
ASSIGN TASKS
Whether your event is small or large, you can’t do everything on your own. That’s why it’s wise to delegate tasks to your workers whenever possible. By knowing their strengths and weaknesses, you’ll know exactly where their skills will help the most.
PROMOTE YOUR EVENT
If you want people to come to your event, they need to know about it. One little sign in your pharmacy won’t do the job. So, think of creative ways to get the word out. Some of the top ways to promote an in-store event are:
• Word of mouth: Your employees will spread the word to customers, who will then tell friends and family about it.
• Bag stuffers: Have employees put a printed invitation to your event in their prescription bags.
• Send invitations: Send out invitations to your current customers through email or snail mail.
• Social media: Post your event on your social media pages at least a couple of weeks in advance. Check it regularly to see if viewers comment or have questions. You can also create a Facebook event to reach more people.
• Phone: Call your neighboring professionals and invite them.
• Posters: Whip up a few posters promoting your event and hang them around your pharmacy where customers will see them.
• Media: Contact your local radio stations or news stations.
THE MEASURE OF YOUR SUCCESS
While most businesses use sales as a measure of success, it isn’t always accurate. There are too many factors to base success on an uptick of sales. Instead, look for goals that are less sales related. If one of your goals is to get more people signed up for your pharmacy newsletter, set a goal to get 50 new contacts on your email list as a result of your event.
What it all boils down to is getting your community to know about your pharmacy. Here are a few ways to put your name out there while participating in an outside event:
• Set up a booth and provide goodies
• Wear clothes with your pharmacy’s branding
• Sponsor the event
Remember that even if the event’s success wasn’t what you had hoped, keep going. Look at each event as a learning experience, and then get busy planning your next one. Keep the momentum going because an event is part of a continuum.
Types of Pharmacy Events
If you want your pharmacy to stand out, consider these event ideas:
Health awareness event
Plan a pharmacy event around health observances.
• American Heart Month
• National Nutrition Month
• American Diabetes Month
• National Influenza Vaccination Week
• World Health Day
Vaccination event
Host a travel vaccination event for people going on trips.
• Pre-cruise planner
• Mission trip planner
• Spring break trip planner
• Semester abroad
Seasonal event
Celebrate different seasons by planning pharmacy events. Use them to sell your seasonal products and services.
• Summer fun
• Back-to-school month
• Winter solstice
• Spring into spring
Community event
Host an event in conjunction with celebrations, activities, and holidays in your community.
• Sidewalk sale
• Holiday parade
• Back-to-school party with education freebies
• Block party with neighboring businesses
TAKING CHARGE OF OBESITY
How clinical practice can offset DIR losses
Rates of obesity are quickly rising. In fact, the World Obesity Federation’s 2023 Atlas predicts that 51 percent of the world will be obese or overweight within the next 12 years. And not only does obesity increase the risk of severe illnesses from viruses such as COVID-19, but it’s also linked to between 30 to 53 percent of new diabetes cases in the U.S. every year, according to the Journal of the American Heart Association. Obesity is a worldwide problem and a major global health concern.
The factors that contribute to the rise in obesity include modern lifestyles that allow for easy access to unhealthy foods, a sedentary lifestyle, and environmental factors that limit access to healthy food and exercise. To effectively manage the obesity problem, it will require the promotion and acceptance of healthy lifestyle habits. However, this depends on the availability of resources such as affordable, nutritious food options and access to places that promote exercise. Counseling and guidance by healthcare professionals is also necessary for disease state prevention and treatment.
A position statement by the American Society of HealthSystem Pharmacists recommends increased counseling
by pharmacists to help obese patients manage lifestyle modifications. Since you are easily accessible to patients who live in locations throughout the community, you can serve as an alternative source for lifestyle and weight-loss counseling.
Take Charge, a pharmaceutical company that’s been around for 20 years, happens to do just that.
“Education is the only thing in the entire marketplace that’s ever been proven that will work long term for obesity,” Terry Forshee, DPh, PD, CDE, President and CEO of Take Charge, said. “There hasn’t been an opportunity for healthcare
“The advantage as an independent pharmacist is we have tremendous communication skills. We’re naturalborn communicators. We’re on every street corner, every city, and we’re available to do a process like this. We owe it to our patients to help them.”
professionals to tie into any kind of educational process to facilitate this education. That’s what we do in my company.”
Take Charge trains independent pharmacy teams to address obesity, the nutritional aspects of type 2 diabetes, and cardiovascular disease. It’s a 26-week process in which the pharmacist and team walk a patient through step-by-step, weekly meetings where they teach them nutritional concepts.
