E
ELEMENTS FROM RED TO BLACK Where to cut costs when you have no other choice
READY FOR ROLLOUT The Covid-19 vaccine boosts this pharmacy’s patient base and its profits
5 Lucrative Ways to Monetize Your Pharmacy VOL. 10 ISS. 1 | MARCH 2021 | PBAHEALTH.COM/ELEMENTS
COMPREHENSIVE COVID-19 Solutions Powered by PrescribeWellness
Transform your practice into a healthcare destination through comprehensive COVID-19 pharmacy solutions
Filtering Capabilities Target COVID-19 vaccination-eligible patients within moments and identify patients in need of 1st and 2nd doses.
Communications and 2nd Dose Reminders The PrescribeWellness solution enables pharmacists to: • Inform patients of vaccine availability through customized voice/text communications and marketing kits. • Automatically connect with patients who are due for their 2nd dose with effective reminders through predictive analytics. • Schedule 2nd dose appointments with a Custom Calendar.
State and Federal Reporting Leverage continually updated fields, aligned with CDC requirements, designed to ensure compliance with COVID-19 vaccination guidelines - including reporting to your state’s IIS and federal programs (where applicable).
Contact-free Vaccination Intake & Scheduling Introduce convenience and safety through online pre-screening and appointment scheduling.
Connect with our team: sales@prescribewellness.com or (800) 960-8147
18
CONTENTS ON THE COVER
18 FEATURE
| 5 Lucrative Ways to Monetize Your Pharmacy
harmacy owners share their most profitable P revenue streams
DEPARTMENTS
06 NEWS
| A Shot for Techs
new training program qualifies technicians to administer A Covid-19 vaccines in a single day
08 TRENDS FEATURE | 5 Lucrative Ways to Monetize Your Pharmacy
22
| What to Expect When You're Inspected
How to pass any surprise pharmacy inspection with flying colors
12 RETAIL
| Supplement Your Sales
he supplement market is thriving. Is your pharmacy T taking advantage?
16 SOLUTIONS
24
26
ap into loyalty for bigger profits, happier employees, and T faster growth
SPOTLIGHT | Ready for Rollout he Covid-19 vaccine boosts this pharmacy’s patient base T and its profits
MONEY | From Red to Black Where to cut costs when you have no other choice
30 OUTLOOK
| From Patient to Promoter
| Flip the Pharmacy
How to transform pharmacies into patient care centers
ELEMENTS | The business magazine for independent pharmacy | MARCH 2021
RETAIL | Supplement Your Sales
3
E
ON THE WEB
ELEMENTS
The business magazine for indpendent pharmacy
VOLUME 10, ISSUE 1
Find more strategies, tips, and expert advice to improve your business.
MARCH 2021 PUBLISHER & EDITORIAL DIRECTOR Matthew Shamet EDITOR Greyson Honaker SR. ART DIRECTOR Brenda Reagan
How to Lose Your Best Employees Keeping employees around for a long time benefits your bottom line and the long-term viability of your pharmacy business.
CONTRIBUTING WRITER Erin E. Rand
INTERESTED IN ADVERTISING? elements@pbahealth.com
Independent Pharmacy Key Performance Indicators These are the most critical formulas to measure the success of your business. Learn how to use them to improve performance and profitability.
Can You Require Employees to Get a Covid-19 Vaccine? Now that Covid-19 vaccines are rolling out, here’s what you need to know about requiring employee vaccination.
Follow Elements magazine on Facebook, Twitter and Elements magazine is published quarterly by PBA Health. Copyright© 2021 PBA Health. All rights reserved. Neither this publication nor any part of it may be reproduced without written permission by PBA Health.
2
pbahealth.com/elements
Instagram for pharmacy business tips and advice, news announcements, industry information, and exclusive offers.
@PharmacyLender Member FDIC | Equal Housing Lender
Experience Matters Preferred Lending Partner of the SBA* R.Ph, PharmD, current and former owners on our team Nearly a century of investing in small business
How We Can Help Acquisition & Real Estate Equipment financing Expansion & remodeling Business refinancing Start-up loans
“Anytime I needed my lender, he was there, even after hours.” — Amy, South Carolina
“To be honest, I can’t think of one thing that was negative about the loan process.” — Patrick, California *Approved to offer SBA loan products under SBA’s Preferred Lender Program or SBA Express Program.
Year Old National Lender
Years of Pharmacy Experience
Committed To Community Pharmacy
First Financial Bank is proud to partner with over 50 different pharmacy organizations! With our high-touch model, we want to know you and your story, so we can deliver a customized solution to help you accomplish your goals.
Drew Hegi, MBA Loan Officer Pharmacy Owner (601) 594-6237 dhegi@ffb1.com
Bo Garmon Loan Officer (479) 856-3001 bgarmon@ffb1.com
Bob Graul R.Ph, MBA Business Development Consultant (619) 993-3096
Larry Alexander Managing Director (832) 244-9656 lalexander@ffb1.com
ELEMENTS | The business magazine for independent pharmacy | MARCH 2021
5
NEWS
A SHOT FOR TECHS A new training program qualifies technicians to administer Covid-19 vaccines in a single day
O
nce the coronavirus pandemic landed in the United States
and forced the country into lockdown, many people stopped
This option allows the pharmacy to train as many technicians as it
going to their physician and neglected routine preventive healthcare
Another unique feature is the option to purchase a ″site license.″
wants within the calendar year. This would be ideal for a pharmacy
like getting immunizations. This gap in preventive care motivated
with a large staff, but would also benefit any pharmacy that expects to
the Department of Health and Human Services (HHS) to authorize
offer the vaccine for the rest of the year. ″In the technician world, you
state-licensed pharmacists and interns to administer childhood and
have some turnover,″ Potter said. ″So the pharmacy is paying to get
Covid-19 vaccines in August and September. A month later, looking
that technician certified and then they leave. Through this site license
at the vast challenge of rapidly inoculating more than 300 million
model, a pharmacy can certify and train all their technicians if they
Americans, the agency released another guidance authorizing
wanted to.″ A site license costs $399 while an individual costs $149.
pharmacy technicians to administer Covid-19 and childhood vaccines.
The authorization came with some requirements, one of them
being a practical ACPE-approved training program. To help technicians
7 TRAINING MODULES
fulfill this requirement, PRS Pharmacy Services, a consulting firm that specializes in helping pharmacy owners, has partnered with the
The National Pharmacy Technician Association’s vaccination training program takes technicians through six online modules, plus a hands-on skills assessment in person. The modules cover the following topics:
National Pharmacy Technician Association (NPTA) to offer a program designed to rapidly train pharmacy technicians to administer these vaccines. This new program was developed by NPTA under the guidance of HHS.
1. Vaccine-preventable diseases
According to the NPTA, the ″Immunization Administration
2. What is a pharmacy-based immunization service?
Training Program is by far the most affordable, accessible and
3. Storage and handling
scalable program of its kind. The program has been designed to train
4. Vaccine administration
hundreds of thousands of technicians within weeks, enabling the
5. Vaccine safety
rapid deployment of vaccines to the public.″
6. Increasing the awareness of the immunization service
ALL IN A DAY’S WORK
7. Hands-on training and skills assessment
With this program, technicians can become qualified to administer vaccines in a single day. The training is online and on-demand, and it takes about seven hours to complete. The program consists of seven modules, culminating in a hands-on training and skills assessment, which is another requirement from HHS. The pharmacist performs the hands-on training right there at the pharmacy, and if they need guidance for that, they’ll receive it from the program. ″One of the things the NPTA is doing is making sure the pharmacists are capable of doing that,″ said Josh Potter, director of compliance for PRS Pharmacy Services. ″They are basically training the pharmacist on how to do this hands-on skills assessment of the pharmacy technicians.″
The on-demand aspect of the training, especially for the
hands-on portion, sets this program apart from others, Potter said. NPTA’s training can be done entirely at the pace preferred by the technician and pharmacist. With other programs, the technician might have to sign up for a Zoom training on a particular day, and if other technicians need training, they may have to wait until the next scheduled meeting, which could be as much as a month away.
STATE QUALIFICATIONS To be considered a ″qualified pharmacy technician,″ the HHS guidance says: ″Pharmacy technicians working in states with licensure and/ or registration requirements must be licensed and/or registered in accordance with state requirements; pharmacy technicians working in states without licensure and/or registration requirements must have a Certified Pharmacy Technician (CPhT) certification from either the Pharmacy Technician Certification Board or National Healthcareer Association.″ This additional requirement makes things more difficult for technicians in certain states and is something to keep in mind, Potter said.
Although this expansion of the technician’s role will help with
Covid-19 vaccine uptake, Potter sees it as part of the larger trajectory of the pharmacy industry. ″We’ve seen more pharmacies starting to get into the clinical aspect of pharmacy and the administration of drugs and vaccines,″ he said. ″It’s something that’s the logical next step,
6
pbahealth.com/elements
utilizing the technician to do more tasks.″
Al Underwood 877.766.0321 questions ? Call
SUNGLASSES & SUN-BIFOCALS
READERS
FRANKLIN EYEWEAR® “BOUTIQUE” SUN AND READING GLASS DEALS Displays hold 72 pair plus Storage Base!
FREE DISPLAY! FREE SHIPPING!
Base 14” square, 66” tall – $200 Value
Al Underwood, Owner
Reading Glasses – Color Coded by Strength 144 pair $6.99 Readers @ $3.50 each FREE BOUTIQUE DISPLAY INCLUDED Deal #FRB72
$ 504.00 0.00 Total cost $ 504.00
Sunglasses – Color Coded by Category 108 pair $6.99 Sunglasses @ $3.50 each 36 pair $9.99 Polarized & Sun-Bifocals @ $5.00 each FREE BOUTIQUE DISPLAY INCLUDED Deal #FSB72 Total cost
$ 378.00 $ 180.00 0.00 $ 558.00
Displays are plan-o-gramed with labels to match the price tags on all glasses. This helps you keep your display organized for maximum sales, and simplifies re-orders.
See My See My
MORE AT WWW.FRANKLINEYEWEAR.COM questions?
Al underwood at 877.766.0321
refills: Sunglasses: $42 dozen assorted Sun-Bifocals & Polarized: $60 dozen assorted Sunglasses
Video
Video
$699 retail$350 cost
readers
$699 retail$350 cost Always A Variety Of Styles
refills $42 dozen assorted
sun-bifocals & polarized
We hand pick a mix of men’s and women’s, trendy and traditional styles.
