E
ELEMENTS
WINNING PRODUCTS These are the top front-end items to get on your pharmacy shelves
BEYOND TRANSACTIONS How to reap more revenue with your point-of-sale system
Total Purchasing Solution How to maximize rebates and profitability on pharmacy inventory
VOL. 8 ISS. 2 | JUNE 2019 | PBAHEALTH.COM/ELEMENTS
Embrace your inner corner store.
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20
CONTENTS ON THE COVER
20
FEATURE | Total Purchasing Solution How to maximize rebates and profitability on pharmacy inventory
DEPARTMENTS
07
NEWS | Path to Adherence Recent studies show mobile apps’ promise to improve medication adherence
FEATURE | Total Purchasing Solution
08
08
TRENDS | Winning Products
10
RETAIL | Lay of the Land
15
SOLUTIONS | Rave Reviews
28
SPOTLIGHT | Call to Action
31
MONEY | Beyond Transactions
34
OUTLOOK | Harm’s Way
These are the top front-end items to get on your pharmacy shelves
The essential guide to retail pharmacy layouts
How to get five-star reviews online and why you can’t afford anything less
Pharmacist Byron Berry raises his voice for industry change
How to reap more revenue with your point-of-sale system
How safe is your pharmacy from a robbery?
ELEMENTS | The business magazine for independent pharmacy | JUNE 2019
TRENDS | Winning Products
3
E
ELEMENTS
The business magazine for independent pharmacy
ON THE WEB Find more strategies, tips, and expert advice to improve your business at pbahealth.com/elements
VOLUME 8, ISSUE 2 JUNE 2019
Is Owning a Pharmacy Profitable? PUBLISHER & EDITORIAL DIRECTOR Matthew Shamet
Owning an independent community pharmacy requires a large investment—financially, physically, and emotionally. But is owning
EDITOR
a pharmacy profitable? We’re here to help
Greyson Honaker
you find out. Read more at pbahealth.com/ is-owning-a-pharmacy-profitable.
ART DIRECTOR Anna Brooks CONTRIBUTING WRITER Erin E. Rand Sarah Kelly
25 Irresistible Pharmacy Promotion Ideas to Get More Patients If you don’t promote your independent pharmacy, it won’t grow. Use these easy
INTERESTED IN ADVERTISING? elements@pbahealth.com
pharmacy promotion ideas sure to attract new patients to your pharmacy. Read more at pbahealth.com/pharmacy-promotion-ideas.
These Are the Most Important Pharmacy Metrics Learn 30+ formulas to calculate the most important metrics for independent pharmacies. You’ll understand how to think like a retailer, discover the methods to track and measure meaningful pharmacy metrics, and learn ways to use metrics to get insight into business performance. Read more at pbahealth.com/metrics-to-know-the-mostimportant-numbers-for-pharmacies-to-measure.
Follow Elements magazine on Facebook and Twitter for pharmacy business tips and advice, news announcements, industry Elements magazine is published quarterly by PBA Health. Copyright© 2019 PBA Health. All rights reserved. Neither this publication nor any part of it may be reproduced without written permission by PBA Health.
information, and exclusive offers.
CHANGE THE OUTLOOK FOR THE FUTURE OF YOUR PHARMACY
YOUR LOCAL CPESN NETWORK IS LOOKING FOR PATIENT-CENTERED, LOCALLY INTEGRATED PHARMACIES Pharmacies need to band together with like-minded, locally integrated pharmacies and change the future of pharmacy. You can join pharmacies from across the state to make significant improvements to the health of your community and to the health of your pharmacy’s bottom line. CPESN® USA is a clinically integrated network of community pharmacies that stretches across America. Join the movement. Here Are the Key Benefits of Joining a CPESN Network: ®
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Ownership of each local CPESN network remains with its members
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Members are provided guidance and support as they connect with the broader patient care team
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Members are empowered with marketing support and collaboration opportunities
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CPESN USA is a clinically integrated network allowing member pharmacies to negotiate directly with non-PBM payers on payment for services
Change the outlook for your pharmacy. Become a part of the local CPESN network forming in your area.
For more information on local CPESN networks in your area, contact Casey Schwartz at cschwartz@cpesn.com For more information on CPESN visit www.cpesn.com 032518
For 60 years, PPRB has partnered with independent pharmacies to offer a variety of personalized marketing products. Our high quality, low-cost personalized products are a valuable marketing tool that keeps YOUR store’s information in front of your customers year-round.
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Each month, work with your local post office to identify individuals that are new to the area. Mail them a calendar to let them know you’re nearby! Due to the size and shape of the envelope you’ll be sure to make it into their home!
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NEWS
PATH TO ADHERENCE Recent studies show mobile apps’ promise to improve medication adherence
Perfect medication adherence has long been a holy grail of
someone to missed doses, and keep track of doses—didn’t help. All
healthcare—with promises of longer, healthier lives and fatter,
patients needed was a simple reminder.
healthier wallets for everyone. Nearly half of the four billion
“These apps seem to be an effective way to minimize
prescriptions filled each year aren’t taken as prescribed, which
forgetfulness by regularly reminding the patients about their
leads to increased re-hospitalization, mortality, and morbidity,
medications in a non-intrusive way, especially given that nowadays
costing an estimated $300 billion annually. And the less compliant
people usually have their mobile phones with them the majority of
patients are, the less medicine your pharmacy sells.
the time,” Santo said.
Various attempts have been made to reach the ever-evasive goal, from smart pill boxes to appointment-based models to
APPLYING THE APPS
making meds more affordable. Many of them have been effective,
How can pharmacists incorporate these findings into their routine
but each solution is only one road on the map to the destination.
care of their patients? “A pharmacy can always recommend the use
One of the latest paths is mobile applications. At least five
of a medication reminder app to its customers, especially those
studies in the past five years, including two last year, have revealed
who are prescribed long-term medications for chronic conditions,”
mobile apps’ promise to increase adherence. Unlike many previous
Santo said.
studies, last year’s were both randomized controlled trials, the
There are upwards of 700 medication adherence apps,
most credible type of study. One studied adherence in patients
according to a comprehensive review published this year in JMIR
with hypertension and the other studied patients with coronary
mHealth and uHealth. Narrowing the list down for patients will
heart disease. In both studies, those who used medication
save them a lot of time and stress. Using the correct search terms
reminder apps were more adherent than those who didn’t. This
will filter out a good portion of irrelevant results, the study said.
recent slew of studies could set the stage for adherence strategies
Instead of searching for “adherence” and “compliance,” look for
for independent pharmacists going forward.
“medication” and “pills,” which yield significantly more relevant results.
HOW THE APPS WORK
In the coronary heart study, patients were assisted in
Patients with strict regimens requiring several medications and
downloading the app, inputting their list of current medications,
multiple doses daily, like those with heart disease, are the main
and setting daily reminders. Pharmacists can help their patients
targets and beneficiaries of this mobile technology. Most of the
adhere to their medication by engaging in these tasks, which Santo
apps work by mitigating the effects of juggling so much all at once.
said were valued the most by the study’s patients. “Pharmacies
“As we know, forgetfulness is one of the main barriers to maintain good medication adherence, especially for those individuals taking long-term medications for chronic conditions,
should probably train their pharmacists to provide this initial training on how to use the app to their customers,” she said. Although much remains to be tested and discovered in the
such as cardiovascular diseases and coronary heart disease,” said
ever-evolving arena of mobile adherence apps, the studies show
Karla Santo, MD, who led the 2018 study on medication reminder
promise. And pharmacists have another tool to safely employ in
apps for patients with coronary heart disease.
the quest to keep their patients adherent and healthy.