“The advantage as an independent pharmacist is we have tremendous communication skills. We’re natural-born communicators. We’re on every street corner, every city, and
we’re available to do a process like this. We owe it to our patients to help them,” Forshee said.
Take Charge offers health education for your patients, such as learning how the body uses proteins, fats, and sugars. The patient's progress is monitored through regular body measurements, such as weight loss, lab testing, and bioimpedance readings. Counseling is also provided by trained healthcare professionals to provide support and guidance.
“Pharmacists know most of what needs to be taught. Everyone knows how to eat healthily, but they don’t do it. So, through the Take Charge program we create a health
coaching process for the community pharmacy,” Forshee said. “We have a face-to-face, one-on-one process. The education is done through our app and our videos. We’ve created 52 extremely high-quality videos that go over every aspect of nutrition, exercise, and all the things they need to do.”
One thing that Take Charge is not is a lose-weight-quick program. Instead, it’s an easy weight-loss program and a natural alternative to the GLP-1 agonists. It’s also an educational process for patients, and one that they’ll carry with them for the rest of their lives.
“We’re the only company that doesn’t want our patients using our meal replacements forever. When they stop, they’re not going to gain the weight back because they’ve learned to replace them with healthy nutrition. It gives them room to make mistakes,” Forshee said. “They drink two shakes a day for six to eight weeks, depending on the patient. Even if they make mistakes during the process, they won’t punish themselves as much as if they were just eating whatever they wanted. It buys them room to make mistakes. The more they learn, the less they rely on the meal replacements. By the end of 26 weeks, virtually every patient is off the shakes.”
Take Charge is an easy weight-loss program. Forshee said that most of the benefits patients gain, from both the
nutritional help and from reducing their weight, comes in the first 10 to 15 percent of body fat they lose.
“Most of our patients reach that initial goal by the end of the first 90 days. During that time, the patient is creating their own blueprint for success under the pharmacy team’s guidance. The next 90 days are focused on permanent implementation of that blueprint, which leads them to reaching their final goal—a lifetime of a healthy lifestyle.”
It doesn’t cost the patient anything to do the Take Charge program. This is because the program saves them enough money off their food bill to completely offset the fees that the pharmacist charged.
“This is the basic core of everything,” Forshee said. “If you can learn that people will pay you, and they will seek you out for a service that they can’t get anywhere else in the nation, it’s your golden ticket.”
OBESITY STATISTICS
• Based on data collected between 2017 and 2020, 41.9% of adults in the U.S. are obese. (Trust for America’s Health)
• Obesity is linked to 30% to 53% of new diabetes cases in the U.S. every year. (Journal of the American Heart Association)
• More than 1 billion people have obesity worldwide–650 million adults, 340 million adolescents, and 39 million children. (World Health Organization)
How point-of-care testing can boost your revenue
Once upon a time, your pharmacy’s biggest threat was the large retail chains. Trying to compete with them was a struggle, as they introduced consumers to conveniences that are now the expected norm, such as extended hours, online refill requests, delivery options, and prescription alerts.
Today, however, there’s a whole different set of challenges. PBMs are continuously growing, and pharmacy reimbursements keep on declining. Plus, as the already outrageous out-of-pocket costs keep rising, your patients continue to reach for prescription discount cards. Yet another hit to your profit.
“As pharmacists work to pass legislation that would allow a fair and equitable professional reimbursement fee, we recommend independent community pharmacies begin offering healthcare revenue-generating services,” said Nicholas Smock, PharmD, MBA, President and CEO of PBA Health. “For example, point-of-care testing, over-the-counter (OTC) hearing aid testing, vaccines, weight loss, tobacco cessation, vitamin and sport medicine, convalescent care and devices, and health and wellness programs that position you and your pharmacy as a healthcare destination.”
In a nutshell, you don’t want to lose your customers due to the constant struggle to protect your bottom line. That means it’s time to begin increasing your revenue by expanding clinical interventions.
BUILDING TRUST THROUGH CLINICAL SERVICES
One way to boost confidence among your patients is by engaging in clinical opportunities. It also strengthens your ties with local healthcare providers, which could lead to collaborative partnerships and referrals.