$999 retail$500 cost 1.25 Diopter
6 99
$
4.00 Diopter
6 99
$
Price Tags Color Coded By Strength
SINCE 1975
www.franklineyewear.com
ELEMENTS | The business magazine for independent pharmacy | MARCH 2021
P: 877.766.0321
7
F:877.766.9542
TRENDS
WHAT TO EXPECT WHEN YOU’RE INSPECTED How to pass any surprise pharmacy inspection with flying colors
W
hen someone walks through your pharmacy door and
disaster recovery plans, and your privacy practices. Based on your
says they are there to conduct an inspection, a hundred
staff’s answers, they may decide they need to stay and assess the
questions might fly through your head. Where are they from? What
pharmacy more thoroughly.
are they going to look for? And where did I put those OIG exclusion
verifications?
verify you’re meeting federal requirements around Medicare Part D
and will verify that you are maintaining OIG exclusion verifications.
Pharmacies have to abide by so many rules from so many
And then there is the notorious PBM auditor. They will check to
different organizations, the thought of getting inspected is enough
They will check your licenses and audit your prescription files.
to make a pharmacist’s palms sweat. Jeff Hedges, president and
Although some PBM audits are done online, other times auditors
CEO of R.J. Hedges & Associates, knows just how hard it is to stay on
will just show up.
top of every regulation and rule from every organization that might
conduct an inspection. ″There was hardly anything going on from
accreditation survey, which will feel similar to inspections. ″The
If your pharmacy is accredited, you will also be subject to an
a regulatory point of view when we started in 2006,″ he said. ″Now
difference is that you are paying the accreditation body for the
everything from the time pharmacies open their door to the time
surveyor to come in, and their primary requirement is to make
they close is regulated by someone.″
sure you are doing everything correctly, and then you can make
corrections to receive your accreditations,″ Hedges said.
But an inspector’s arrival doesn’t mean you should bring your
pharmacy up to DEFCON 1. If you spend a little time preparing, you’ll know exactly what to expect and an inspection will be a non-event. WHAT TO EXPECT The most challenging part of inspections is the number of different inspecting bodies that are all checking for different things. Among them are the Drug Enforcement Administration (DEA), the Centers for Medicare and Medicaid Services (CMS), the Office of Civil Rights, PBMs, and the state boards of pharmacy.
″The most common inspection is the state board of pharmacy
inspection,″ Hedges said. Every year, the state board of pharmacy inspector will verify that your licenses are current and posted. They will also check security measures to make sure patients can’t access anything behind the counter or see what’s on computer monitors.
The DEA is another common inspector. They typically look
for criminal background checks on staff members who handle controlled substances and check for DEA Form 222s. The challenge with the DEA, Hedges points out, is the requirement for paper copies. ″Pharmacies still have to maintain paper copies and initial each line item, then date them with the quantity received and attach it to the wholesaler receipt,″ he explained.
To make sure you are meeting HIPAA compliance
requirements, the Office of Civil Rights may come to inspect your pharmacy. They will ask your staff about your risk management plans, your risk analysis, your contingency or
8
WHO’S AFRAID OF THE BIG BAD INSPECTOR? Whether it’s a scheduled visit or a surprise pop-in, inspections are nerve-wracking. But if you get to know who the inspectors are and what they expect when they visit, the experience can be a breeze. Here are some of the inspecting bodies that could visit your pharmacy: State boards of pharmacy Centers for Medicare and Medicaid Services Drug Enforcement Administration Office of Civil Rights PBMs
pbahealth.com/elements
Accreditation organizations
BE READY To prepare for a pharmacy inspection, Hedges recommends starting with your policies and procedures. ″You go back 10 or 15 years, and most people had simple standard operating procedures
WHAT POLICIES DO I NEED?
written out on a piece of paper and it was not a big deal,″ he said. ″Now it’s a bigger deal. Especially on the federal side, you don’t get
When PBMs began auditing pharmacies, one item they required was comprehensive documentation of policies and procedures. Now, other regulatory bodies will check for that documentation, too. Below are some items you should include in your pharmacy’s policies and procedures:
dinged because you violated a rule, you get dinged because you didn’t follow your policies and procedures.″
Because following procedures is of the utmost importance,
training your staff so they all know the processes in place is crucial. Hedges recommends spacing out the training sessions. ″If you do everything at one time, everybody glazes over after about two sessions and it becomes a requirement that you have to suffer through,″ he said. ″If you schedule them throughout the year, you’re constantly being reminded of all these compliance rules. Plus, your training is a lot shorter and doesn’t disrupt pharmacy operations.″
After that, the biggest challenge is simply knowing what the
• Medication errors
• Inventory
• Recall procedures
• Patient counseling
• Partial refills
• Misfills and expiration
• Return to stock
• Brand and generic pricing
• H IPAA privacy and security
• Patient demographics
• H IPAA business associate agreements
rules are that you need to follow. ″Every day, something changes,″
• Allergies • And more
Hedges said. ″You have to have the time to understand what’s happening and how to comply with it. Sometimes it’s very simple and other times it’s very complicated.″
If that sounds impossible, it is a task that can be outsourced.
For example, R.J. Hedges & Associates writes all the policies and procedures for their clients, provides training to their staff, and stays on top of all current requirements. When an inspector walks in with their checklist, the pharmacy has the exact same checklist and will know exactly what the inspector is going to ask of them.
STAY CALM, CARRY ON
When the inspector shows up at your pharmacy, no matter what
Another critical part of being prepared is staying on top of your
documentation. When the pharmacy gets busy, keeping up with
agency or regulatory body they are from, Hedges gives the same
manual copies and making sure everything is up to date can fall by
advice: don’t panic.
the wayside, but that can come back to bite you. ″A good example
is the OIG exclusion verification,″ Hedges said. ″PBMs will pick a
before you speak. ″Listen to the questions being asked and provide
month and say, ‘I want to see your OIG exclusion verifications for
exactly what is being asked for,″ he said. ″Don’t give the inspector
This goes hand in hand with his second piece of advice: listen
March 2019,’ and you have to produce it!″
too much information, because that can open up Pandora’s box.″
He points out that some agencies use contractors to complete their
One mistake to avoid is relying on other pharmacists to give
you accurate information on what is important. ″I talk to a lot
inspections, and these contractors aren’t necessarily experts in
of pharmacies, and they will be told by another colleague that
how a pharmacy should be run. They rely on a checklist to tell them
you don’t need to do this or you don’t need to worry about that,″
what they should look for, so by talking too much and giving out
Hedges said. ″It’s easy to follow why, but a lot of times people have
too much information, you may raise a red flag that would have
old rules or they interpret them incorrectly.″
otherwise gone unseen.
Hedges added, ″When the inspector is there, you don’t want to
be in the back room calling a colleague and saying, ‘I don’t have this policy thing? Can you fax it over?’ It’s not a good thing to do.″
If you have your documentation ready and your staff members
are well-trained, an inspection doesn’t have to be a painful experience, Hedges said. ″For example, when the Office of Civil Rights comes in for a HIPAA inspection, they ask for four things. If your clerk is able to answer the questions and provide all of that, the inspector is going to look at it, say, ‘Great job, thank you very much,’ and walk out the door.″
On the other hand, if your clerk fumbles and has to ask
the manager about whether the pharmacy has the requested documents, the inspector could decide to spend all day with you, giving them more opportunities to catch errors and violations.
ELEMENTS | The business magazine for independent pharmacy | MARCH 2021
9
CONSEQUENCES OF CITATIONS After an inspection, if things have gone smoothly, you can go
other PBMs—so everybody is coming to pull back their money
back to your usual work. But if you receive a citation or deficiency,
because you’re in violation,″ Hedges said.
Hedges said, ″You have to remedy that action immediately.″ Just
like the inspection itself, the consequences for falling short depend
action quickly, because failing to respond can create even more
on which party is doing the inspection.
consequences. ″If you don’t respond to CMS when they request
If you’re given instructions to correct something, take
″You may get a deficiency letter from an inspector and have X
documentation, they can revoke your PTAN number,″ Hedges
number of days or hours to respond,″ Hedges said. ″For CMS, you
explained. ″Now, that’s for a 10-year period, so the pharmacy
have 48 hours if you miss anything. Depending on the deficiency,
owner can’t open up another pharmacy or DME during that 10-year
state boards may come back in 30 days to verify it’s been corrected.″
revocation period, or read a PTAN. Future PTANs are blocked by
CMS during this period.″
But it’s not always as simple as demonstrating you’ve fixed the
problem. If you miss something on a DEA inspection, you will find
yourself facing a fine of $14,000 per line item. And PBMs have a lot
mistakes. Get your documentation organized so it’s easily
of power to wreak havoc on your pharmacy if you fail to meet their
accessible the next time an inspector pops in. Conduct training with
The most important thing you can do is learn from your
expectations in an audit. One measure they might take is to cancel
your staff to make sure they know where things went wrong. And
your contract, eliminating your access to patients. If they come
set expectations for what they need to know and how they should
in and ask for a certain month’s OIG exclusion verification that
behave during future inspections.
you can’t produce, they can stop all reimbursement for Medicare,
Medicaid, and Tricare. ″Then they notify everybody else—all the
inspections with flying colors, the best defense is a good offense.
10
pbahealth.com/elements
When it comes to avoiding citations and passing your
THE Glucagon Emergency Kit from Fresenius Kabi is a cost-effective alternative to emergency solutions you have trusted for years.
NDC Number: 63323-582-82
Glucagon Emergency Kit FDA-Approved, Available Now
The FDA-approved Glucagon Emergency Kit provides flexibility and choice for your patients. Fresenius Kabi’s Glucagon Emergency Kit is a cost-effective alternative that meets the same quality standards as other products on the market. Fresenius Kabi is a global healthcare company that specializes in lifesaving medicines and technologies for infusion, transfusion and clinical nutrition. We are a leading provider of generic medications with a 100-year history of delivering innovative therapies that are safe, efficient and affordable. That’s how we bring confidence within reach.
A co -pay assistance program is available for your eligible patients. Pay As Little As $5 Per Kit* ACTIVATION IS NOT REQUIRED.
For more information visit GlucagonEmergencyKit.com Please see full prescribing information at www.fresenius-kabi.com/us *Subject to eligibility requirements and program terms and conditions at kabicare.us. THIS OFFER IS INVALID FOR PATIENTS WHOSE PRESCRIPTION CLAIMS ARE ELIGIBLE TO BE REIMBURSED, IN WHOLE OR IN PART, BY ANY GOVERNMENTAL PROGRAM.