In Santo’s study, published in Heart, patients were split into three groups: one using a basic medication reminder app, one an advanced reminder app, and one with no app at all. None of the participants had been using adherence apps before the study. After three months, the groups using a reminder app fared better than those who didn’t use an app. “Low adherence” decreased by 10 percent in the groups using the apps. However, the advanced features—such as the ability track adherence statistics, alert
Top Five Adherence Apps Medisafe Pill Reminder CareZone
MyTherapy Round Health Based on user ratings
ELEMENTS | The business magazine for independent pharmacy | JUNE 2019
7
TRENDS
WINNING PRODUCTS These are the top front-end items to get on your pharmacy shelves In 2018, Hamacher Resource Group (HRG) evaluated a whopping
guide their inventory choices for improved turnover and increased
2,587 new products to determine which were most suitable for
front-end sales. Start with the top-ten and top-five lists provided in
independent pharmacies. The result of the company’s rigorous
this article. If you need to remove items from your shelves to make
review process is a surefire list of top-performing products
room for top performers, Kaifesh advises first getting rid of any
independent pharmacies can’t afford to miss out on.
discontinued items that aren’t available to reorder as well as any
“These are items that we believe are going to do well in the
particularly slow-moving products. If there are multiple sizes of one
near future across all the different categories,” said Tara Kaifesh, a
product on the shelf—for example, a 30 count, 90 count, and 120
category analyst at HRG.
count—consider trimming that selection down for a potential hot
Items that made the list survived a fierce evaluation: Of 2,587 items reviewed, a mere 208 health, beauty, and wellness items
seller. Make sure to promote new items and have signage that calls
were awarded a Star Rating. This coveted designation means an
attention to them. People need to know you’re stocking particular
item has a high potential for success when placed on the shelves
items so, as Kaifesh pointed out, “they’re not thinking, ‘Oh, I can’t
of an independent pharmacy, according to HRG’s New Item Review
get that here, so I’ll go somewhere else.’”
team. Products expected to perform well can earn up to three
Product performance is always changing, so make sure to keep
Stars. A product that’s been awarded three Stars is, in the eyes of
your finger on the pulse of new trends to give your pharmacy
HRG’s review team, one you need to get on your shelves, pronto.
an edge. Follow HRG on their company website and join HRG’s
The review process takes into account factors like innovation, promotional support from the manufacturer, potential for growth,
Independent Pharmacy Facebook group, where they post monthly merchandising tips including new product information.
and more. A product needs to be well-rounded in all areas to earn at least one Star. “We’re usually pretty spot on with our
Hamacher Resource Group focuses on improving results across the
assessments of new items,” said Colleen Volheim, HRG’s category
retail supply chain by addressing dynamic needs such as assortment
research and analysis manager.
planning and placement, retail execution strategy, fixture coordination,
Last year, new products from names like Robitussin and BandAid topped their rankings, but more niche products, like specialty toothpastes and refrigerated probiotics, also made appearances. This year, the analysts said the market is trending toward products that are completely or partially natural. “People want to know what they’re putting into their bodies,” Kaifesh said. Face masks and bath salts have proven popular, along with lidocaine pain relief treatments. Charcoal products have begun to pop up everywhere, from oral care to skin care to hair care. Cough and cold products containing elderberry are also sought after. One craze that was hot in 2018 and is only getting hotter? CBD. “We’re really going from zero to ‘everybody wants to get a piece of the CBD pie,’” Kaifesh said, noting that products containing CBD were going to be “huge” in the coming year. COMPETITVE ADVANTAGE Independent pharmacies can use HRG’s ratings and rankings to
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item database management, brand marketing, and analytics.
Top 10 Products Introduced in 2018 for Independent Pharmacy Based on analysis by Hamacher Resource Group, Inc.
Pain Relief .
•
Aleve Back & Muscle Pain Tablets 50 Count
•
Biofreeze Soothing Pain Relief Cream 3oz
•
ASPERCREME Lidocaine Patches XL 3 Count
•
ICY HOT Pain Relieving Cream Lidocaine plus Menthol 2.5oz
•
ThermaCare Ultra Pain Relieving Cream 2.5oz
Aleve Back & Muscle Pain Tablets 24 Count
•
Aleve Back & Muscle Pain Tablets 50 Count
•
Bausch + Lomb Lumify Redness Reliever Eye Drops 2.5ml
•
Robitussin Adult Honey Cough + Chest Congestion DM Liquid 4oz
•
Biofreeze Soothing Pain Relief Cream 3oz
Vitamins
•
Sensodyne Rapid Relief Toothpaste Extra Fresh 3.4oz
•
Emergen-C Energy Plus Gummies Orange Zest 30 Count
•
Band-Aid Hydro Seal Blister Heels Hydrocolloid Gel Bandages 6
•
Natrol Melatonin 10 mg Gummies Strawberry 90 Count
Count
•
Bausch + Lomb PreserVision AREDS 2 Chewables Mixed Berry
•
ASPERCREME Lidocaine Patches XL 3 Count
•
Systane Complete Optimal Dry Eye Relief Lubricant Eye Drops
Flavor 60 Count •
10ml •
TUMS with Gas Relief Antacid/Antigas Chewy Bites Lemon &
Gummies 60 Count •
Strawberry 28 Count •
One A Day Women’s With Nature’s Medley Complete Multivitamin Schiff Move Free Ultra 2 in 1 Joint Health Coated Tablets 30 Count
Vicks VapoCool Severe Medicated Drops Winterfrost 18 Count
Skin Care
Top products in 2018 for independent pharmacy by category Based on analysis by Hamacher Resource Group, Inc.
Cold & Allergy •
Robitussin Adult Honey Cough + Chest Congestion DM Liquid 4oz
•
Vicks VapoCool Severe Medicated Drops Winterfrost 18 Count
•
DayQuil/NyQuil Severe Cold & Flu LiquiCaps 16+8 Count
•
Halls Real Honey Cough Drops Honey Vanilla 30 Count
•
Mucinex Sinus-Max Pressure Pain and Cough Caplets 20 Count
Digestive Health •
TUMS with Gas Relief Antacid/Antigas Chewy Bites Lemon & Strawberry 28 Count
•
Alka-Seltzer PM Heartburn Relief + Sleep Support Gummies Mixed Berry 46 Count
•
TUMS Extra Strength 750 Antacid Chewable Tablets Sugar-Free Melon Berry 80 Count
•
Dramamine-N Long Lasting Formula Tablets 10 Count
•
Pepto-Bismol Ultra Caplets 12 Count
•
Dr. Teal’s Pure Epsom Salt Soaking Solution Activated Charcoal 3lb
•
Gold Bond Ultimate Cracked Skin Relief Fill & Protect Cream .75oz
•
Neutrogena Hydro Boost Hand Gel Cream 3oz
•
Vanicream Gentle Body Wash 12oz
•
Burt’s Bees Hydrating Sheet Mask with Clary Sage1 Count
RETAIL
LAY OF THE LAND The essential guide to retail pharmacy layouts Think about your last experience in a retail store. Did you pause
essentially be your guide as to where you’re going to merchandise
for a brief moment at the front of the store, and then turn right?
everything,” Mayslak said. “For example, if CBD has been a big
You’re not the only one. Did certain fixtures or displays catch your
boost to your sales in the past six months, we want to make sure
eye as you made your way to the product you wanted? That’s not
that everybody gets to see them. If we know the traffic pattern then
a coincidence. Was the most necessary item on your list located at
we know predictably where you’re going to go. We can have that be
the back of the store? Not an accident.
right in an area displayed to where you can’t help but stop and look
“Everything, everything in retail is done for a reason,” said Bob Mayslak, a retail design consultant with Gladson Design Group, a
at it.” Your pharmacy layout influences your customer experience,
Syndigo company that helps retailers plan and execute in-store
for better or for worse. “Knowing how to best flow your customers
arrangements. “There’s quite a bit more science to it than you
through that space won’t only affect your bottom line, but it will
would think.”
impact how your customers perceive you,” said Jason Trail, a senior
The science of store layouts has been studied, tested, and
enterprise solutions architect and floor and space planning expert
honed by corporate retailers and big-box giants for decades. In
for Plantensive. “It will greatly impact the customer’s perception of
the end, the science is about money. How do you arrange your
how well-managed and well-run some locations are. So, unless you
store layout to move the most merchandise? And to enhance the
use your space appropriately, just putting out more merchandise
customer experience so they keep coming back?
isn’t necessarily going to help. It actually could hurt you in the long
A layout primarily refers to the floor plan and the arrangement
run.”
of fixtures in your front end, which reflects how you want to flow your space and present your merchandise. The best layouts
THE BASICS
increase sales at every stage of the shopper’s journey through the
There are certain universal truths about how shoppers move
store.