“In 2003, I saw an opportunity. At that time all the point-ofcare testing (POCT) devices were being marketed by different manufacturers and suppliers," said Tim Drapeau, President/ CEO of CLIAwaived Inc. “It was very difficult to source because you’d have to go to all the different manufacturers to find these devices. So, I said, ‘Let’s build a website where you can actually pick and pack a strep kit, a flu kit, and a drug cup for doing POCT supplies.’”
That was the premise of the business, and Drapeau continued to expand to all types of wellness products, such as POCT products for urine, saliva, and blood.
“Basically, you can do an instant test from any bodily fluid, whether it’s a lateral flow test like a pregnancy kit, or a little
handheld meter like a cholesterol analyzer. We wanted to be that one-stop shop,” he said. “This then led me and my team to build a medical store online for POCT.”
IF YOU BUILD IT, THEY WILL COME
Soon after their store was online, Drapeau and his team saw a huge increase in their customer base.
“During Covid, we added over 2,000 direct community pharmacies that started buying products from us, and it was those that were offering in-store testing for Covid. Some were setting up testing centers, maybe even outside the pharmacy to service the communities,” Drapeau said. “That’s really what started it. Prior to that we did have some clinical pharmacies that were doing basic biometric screening, such as cholesterol, corporate wellness testing, and probably A1C testing, but it was very limited.”
With POCT and its uniquely developed technology, it’s now set to become a staple of modern health care. The tests produce reliable, rapid results and help identify and monitor acute infections or chronic disease. In fact, GlobalData analysts predict that the POCT market will grow by 2.2% yearly. Plus, with the new range of devices that can detect a variety of diseases, global revenues from POCT could exceed $25 billion by 2028.
THE FOUR PRIMARY GOALS OF POINT-OF-CARE TESTING ARE:
• Identifying the disease
• Monitoring the disease
• Modifying behavior
• Breaking down barriers to care
“Flu A&B just got approved for home testing,” Drapeau said. “There’s never been a flu A&B home test available. Pharmacists may not know that these tests are now available.”
The reason for this, Drapeau said, is that anyone who is going to draw blood, urine, or saliva from the human body and try to provide a diagnosis or treatment must have a waiver. To get a waiver, go to the Center for Medicaid Services website (cms.gov) and look up how to get a CLIA certificate. Then, find the CMS form 116 to fill out. A medical doctor needs to sign off on it, and you’ll need to pay the $150 fee.
“Obtaining a CLIA waiver is easy and is the first step in your pharmacy being able to provide a number of testing products,” Smock said.
Once a pharmacy has CLIAwaived, they can download the guide from NCPA on how to start point-of-care testing.
“The NCPA guide is an excellent resource. It directs you toward the point-of-care testing certificate, which would be good to have as well as the process for the CLIA waiver,” said Griff Danheim, Pharmacy Channel Strategy Advisor at CLIAwaived.
A PARTNERSHIP THAT WORKS
CLIAwaived recently partnered with Workflow Services, a company that enables pharmacies to deliver different types of clinical services.
“For pharmacies looking for an application to help them get the word out about services and the ability for patients to download an app and book a flu screening appointment, Workflow Services offers a great app that does just that,” Drapeau said.
Workflow Services offers scheduling apps, reporting apps, and they have all the HIPAA-compliant reporting technology to text and email results after engagement with the pharmacy.
“Anything that the pharmacist does in front of the counter, we have a system that can help them manage it,” Shannon Brekendorff, VP of Technical Solutions with Workflow Services by ImageMover, said.
Medical billing is quite different than the billing from the past through the pharmacy management system. No longer do you have to know you’re doing a strep test and its associated CPT code. It’s already built into the platform.
“With a turnkey solution, you don’t have to figure out how you’re going to manage your patients or how you’re going to charge for the services. We do that for you. We help you set up your website, and you can set your cash-pay price for
all the different services you offer,” Brekendorff said. “At the end of an encounter, you save it. The patient goes on their way, and you go on to your next thing.”
As a pharmacist, you don’t have to be hands-on with the Workflow system. It's so easy that your techs can do it, and you’ll have a high-level overview on everything.
“We help independent pharmacists with every step,” Robert Merry, Business Development Associate with Workflow Services, said. “Whether you want to do cash pay or get credentialed with medical billing, we’re going to remove a lot of that administrative burden that comes with getting set up with pairs. Then, we’re going to handle the claims management at the end to make sure your pharmacy gets paid. We also follow up to make sure that every single claim gets paid.”