0725-GLU-05-05/20
RETAIL
SUPPLEMENT YOUR SALES The supplement market is thriving. Is your pharmacy taking advantage? UNIVERSAL APPEAL So, who is buying supplements? In short, almost everyone. According to the Council for Responsible Nutrition (CRN) 2019 Consumer Survey on Dietary Supplements, 77 percent of all adults take dietary supplements.
While pharmacy clientele tends to skew older, supplements
provide an opportunity to reach a younger group of patients. CRN reports 70 percent of adults ages 18 to 34 take dietary supplements, which means promoting your supplement products can bring them into your pharmacy. ″I think there’s a bigger push for health and wellness these days, and millennials care a lot about their health,″ said Leach. ″Everybody uses them, but the younger generations are on a healthier kick than other generations.″ To appeal to this younger crowd, make sure to stock supplements in gummy, powder, liquid, and soft-chew forms, which CRN says the 18-to-34 crowd prefers.
Overall, adults who take supplements cited general health and
wellness as the top reason they include them in their healthcare routine. Other top reasons include energy, immunity, heart health, healthy aging, and filling nutrient gaps. Many patients start taking supplements on a doctor’s recommendation. Because certain drugs deplete certain nutrients in the body, doctors may follow up their prescription with a recommendation for a specific supplement to offset that depletion.
The Covid-19 pandemic has also caused an uptick in
supplement sales as patients become more concerned about their immunity in the face of a deadly virus. ″There was a lot of stockpiling that took place in March 2020, so we saw sales drop in April and May,″ said Leach. ″Since then, it has come back, and sales have been better than they were prior to Covid.″ Supplements such as vitamin C, vitamin D, zinc, and electrolyte powder increased in
I
n the last year, the supplement market netted $9 billion in sales, with a total of 828.8 million units sold, according to data from
Information Resources, Inc (IRI). If your pharmacy doesn’t have a comprehensive supplement section, you’re missing out on a piece
of that $9-billion pie.
″I believe that right now, people are thinking more about their
general health and immune support,″ said Kim Leach, national account manager for Quality Choice, a private label that includes a comprehensive line of supplements. Patients’ new concerns about health and immunity mean that even in an uncertain economy, supplement sales continue to thrive.
12
pbahealth.com/elements
demand because of the pandemic.
For those who aren’t yet taking dietary supplements, 49
percent told CRN they would consider adding them to their health routine if they were recommended by a doctor, and 15 percent said they would consider adding them if another healthcare professional—like a pharmacist—recommended them. WHAT’S HOT Pharmacies have limited shelf space, and the supplement market is vast. To get the most out of a supplement section, pharmacies have to research what kind of supplements consumers want right now.
SUPPLEMENTS STATISTICS This market is the biggest it’s ever been, with a majority of all adults in the United States taking some sort of supplement. Get to know the patients who can’t get enough of supplements. • 77% of U.S. adults take dietary supplements • 30% say they take supplements for overall health and wellness • 58% take a multivitamin • 54% talked to their doctor about adding supplements
prefer 60-count, 90-count, or 150-count multivitamin bottles— these three sizes account for 30 percent of all dollar sales. For liquid vitamins, powder forms lead the pack, capturing 63 percent of all dollar sales, driven by Emergen-C.
• Patients ages 35 to 54 are most likely to take dietary supplements
WHAT SHOULD YOU STOCK? Kim Leach, national account manager for private label Quality Choice, recommends divvying up your shelf space based on sales ratios for the various supplement categories and by popularity of the various formulations. Here’s a breakdown of the data based on Information Resources, Inc (IRI).
• S upplement users are more likely to practice healthy habits like exercising, eating a balanced diet, and visiting the doctor
Categories 40% Minerals 25% Multivitamins 25% Letter vitamins 10% Liquid vitamins
Source: CRN 2019 Consumer Survey on Dietary Supplements
Mineral forms 1. Capsules 2. Tablets 3. Liquid soft gels
Mineral supplements are the hottest segment at the moment. ″If you are a pharmacist and you want to set up a supplement section, about 40 percent should be focused on minerals, based on sales
Multivitamin forms 1. Gummies 2. Tablets 3. Liquid soft gels Liquid vitamin forms 1. Powders/packets/sticks 2. Liquid 3. Drops
Letter vitamin forms 1. Tablets 2. Liquid soft gels 3. Gummies
ratios,″ Leach said. This part of the market includes products such as elderberry and zinc supplements for immunity, herbal supplements for brain health, and probiotics. Over the last 5 years, national brands have seen a 5.6 percent uptick in unit sales for mineral supplements, while private label products have seen an 8.6 percent increase.
Other categories on the supplement shelves include
MARKETING MINERALS
multivitamins, with national brand products like Airborne, Olly,
″The most popular way to promote supplements within the store
and those classic Flintstones vitamins. Letter vitamins are exactly
and get the greatest lift in sales are BOGOs, which is a ‘buy one, get
what they sound like: Vitamin B12, Vitamin C, Vitamin D, all the
one free’ or ‘buy one, get one 50 percent off’ promotion,″ Leach
way down the alphabet. Liquid vitamins make up the rest of the
said. And of those two choices, the "buy one, get one free" will
category, which includes products like syrups, drops, and powders
return the best sales results.
you mix into your drink.
make sure they have visibility within the store. ″For example, set
If you’re not sure which supplements to stock, Leach
Another important way to promote your supplements is to
recommends referencing data from IRI, which can show you the
up a ‘Pharmacist Recommended’ table along with point-of-sale
top-selling products in every sub-category. You can also reach out
brochures. Place informational charts and signage indicating the
to your supplier for guidance. Leach provides a category review
SRP for the vitamins being featured,″ Leach said.
to Quality Choice customers, for example. ″I can review your
Setting up your supplements so patients can find what’s needed
SKU assortment and internal sales data if available and provide
on the shelves is important, too. If you aren’t sure how to organize
recommendations regarding any opportunity gaps or suggestions
everything, a planogram can help. Detailed planograms show you
for items to discontinue for underperforming SKUs,″ she said.
how to merchandise products and make the shopping experience
and decision-making easy for the consumer.
In addition to deciding on categories, you also need to consider
which forms to stock. For mineral supplements and letter vitamins,
tablets and caplets are the most popular forms, according to IRI
vitamin department and the private label brand is merchandised
data. For multivitamins, gummies are more popular. Consumers
to the right of the national brand. The set flows into brand blocks.
Typically, national brands are anchored on one end of the
ELEMENTS | The business magazine for independent pharmacy | MARCH 2021
13
Leach points out that supplements provide an avenue to promote
green, vitamin B is blue, vitamin C is orange, and so on. There is
your private label products, as private labels captured nearly 25
also signage that helps patients tell the difference between the
percent of dollar share and around a third of the unit share in
national brands and private label equivalents, so they can choose
the supplement market last year, according to IRI data. ″Within
the right private label alternative. Materials like bag stuffers will
your private label brand block, you could place ‘Satisfaction
also do some heavy lifting to educate patients on their options.
Guaranteed,’ ‘Pharmacist Recommended,’ or ‘Everyday Savings’
″Quality Choice provides all these marketing pieces free of charge,″
signage,″ she suggested.
Leach added.
Proper signage—like shelf-talkers, aisle blades, and even
brochures—is an important part of marketing. Signage can also
In addition to in-store marketing materials, your one-on-
one counseling sessions are a unique opportunity both to build
educate your patients on what they’re looking at. If a patient
relationships with your patients and promote your supplements.
has never taken supplements before, they might walk into your
supplement aisle, find the plethora of options overwhelming, and
allergies, and other conditions may experience nutrient depletion.
leave without buying anything. In-store marketing materials can
When dispensing those medications, you can point out potential
help prevent that.
nutrient deficiencies to patients and educate them on which
For their products, Quality Choice offers a laminated, color-
Many patients on medications for diabetes, high cholesterol,
products can help combat the problem. ″You can say, ‘If you’re
coded chart, which can hang from the shelf within the vitamin
on these drugs, this is what you need to take to replenish your
set to help patients find what they need. Herbal supplements are
system,’″ Leach said.
ARE YOUR PATIENTS NUTRIENT-DEPLETED? Patients on certain medications may be more likely to
supplements they should add to their health regime based
suffer from vitamin and mineral deficiency, providing you
on their medications.
with an opportunity to point more people toward your supplement section.
Use this information to market your supplement section, and keep these recommendations in mind when you chat
Quality Choice provides materials such as a vitamin
with patients about their medications.
depletion chart so patients can find out what vitamins and
Medication Categories
Medication Names
Potential Nutrient Needs
Antibiotics
Augmentin, Keflex, Amoxil, Zithromax, Biaxin, Rocephin
B-Complex, Calcium, Vitamin K
Anti-Inflammatory
Naprosyn, Anaprox, Celebrex, Indocin, Aspirin
Calcium, Folic Acid, Vitamin C, Zinc
Anti-Seizure
Dilantin, Tegretol, Lyrica
Biotin, Folic Acid, Vitamin D, Vitamin K
Hypertension
Accupril, Lysinapril, Norvasc, Cozaar, Hyzaar, Prinivil, Prinzide, Univasc
Co-Enzyme Q10, Magnesium, Vitamin B6, Zinc
Cholesterol
Zocor, Lipitor, Pracachol, Mevacor, Crestor
Co-Enzyme Q10
Diabetes
Glucophage, Humulin, Avandia, Glucovance, Humalog
Co-Enzyme Q10, Folic Acid, Vitamin B12
Antacids & Ulcers
Prilosec, Aciphex, Tagamet, Nexium, Pepcid
Calcium, Potassium, Vitamin B12, Zinc
Oral Contraception
Minastric, Desogen, Depo-Provera, Tri-Sprintec, Ortho Novem, Alesse, Necon
Folic Acid, Magnesium, Vitamin B6, Vitamin B12, Zinc
Allergy
Allegra, Claritin, Zyrtec
Calcium, Folic Acid, Magnesium, Potassium, Selenium
Source: Quality Choice
14
pbahealth.com/elements
From the front lines to the physician's office, the lesson of the COVID-19 pandemic is clear: there’s no such thing as being “too prepared.”
Let InSource be your source for
Pandemic Preparedness. InSource currently has UNRESTRICTED stock of the following products:* Isolation Gowns
Face Masks
Face Shields
Thermometers
Hand Sanitizer
CHERI GMT
Chongqing CCU Cheri Garment Company Limited
ISOLATION COVERALL SUIT AAMI2 (without shoe covers) Water- Repellent
- //%%/ > > "
"
Coveralls
< ?= @ # A B ,A/ > B A, ? B C ? # ? #
<- = F " ! ? $
> > F $ 6 ? , " $ ? # F ?
H 6 > $ # H > 7 F #$ $
H H F
H ? F ?