through, perceive, and experience a retail space. These tried-and-
“If you can create a predictable traffic flow pattern, that will
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true concepts apply to every retail layout and should influence how
you design your front end. When people first walk in the store, they enter the
shoppers will make the whole loop around the front end. As shoppers work their way through the store, they should
decompression zone. This is the first 10 or so feet of space just
experience speed bumps along the way. “The idea of speed bumps
after the entrance of your pharmacy. “It’s essentially like an invisible
is to slow them down and actually make them stop and look at
vestibule where you stop and gather yourself when you walk into
something that they may not have thought about before,” Trail said.
a place,” Mayslak said. “It puts everyone into a calmer frame of
“The big thing is to think about getting a display that will draw them
mind. Everybody needs to decompress when they get into a new
in. The display can be interactive, it can be demonstrative, or it
environment. So that’s a very important area.” It should always be
could even provide an overall solution.”
clear of ads or merchandise so visitors can orient themselves in the new space. After leaving the decompression zone, almost everyone will turn to the right and work through the store counter-clockwise, Trail said. Because of this, most stores place a display known as a
“Essentially,” Mayslak said, “it’s anything that will get you to stop your natural flow of walking through the store to engage in some of the things that you’re trying to sell additionally.” With these core concepts in mind, you can begin to draw up your layout.
power wall directly to the right of the front door. It contains their highest-margin products or premium products they’re interested
CHOOSING YOUR LAYOUT
in promoting. The tendency of people to move counter-clockwise
Designing a layout is a little bit art and a little bit science. There’s no
is also why many pharmacies put the pharmacy counter in the
one-size-fits-all for community pharmacies. The only universal truth
back of the store, depending on the location of the entrance, so
is the placement of the pharmacy counter. “Having the pharmacy at the back is the most ideal scenario for independent pharmacy,”
“Everything in retail is done for a reason.”
Mayslak said. “Use the pharmacy as an anchor and have that be the guide through the store.” Other than that, your layout will depend on several factors, starting with your goals. “It’s all going to be dictated upon what it is that you’re trying to accomplish,” Mayslak said. “You want to highlight whatever it is that you’re known for or want to be known for and expose everybody to as much of what you’re offering as
The Language of Layouts
possible. And keep the future in mind. Don’t design it for what you’re doing right now. Design it for what you’re doing five years from now, so you’re not doing this project every ten years.”
Are you fluent in the vocabulary of retail layouts? Here are some key terms to know.
Decompression zone: The area around a store
He gave the example of a pharmacy that specialized in compounding—that was the engine of the business, what drew patients through the pharmacy doors. Instead of designing the space around the compounding area—adding unique features like
entrance where the customers will get their bearings
a window into the lab—they went with a traditional layout with lots
before proceeding through your space.
of front-end space. That choice cost them. “They wanted to focus
Power wall: A large, visually appealing display in the area to the right of the decompression zone. This
on something else rather than what we already knew was their bread and butter,” Mayslak said. Two other factors that Trail said should shape your layout
is typically a customer’s first interaction with your
choices are your space and your customers, which vary from
merchandise after entering the store.
pharmacy to pharmacy. Don’t assume you can mimic any other
Speed bump: Strategically placed displays in the store
store and plug in some standard pharmacy layout. Mayslak echoed that sentiment. “Work with the space that’s
that attempt to grab the attention of the customer and
there as opposed to trying to take what you know in a more
get them to slow down and browse.
traditional setting and make that work,” he said. “Make sure you
Planogram: A diagram for arranging products in categories on retail shelves to maximize front-end sales.
Gondola: A freestanding, shelved fixture used to
allocate your bread and butter and then work around the stuff you want to add.” Carefully consider the overall square footage and the shape of your building. With that in mind, think broadly about where the different departments should live, where the pharmacy counter
display merchandise.
ELEMENTS | The business magazine for independent pharmacy | JUNE 2019
11
basic floor plans GRid:
will be, where the checkouts should go. As you consider each of these factors, tailor your choices to what’s most important to your pharmacy, Trail said. Then factor in elements that could pose a challenge: Do you
The traditional grid floor plan allows you to maximize
have large columns or load-bearing walls that can’t be moved?
the use of your available floor space to display the most
Is your fire exit at risk of being blocked? Is the store’s shape
products.
highly irregular? Pharmacies can adapt their building to highlight the space’s strengths and minimize its challenges. “Look at the constraints of the building as an asset to differentiate yourself,” Trail said. For example, Trail has seen businesses with extremely long, narrow properties utilize different floor tiles to help indicate a clearer path through the store. Other pharmacies may employ techniques like “waterfall” fixture heights to pull patients’ attention to the back of the store. For unusual or irregular shapes, it might
LOOP/RACETRACK:
make sense to combine multiple layout patterns, Trail said. For example, a store that’s narrow up front and wide in back could use
The loop floor plan forces customers to walk a certain
a main aisle in the narrow space which opens up to a racetrack in
path, giving you complete control over traffic flow and
the wide space.
guaranteeing extra exposure to your products.
Once you take your space, priorities, and restraints into account, consider who patronizes your pharmacy and who’s competing with you down the street. Are you in an area where your customers just want to get in and out quickly? Are you the go-to stop for retail products? Is your store the only place for local and boutique merchandise? What do you want to be known for? “Start thinking about your customer base and how you want to flow them through the area,” Trail said. “That’s where you can decide how much space you’re going to give to the individual
freeform:
merchandise categories for your sales floor.” After you’ve finished your layout and customers come
The freeform floor plan allows you to prominently and
streaming through your store, there’s still work to do. Mayslak
creatively highlight products and provides an attractive,
said to keep close track of your sales data for every category and
comfortable space for customers to walk through.
area of the store, which will allow you to adjust your fixtures and merchandising decisions to find an optimal arrangement that maximizes your sales. “I know you’re never, as an independent pharmacy, you’re never going to do 40 or 50 percent out front,” Mayslak said. “But if you can raise that revenue number 10, 15 percent, that’s a significant amount of additional revenue that would be very helpful to every small business owner.”
combination: The combination floor plan utilizes multiple floor plans to suit your store’s particular needs and strengths.
“Knowing how to best flow your customers through that space won’t only affect your bottom line, but it will impact how your customers perceive you.”
Quick Tips From the Experts
shoppers search for their intended products on the inner aisles, they’ll have to pass the outer aisles to get there. “Having a reminder that it’s there might get me to stop and buy something that I didn’t
A retail layout is only as good as the merchandising it’s paired with. Retail design experts Bob Mayslak and Jason Trail give some layout
necessarily intend to buy,” Mayslak said.
and merchandising recommendations for strategic and commonly
End caps
neglected areas of your store.
End caps can bring people’s attention to an item they wouldn’t
Pharmacy counter
have seen in the aisle and lead to more sales. Switch up your end caps at least once a month, but ideally twice a month. “If you have
Use the area near the pharmacy counter for items that can benefit
the same item in an aisle versus on the end cap, you’re going to
from a pharmacist’s expertise, like vitamins and supplements or
sell roughly 25 to 30 percent more, so changing those things out is
CBD products. Keeping them close to the pharmacy counter makes
going to get them to buy a little bit more,” Mayslak said.
it easier for curious shoppers to ask questions about unfamiliar products and helps pharmacists more easily recommend items to
Breaks
patients. “About 98 percent of the time when a pharmacist hands
Every layout should include strategically placed areas for people
you a product, you’re going to buy it,” Mayslak said.
to slow down. “You want to give them areas to naturally stop
Checkout
and survey the products that are out there,” Mayslak said. “And that’s why the end caps or promo aisle or anything that kind of
A common pitfall in checkouts is an inefficient or confusing setup.
draws your eye to it is rather important as far as retailing and
Mayslak and Trail both stressed the value of clear paths and
merchandising.”
signage that guide customers to the right checkout lines. The checkout should also be arranged to minimize cluttered space and
Aesthetics
long lines. “If it gets frustrating enough, somebody’s going to set
As you’re drawing up your layout plans, don’t neglect any details of
their product down and walk out the door,” Trail said.
your store design. “Make sure that you look at every little thing, as it
Product placement
affects something else. How you want that place to be perceived is going to be affected by all the decisions you make from the ceiling
Put items that shoppers aren’t typically coming into the store to
tiles down to the flooring, down to where the shelving is and how
buy, such as impulse items and promotional products, in outside
the pharmacy is set up,” Mayslak said. “So take everything into
aisles where there’s high visibility and traffic. Put your “seek-and-
consideration when you’re doing it.”