It’s important to note that, according to the National Community Pharmacists Association (NCPA), each state has its own regulatory requirements on what their pharmacists can or cannot do as it relates to pharmacy-based POCT services, such as:
• Order lab tests
• Administer lab tests
• Interpret the results of the lab test
• Prescribe medication based on the results of a lab test
In fact, requirements for POCT in pharmacies vary by state and may include such things as collaborative practice agreements (CPA), additional certifications, or written protocols.
HOW TO IMPLEMENT POCT IN YOUR PHARMACY
According to the NCPA, you need to consider several things when you’re setting up your pharmacy to offer point-of-care testing (POCT) services.
First, you need to establish legality by preventing liability. Ensure protocols are in place that define POCT procedures for each device used and disease state encountered. Most liability insurance policies will cover appropriate legal practice in terms of dispensing, immunizations, and point-of-care testing.
Following the manufacturer testing instructions is vital, as is obeying CLIA regulations. If your pharmacy is providing vaccinations, you should already have policies in place regarding record keeping, needle-stick prevention, blood-borne pathogen training, and proper disposal of sharps and samples.
Test-to-Treat: Flu
Test-to-Treat: Strep
NEEDED SUPPLIES
You can purchase POCT supplies directly from a testing device manufacturer. However, it would be wise to have more than one supplier. Some pharmacy wholesalers also have programs that provide POCT protocols, resources, supplies, business guidance, and more to help pharmacies elevate their POCT services.
POCT supplies you may need:
• CLIA-waived POCT tests
• HbA1c and blood glucose
• Cholesterol
• Urine albumin
• Strep test
• Mononucleosis
• UTI
KNOW YOUR CUSTOMER
Before you jump into marketing strategies, you need to understand your target market thoroughly. You don’t want your campaign to fall flat. So, here are some tips on how you can get to know your customers even better:
• Talk to your patients: Have your staff engage in conversations with them to get insights into what their needs and preferences may be. You can also conduct a formal Q&A survey.
• Determine your demographics: Does your pharmacy cater to an elderly population, families with children, or busy executives? Once you know, you can adjust your tests and messaging properly.
• Analyze your competition: Find out what urgent care centers or same-day clinics offer around your area of town. Don’t forget their pricing and accessibility. See if you can identify any gaps in their service and then focus on filling them.
THINGS TO CONSIDER FOR YOUR BUSINESS PLAN
• Where will POCT testing take place in your pharmacy?
• What tests will your pharmacy administer?
• What services are local competitors providing?
• Tuberculosis purified protein derivative test
• STIs
(Source: NCPA.org)
• Who is your target market?
• How will you advertise the services?
• What training does your team need?
• How will test results be reported to patients, physicians, and any required public health agencies?
• What additional resources will you need for counseling patients?
• How can you best use your support staff to make this service doable?
(Source: NCPA.org)
MAKE USE OF SOCIAL MEDIA MARKETING
Reach a broader audience by using social media. Let others know about your services and address potential questions and concerns about new services like POCT. Answer common queries such as appointment requirements, walk-in availability, duration, costs, required documentation, and operating hours.
Here are some types of posts you can incorporate:
• Educational: Inform your audience by sharing video clips, photos, infographics, or live Q&A sessions with healthcare experts.
• Customer testimonials: When someone lets you know they’re a satisfied customer, ask them if you can capture a video of their testimonial. Or, if someone videos their own testimonial, ask if you can share it on your social media pages.
• Promotions: Countdown timers and flash sales are fun ways to promote special offers. You can also encourage family or group testing by offering multiple-test discounts.
MARKETING TO YOUR PATIENTS
Keep your customers coming back with these simple, in-store, low-cost marketing strategies:
• On the walls and in their hands: Create flyers, posters, and signage with vibrant colors and clear, concise messaging throughout your pharmacy. Posters should be placed strategically where your patients spend the most time, such as waiting areas, cash registers, and the drive-thru lanes.
• Bag stuffers: Use bag stuffers to promote different POCT services you provide in your pharmacy. Offer discounts or special promotions to encourage customer purchases.
• Trained staff: Your staff needs to be knowledgeable and comfortable discussing POCT with patients. Provide regular training sessions to improve their ability to upsell and cross-sell related products.
PARTICIPATE IN COMMUNITY HEALTH EVENTS
This is a great way to position your pharmacy as a healthcare hub. You can offer free or discounted tests during local health events. Establish expertise by presenting educational material.
MAKE USE OF LOCAL MEDIA
Spread the word of your pharmacy services through local media outlets, such as TV, radio stations, and community newspapers or magazines. When you’re planning to launch a new POCT service, send emails to these same media outlets. You can build relationships with them by keeping them updated on your clinical products and services by emailing them regularly.