*while supplies last
To learn more about InSource’s pandemic essentials or to place an order, please contact an InSource sales consultant at 1-800-366-3829, 8:30 a.m.—5:00 p.m. ET or visit insourceonline.com
SOLUTIONS
FROM PATIENT TO PROMOTER Tap into loyalty for bigger profits, happier employees, and faster growth
M
etrics like net worth, gross profit, and prescriptions per day
signal they are probably doing something right, but you get a lot
are all important to track, but when it comes to fostering
of false positives,″ he explained. ″Especially in retail, if your store is
long-term growth for your independent pharmacy, one factor
the closest, people are going to tend to go there because you have
outweighs them all: customer loyalty.
a little monopoly on that real estate.″
Frederick Reichheld, a Bain Fellow at Bain & Company whose
But how do you know the difference between retention and
recent book on loyalty was the New York Times bestseller The
loyalty? And how do you measure something as abstract as loyalty?
Ultimate Question 2.0, has spent the last 25 years researching why
You could keep track of individuals, noting how frequently they
customer loyalty is so important, and how companies can earn it.
come in, how much they buy, or how many people they refer. But
″I recognized many years ago in my work at Bain that the
companies that earned the loyalty of their customers were growing
collecting information about those trends can be time- and laborintensive. In his time at Bain, Reichheld developed a simple metric
faster, were more profitable, their employees liked working there
to measure customer loyalty: the Net Promoter Score.
more, and in general, they were winning their competitive battles
″Net Promoter has grown to become the predominant system
in ways that would far exceed what you would expect from all the
in business today,″ Reichheld said. ″Fortune had an article earlier
other classic business strategy perspectives,″ Reichheld said.
this year that concluded that two-thirds or more of the Fortune
1000 used Net Promoter as their primary customer success statistic.
Reichheld points out Enterprise Rent-A-Car. ″When I asked
the founder what the magic was, he pointed out there’s only one
And I see this expanding into small and medium businesses and
way you grow a sustainable business: you treat your customers
non-profits.″
so that they come back for more and they bring their friends. It’s that simple,″ he said. That philosophy allowed Enterprise to grow from a small service in St. Louis to one of the largest car rental companies in the world, all without having to turn to public sources for funding.
While most small business owners might agree in principle
that customer loyalty is important, many still fixate on the hard accounting numbers rather than measuring and cultivating loyalty. But when business owners tap into loyalty, they tap into growth. WHAT LOYALTY LOOKS LIKE When your patients are loyal, your pharmacy reaps benefits. Loyal patients will come back, and they’ll come back more frequently. They might increase their basket size during those frequent visits and be willing to pay more for products and services. And they will likely treat employees ″with a little more thoughtfulness, because they feel like they are part of a community and they expect to be a member for a long time,″ Reichheld said.
But the biggest benefit to loyalty, according to Reichheld, is
customer referrals. ″When a customer becomes convinced a supplier, retailer, or pharmacy is special and makes their lives better, they recommend it to their friends. That isn’t just a signal of loyalty, it’s the thing that drives your reputation and your growth,″ he said.
Reichheld warns against mistaking customer retention for
loyalty, which are not the same thing. ″Customer retention is a
16
pbahealth.com/elements
WHAT IS THE NET PROMOTER SCORE? The Net Promoter Score, developed by Reichheld, is a way to quantify your customer loyalty. Finding out your Net Promoter Score is simple. Just ask your patients how likely they are to recommend your independent pharmacy to a friend on a scale of 0 to 10. People who give you a 9 or 10 rating are considered promoters. ″They are the people who are the true assets of the business, and they drive your success,″ Reichheld explained. People who rate your pharmacy with a score of 0 through 6 are considered detractors. Not only will they not share good things about your pharmacy, they could even damage your reputation by spreading negative experiences. To find your Net Promoter Score, take the results from your survey and plug them into this formula: % of Promoters – % of Detractors = Net Promoter Score Your Net Promoter Score can be anywhere from -100 to 100, and the higher your score is, the more loyal your patients are.
The best time to ask your patients to give feedback is after
CULTIVATING LOYALTY
they’ve made a key transaction at the pharmacy. Although your
Capturing loyalty may seem like a tall task, but Reichheld said it’s
patients may have an inbox full of survey requests, Reichheld said
actually simple: strive to enrich your customers’ lives more than
businesses can distinguish themselves if they only ask two or three
you diminish them. ″When you treat people in a way that enriches
questions: ″How likely are you to recommend us to a friend on
their lives, you find ways to be thoughtful and kind and surprising,″
a scale of 0 through 10? What’s the primary reason? And is there
he said.
anything else we could have done to make your experience better?″
its customers’ lives even as the company has grown. With its Prime
The first question is a simple rating, and the last two questions
He cites Amazon as a company that has found ways to enrich
are open-ended. The score lets you know if there is a problem,
program, Amazon started with two-day shipping but has continued
but the open-ended questions let you know what that problem
to add value with services like music and TV streaming, grocery
is. Having open-ended questions in addition to the rating can
delivery, and responsive customer service when people run into
also signal to patients that you are eager to listen to them, which
problems. ″Companies with that philosophy—of obsessing over
encourages them to take time to fill out the survey instead of
their customers to make their lives better—come up with really
deleting it from their inbox. ″When people know that you’re going
creative ways to achieve that.″
to take action, I see response rates for those surveys as high as 20,
30, or even 50 percent,″ Reichheld said.
them with respect. ″Don’t make customers feel stupid, or like
USING THE NET PROMOTER SCORE
or transaction, or that you don’t know who they are,″ Reichheld
Once you have your Net Promoter Score, use it to make your
advised. When patients have issues, keep track of those issues and
pharmacy better. The score itself is a good indicator, but Reichheld
work to correct them.
On the flip side, you can lose patients’ loyalty if you don’t treat
they can’t trust you. Don’t make them feel like they are a number
advises paying special attention to those open-ended questions.
The comments have direct advice from your patients about
what you do well and where you can improve, so make sure to read them and act on them when you can. This is especially important when you run into a detractor. ″When a customer tells you that you have diminished their life and failed to live up to their expectations, for heaven’s sake, apologize and try and fix it,″ Reichheld said. ″Otherwise, they’re not going to bother filling out more surveys and you’ve diminished your reputation even further.″
One common mistake is tying the Net Promoter Score to a
bonus or turning it into a key performance indicator. The main point of the score is to gather the feedback and learn from the feedback. If you do, the score will go up. But if you incentivize your employees to focus on improving their score rather than
THE ONLY THREE QUESTIONS YOU NEED TO MEASURE AND BUILD LOYALTY 1. How likely are you to recommend us to a friend on a scale of 0 through 10?
their performance, your pharmacy might start to feel more like
2. What’s the primary reason?
a car dealership. ″If people plead for high scores and game and
3. Is there anything else we could have done to make your experience better?
manipulate, it gets ugly,″ Reichheld said, and you won’t be able to trust the score.
ELEMENTS | The business magazine for independent pharmacy | DECEMBER 2020
15
FEATURE
5 LUCRATIVE WAYS TO MONETIZE YOUR PHARMACY Pharmacy owners share their most profitable revenue streams
I
t’s no secret that the business of pharmacy is not what it once was. Although the average independent pharmacy still makes 94
percent of its profit from prescription sales, those sales aren’t as reliably profitable as they used to be. Last year, gross profit per pharmacy location fell by an average of $10,975, according to the most recent NCPA Digest. Community pharmacies consistently report not only comically low reimbursements but even significant losses when dispensing prescription medications.
As the old fuel of pharmacy business sputters, many
pharmacies have started to look to new sources to energize their business. They’ve embarked on unexpected endeavors to power their profits and help their patients, and now they’re sharing their successes with you. Here are five ways independent pharmacies are making money beyond traditional prescription sales.
1. LONG-TERM CARE Eric Abramowitz, owner of Eric’s Rx Shoppe in Horsham, Pennsylvania, is no stranger to the challenges plaguing the pharmacy industry. ″We’re trying to stay relevant in this super competitive pharmacy space. Decreasing reimbursement, mail order, online pharmacies, DIR fees—all these things are killers,″ he said. ″So it forces us to try to differentiate ourselves and find another avenue for income within filling prescriptions.″
One of these avenues for income has been especially
successful for Abramowitz, even amid the increasing pressures of the industry and the pandemic. A few years ago he started serving long-term care facilities in his area and was immediately astonished by the results. ″Why we didn’t do it years ago?″ he asked himself. ″We were just worried about that whole ‘if it sounds too good to be true it must be too good to be true.’″
What exactly sounds too good to be true? For starters, no DIR
fees. This benefit alone makes long-term care a reliable way to stay competitive. ″When you start seeing those DIR fees go away, it makes it all worthwhile,″ Abramowitz said.
LTC business not only provides great margins but also
increases prescription volume substantially. Between all of his facilities, Abramowitz serves more than a thousand patients. And this volume is reliably consistent, even during difficult times like a pandemic. ″This is business that is always coming in,″ he said. ″So in a time when people aren’t going to doctors, people aren’t taking care of themselves, and we aren’t getting a lot of new business, this is recurring business.″
For a long time Abramowitz was hesitant to get involved
with LTC because he thought he would have to become a closeddoor pharmacy with a separate building. But once he realized he could serve his retail patients and long-term care patients without changing his business structure, he took the plunge, and now he enjoys benefits from both parts of the pharmacy without all the restrictions and red tape of a closed-door. ″Becoming a combo pharmacy gives us the advantage of being classified as a long-term care pharmacy and reaping some of those benefits of increased reimbursements and no DIR fees, while still being able to continue to service the public as an independent pharmacy.″
18
pbahealth.com/elements
BUILDING RELATIONSHIPS Abramowitz has won the business of the local LTC facilities by
PROFITABLE PARTNERSHIPS
consistently getting his name, and face, in front of them. ″This
These are some long-term care facilities pharmacies can partner with to add a profitable revenue stream.
doesn’t happen overnight,″ he said. ″It’s a process, it takes time. We have a relationship with quite a few assisted living facilities, but it took a lot of time and a lot of energy.″
• Assisted living • Skilled nursing • Hospice • Subacute care
Every month he advertises free drug disposal and brings a bin
with him to the facility. He shows up with soft pretzels and caramel creams, which the residents love. While he’s there, he answers any questions they have about their medications, even if they aren’t his
• Independent living • Active adult living • Senior’s home • Adult daycare
patients. ″These people look forward to knowing that I’m coming every first Tuesday of every month with pretzels and candy, and people want to come down and just talk,″ he said. ″They’re in assisted living. This has become a social event. We found that going once a month increases our visibility, and visibility is everything.″
He also offers vaccine clinics, with shingles being in top
demand. He writes an article once a month in the facility’s newsletter called ″Notes from Eric’s Rx Shoppe.″ He does speaking engagements. He brings sample blister packs to demonstrate
2. CPESN® USA
how they work, which typically increases enrollment. All of this engagement results in patients who appreciate Abramowitz’s
When it comes to expanding his pharmacy business, Chris
services and tell other residents about his pharmacy, which keeps
Watts faces a special challenge. His store, Valley Pharmacy in
his business growing. ″Word of mouth is the best and cheapest
Kearney, Nebraska, is only 660 square feet. That means several
form of advertising,″ he said.
potential avenues of revenue aren’t available to him. Like other
entrepreneurial pharmacists, he set out in search of ways to make
One of the other advantages of LTC and the assisted living
environment is less competition. The chains can’t provide the level
money outside of traditional prescription sales, but he needed
of service that an independent can. While the chains are involved
something that didn’t require the use of new space.
within the skilled nursing setting, they are less involved in the assisted
living arena. Blister packing of daily meds and a close relationship
USA—a clinically integrated network of community pharmacies that
with the nursing staff separates independents from any competitor,
provide enhanced services and engage with payers to get paid for
Abramowitz said. ″The chains just cannot compete there.″
Eventually his search led him to a program called CPESN
those services. This program would enable Watt to start counting on revenue from a new type of payment model for several services
ENHANCED SERVICES
he already offered in his practice.