destroy” products, like cough and cold, in your inner aisles. As
ELEMENTS | The business magazine for independent pharmacy | JUNE 2019
13
SOLUTIONS
RAVE REVIEWS
How to earn five stars on review websites The prevalence of online reviews on websites like Google, Facebook, and Yelp have completely changed how people discover
So, how do you increase your reviews and boost your ratings to five stars? Try these strategies.
and choose where they shop, especially for small businesses like independent pharmacies. According to a consumer survey from BrightLocal, a company
REQUEST REVIEWS “The best way to get more reviews is to ask your patients,” said
specializing in search engine optimization tools, 90 percent of
Malcolm Stone, founder of ReviewIgnite, an online reputation
consumers read online reviews before visiting a business. That
management firm. You already have a large patient base that views
means almost everyone will find your pharmacy online and read
you as a five-star pharmacy. More than likely, those patients will
reviews before deciding to visit.
happily leave a review. In the BrightLocal survey, almost three-
“Online reviews have quickly become the way that consumers find local businesses, replacing window shopping, Yellow Pages,
fourths of customers said they’d leave a review if asked. When you ask for a review, make it as easy as possible on your
and even word-of-mouth,” said Brad Plothow, vice president of
patients. You can request reviews in person, but patients may
marketing and communications at Womply, which helps small
forget as soon as they walk out of your pharmacy. Requesting
brick-and-mortar businesses manage their online presences.
electronically allows them to immediately go to the website while
“Businesses that ignore online reviews are ignoring the most
they’re already on their phone or computer. In an email, text, or
effective channel for acquiring new customers.”
social media post, include a link to the review website. For patients
None of the trust that has long empowered word-of-mouth marketing is lost when recommendations move from the living room to the internet: Nearly 90 percent of consumers view online
who don’t know how to leave a review, offer to show them in the store, or have step-by-step instructions handy. Make sure to ask for reviews at appropriate times. The best
reviews as trustworthy as personal recommendations. And while
moment is when a patient compliments or thanks you. Use this
traditional word-of-mouth might reach a handful of people in
opportunity to tell them you’re glad to hear that and ask if they’d
someone’s circle of friends and family, online reviews reach
like to share their experience on a Google or Facebook review.
thousands of people in the entire community. This free, far-reaching, and effective advertising is particularly
“The owner should make it a policy and train the pharmacists and technicians on staff regarding when and how to ask for
good news for small businesses like your independent pharmacy.
reviews,” Stone said. “You can also automate this process by
No longer do deep resources and high visibility give CVS and
using one of the many online reputation management software
Walgreens a huge leg up. People who once would have never heard
platforms available.”
of your pharmacy can now easily discover you. When people search for a pharmacy online, your pharmacy’s name will appear just as
REWARD REVIEWS
readily as the national chains.
Even if patients are happy with your pharmacy, they may need
Psychology research tells us that people are more inclined
more than a nudge to do the work of reviewing and rating your
toward businesses they’re familiar with than to ones they know
business. Rewarding people for their honest reviews will give them
nothing about. Patients know what they’re getting at Walgreens
an incentive to get it done.
and CVS, but your independent pharmacy is unique. Reviews give patients a way to become familiar with you. Of course, the benefits of online reviews depend on the
Consider giving patients a front-end discount, entering them into a contest for a prize, or offering a coupon to anyone who posts a review within a certain timeframe. The combination of a reward
strength and number of your ratings and reviews. In one consumer
plus a time limit—two classic advertising techniques—will drive
survey, more than half of respondents said they won’t patronize a
people to post a review.
business with less than four stars. And if the business has four or five stars, more than 70 percent of people will be inclined to visit it.
RESPOND TO REVIEWS
However, according to the research from BrightLocal, it takes about
It’s good policy to respond to every review directly. The
40 reviews for people to trust the average star rating.
ReviewTracker survey revealed that 80 percent of consumers
ELEMENTS | The business magazine for independent pharmacy | JUNE 2019
15 13
believe a business cares more about them when its management
on addressing angry patients before they take their issue to the
responds to their reviews. And almost 90 percent say they read the
internet. Head off complaints in person before they get posted
business’s responses.
online by making sure patients don’t leave your pharmacy upset.
“The worst thing you can do is let reviews pile up without
Even if you can’t fully solve their problem right then, you can soften
any response,” Plothow said. “Most consumers see a measured,
their anger and begin proactive steps to meet their needs, which
thoughtful response to a negative or positive review as evidence
might be enough to deter them from posting a negative review.
that the business cares about customer service.” For positive reviews, respond by thanking them for the review
PROVIDE CONVENIENCE
and mentioning that you’re happy to have them as a patient. For
In a Drug Store News survey, 94 percent of patients said that the
negative reviews, respond promptly, apologize, offer an honest
most important factor in choosing a pharmacy is convenience. The
explanation, and then find a way to make amends. Take the
survey respondents noted that short wait times were the most
conversation to a private message or phone call.
important convenience, followed by hours of operation.
LEARN FROM POOR REVIEWS
independent community pharmacies this includes flexible store
What if your pharmacy doesn’t actually deserve a five-star review?
hours, prescription delivery, website access, onsite flu shots, etc.
When enough patients give the same feedback, it’s time to take a
Helping your patients out in these ways will drive more five-star
look at what they’re saying. Consistent negative reviews can reveal
reviews.”
“Make it easy to do business with you,” Stone said. “For
real problems with your pharmacy. Fixing those problems will give your patients a better experience, eventually turning those low-star
PROVIDE A FIVE-STAR EXPERIENCE
reviews into five-star reviews.
Patients’ experience of your pharmacy is the single most important
“Independent pharmacies need to commit to taking reviews
factor that influences reviews. No strategies can overcome a poor
seriously,” Stone said. “The pharmacy owner should share all
experience, and no tactics can earn better pharmacy reviews than
reviews and feedback with their staff and, depending on the
great care.
staff size, appoint one or two individuals to analyze and work on
“Deliver a ‘wow’ patient experience,” Stone said. “Getting
improvements to their customer experience delivery. Then conduct
more five-star reviews starts with the pharmacy staff. This means
a customer experience training session with the entire staff—which
having a patient experience plan in place. And as the owner of the
should be repeated regularly—to make sure the negative situation
pharmacy, you should be setting the tone for what a good patient
does not happen again.”
experience looks like.”
ACTIVELY ADDRESS COMPLAINTS
Learn how to provide a great pharmacy experience at pbahealth.com/
Negativity influences people more easily than positivity. So, focus
elementspharmacy-experience
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These Are the Most Important Review Websites Your Pharmacy Needs to Know
page, before other review websites like Foursquare, when people search. That’s significant because 63 percent of consumers use a search engine to find online reviews. How to set up your business on Yelp
Review websites are the easiest, cheapest, and most effective
• Claim your business page
way to attract new patients. Which review websites should you be
• Someone else may have already listed your business on Yelp. If
paying attention to?
so, contact Yelp to claim that you’re the owner and to verify that
all the information is correct.
More people will find your pharmacy through Google than through
Foursquare
any other review website. Google’s search engine and Google Maps
Like Yelp, Foursquare helps people discover new places with
guide consumers to 1.5 billion destinations every year. Nearly two-
recommendations from the community. More than 50 million
thirds of consumers say Google is their first choice for checking on
people use Foursquare every month. Although Foursquare isn’t as
a business. And it’s the site people are most likely to use to leave
popular as Yelp, you need to have a positive presence on it. People
reviews.
who use Foursquare might not use Yelp and vice versa. This means you’re missing out on a large number of potential customers if you
How to set up your business on Google
don’t focus on both websites.