IMPLEMENT A REFERRAL PROGRAM FOR YOUR POCT SERVICES
You can grow through referrals by following these steps:
• Determine the reward amount
• Establish guidelines and logistics
• Track performance
• Train your team
• Promote to the world
START A THANK-YOU CARD PROGRAM
After a patient undergoes testing, send them a handwritten thank-you card. This gesture enhances referrals.
EVALUATE YOUR MARKETING EFFORTS REGULARLY
Track key performance indicators (KPIs). Focus on 3-4 essential KPIs, such as the total number of tests performed, gross sales, referrals, and customer feedback. Keep an open mind and be ready to change your strategies based on both performance metrics and customer feedback.
DRUG-INDUCED NUTRIENT DEFICIENCIES
Recommend OTC products and increase your front-end sales
Your patients may or may not know that the medications they’re taking could be harming them. In fact, a large number of prescription medications deplete the body of vital nutrients. This can lead to unwanted side effects and can potentially worsen chronic conditions.
You are in an ideal position to counsel patients on prescription and over-the-counter (OTC) medications that cause nutritional deficiencies. You can help your patients who are on these medications maintain a healthy nutritional status by recommending the appropriate OTC products to boost levels of nutrients.
Here are the 10 most common types of nutrient-depleting medications along with the nutrients your patients should look for in OTC products to get their levels back on track.
1. PROTON PUMP INHIBITORS (PPI s)
PPI medications target proton pumps and inhibit stomach acid production. While they might temporarily reduce heartburn, many patients’ heartburn returns due to lower stomach acid levels and causes a continuous cycle of overprescribing different types of acid-blocking medication.
The common nutrient depletions from taking PPIs are:
• Vitamin B12: Gastric acid inhibitors slow the release of hydrochloric acid (HA) into the stomach and interfere with vitamin B12 absorption from food.
• Folic Acid, Iron, and Zinc: Long-term use of acid-reducing medications decreases stomach acid production and leads to deficiencies.
• Calcium: Calcium is absorbed in the small intestine and requires stomach acid for the absorption process. Some studies have found an association between proton-pump inhibitors (PPIs) and an increase in osteoporosis and bone fractures, especially with prolonged use of the medications.
• Magnesium: Chronic PPI use has shown reports of hypomagnesemia. Supplements weren’t successful in reversal until PPI therapy was discontinued.
2. ANTIBIOTICS
The “good” bacteria inside the gut can be killed off by taking antibiotics. These bacteria are beneficial for nutrient absorption in the food we eat. Therefore, disruptions can lead to micronutrient deficiencies due to decreased absorption from the food consumed.
The common nutrient depletions from taking antibiotics are:
• B Vitamins, Potassium, and Biotin: Disruptions in the gut flora can cause low B vitamins, potassium, and biotin levels due to decreased absorption of these in the GI tract.
• Calcium, Iron, Magnesium, and Zinc: Taken concurrently with antibiotics, absorption of both can be affected.
• Vitamin K: Because vitamin K is made by the bacteria in the gut, imbalances in the gut bacteria can affect vitamin K levels.
3. ANTIPSYCHOTICS
These medications alter brain chemistry to help reduce psychotic symptoms, such as hallucinations, delusions, and disordered thinking. Because antipsychotic drugs block some of the dopamine receptors in the brain, the flow of these messages is reduced, which can help to reduce psychotic symptoms.
The common nutrient depletions from taking antipsychotics are:
• B Vitamins, Folic Acid, and Inositol: Antipsychotics, like lithium, can inhibit the absorption of B vitamins and folic acid and lead to lower levels in the body. So, an ongoing supply of B vitamins need to be available as co-factors to help manufacture the needed neurotransmitters, such as serotonin and dopamine.
4. ANXIETY MEDICATIONS (BENZODIAZEPINES)
For patients who suffer from panic attacks or extreme fear and worry, anxiety medications reduce those symptoms. Benzodiazepines enhance the activity of the neurotransmitter GABA, a brain chemical that helps you feel calm. However, their effect also produces drowsiness, which makes it easier to fall asleep and stay asleep.
The common nutrient depletions from taking anxiety medications are:
• Calcium: Anxiety medications decrease calcium absorption by increasing vitamin D metabolism. Vitamin D is needed for calcium absorption.
• Melatonin: Taking benzodiazepine long term can impair the endogenous melatonin rhythm. This can induce or aggravate sleep disturbances.