LTC facilities require more from the pharmacy than a typical
retail customer. You have to be able to provide a range of
year and a half as a CPESN member, his group finally secured a
At first, Watts didn’t see any financial gains, but after about a
services and sometimes be available during non-traditional hours.
contract with a payer. ″First it was this pipe dream of, ‘We’re going
Some services include medication synchronization, medication
to get paid for clinical services outside of billing prescriptions,’″ he
reconciliation, blister packaging, and medication reviews. Perhaps
said. ″But now, we’re starting to see all that work come to fruition.″
the biggest strain on pharmacy operations is deliveries. Abramowitz
will sometimes make his final delivery on his way home, often
Enhanced Services Pharmacies (NESP), Watts is now in group
Through both CPESN USA and regional affiliate Nebraska
late in the evening. ″You can’t put a price tag on how valuable
contracts with three different payers. With these contracts, Watts’s
somebody will think of you when you go out of your way to get
revenue from services has increased sevenfold in just two years.
them their antibiotic at seven or eight at night,″ he said.
The pharmacy already provides these personal touches and
enhanced services, so offering them to the assisted living facilities is just an extension of its community retail business. Abramowitz said, ″We pride ourselves on giving good service and taking care of them. We answer the phone when you call. We do the little things you don’t always get at our competitors.″
ELEMENTS | The business magazine for independent pharmacy | MARCH 2021
19
With these contracts, Watts’s revenue from services has increased sevenfold in just two years.
ride on their coattails,″ he said. ″They get the contracts lined up and we just have to perform.″
For Watts, CPESN has been the perfect solution for his small
pharmacy. He’s able to perform all of his tasks for payers without having to make any major additions. ″For people with limited space, this is something great they can do because you don’t have to add this product line or something else,″ he said. ″It’s just doing their job in a different way.″
The first pays him to conduct medication therapy management with its patients. He meets with each patient twice per year and receives a flat rate for each meeting—at a significantly higher rate than he receives for MTM with his traditional patients.
The second payer pays a flat rate per member every month.
Rather than requiring a specific service for all patients, the payer
PAYMENT METHODS
will request different tasks for different patients throughout the year. For instance, they might want a pharmacist to speak with a
CPESN pharmacies get paid from the medical side
patient who has started a new medication to answer any questions
of healthcare, directly from the payers. Payment
and make sure they are aware of side effects. Or they may request
methods vary for each agreement and can take
an immunization screening or medication reconciliation. There
these different forms:
isn’t a routine or recurring requirement, so the amount of work
• • • • •
varies from month to month. The amount paid depends on how many tasks the pharmacy completes. With 65 patients, the fee-permember model provides a steady and lucrative stream of income for the pharmacy.
The third contract is also based on fee-per-member
but requires some specific services, such as medication
Fee-for-service Fee-per-member Tiered fee-per-member based on patient risk Rebates Pay-for-performance
synchronization, adherence packaging, and delivery services. This contract is relatively new, so Watts is waiting to see what is entailed and how many patients will be included. For all the contracts, the payers send their patients to the pharmacy, so Watts doesn’t have to do any legwork to recruit them. INSTANT RETURNS Although Watts participated in CPESN and NESP for almost two years before seeing any money, pharmacies that join the network
3. ANTIPSYCHOTIC INJECTABLES
now may not have to endure the wait. For CPESN pharmacies in his state, contracts have already been established through NESP, and
Alex Berce, president of Good Value Pharmacy with four locations
national contracts are available with Humana. ″I guarantee you it
in Wisconsin, has been routinely gaining new patients since he
will give you a return on investment,″ he said. ″People have already
began offering a rare pharmacy service: long-acting injectable
spent the time, now the contracts are here. If you join now, your
medications. Most of the drugs in this class are antipsychotics,
return on investment is almost immediate.″
such as Invega, Abilify, Aristada, and Risperdal, and patients must
And the payout comes with hardly any investment. CPESN
receive them at a healthcare provider.
charges a small monthly fee and requires pharmacies to provide
A few years ago, Wisconsin authorized pharmacists to
a certain number of services, most of which pharmacies already
administer injectables, which opened the door for new business.
offer. And many of the services, like medication synchronization,
Prescribers, who are typically psychiatrists, were relieved to get the
provide benefits to the business even if they don’t earn payment.
injections off their plates, and Berce was eager to take them on. Now
the pharmacy administers more than 20 injections every month.
The pharmacy also doesn’t have to do anything to find
and negotiate the contracts with payers. CPESN has dedicated
″luminaries″—pharmacist owners and leaders of the regional
first thing he did was track down all the psychiatry offices in the
affiliates—who put in the work to get the contracts. ″We kind of
area and give each of them a ring. After that, word spread on its
20
pbahealth.com/elements
Berce didn’t have to do much to start generating interest. The
own, and since then referrals have continued to provide a steady stream of new clients without the need for additional marketing. He is one of the only providers of injectables in his area, so patients naturally funnel to his pharmacy. And his reports to the prescribers serve as free advertising, keeping his pharmacy top of mind.
″Word spreads pretty quick, especially when you’re routinely
sending doctors the confirmation of the injection,″ Berce said. ″After giving the injection every month it’s a reminder that Good Value just did this again for this patient.″ THE PAYOFF In terms of revenue, some manufacturers will pay a fee for administering the injection, but generally the injections are not a great source of income on their own. Most of the drugs are brand name, and payment runs through third parties, so they suffer from low reimbursement and DIR fees just like any other prescription.
The payoff of the service is the substantial boost in prescription
volume. Berce hooks patients with the antipsychotics but nets their entire medication profile for the long term. Most prescribers don’t want to administer these drugs, so Good Value has almost total exclusivity on these patients. They don’t have to worry about competing with a chain pharmacy or big box store, either. And these patients, Berce said, are typically on several other medications, which they often end up transferring to his pharmacy.
To get those prescription transfers, Berce said it’s important to
start building the relationship with the patient right away. ″I think part of the solution to making it work from an overall financial standpoint is talking to the patients after you’ve given the shot, developing a rapport,″ he said. And by the second or third injection, go ahead and ask them directly if they’d like to transfer the rest of their prescriptions.
In addition to antipsychotic injectables, Good Value offers
Vivitrol, a drug that prevents relapse in patients recovering from opioid addiction. The general upshot for this drug is the same as the antipsychotics except that it takes a bit more work—patients need to submit a urine sample before they get the shot to prove they’ve been opioid-free.
Not every state allows pharmacists to administer injectables.
At least 11 states do not, and 7 require a collaborative practice agreement. Pharmacists interested in offering injections should check with their state board of pharmacy.
4. IMMUNIZATIONS The landscape of immunizations has shifted considerably over the last decade. When Bill Drilling, owner of Drilling Pharmacy in Sioux City, Iowa, started offering Zostavax, there was still a stigma associated with pharmacy-based immunizations. The greatest challenge was convincing patients that he was more than qualified to administer the vaccine. Since then, a lot has changed. Now it has become as normal to get a shot at a drug store as it is to pick up a prescription—about one-third of immunizations in the United States are administered by pharmacists, and this has provided another reliable avenue for revenue.
Drilling has approached immunizations gradually, adding
them one at a time as opportunity allows. After Zostavax, he added the flu, then shingles (this time Shingrix), then pneumonia. Next up are TDaP and HPV. That is one of the attractive aspects of an immunization program—you can go at your own pace, and the growth opportunity is massive. For example, Katterman’s Sand Point Pharmacy, in Seattle, Washington, started with only the flu vaccine but now offers 28 vaccines year-round. Vaccines account for nearly 20 percent of its business and 30 percent of its profit.
But even with a modest offering of vaccines, the money starts
to add up quickly. The pharmacy gets paid twice for immunizations: a dispensing fee and an administration fee. Among all the vaccines, Drilling estimates he earns an average of $20 per immunization. Multiply that by the 700 patients he immunized for shingles and flu last year, and from those two alone he was looking at an estimated $14,000 in additional revenue.
What you can offer depends on the laws of your state.
Although every state allows pharmacists to administer vaccines, the scope of authority varies widely. You may not have any options to administer certain vaccines, you may need a standing protocol, or you may need a collaborative practice agreement. MAKING THE MOST OF IT Drilling Pharmacy uses the administration of one vaccine as an opportunity to offer other vaccinations to improve the overall health of the patient. Whenever patients get a flu shot, for example, he suggests a shingles or pneumonia vaccine if they need one. And studies support this approach: According to a 2018 study in Psychological Science in the Public Interest, patients who get the flu shot have already shown an openness to vaccinations, which means they’ll be much more inclined to accept further vaccines.
Another tactic that has worked well is advertising
immunizations on prescription bags. During flu season, every bag gets a sticker telling patients they can get their shot at the pharmacy. He also does various in-store marketing like flyers and signage. And he makes sure to market the immunizations on social media. ″Getting the word out to the public about what the local
ELEMENTS | The business magazine for independent pharmacy | MARCH 2021
21
pharmacist can offer to the individual is just a start in improving the health of each individual,″ Drilling said.