• Search for your pharmacy and make sure it’s listed on Google My Business • If you don’t see it, or if information is incorrect, follow the instructions on Google’s website to set up your business page
Facebook Facebook isn’t technically a review website, but it has ratings and reviews for businesses. The social platform has more than two
How to set up your business on Foursquare • Check to see if you’re already listed on the site • If so, claim your pharmacy • You’ll get access to its business tools to help you maximize your
presence on the site and gain valuable marketing data on users who visit your listing • If you’re not already listed, follow the instructions on the website
billion active users per month and Facebook pages receive nearly five billion comments every month. It’s second only to Google when it comes to business reviews. People are far more likely to share or like your business page on Facebook than any other website, including Google, and those shares can generate more traffic to your business page socially. One survey revealed that Facebook is the most popular way consumers recommend or review local businesses. How to set up your business on Facebook • Create a Facebook business page • Use Facebook’s free tools to help you understand who visits your page and how to engage with them better
Yelp Yelp is a website and mobile app that connects people with local businesses, attracting more than 170 million users per month. It’s also the most trusted of all review websites. Yelp’s influence on consumers has been so strong that critics have asked whether it
“Businesses risk losing as many as 22 percent of customers when just one negative review is found, 44 percent for two negatives, 59.2 percent for three negatives, and 70 percent for four negatives.” Source: Moz Survey
has too much power over consumer choice. According to an article from the Harvard Business School, a one-star increase on Yelp leads to a 5 to 9 percent increase in revenue. Yelp reviews also rank high on search engines. That means your pharmacy’s Yelp business listing will display near the top of the
ELEMENTS | The business magazine for independent pharmacy | JUNE 2019
17
HOW TO HANDLE NEGATIVE ONLINE REVIEWS
refills and free delivery.
Negative reviews have a disproportionate effect on your business.
Plothow said. “It’s tempting to get defensive and emotional when
A spotless record can be tarnished with a single complaint. In
responding to negative online reviews, but that’s self-defeating.”
“Be measured, thoughtful, and brief in your response,”
one survey, 94 percent of shoppers said an online review has convinced them to avoid a business. And a study from Convergys
RESOLVE THE ISSUE
concluded that a single negative online review can cost businesses
Sometimes, your staff will make a mistake. When you’re at fault, do
30 customers.
whatever it takes to resolve the issue until the patient is satisfied.
For community pharmacies, a tarnished reputation will be
Then make sure to explain what steps you’re taking to ensure it
difficult to overcome. “Local reputation is critical—and negative
never happens again. Thank them for their review and their time to
reviews live forever,” said Nicole Pinero, a specialist with
help improve your pharmacy’s service.
Evergreen Partners, a public relations firm specializing in crisis communications, reputation management, litigation support, and
KNOW WHEN TO COMPENSATE
issues management consulting.
It’s tricky to determine when you should and when you shouldn’t
But negative reviews don’t have to leave a permanent mark on
provide patients who complain with compensation. A good practice
your business. With the right responses, you can turn a poor review
is to offer online reviewers compensation only if you or your
into a positive. Preserve your pharmacy’s reputation with these
employees made a legitimate mistake or oversight. Any obvious
proven PR strategies when you encounter negative reviews.
customer service issue, like unfriendly techs or clerks, also warrants
RESPOND PROMPTLY Don’t let the patient’s complaints go unanswered for long. “Jump on
some kind of compensation. But do it privately, through email or by phone.
it and keep it simple,” Pinero said. “Be personable and apologetic.”
BE PREPARED
Assign someone to monitor your online reviews daily so you’re
“The first thing is to have a plan for responding to negative
always on top of negative posts.
reviews,” Malcom Stone said. Consider putting together a script
In your response, invite the person to continue the conversation
with general responses, keeping them brief and HIPAA-compliant.
privately by phone or email. “Leaving a manager’s name and
Establishing a protocol or policy will enable quick and consistent
contact information is good customer service,” Pinero said. “It
responses.
shows a level of commitment to the customer by wanting to resolve the problem. A personal response to a negative review can open the door for the reviewer write a positive review about how the business responded.”
OFFER HONEST EXPLANATIONS
The POWER OF ONLINE REVIEWS Online reviews are too powerful to be ignored, no matter how small your pharmacy business.
Don’t divert, justify, or make excuses when someone lodges a complaint. And definitely don’t tell patients they’re wrong. Try to
•
empathize with the negative reviewer, even if the complaint seems unreasonable. “The customer isn’t always right, but we absolutely
•
don’t want them to feel they’ve been wronged,” Pinero said. •
73% trust a local business more if has positive reviews
•
49% need at least a four-star rating before they
experience may have occurred and how it will be improved in the future. For example, say a patient complains about a long
90% say that positive online reviews influence what they decide to buy
Face the gripe head on first by apologizing for their poor experience. Follow that with an honest explanation for why the
97% use the internet to find local businesses
wait time when she went to your pharmacy at 5 p.m. to fill a new
choose to use a business
prescription. Politely respond by saying that your pharmacy offers opening hours beyond just 8 a.m. to 5 p.m. to accommodate patients with regular work schedules, but note that the pharmacy often gets busy around 5 p.m. Give an explanation of the options you provide to patients to avoid long wait times, like automatic
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•
75% who use their smartphones to search for something nearby end up visiting a local business within a day
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info@synmedrx.com - 1 866 764 7966
FEATURE
TOTAL PURCHASING SOLUTION How to maximize rebates and profitability on pharmacy inventory
Of the many ways retail pharmacies differ from other retailers, managing the cost of inventory might be the most significant. For traditional retailers, inventory costs are simple. They pay a flat price for their product, which they know upfront, and nothing they
It’s Complicated: Factors That Determine Your Final Cost of Inventory
do after that will alter the cost. Not so for pharmacy inventory, of
A host of factors influence a pharmacy’s total cost of inventory
which the sticker price is only a small piece of a large pricing puzzle.
beyond the sticker price. Most of the factors are interdependent—
“There’s an array of complex, interconnected factors that
changing one affects another. All of them depend on the
determine a pharmacy’s ultimate cost of goods, including their
pharmacy’s buying behavior. To truly achieve the lowest cost of
buying behavior,” said Clark Balcom, senior vice president
inventory, you need to continuously monitor and optimize every
and COO of PBA Health, a company that helps independent
factor simultaneously every month. Below are some those factors
pharmacies improve the buy-side of their business with purchasing
that could influence a pharmacy’s cost of inventory.
optimization technology, group purchasing services, expert contract negotiations, and VAWD-accredited distribution services. A pharmacy’s cost of goods is primarily tied to a variety of complicated terms and incentives found within their wholesaler contracts. For example, a pharmacy wholesaler contract may
Generic rebate based on Generic Compliance Ratio Rebates for reaching specified ratio of generic purchase volume relative to overall Rx volume
include a brand discount, brand rebate, and generic rebate, each
Generic rebate based on Generic dollar volume
with its own tiered incentive structure based on a certain volume
Rebates for reaching a specified dollar volume of generic purchases
of purchases relative to certain commitments in certain categories and with certain formularies. Sound like a mouthful? That’s because
Brand discount
it is. And any given purchase affects your compliance to those
Upfront, or off-invoice, savings the pharmacy receives on every
incentives, meaning any given purchase could reduce your rebates
brand purchase
if you buy incorrectly. “You have to be able to track and predict how every purchase
Brand discount based on volume
will affect your incentives in addition to ever-changing prices and
Additional brand savings after reaching specified dollar volumes or
availability,” Balcom said. “And to even begin to do that you have to
other incentives
have a complete grasp of all your contract terms and arrangements in the first place.” Without understanding how every single purchase at any moment affects your overall arrangement now and at the end of the month, you can’t know how much the true cost of any item is. That cost complexity means that getting the lowest cost of
Additional performance/program related incentives Rebates based on participation in certain programs or specified performance metrics
Current pricing and availability
inventory takes much more commitment and resources than most
Lowest sticker price across primary wholesaler and secondary
independent pharmacies are able to give to their purchasing. “As
suppliers
managing the financial and operational costs of inventory has become more complex, the most costly mistake we see pharmacies
Specified contract items
make is failing to have a comprehensive purchasing strategy that is
Portfolio of generic contract items that are eligible for rebate
supported by formalized management systems and procedures,” Balcom said. “It’s just an inexcusable flaw existent in too many
Designated specialty items
pharmacies today.”
More expensive brand items that factor into incentive structures differently than traditional brand items
COSTLY CHOICES Because every contract contains incentive structures, the
Pay terms
amount you end up spending on inventory depends on repeated
Additional discounts based on how quickly the pharmacy pays
purchasing decisions. On any given day, those decisions may
for the inventory
not seem consequential, but they could be catastrophic when compounded. “Habitually making suboptimal purchasing decisions
Total dollar volume commitments
is a pharmacy’s fastest path to business failure,” Balcom said.