5. BIRTH CONTROL (ORAL CONTRACEPTIVES)
All hormonal contraceptives contain a small amount of human-made estrogen and progestin hormones. These hormones inhibit the body’s natural hormones to prevent pregnancy.
The common nutrient depletions from taking oral contraceptives are:
• Vitamin B6: Tryptophan metabolism, an indirect measure of vitamin B6 status, is abnormal in those who take oral contraceptives.
• Vitamin B12: Lower levels are found in oral contraceptive users. The medical theory is they affect circulating protein levels.
• Folate: Levels decrease due to increased metabolism and urinary excretion of folate.
• Magnesium: Estrogen is responsible for depleting magnesium.
6. BLOOD PRESSURE MEDICATIONS
These medications work in different ways to lower blood pressure, so there are several types of depletions that can take place.
The common nutrient depletions from taking blood pressure medications are:
• CoQ10: Statin treatment lowers serum CoQ10 levels in hypercholesterolemic patients, especially the elderly. It’s still unclear why.
• Melatonin: Beta-blockers have been shown to reduce melatonin production through specific inhibition of adrenergic beta 1 receptors. Central nervous system side effects of sleep disorder and nightmares while on beta blockers are related to reduced melatonin levels.
• Zinc: ACE inhibitors may increase the risk of zinc deficiency. The effect is more pronounced with captopril than with other ACE inhibitors.
• Iron: Due to the downregulation of nitric oxide synthesis, ACE inhibitor use can decrease iron levels.
• Potassium: Calcium channel blockers, beta-blockers, and ACE inhibitors are known to deplete potassium levels.
7. STATINS
Statin drugs slow down the liver’s production of cholesterol and lower LDL cholesterol. They’re also known for increasing the liver’s ability to remove LDL cholesterol already in the blood.
The common nutrient depletion from taking statins is:
• CoQ10: The depletion of CoQ10 can lead to serious side effects, including muscle pain and weakness, depression, and heart failure.
8. CORTICOSTEROIDS
Corticosteroids relieve inflammation, pain, and discomfort resulting from various health conditions.
The common nutrient depletions from taking corticosteroids are:
• Calcium and Vitamin D: Corticosteroids decrease the number and function of bone cells. They also prevent the absorption of calcium and vitamin D.
• Electrolytes: Electrolytes like sodium and potassium are depleted with steroid use due to increased elimination of these minerals.
9. ORAL HYPOGLYCEMICS
Oral hypoglycemic drugs are used to treat type 2 diabetes.
The common nutrient depletion from taking oral hypoglycemics is:
• B12: Metformin blocks the absorption of vitamin B12. However, it hasn’t yet been established how.
10. DIURETICS
Diuretics deplete the body of nutrients through increased excretion of these minerals through their diuretic effect on the kidneys.
The common nutrient depletions from taking oral diuretics are:
• Sodium: Diuretics depend on sodium to help remove water from your blood and increase sodium in the urine.
• Magnesium, potassium, and zinc: Loop and thiazide diuretic action interferes with magnesium, potassium, and zinc.
• Folic acid: One study has shown that people taking diuretics for more than six months had dramatically lower blood levels of folic acid and higher levels of homocysteine compared with individuals not taking diuretics.
• Calcium: Thiazide diuretics reduce calcium excretion by the kidneys and might increase the risk for hypercalcemia, metabolic alkalosis, and possible renal failure.
(Source: rupahealth.com)
By setting yourself up as the drug expert and recommending the appropriate vitamins, your pharmacy’s front-end sales will increase, and word of mouth will spread throughout your town.
PROTECT YOUR PHARMACY
How to choose the right insurance policies
Anything can happen in your community pharmacy. A tornado can blow through and cause a lot of damage. A delivery driver might get in a fender bender. A customer might slip and fall. Or an employee might get injured. How would you pay if any of these happened?
Unplanned expenses like these are rough, which is why it’s vital to protect your valuable business assets with the right type of insurance. Business insurance for pharmaceutical companies is important, because you’ll find most other insurance companies have coverage forms that exclude a lot of what pharmacists do daily. So, make sure you’re getting the right kind of coverage for your pharmacy.
There are numerous ways things can go awry. Here is a list of available coverage options to determine which policies are best suited for your pharmacy:
PHARMACY BUSINESS OWNERS POLICY (BOP)
With a business owners insurance policy, general liability coverage is rolled into a larger policy with several different pieces you can tailor to your company’s needs. It adds physical and intangible asset protection based on the size and type of your business and the options you select.