VACCINES GALORE
When patients come in for their prescriptions, the pharmacy
software system will alert staff if they are eligible candidates. The
Here are some vaccines pharmacies can offer, depending
staff will let the patient know they qualify for the vaccine and ask if
on state laws:
they’re interested in getting it.
• Shingles • Whooping cough (TDaP) • MMR • HPV • Meningitis • Tetanus-Diphtheria • Chicken pox • Hepatitis B
Although immunizations have been good for business, for
Drilling they are ultimately about his patients, not the profit. ″Our real motivation is to take care of people,″ he said. ″It’s about helping people improve their health in a convenient manner.″ He recalled an encounter with a patient a few years ago that has stuck with him. The patient couldn’t afford to get the flu vaccine at his physician’s office, but at Drilling Pharmacy he didn’t have a copay. ″He thanked me and said, ‘If it wasn’t for you, I wouldn’t be able to
• hiB • Yellow fever • Typhoid • Hepatitis A • Polio • Rabies • Japanese encephalitis
get a flu shot,’″ Drilling said. ″That made it all worthwhile.″
5. CBD (Cannabidiol) When the local Skippack Pharmacy in Pennsylvania was bought by mega-chain CVS, Mayank Amin decided to take matters into his own hands. The community pharmacy had been around for more than 50 years in a ″mom-and-pop town″ where Amin was born and raised. When he got word of the sale, Amin decided to purchase the pharmacy himself to keep it independent even though he had never intended to be an owner. ″I didn’t know anything about the independent pharmacy world,″ he said, ″but I decided that we’re bringing this place back to life and we’re going to give people an experience they've never had in their entire life at a pharmacy.″
And he did just that. But it wasn’t long until the harsh realities
of the independent pharmacy world became apparent. As a former pharmacist for Walgreens, what shocked Amin most about independent pharmacy was the fact that he could get reimbursed less than what he paid for a product. ″I never knew that a pharmacy could lose money filling a prescription,″ he said. ″In what world is that okay or does that make sense?″
This reality stifled his profit, and if he hadn’t found alternative
ways to make money he may not have been able to keep Skippack afloat. One addition that rescued him was an over-thecounter product that is cash only, comes with a nice margin, and genuinely helps patients with their health: cannabidiol, commonly known as CBD.
″I can say that our pharmacy stayed alive in these last few
years because of CBD,″ Amin said. ″It's been a gateway for us to just stay open.″
Amin sells hundreds of CBD products every month, ranging from
$20 to $140. Each product comes with a 30 percent markup—all cash sales. And his sales have been high even though Amin will never pressure a patient into a sale, and sometimes will even discourage them if the product isn’t helping. ″I don’t want to sell a product that could have no benefit to the patient and just make money off them,″ he said. ″We’re healthcare professionals, not salespeople.″
22
pbahealth.com/elements
On top of the profit it provides, CBD also creates opportunities
to attract more patients. Amin has found that taking time to
ask them about their pain or about why they are taking a certain
When patients are in the pharmacy, Amin and his staff will
work with patients on a CBD regimen—getting to know their
medication, which opens the door for CBD. He has found that
whole health profile, educating them, and then following up with
many patients don’t know the damage Motrin wreaks on their
them—cultivates a trust that cannot be matched anywhere else.
kidneys or Tylenol on their liver, for example. ″And now there you
″When they have that kind of trust, even if they don't look at the
go, we have a counseling point,″ Amin said. ″By the way, did you
product now, they just walked out thinking, ‘This pharmacy genuinely
know that if you’re using this for pain, there are other alternatives?
cares about me as a person. I've never had that experience before
Natural therapies. If you’re interested, I’d be happy to talk to you
at another pharmacy.’″ Next, they are asking if Amin accepts their
about how CBD works in your body, and you don’t have to buy a
insurance plan and if they can get their prescriptions transferred from
bottle, you can take a free sample.″
CVS. ″Now you have that trust from the patient, and they'll switch their
prescription medications. They not only come in to get counseling on
and facilities. He will stick around afterward to talk, share success
CBD, but they purchase over-the-counter items as well.″
Amin makes CBD presentations at various community events
stories from his patients on CBD, and hand out some samples. After a single speaking engagement at a senior living center last year,
MAKING CBD A SUCCESS
50 residents showed up at Skippack Pharmacy within a week.
For Amin, educating yourself on CBD and investing time with the
patient are the most important factors to make a CBD offering a
the product fits exactly the type of practice Amin wants to offer
success. Everything else flows from that. Patients trust you, they
to patients in his hometown. ″I like a customized approach to
The sales have been good for business, and more importantly,
discover that the products work, and then they spread the word.
medication,″ he said. ″I grew up in that kind of background where a lot
This is how his offering took off so quickly. ″Word just spread as
of natural therapies were used in our own household, and I wanted to
they realized the knowledge we have about the product. And
be able to incorporate some of that into my own pharmacy.″
once they saw how well it worked for them, they would tell their neighbors and their friends, and they would come to us,″ he said. ″Now, we have people as far as a half-hour away driving here to get a consultation with us.″
At Skippack, selling CBD always starts with counseling
and always continues with follow up. While building trust, the feedback also helps the pharmacy learn more about CBD and its effectiveness, which they can then use to educate more patients. Amin said, ″The whole aspect of us following up with the patient, having them give us a call and let us know how it’s going, has really helped us continue our CBD sales.″ ELEMENTS | The business magazine for independent pharmacy | MARCH 2021
23
SPOTLIGHT
READY FOR ROLLOUT
The Covid-19 vaccine boosts this pharmacy’s patient base and its profits
A
year into the coronavirus pandemic, and there is finally a
was available, there were still hoops to jump through before
light at the end of the tunnel: Covid-19 vaccines have been
Sunflower Rx was approved by the Texas Department of State
approved by the FDA and are being distributed across the country,
Health Services to become one of the first providers. The total
with priority groups like healthcare workers, older patients, and
approval process took about a month.
high-risk patients being first in line.
before they were ready to receive the vaccine, including a freezer
As vaccines get distributed, retail pharmacies are presented with
On top of that, the pharmacy had to make some purchases
an opportunity not only to make their communities healthier and
and digital data loggers, which are required to ensure vaccines are
safer but also to market their brand and make a profit. Brian Meyer,
always kept at appropriate temperatures.
pharmacist and owner of Sunflower Rx in Odessa, Texas, became
one of the first-round providers of the vaccine in his community,
requires storage in special, super-cold freezers kept between -76
which turned into a chance to connect with new patients.
and -112 degrees Fahrenheit. Sunflower Rx didn’t have access to
Of the two vaccines currently in distribution, Pfizer-BioNTech’s
that kind of specialty equipment, and instead bought a standard chest freezer to store 100 doses of Moderna’s vaccine, which only
I’ve had customers from other pharmacies who didn’t realize we were here and were happy to find us.
needs to be stored between 5 and -13 degrees Fahrenheit. LOGISTICS Initially, Meyer thought the pharmacy would have to advertise the vaccine and convince people to come in to get the shot. ″But word spread really quickly,″ he said. Within a single day, the pharmacy had administered every one of the Moderna shots it had received.
The message got out to community members via doctor’s
GETTING THE VACCINE
offices and hospitals, which sent qualified patients over to get the
Since every provider is eager to distribute the Covid-19 vaccine,
vaccine. Meyer followed the Texas Department of State Health
getting hands on doses early in the game is a challenge for
Services guidelines for who to prioritize, which at that time included
independent pharmacies. Sunflower Rx is partnered with Health
healthcare workers, people 65 and older, and people who have
Mart, which let Meyer know they would have a first round of
other health conditions that predispose them to complications
vaccines available to their pharmacies. But even though the vaccine
from Covid-19—including cancer, kidney disease, heart disease, obesity, and more.
24
pbahealth.com/elements
The vaccinations came with a screening form that asks patients
said. ″I’ve had customers from other pharmacies who didn’t realize
about things like allergic reactions, but when it came to verifying
we were here and were happy to find us.″
that people had health conditions, Meyer decided to take their
word for it, as the Texas Department of State Health Services
Covid vaccine. It has also created an immediate opportunity to
Getting new patients isn’t the only added benefit of the
doesn’t currently require documentation. ″I think if you require
boost retail sales because patients have to stay at the pharmacy
documentation like some people have from the doctor’s office, it
for a while after they get the vaccine. Meyer explained, ″With
would probably hinder a lot of people from getting it,″ he said.
other vaccines, it’s something like 10 minutes, but with these
″Eventually, everyone does need to have it, so we’re just trying to
Covid vaccines, the minimum is 15 minutes, unless they have a
get it out as quickly as possible.″
history of allergic reactions, and then we might have them wait 30
minutes.″ While they’re waiting, patients have nothing to do except
With such a high demand for the vaccine, Meyer and Sunflower
Rx were faced with the challenge of vaccinating 100 people in one
browse the pharmacy, picking up front-end items they might have
day, all while keeping them safe and socially distanced. ″We found
otherwise left without.
it a lot more efficient to schedule people to come in a few at a
time, every 10 or 15 minutes,″ Meyer said. ″That allowed people to
been welcome perks, Meyer emphasizes that the true benefit of
social distance, and we were able to get people in all day long.″ This
administering the Covid-19 vaccine is getting people immunized
system was also more efficient for patients. Instead of spending
so they can return to participating in the community. He urges any
Although the additional revenue and increased attention have
their day waiting in line, they could come in, get the shot, then get
pharmacies that have the opportunity to distribute the Covid-19
back to their day.
vaccine to jump on it. ″There are a lot more shots out there that
people are just sitting on in pharmacies and hospitals and clinics,″
Sunflower Rx only opened its doors at the beginning of January
and is still building up its prescription volume. This gave them an
he said. ″They do have the vaccine and need to get it out as quickly
advantage in keeping people socially distanced while they were
as possible.″
getting their shots, as the pharmacy wasn’t overrun with patients coming in for regular pharmacy business. Meyer acknowledged, ″This might be harder for bigger pharmacies with larger script volume, so it’s all the more important to have good scheduling services. They will need to have some kind of centralized scheduling form for people to sign up.″
The Moderna vaccine requires two shots, which means the
people who received the first shot from the pharmacy need to return in a few weeks to get a booster. The vaccination kit they received came with cards to give to all vaccine recipients, which have the date they received their first vaccine along with a spot for the date of the second shot.