Total dollar amount the pharmacy agreed to commit to purchase from wholesaler
Percentage of volume commitments Percentage of purchases the pharmacy agreed to commit to purchase from wholesaler
suppliers hunting for the best deal, a task that involved tracking down prices from up to six different suppliers. “We were simply
“Habitually making suboptimal purchasing decisions is a pharmacy’s fastest path to business failure.”
trying to find the cheapest price out there,” she said. “This might even be for an item that was $3 in savings—it’s hard to change this habit in employees.” In Balcom’s 20 years working behind the scenes on independent pharmacy wholesaler contracts, he’s seen this scenario everywhere—even from the smartest and most successful owners like Butler. “Without exception, we find losses in rebates and other incentives offsetting the savings these pharmacies intended,” he said. “Worse, frustration and complaints about the time and effort it takes to ultimately make wrong purchasing
Consequences are so steep because of the monumental cost of a pharmacy’s inventory, which makes up 80 percent of an average pharmacy’s total expenses. A compass skewed one degree won’t
decisions is a real pain point. Unfortunately, we come across these scenarios every day.” In other cases, pharmacies will be diligent in meeting their
take you too far off track when you’re traveling one mile. But use
primary volume commitments needed to achieve incentive
that same compass to cross the Atlantic and you’ll end up in wrong
requirements, but then they end up overcommitting and missing
country. Likewise, each incorrect purchase nudges your pharmacy
out on thousands in sticker price savings. “Saving money is a good
off the course of your incentives and eventually lands miles away
thing,” Balcom said. “There are times when purchasing from a
from your maximum rebates.
secondary supplier is both necessary and beneficial. Finding the
Poor purchasing choices are perpetuated by failing to know exactly where you stand and exactly what effect every purchase has
right balance that produces maximum benefits is key.” These common purchasing woes are only some of what
on your overall contract arrangement. Much of the time, purchases
Balcom sees consistently in pharmacies. And the unfortunate truth
that appear smart end up smarting.
is that no matter what they do, pharmacies can’t truly optimize
For example, take one of the most common purchasing
their savings because than can’t really know if any purchase will
strategies pharmacies use to try to reduce costs: chasing cheap
ultimately save them or cost them, he said. “Pharmacies don’t know
deals from secondary suppliers. Say you find discounted amoxicillin
where the line is. Pharmacy cost of inventory is really a challenging
from a secondary supplier for $100 in savings. Looking at the
game of effective portfolio management. It’s a very complex set of
sticker price comparison alone, that’s a good move. But what you
mathematical problems that must be recalculated every day and
didn’t realize is that shifting that purchase away from your primary
take into consideration all purchases made since the beginning of
contract dropped you a tier on your generic rebate structure.
a month, as well as all purchases that’ll be made throughout the
Instead of getting 30 percent back this month, now you’ll be
remainder of a month. And these calculations need to account
getting 25 percent. For the average pharmacy, that’s a potential
for contract incentive structures, purchase volumes, product mix,
loss of $3,000. And that’s only one of your incentives that has been
multiple suppliers, availability of product, and daily price changes.”
skewed—your purchase decision may have also reduced other rebates available in your contract.
THE TOTAL PURCHASING SOLUTION
“If you only do item-by-item comparisons, then you’re likely
So then, what can a pharmacy do? Even though a person can’t fully
going to force yourself to miss your incentives. You might save ten
optimize purchasing, technology can. “Large chains like Walgreens
dollars only to give up fifteen. And that’s usually what pharmacies
have had extensive decision support systems in place for over two
do,” Balcom said. “If you start spreading your purchases among
decades to help them make optimal daily purchasing decisions,”
several different suppliers, then you’ve probably hit the point
Balcom said. “Independent pharmacies should have the same
where you can’t optimize because you’re spreading your volume in
advanced solutions and benefits. It’s time to modernize and employ
so many different directions that you can’t get the benefit of that
technologies and tools to operate a lot more effectively.”
volume. Or you’re spreading the best part of your volume, which
ProfitGuard Navigation, a purchasing optimization tool from
is your generics, to where you can’t get your mix to be healthy
PBA Health, can calculate how every purchase will affect your
anywhere.” He added, “And what does this say about the overall
total cost of inventory. And it harnesses that precise, predictive
quality of your primary wholesaler arrangement in the first place?”
data to maximize your savings. “It’s taken over twenty years and
That was the case for Teresa Butler, owner of RxShoppe in Grove, Oklahoma. Her team habitually spread purchases across
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countless resources to build up the assets, processes, and systems that comprise a total management solution,” Balcom said. “There’s
The Most Important Purchasing Factor Pharmacies Neglect It’s no secret that wholesalers make their money on generics.
by total Rx purchases—but most underestimate just how much
But it’s easy to forget how important that is to your total cost of
money they stand to gain or lose from it.
inventory. “Generic product mix is a fundamental economic driver
Take a look at this sample rebate matrix for an average
to every pharmaceutical customer-supplier arrangement,” Balcom
independent pharmacy, which illustrates the substantial difference
said. “Whether it’s hidden or explicit and how it works for them or
in monthly savings a pharmacy can earn or lose based on its
against them are the important questions.”
generic compliance.
Wholesalers will typically include incentives in your contract
Notice how a seemingly innocuous purchase outside the
to motivate generic volume purchases. Buying more generics
primary contract may take you from 18% to 17.99%, which would
typically earns the pharmacy rebates as well as deeper brand
drop you a tier and lose you more than $4,000. Also take note
discounts, both of which add up quickly. If you spread your generic
of the difference between meeting the top compliance goal and
volume among other wholesalers and miss your generic volume
meeting none of the goals: $15,000 for a single month. By the end
requirement, you stand to lose a considerable amount of money.
of the year, pharmacies could be looking at savings upwards of
Most pharmacy owners are aware of their Generic Compliance
several hundred thousand dollars.
Ratio (GCR)—usually measured as total generic purchases divided
TIER
GCR
REBATE %
Total Rebate $*
TIER 1
23%
33%
17,509
TIER 2
20%
30%
13,841
TIER 3
18%
25%
10,381
TIER 4
15%
15%
5,190
TIER 5
10%
10%
2,306
* Monthly numbers based on the average pharmacy’s annual costs of goods, per the NCPA Digest.
“It’s time to modernize and employ technologies and tools to operate a lot more effectively.”
ELEMENTS | The business magazine for independent pharmacy | JUNE 2019
23
nobody else that provides pharmacies with an entire end-to-end
part. And that is the action plan. The control tower says, ‘I need
solution that takes into consideration all possible economic factors
you to go to 31,000 feet and I need you to change your heading X
associated with achieving maximum rebates and profitability.”
degrees, here’s the adjustments you need to make.’ The Navigation
The Navigation tool takes all the pharmacy’s contract
report is the control tower coming back to you, as the pilot of your
information and every purchase from the last 90 days and
business, and giving you the timely and clear adjustments you need
puts it into a sophisticated modeling system. The system takes
to make to stay on heading for where you need to get to in order to
everything into account: all contract incentives from your primary
achieve maximum financial performance.”
wholesaler and PBA Health, current prices, availability, volume
For example, the report may guide you to swap your Actavis
commitments, personal preferences, etc. Using this information,
methylphenidate for SpecGx methylphenidate. And it may tell
it recursively simulates all possible variations in your product and
you to stop buying the methylphenidate from one supplier and
supplier purchasing mix, ultimately landing on a targeted model to
start buying it from another. In one pharmacy’s model, that
maximize your rebates and savings.
methylphenidate switch saved them nearly $300 from that single
“We use predictive modeling to help pharmacies figure out the optimal purchases they should make with their primary wholesaler to meet their contractual commitments while earning
item change. “Now take that times fifty to a hundred purchases a day times thirty days a month,” Balcom said. And the report does this calculation for every item in your inventory. Every day. “We recalculate every day based on the purchasing
the most dollars they can under their performance
decisions a pharmacy has made throughout the
incentives.” Balcom said. “And many times, this leads
month and up to and including the day
to us helping pharmacies negotiate needed
before,” Balcom said. “We then adjust
improvements to their wholesaler
our guidance to recalibrate and
contracts such that the exchange of purchases for incentives is a win-win for both the pharmacy and wholesaler.” The tool then takes the model’s computations and turns them into simple and actionable recommendations for the pharmacy. If the recommendations are implemented by the pharmacy, it will maximize rebates and profitability, arriving at the lowest total cost of inventory possible.