A business owner’s policy shields against:
• Damage to inventory, equipment, and other business property
• Lawsuits over customer injury or property damage on your premises
• Lawsuits related to faulty products
• Lawsuits related to advertising injuries
• Temporary closure
PHARMACY GENERAL LIABILITY INSURANCE
This helps cover claims that your business caused, such as bodily injury or property damage to someone else’s belongings. For example, if one of your customers falls and injures themself inside your pharmacy, then a general liability policy will protect you from having to pay associated damages. This insurance will also protect you from liability over products you sell as well as protect your physical business assets.
PROFESSIONAL LIABILITY INSURANCE
You have a lot to keep track of day in and day out at your pharmacy, so naturally, mistakes and accidents can happen. However, professional liability insurance, also called errors and omissions protection, will protect you from the expenses caused by professional mistakes.
PROPERTY AND CASUALTY INSURANCE
This insures the building and business property within the building. This includes prescriptions, over-the-counter merchandise, improvements, and office furniture. This is insurance you’ll need if your pharmacy experiences loss due to a natural disaster or theft.
COMMERCIAL PROPERTY INSURANCE
This coverage helps protect your owned or rented building and equipment you use to run your pharmacy, including:
• Scales
• Shelves
• Pills and drugs
• Computer systems
WORKERS’ COMPENSATION
If an employee is injured on the job, workers’ compensation will provide unlimited medical expense coverage and will provide loss of income protection while your employee is recovering. Most states require that businesses with employees carry worker’s compensation coverage.
COMMERCIAL AUTO INSURANCE
This will cover any delivery vehicles your pharmacy has. It’ll provide protection in case the vehicle is damaged in an accident. It also protects your pharmacy from lawsuits against damage your driver caused to another party while using the vehicle.
UMBRELLA INSURANCE
If you want to increase liability limits on your auto, general liability, and professional insurance policies, this is it. Think
of it this way: If your professional liability insurance has a $1 million limit and your umbrella policy has a $1 million limit, that gives you $2 million in coverage.
CYBER LIABILITY INSURANCE
If your data is compromised, this insurance will protect your pharmacy. Also, if your pharmacy’s private health information is compromised by a hacker, cyber liability insurance will cover the fines and penalties associated with HIPAA and the cost of notifying everyone affected.
While you may be happy with your coverage from an agency that has experience with pharmacies, you shouldn’t blindly renew your policies year after year.
EMPLOYMENT PRACTICE LIABILITY INSURANCE
This insurance will cover your pharmacy if an employee sues for wrongful termination, discrimination, or harassment. While this isn’t usually covered by a general liability insurance policy, it can be built in at a nominal cost.
BUSINESS INTERRUPTION INSURANCE
Having to temporarily close your pharmacy can lead to longterm financial issues, especially since you depend on daily transactions. Business interruption insurance can reimburse your pharmacy for lost revenue and other expenses related to closure caused by a covered loss. So, if your pharmacy needs to close for several weeks for renovation after a fire, business interruption insurance would cover your lost profits and normal operating expenses, including payroll.
While you may be happy with your coverage from an agency that has experience with pharmacies, you shouldn’t blindly renew your policies year after year. While the coverage could remain flawless, your insurance company may be passing on unjustified rate increases that are cutting into your pharmacy’s bottom line. If you notice that happening, it’s time to shop around.
OUTLOOK THE ART OF APOLOGIZING
How and when to tell patients you’re sorry
Mistakes can happen in your pharmacy. When they do, an apology goes a long way in easing the situation.
After causing a patient an inconvenience or when a serious mistake happens, saying you’re sorry can help smooth over an error and prevent a lawsuit. Giving a heartfelt apology will leave you and your patient feeling better about the situation.
A bad apology, on the other hand, can be worse than no apology at all. If you rush an apology, it will feel insincere to your patient. And if you wait too long to apologize, one small mistake can get blown out of proportion and become a huge offense. You don’t want your pharmacy exposed to unnecessary liability.
However, no matter what, say you’re sorry. It might be difficult, especially if you don’t agree with their complaint. But remember that apologizing doesn’t mean you’re agreeing with their complaint or accepting blame for it. It’s just for the inconvenience your patient is dealing with. By doing this, you’re showing them that you listen and are going to try to resolve the situation.
Here are some tips you can use when making an apology that can benefit both your patients and your pharmacy.