Meyer is also taking advantage of his pharmacy management
software, which normally reminds patients about refills, to keep track of the patients who got their first shot and need to return. ″Our computer software will remind people by text message to come in, and we will schedule them for an appointment,″ he said. FINANCIAL RETURNS As a brand new pharmacy, being an early provider of the Covid-19 vaccine has been a boon. The financial return so far has been about the same as flu shots, around $18 a dose. Accounting for uninsured patients, Meyer estimates the true return for the Covid-19 vaccine will come out to around $16 a dose. ″For people who have insurance or Medicare Part B, we are able to bill those for an administration fee much like the flu shot,″ Meyer said. ″As far as copays or charges, there’s no charge for anybody.″
But in addition to those fees per dose, being one of the first
places in town to offer the vaccine has brought welcome attention to the pharmacy. ″It’s really giving us a lot more attention than we first expected, and we have gotten quite a few transfers,″ Meyer
WHO GETS VACCINES WHEN? While each state is allocating vaccines depending on the specific needs of their population, the Advisory Committee on Immunization Practices has issued recommendations on how vaccines should be distributed in the early months when demand is much greater than the supply. Most state rollouts will look something like this: Phase 1a • Healthcare workers • Long-term care residents Phase 1b • People age 75 and older • Non-healthcare frontline essential workers Phase 1c • People age 65 to 74 years • People age 16 to 64 with high-risk medical conditions • Other essential workers Phase 2 • General population age 16 and older
23
MONEY
FROM RED TO BLACK Where to cut costs when you have no other choice
T
here’s no doubt about it—the independent pharmacy industry
is shrinking. Average annual sales per location are down from
performance indicators: the current ratio and the quick ratio. The
Keep tabs on your cash flow by referencing two important key
$4 million in 2010 to $3.4 million in 2019, according to the 2020
current ratio looks at the assets of your pharmacy and measures
NCPA Digest.
how well they can cover your current liabilities. If your current ratio
is less than two, it’s a signal that you have a cash flow problem. It’s
These troubling trends mean many independent pharmacies
may face the difficult decision of whether or not to start cutting costs.
calculated using this formula:
At what point has the financial situation become so dire that an
Current Ratio = Current Assets / Current Liabilities
owner’s best option is to let staff go or sell off the robotics system? And once cuts are required, what can you part with that won’t doom your business?
Nishank Khanna, an entrepreneur who has founded and run
six small businesses and currently serves as the chief marketing
The quick ratio reflects how well-equipped your pharmacy is to immediately cover all current liabilities without liquidating your current inventory. A healthy pharmacy will have a quick ratio of more than one. Here’s how you calculate it:
officer for Clarify Capital, provides some crucial cost-cutting tips to
Quick Ratio = (Cash) + (Accounts Receivable) / Current Liabilities
help you make tough financial decisions without damaging your
By frequently checking in with these ratios, you won’t be blindsided
chances at growth. WHEN TO CUT COSTS The best indicator for whether your pharmacy needs to cut costs, according to Khanna, is cash flow. ″If you see a down-trend, that’s a clear sign that something is not working,″ he said. ″Either your revenue has gone down and your expenses are still the same, or your expenses have gone up, but your revenue hasn’t gone up at the same rate.″
Khanna advises that businesses take a look at their cash
reserves at the end of each month. ″If you’re not looking at your cash flow every month, it’s really hard to see where the leak is coming from,″ he said. ″A lot of times, smaller businesses will wait until the end of the year or every six months to look at their finances. And then you miss out on all these red flags that show up.″
26
pbahealth.com/elements
by a cash flow squeeze and be forced to make sudden, unexpected cuts to your business. WHAT COSTS CAN YOU CUT? How to cut costs—and where—is not a cut-and-dried business. ″You have to be smart,″ said Khanna. ″You don’t want to cut things that are one, essential, and two, are part of your larger growth plans.″
Whether businesses should make incremental cuts over time or
big cuts upfront depends on how dire the cash flow situation is. ″If you’re burning cash at a higher rate each month, it’s a sign that you need to make big sweeping changes,″ said Khanna. ″However, if you see that your revenue is growing but your cash flow is slowing down, that’s a situation where you can make smaller cuts and work to match your cash flow with your revenue growth.″
COST CUT #1: INVENTORY
For example, Khanna said, ″The days of just spending marketing
Inventory is a prime target when you decide to make cuts. ″If you
dollars just to get the brand-name recognition are over. It’s more
order too much, you end up with money sitting on the shelves. If you
about if you’re putting in a marketing dollar now, are you able to get
order too little, you lose out on sales,″ Khanna said. To get a handle
a dollar-plus out on the other end.″
on your inventory, he recommends carefully looking at how you’re
meeting the demands of your patients, and if you’re making the right
calculate your return on investment using this formula:
decisions when it comes to supply. ″After looking over purchase
Marketing ROI = (Sales Growth - Marketing Cost) / Marketing Cost
and sales history, it may become clear that there are some misprojections with inventory management.″
Taking a look at your pharmacy’s inventory turnover can clue
you in. If you have a high inventory turnover rate, that means your supply is meeting your patients’ demand, but if it’s low, that’s a sign
To measure whether your marketing dollars are well spent,
If you’re investing money in marketing campaigns and it’s
not leading to sales growth, it’s a sign that you should redirect your marketing expenses into other, more essential parts of your pharmacy business.
you are over-supplying your inventory and need to reassess. Here’s how you calculate inventory turnover rate, which demonstrates how often you turn over your inventory in a single year: Inventory Turnover = Annualized Inventory Cost of Goods / Total Inventory
MARKETING COST-CUTTING TIP
Your inventory turnover rate should be more than 10. If it’s lower than that, it’s a signal to reassess your inventory management
Reassess which marketing channels you are currently
to cut costs. In this case, Khanna recommends doing what you
using to find places to reduce expenses. Avenues like
can to automate your inventory management. ″While it might
print ads, television spots, and direct mail can be costly.
seem counterintuitive, buying software to automate inventory
If you need to slim down your marketing budget, pivot
management can free up cash flow and reduce waste,″ he said. ″The
to free or low-cost options.
upfront costs are offset by savings down the line when you consider reduced inefficiencies and operational improvements. Long term,
Bolstering your Facebook or Twitter presence doesn’t
pharmacists who outsource inventory management can benefit by
cost anything but time, and you can reach new eyes
avoiding unnecessary profit loss and increasing working capital.″
organically if you post regularly and interact with your followers. Another free marketing opportunity is encouraging your patients to leave reviews online. Good reviews on sites like Google or Yelp are essentially free advertising for your unique services and top-notch
INVENTORY COST-CUTTING TIP
customer care, and they can be the deciding factor in convincing a new patient to visit your pharmacy.
Reduce your overall inventory costs by joining a pharmacy buying group like ProfitGuard . ProfitGuard ®
groups independent pharmacies together to get the best possible deals from wholesalers, lowering your overall inventory costs. You’ll also have access to ProfitGuard’s proprietary data analytics tools that can automate purchasing decisions, ensuring you maximize your wholesaler rebates and meet your contract terms so there’s more money in your pocket at the end of every month.
COST CUT #3: PERSONNEL If you’ve reassessed your inventory management and slashed your marketing budget but are still struggling with cash flow, you may have to make one of the hardest decisions: letting some of your
COST CUT #2: MARKETING After you’ve leaned up your inventory, the next place to look for cuts is your marketing budget. ″A lot of the time, people spend money on marketing without looking if those marketing dollars are actually bringing in more revenue,″ said Khanna. ″It’s easy, lowhanging fruit.″
employees go. ″You have to see if you can scale down the entire operation in order to remain cash flow positive,″ Khanna said.
Deciding who has to go is tough, but Khanna recommends
looking at your staff in terms of who you absolutely need to keep the business running. ″The way to go about that is asking what is essential in terms of the manpower you need to achieve your
ELEMENTS | The business magazine for independent pharmacy | MARCH 2021
27
primary function,″ he said. ″There are always ancillary employees you have on the payroll who might not be essential in the immediate short term.″
In addition, look for situations where you can outsource
tasks instead of having people do the work in-house. If you have employees handling your marketing or accounting, for example, you may be able to find an agency or freelancer who can do the same work for less money. ″When you hire people in-house, a lot of overhead goes along with that,″ Khanna said.
OUTSOURCING OPTIONS Outsourcing non-pharmacy tasks is an easy way to lower personnel costs and gives you more time to cultivate more profitable services. These are some management and administrative tasks primed
PERSONNEL COST-CUTTING TIP Before you lay employees off, look at your scheduling. Is your pharmacy full of staff members during off-hours? Try to match your scheduling with pharmacy traffic so you have enough employees on duty to serve patients during peak hours but not so many milling about during the daily lulls. Overscheduling means bloated payroll, and scheduling more efficiently is one way to trim costs before you eliminate employees.
for outsourcing. HUMAN RESOURCES HR functions like compensation, benefits administration, records management, and hiring can be easily outsourced to a third party. INFORMATION TECHNOLOGY Hiring an outside IT professional to deal with tech problems, data storage, and protecting the pharmacy from cyberattacks can save you in the long run. MARKETING Marketing professionals can efficiently develop the right messaging for your marketing while identifying which efforts give you the best ROI.
GROWTH MINDSET One mistake that businesses make, according to Khanna, is making cuts that end up hampering growth. ″If you cut out marketing spend that’s not generating revenue, that’s one thing,″ he said. ″But parts of the marketing might be the reason why your pharmacy is even in business—it actually brings in customers.″ In those cases, cutting your marketing also cuts your revenue.
On the personnel side, cutting down too much staff can
damage your productivity. ″You’re over-extending the existing people with the amount of work they have, and then you run into a situation where you overload staff, and they might just quit because your work environment has gotten very hard to deal with,″ Khanna said.
When making cuts, Khanna emphasized that businesses
should think first about what is truly essential, and second about what the larger growth plan is for the business. He explained, ″You have to look at where you’re spending money and what amount is essential and what amount is unessential, then move the nonessential funds into areas that support the long-term growth that you’re hoping to achieve.″
28
pbahealth.com/elements
FINANCE & ACCOUNTING A professional accountant will know the latest rules and reporting methods to keep your pharmacy finances organized. ADMINISTRATIVE SUPPORT You can cut down on the administrative workload by using an interactive voice response system for phone calls and using a virtual assistant to manage email or set up patient appointments.