“The Navigation report is short and to the point, allowing us to maximize our rebates by allocating purchases to the proper supplier.”
NAVIGATION REPORT
make sure they remain on a peak performance trajectory.” Many pharmacies have averaged a four-percent savings on their total volume with ProfitGuard and the Navigation tool. For the independent pharmacy whose cost of goods is $2,768,280—the annual average according to the NCPA Digest—that’s $110,731 straight into their pocket by the end of the year. Many have averaged even more. “The Navigation report is short
and to the point, allowing us to maximize
The pharmacy receives these recommendations in
our rebates by allocating purchases to the proper
a daily Navigation report, which can be thought of as a
supplier,” said Dick Roberts, owner of Eureka Pharmacy
GPS. Every day, the report provides step-by-step instructions
in Eureka, Kansas. Before using the Navigation report, Roberts
to guide you to your end destination: maximum rebates and
hadn’t been keeping up with his generic compliance and had been
profitability.
“making adjustments on the fly,” he said. “Now we are able to move
The report shows you where you’re currently located with your
purchases from Cardinal to PBA Health or from PBA Health to
purchasing for the month. Then, using the predictive modeling
Cardinal to maximize our GCR on both accounts and maximize our
information, it guides you to the optimal NDCs and dollar volumes
rebates.”
to purchase from your primary wholesaler. “If you’re in the cockpit of a plane, you have heading, speed,
If you’re already purchasing correctly, the report won’t make recommendations, just as a GPS won’t talk to you until it’s time
and turn indicators as well as an altimeter, all of which are
to change direction. “We’re only correcting what’s not optimized,”
important to knowing where you’re at, whether you’re level, and
Balcom explained.
whether you’re going where you need to go. That’s the first part
And the good news for skeptical owners is that you’ll get a
of the Navigation report,” Balcom said. “But just like the pilot of
walkthrough of how exactly these savings occur, which means you
an aircraft relies on air traffic control and guidance systems to see
don’t have to take PBA Health’s word for it.
what the pilot cannot easily see, the Navigation report has a second
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EASY, SIMPLE, STRESS FREE
them. “We provide all the systems, analysis, and reporting, but the
The Navigation tool not only maximizes rebates and profitability,
pharmacies still make the final decision as to what’s best for them,”
it also makes your purchasing easy. “What every pharmacy wants
Balcom said. “It’s the perfect mix between getting the benefit of that
is to make the most money they can while expending the least
holistic analysis and guidance but with your degree of control that
amount of time and effort,” Balcom said. “The more pharmacies
you want to have.”
use the tool, the more money they make and the more resources they conserve.” At RxShoppe, this time-saving benefit has been a sigh of relief
Everything about the Navigation tool is designed to make life easier and more profitable for independent pharmacists and pharmacy owners. A membership company exclusively owned by
for Butler and her team. “We were spending way too much time
the independent pharmacy owners it serves, PBA Health’s end goal
trying to find a better deal, working with too many companies to
is to help independent pharmacies better manage the buy-side
find the one that worked for one item,” Butler said. The Navigation
of their business, so they achieve better profitability. And in turn,
report has simplified and streamlined her pharmacy’s ordering,
better care for their patients.
freeing up valuable time for her and her employees. “It has
“Our mission is to help every pharmacy as much as we can and
definitely made it easier to order,” she said. “We do not have the
as much as each pharmacy will permit us to,” Balcom said. “With
manpower to devote someone to evaluating all the purchasing data
all the pain we see pharmacies facing on the payor-side of the
to make the decisions. The Navigation tool narrows this all down
business, it’s good to know we can bring them benefits that make
for us—makes life easier. Saving time and money.”
their lives better and allow them to go home feeling successful on
The same goes for Roberts. “It’s very easy to use and it makes
the buy-side of the business.”
summaries of both accounts that I did not take the time to do,” he said. “It is very user friendly.” And it does that while preserving the pharmacy’s autonomy and control. It’s entirely up to you to make the changes or ignore
ELEMENTS | The business magazine for independent pharmacy | JUNE 2019
25
SPOTLIGHT
CALL TO ACTION Pharmacist Byron Berry raises his voice for industry change Independent pharmacy runs through Byron Berry’s veins. Graduating from pharmacy school in 1974 and buying his first
THE TOP ISSUE
pharmacy in 1986, Berry has been steeped in the industry for the
The biggest problem standing in the way of a thriving future for
better part of his life. After spending the last 30 years growing his
independent pharmacy? Pharmacy benefits managers, Berry
single location into a line of seven pharmacies across Illinois, he’s
said. “PBMs are determining winners and losers. They are doing it
gained a clear-eyed view of the challenges facing independent
cloaked in secrecy, while costing healthcare billions of dollars.”
pharmacy. “Something needs to be done to save independent pharmacy
Originally spun as an efficient way to help manage prescription drug claims, PBMs have come under increasing scrutiny in recent
for the future and healthcare for our patients,” Berry said,
years. Just a few PBMs control more than three-quarters of
whose seven pharmacies include full-line remote dispensing
pharmacy benefits in the United States, and critics say their lack of
and traditional pharmacy locations operating under the banner
transparency affects everyone from patients to pharmacies to plan
Pharmacy Plus. “Pharmacy has been good to me in the 47 years
sponsors.
I have been involved, and I want it to be rewarding for future
As one of their harshest critics, Berry has no qualms
generations of pharmacists and for the patients they serve.”
pointing out the laundry list of PBM schemes that have been
For Berry, saving the future of independent pharmacy starts in
harming patients and eroding the bottom line of independent
Congress, where the country’s decision-makers control legislation
pharmacies. These include “mandatory 90-day supplies with lower
without truly understanding the complex industry. Their views, he
reimbursement formulas, forced mail order, preferred pharmacies,
says, are informed by self-interested corporate entities rather than
forced use of PBM-owned pharmacies,” among others.
by patient-centered independent pharmacies. “If independents don’t step up and educate legislators, the
Berry lists those in addition to the more well-known tactics, such as spread pricing, which inflates drug costs; “unconscionable
legislators only have lobbyists from PBMs, chains, and insurance
reimbursements,” which have been plummeting since 2010,
companies to rely on for information,” Berry said. “Unfortunately,
according to the 2018 NCPA Digest; DIR clawbacks, which were voted
these giant corporations are primarily concerned with corporate
the top legislative or regulatory obstacle by community pharmacies
profits and not our patients. If pharmacists and our patients aren’t
in 2018; and audits, where the PBMs punish pharmacies for small
calling or emailing, legislators are voting on what the PBM lobbyists
administrative errors for their own financial gain.
are telling them. And the lobbyists are not telling them the true facts.” Correcting this misinformation has been the primary focus of Berry’s persistent advocacy efforts. He’s always contacting and
The unrelenting carousel of PBM maneuvers takes a significant toll on pharmacy business. “All of these factors affect pharmacy’s bottom line,” Berry said. “DIR fees, low reimbursement, and audits are all destroying independent pharmacy.”
developing relationships with local, state, and federal legislators through any means—visiting them at their offices, inviting them to
PATIENT PAIN POINTS
his store, speaking to them on the phone, writing them letters, and
Although pharmacies face the brunt of PBM bullying, Berry’s
emailing. He’ll also take to the local news and his social media to
concern extends to the patients he cares for every day, who suffer
spread awareness and prod other pharmacists to action.
from increasingly high prescription drug costs. Among the many
“I try to encourage every pharmacist to get involved in the
unsavory PBM dealings that affect patients—such as requiring
political process, not party politics,” he said. “Legislators need to
pharmacies to charge copays that are higher than the cost of
hear from us. We are the ones on the front line. We are the ones
the drug—are the backdoor handouts that PBMs receive from
that actually care for patients. We need to speak up and tell our
manufacturers.
story.”