ACTIVELY LISTEN
When a patient comes to you with a complaint, listen actively. By doing so, you’ll be better able to understand what headspace they’re in and determine the best way to help them.
Once they’ve said their piece, agree that what they’ve experienced is frustrating and then validate their feelings. You may not feel that their complaint is legitimate, but what matters is they feel something is wrong.
Repeat what they’ve said to confirm you’re on the same page, and then assure them that you understand and are taking it seriously. There are times when just having their position validated will help appease an upset patient.
COOL OFF
It’s natural to want to respond immediately when you receive a complaint from a customer. However, the best idea is to take a break to collect yourself before addressing criticism. Allowing
yourself to get some perspective for even a few minutes will help when you have an irate patient. Step back and take a few deep breaths before you jump into the complaint.
HAVE A PLAN
When an error occurs in your pharmacy, you need to have a plan in place. Writing up an outline for apologizing can get your thoughts together before a face-to-face interaction. It allows you and your employees to organize thoughts and put together professional responses before speaking with upset patients. This will keep everyone more focused and less flustered.
APOLOGIZE
If there’s been a mistake with a patient’s medication, correct it and apologize as soon as possible. Help control the damage it may have caused by contacting the patient immediately. If you catch a mistake early enough, you will probably be able to fix it before they leave your pharmacy.
EXPLAIN THE MISTAKE THOROUGHLY
If a patient received the wrong medication, explain what the medication does and how it might affect him or her. Do this
even if the wrong medication will have little to no effect. Your patient will want to know, and this will put the entire mistake to rest without having multiple conversations.
CONTACT YOUR PATIENT’S DOCTOR
Contact your patient’s doctor after a mistake has been made, especially if the two of you have a good relationship. As members of the patient’s healthcare team, work together to assess any damage and decide what needs to be done.
It’s also important for doctors to know about any medication mistakes so they have a complete and accurate medical history. Consider apologizing to the doctor, as well, to avoid jeopardizing the trust and relationship you currently have with each other.
WHEN APPROPRIATE, COMPENSATE
A verbal apology is sometimes the most appropriate compensation for small inconveniences, such as a longer wait time. But for more serious mistakes, like filling the wrong prescription or forgetting to give a patient both prescriptions, it’s best to provide some kind of compensation.
Small gestures of compensation along with apologies can go a long way to calm a frustrated patient. Consider refunding the patient’s out-of-pocket cost for a prescription that was filled incorrectly, offer a percentage off a future front-end purchase, or offer them a gift card.
ASK FOR HELP
It can sometimes be hard to know which type of apology to make, or if an apology is needed. If you’re unsure, consult with your risk manager, insurance company, or state pharmacy association.
AVOID LEGAL ACTION WITH APOLOGIES
According to Sorry Works!, an advocacy group promoting medical professionals’ use of disclosure, empathy, and
apologies, you can potentially deter lawsuits, litigation, and settlements by using their strategies. You can also reduce anger and make patients and their families less likely to pursue legal action.
FOLLOW UP
By making up for a bad experience, you can actually make a patient more loyal than they were before the incident because it shows how much you care about them.
Always follow up with patients after a complaint. Keep them loyal by apologizing and finding out if they’re still satisfied with the solution. While you may not be able to win back everyone with a complaint, don’t dismiss all of your patients who complain as lost causes.
BONUS TIPS FOR HANDLING COMPLAINTS
Don’t take it personally
It’s easy to get offended by someone complaining about your pharmacy and the services you provide, especially if the patient is downright rude. However, don’t take it as a personal attack. The complaint, even if not delivered politely, could give you useful information to improve your business.
Try not to let your emotions get the best of you when handling a complaint. Otherwise, you could risk losing that patient’s business forever. And if they tell their friends and family in the community, it might damage your wider reputation.
Never challenge the patient
When a patient comes to you with a complaint that’s based on their own misperception or unreasonable expectation, it’s easy to want to push back. However, challenging an upset patient is one of the quickest ways
to blow things out of proportion. Instead, accept your patient’s version of events while talking to them. If you question what they’re telling you, it’ll make the patient feel like you’re saying you don’t believe them. You can go back to your employee later to get their side of the story; but in the moment, assume the patient’s story is accurate.
Let experience be your teacher
Whether or not the complaint was justified, every dissatisfied customer provides an opportunity to learn and improve your processes. Document each complaint and what action was taken to remedy it. Having a concrete record will help you implement improvements.
While not every complaint will lead to a major change to your procedures, it’s important you don’t dismiss complaints without thinking about how to avoid them in the future.