High Quality Products Low Industry Pricing! For 60 years, PPRB has partnered with independent pharmacies across the United States. Our high quality, low cost personalized printed products are a valuable marketing tool that keeps YOUR store’s information in front of your customers year-round. Featuring valuable information such as health tips, recipes and gardening information, PPRB offers a wide variety of personalized marketing products that your customers will surely appreciate receiving. PPRB CALENDAR FEATURES • • • •
13-month calendar format (December 2021-December 2022) Large bottom flap personalization area that prominently displays your information all year-round Holidays and Before & After months on every datepad Popular almanac information, including: sunrise/sunset times, daily fishing guide, gardening guide, and moon phases
WHY CALENDARS? SUNDAY
4
5:39am/ 6:28pm
s
11
5:45am/ 6:18pm
w
•
MONDAY
SEPTEMBER 2022 0
5:39am/ 6:28pm
5
•
6
7
8
9
12
13
14
15
16
17
19
20
21
22
23
24
26
ERICA SCENIC AM
5:45am/ 6:18pm
•
Labor Day 1
5:50am/ 6:08pm
Patriot Day (US)
18
25
5:50am/ 6:08pm
5:55am/ 5:58pm
f
q
4
7
5:55am/ 5:58pm
q
27
28
29
30
1
Rosh Hashanah
2022
•
HOW TO USE A MARKETING CALENDAR? • • •
1.877.544.4575 pprb.com
Customers appreciate receiving a tangible product, especially one with valuable content. Costs less than a penny a day to stay in front of your customers all year-round. Calendars are useful items in planning vacations and recording daily goals. Over 80% of households and businesses use a calendar.
Hand out your calendars to local offices and buildings at the beginning of every year. Work with your local post office to identify individuals that are new to the area and mail them a calendar to let them know you’re nearby! Utilize content within PPRB calendars, coloring books, etc. to create weekly social media posts.
Need some additional ideas on how to use a calendar? Give your PPRB rep a call at 1.800.232.5727.
OUTLOOK
FLIP THE PHARMACY How to transform pharmacies into patient care centers
I
n June 2019, two community pharmacy organizations created a program designed to transform pharmacies from providers
of medication into providers of care. Board members of the
• Domain 5: Establishing working relationships with other care team members
• Domain 6: Developing the business model and expressing value
Community Pharmacy Foundation (CPF) and the Community Pharmacy Enhanced Services Network (CPESN® USA), who are
HOW IT WORKS
pharmacists themselves, recognized that the daily grind and a lack
Flip the Pharmacy is designed to introduce small process changes
of resources restricted many pharmacies from stepping out and
gradually, step by step. ″This is a journey. It’s a marathon, not a
taking the risks needed to change their practice. So they came up
sprint. So we’re not doing everything all at once,″ said Cody Clifton,
with a standardized, practical way for pharmacies to implement
FtP director of implementation and strategic initiatives.
real changes, with the support of one another and coaches, called
Flip the Pharmacy.
packages,″ which serve as a kind of workbook for each clinical
area and domain. Modeled after government change programs by
″It’s meant to be applied across all pharmacies at the same
The instructions or methods of change are detailed in ″change
time, sharing information, having webinars, adjusting so they all
CMS, these documents include ″tools and links and examples from
learn together and everybody is advancing at the same time,″ said
pharmacies who have made changes in their workflow. Instead of
Anne Marie Kondic, executive director of the Community Pharmacy
it being a really big document, there’s some structure and some
Foundation, a grant-making organization that advances the practice
examples, which are posted on the website so everyone has access
of pharmacy in a community setting.
to a tool,″ Clifton explained.
Equipped with the technical assistance and practical steps
One month in the program looks something like this: During
needed to become a pharmacy centered on patient care, members
domain one, pharmacies will identify 10 patients each week that
of Flip the Pharmacy can begin to change their practice even amid
should be enrolled in med sync. By the end of the month, they will
the pressures of their everyday business. The program focuses on
submit 25 eCare plans for patients on med sync and discuss the
four clinical areas in six-month modules over the course of two
results with their FtP coach. They will take a self-assessment quiz,
years. The clinical topics are hypertension, opioid use disorder,
consider suggestions for optimizing the new time freed up through
immunizations/Covid-19, and diabetes/social determinants of
med sync, and then list three changes they will be implementing.
health. Each clinical area is taken through six operational areas of
They will also receive detailed guidance for identifying the
change, referred to as ″domains:″
right patients, getting them enrolled, making the most of the
• Domain 1: Leveraging the appointment-based model • Domain 2: Improving patient follow up and monitoring • Domain 3: Developing new roles for non-pharmacist support staff • Domain 4: Optimizing the utilization of technology and
appointments, and documenting the results, among other
electronic care plans
30
pbahealth.com/elements
recommendations. In other words, the change packages address big picture issues as well as the small details of the processes and tasks—all applied gradually over the course of one month.
The anchor of this program is the first domain, the
appointment-based model (ABM), which itself centers around
medication synchronization. ″That’s the core and crux of it. Everything begins and everything else builds on that,″ Clifton said. Once ABM is adopted, the rest of the domains are much easier to implement. Workflow hums. You have a better grip on patient traffic and can allocate staffing and tasks to more efficiently meet the needs of the pharmacy. The consistency and reliability
FOUR CLINICAL AREAS OF FOCUS 1. Hypertension 2. Opioid use disorder 3. Immunizations/Covid-19 4. Diabetes/social determinants of health
of ABM increases the flexibility of pharmacists, allowing them to engage with patients, providers, and other business tasks with less disruption and with more efficiency.
Documentation through the Pharmacist eCare Plan (PeCP)
is one requirement for all pharmacies involved in Flip the Pharmacy. It is an interoperable standard so all pharmacy technology providers exchange the same information related to care delivery—including goals, health concerns, active medication lists, medication-related problems, laboratory results, vitals, care coordination notes, payer information, and more. All pharmacies
FLIP THE PHARMACY DOMAINS
are expected to use an eCare plan from one of the 18 technology
Reprinted from FlipthePharmacy.com
solutions partners listed on the FtP website.
By the end of the two years, the pharmacy will not only have
transformed its practice model but will have positioned itself to transform its payment model. ″Ultimately you wrap all that together and you’ve got data to show how the business model is expressing value and then comes the payment return,″ Clifton said.
Domain 1: Leveraging the Appointment-Based Model – Medication Synchronization is at the core of the ABM model, yet what are the patient evaluation, care coordination, and medication use support services that may be efficiency layered alongside the mechanical
″You may not enter a value-based contract within six months, but
medication synchronization process.
you’re building up slowly to make some of those connections.″
Domain 2: Improving Patient Follow Up and Monitoring – Community-Based Pharmacies have great opportunity
GETTING INVOLVED
to lead the health care system in effective patient
So far, there are two Flip the Pharmacy cohorts. A cohort
follow up and monitoring utilizing system-leading
is composed of teams, usually at the state level, who select
number of patient touch points.
pharmacies and coaches to participate. The coaches serve as mentors, walking the pharmacies through the packages to help them implement the changes in their practice. The first two cohorts have 34 unique teams supporting more than 800 pharmacies. Every fall, a new cohort is formed. Although the program is technically open to anyone, to get involved with a cohort at this time you need to be a part of CPESN's clinically integrated network or enter into a data-sharing agreement. However, Kondic emphasized that the program is meant for any and every pharmacy. Anyone can access the change packages and follow along on their own. All the material is online and free to the public.
No matter what the program does for the business of
pharmacy, for pharmacists and non-pharmacist staff the return on investment transcends the bottom line. ″We have heard that the program has brought back their joy for practice,″ Kondic said.
Domain 3: Developing New Roles for Non-Pharmacist Support Staff – Gone should be the days of limiting pharmacies to two types of roles: Pharmacist and Pharmacy Technicians. Roles that address common challenges to the healthcare system such as patient engagement and activation, care team communications, social determinants of health, and analysis of data are essential to successful population health management and accountable care. Domain 4: Optimizing the Utilization of Technology and electronic Care Plans – The eCarePlan is fundamental to the successful operationalization of Domains 1-3 and 6. Working hand in hand with software companies, pharmacies should develop best practices
″That they feel reenergized, that they feel purposeful. It’s brought
documentation processes.
back that patient engagement piece, which was the driver for
Domain 5: Establishing Working Relationships with
going into pharmacy.″
other Care Team Members – Results from CCNC’s CMMI innovation project showed that pharmacies who built and maintained meaningful working relationships with other care team members. Domain 6: Developing the Business Model and Expressing Value – What is the return on investment to the pharmacy for moving towards longitudinal, patient
32
pbahealth.com/elements
level health care services delivery.
Pharmacists and Customers Love QC Products! Quality Choice, a leader in the private label industry for over 25 years, offers trusted, high-quality over-the-counter products in the health, beauty and wellness categories including pain relief, cold & cough, vitamins, first aid, digestive health, personal care, and more.
PBA Health’s Program with QC offers: • High margins
• Everyday savings for consumers
• A wide variety of categories
• Assistance with filling orders when current
with over 700 SKUs • Free merchandising and
wholesalers are out of product stock • Expedited order processing & shipping
marketing services Need assistance with your Quality Choice order or have questions? Contact Customer Care 800-333-8097 ext. 570 | customercare@pbahealth.com
The Fastest Reimbursement in the Industry Receive a single check, for all expired pharmaceutical return credit due through the OneCheck Select program, in as few as 10 days.
The OneCheck Select difference: Trusted by pharmacists since 1992 Our returns process is simple with easy-to-understand reporting, ensuring you can dedicate your time to patient care and running your business.
Receive Credit Quickly We offer you the choice of receiving your credit within 10, 30, 60, or 90 days.
Experienced
Focused
Simplified Reimbursement
Trusted
Flexible
Efficient
Compliant
Simple
Respected
Credit due through OneCheck Select is consolidated into a single check.
1.800.579.4804 Fax 865.675.2474
support@drugreturns.com www.drugreturns.com
No Hidden Charges Our all-inclusive fee is deducted from the check we issue, so there are no surprises.
It’s that
season Protect your patients from
The Flu
From the front lines to the physician's office, the lesson of the COVID-19 pandemic is clear: there’s no such thing as being “too prepared.”
Let InSource be your source for
Pandemic Preparedness. InSource currently has UNRESTRICTED stock of the following products:* Isolation Gowns
Face Masks
Face Shields
Thermometers
Hand Sanitizer
CHERI GMT
Chongqing CCU Cheri Garment Company Limited
ISOLATION COVERALL SUIT AAMI2 (without shoe covers) Water- Repellent
- //%%/ > > "
"
Coveralls
< ?= @ # A B ,A/ > B A, ? B C ? # ? #
<- = F " ! ? $
> > F $ 6 ? , " $ ? # F ?
H 6 > $ # H > 7 F #$ $
H H F
H ? F ?
*while supplies last
To learn more about InSource’s pandemic essentials or to place an order, please contact an InSource sales consultant at 1-800-366-3829, 8:30 a.m.—5:00 p.m. ET or visit insourceonline.com