26
pbahealth.com/elements
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inflate the costs of drugs and incentivize PBMs to cover the more expensive drugs on their formularies. And the rebates are not
that would increase transparency. The consensus that something must be done to change the
shared equitably with the plan sponsors, who then charge patients
PBM-run system and rapidly inflating prescription drug prices is a
higher premiums. Those factors mean prescription drugs are more
rare point of unity for Democrats and Republicans, with Georgia
costly for everyone except PBMs.
representative Buddy Carter promising at the Energy & Commerce
“The PBMs insulated the consumer from the price of prescription drugs and the pharmaceutical manufacturers saw
hearing, “This is going to end.” Though the light being shone on PBMs in Congress is
an opportunity to inflate prices,” Berry said. “Most people in our
promising, Berry said pharmacists shouldn’t be content to just
communities can no longer afford any brand name drug if they
wait for change. “No one can afford to stay behind the counter
were paying cash.”
and not tell their legislators about the PBM corruption,” he said.
And that’s only a small representation of the various tactics
“Look at your business and understand the effects the PBMs are
PBMs employ that burden both patients and pharmacies, which
having on your ability to serve your patients and stay profitable.
fuels Berry’s passion for advocacy.
Give legislators examples from your pharmacies and published facts that they can use to contradict the PBM lobbyists. Give them
FORGING A NEW FUTURE
information to make an educated decision.”
Overcoming the entrenched giants may seem a distant dream, but
He suggests crafting a personal story to tell legislators and then
there are signs that the tables are beginning to turn. Congress has
using various methods to connect with them, such as letters, phone
recently begun to examine PBMs more closely, with politicians on
calls, emails, and store visits. “There are few limits to your options.
both sides of the aisle advocating for regulation and transparency.
Use any method you can think of to get attention to facts.”
In April, executives from drug manufacturers and PBMs alike
For Berry, advocacy is ultimately about enabling independent
were brought in for oversight hearings in front of the House of
pharmacists to do what they got into the profession for in the
Representatives’ Energy & Commerce Committee and the Senate
first place. “I have enjoyed the ability to determine how I care for
Finance Committee. Both posed tough questions about industry
my patients, my community,” he said. “I want future generations
pricing practices.
of pharmacists to have that same opportunity. Now, more than
Radical changes have been proposed, including a suggestion
ever before, is the time to be vocal. If you have never thought of
from Maryland representative John Sarbanes to treat PBMs as
advocacy as part of pharmacy, you must rethink what is required
public utilities or convert them into nonprofits. Senator Ron Wyden
of your profession. We can make a difference, but it takes all
of Oregon brought up the possibility of a ban on spread pricing
independent pharmacies working together to educate our
altogether.
congressmen. Do it for yourself. Do it for your patients. Do it for the
PBMs have traditionally been adamant about playing their
future of pharmacy and the future of healthcare for all.”
pricing decisions close to the vest, but under the scrutiny of Congress, executives expressed openness to moderate changes
ELEMENTS | The business magazine for independent pharmacy | JUNE 2019
29
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BEYOND TRANSACTIONS How to reap more revenue with your point-of-sale system Every day you use a system that’s hiding profit right under
Once you know which products you can’t afford to understock,
your nose. Often relegated to simply processing transactions,
set your system to alert you or to automatically reorder products
the pharmacy point-of-sale (POS) system houses all kinds of
when you start to get low.
information about your products and your customers that can be harnessed to benefit the bottom line. “There are multiple ways that pharmacies can use their
On the flipside of understocking, pharmacies also lose money by letting products linger too long on the shelf. If items are slow moving or don’t sell at all, they should be replaced with ones that
point-of-sale system data to generate sales,” said Brad Jones,
will, according to Jones. During a previous job, Jones would walk
CEO of Retail Management Solutions (RMS), an industry leader in
with owners through their store, going over inventory tracking with
pharmacy POS technology for retail and outpatient pharmacies.
their POS system. He’d ask them how long a particular item had
“Most, unfortunately, do it the wrong way. Because they don’t ever
been on the shelf. “They would give me, ‘Oh, you know, we just got
use their data.”
that in. We’ve only had that for six months.’ And I would show them
Jones has been a part of the pharmacy world since he was a child. His father owned three pharmacies, and he worked with technology on the wholesaler side of the business before founding
the code and I would say, ‘That’s been sitting there for two and a half years, taking up space.’” Once you pinpoint items that aren’t selling, Jones suggests a
RMS 20 years ago. With this experience, he realized valuable POS
simple strategy for moving them quickly. “It’s amazing what you can
data often goes to waste. Many pharmacies fail to use the data at
do on a clearance table,” he said. “You don’t have to give it away.
all, and the pharmacies that do look at the data typically only use it
You just have to put it there and show some markdown and things
for accounting purposes, not to drive more sales.
that haven’t sold for two and a half years will fly off the shelf.”
If pharmacies took the time to mine the data for useful insights,
After they’re gone, replace those products with something
they’d find troves of opportunity to generate additional revenue in
better. “There are millions of products out there,” Jones said. “You
their front end.
need to make sure that the ones you’re carrying are actually selling in your market.”
INVENTORY CONTROL One of those major opportunities is inventory management. POS data, such as product turnover and sales, can help ensure you stock the right amount of inventory and the right kinds of inventory. “Probably the most common mistake that independent pharmacists make is being out of things that they should never be out of,” Jones said. “You’d be shocked at how many independent businesses are out on a regular basis of those things that represent a huge portion of their revenue.” Pharmacies should use the 80/20 rule to figure out which products to always have stocked, Jones said. Those are the 20 percent of your products that produce 80 percent of your revenue, which you can calculate with your POS data.
“You’d be shocked at how many independent businesses are out on a regular basis of those things that represent a huge portion of their revenue.”
ELEMENTS | The business magazine for independent pharmacy | JUNE 2019
31
SALES TRENDS
The most common use of customer purchase history is
Your POS system can uncover specific sales trends in your front
target marketing, which tailors communications to each patient’s
end, down to the individual items in every category, which you
particular buying habits and preferences. Although it’s an effective
can use to make adjustments to improve your sales. For example,
use of POS data, Jones said making personal connections is more
if your front-end revenue is down, the data can tell you not only
important for community pharmacies.
which broad categories are faltering, but which specific items within those categories are the source of the problem. One way to do this is to use the “Fine Line” structure, created
He suggests using POS data to find out who your most frequent shoppers are and give them extra special attention. Personal connection is what brings many people to independent
by Hamacher Resource Group, which labels each product with
pharmacies, he said, so emphasizing and improving that
four digits. The first two digits indicate the department, the third
connection with your top shoppers can help keep them happy and
indicates the category, and the fourth indicates specific types
loyal.
of items within that category. Jones gave the example of an
Another successful strategy Jones has seen from other
independent pharmacy that saw its sales plummet in its hair care
pharmacies is offering to match customers’ rewards points with
department. The data revealed specifically hair color products as
donations to a local organization. For example, for every reward
the culprit, which were taking up sixteen feet of space and facing
point a patient earns, the pharmacy donates a specific amount to
stiff competition from a new Walmart down the street. Once they
the local elementary school. This approach boosted front-end sales
realized this was the issue, they reduced that section and changed
for one small-town pharmacy, which heavily marketed its weeklong
their product selection.
match offer.
“They vastly improved that department,” Jones said. “That’s using your data to go ‘I’ve got to make a change.’” Another way to use sales trends to improve front-end revenue is to perform a basket analysis to discover surprising connections
“It’s not something you can do every week, but it’s certainly something that you can do,” Jones said. “Be creative with ideas and things you can do with loyalty data and loyalty information. I think most don’t even look at that.”
among products. “When you do a net basket analysis, you’ll find that there are things that you didn’t realize go together,” Jones said.
TAKE IT SLOW
With that information, you can start to cross-merchandise to boost
Don’t wait to start using your POS data, but don’t try to do
add-on sales and impulse buys, making the shopping experience
everything at once. Jones said it’s common for pharmacy owners
easier on your patients.
to get excited about the opportunities and burn themselves out by trying to do too much.
CUSTOMER DATA
“We try to teach our customers and tell them, start small,” he
Data from your loyalty rewards program can provide precious
said. “Don’t try to look at it all, just pick one thing. And if you don’t
insight on your customers that you can use to drive more sales.
know how to get to it, then ask your POS provider, ‘How do I do
“Independents have an opportunity to take their customer
this?’ and just take it one small step at a time.”
purchase history and do some special things,” Jones said.
32
pbahealth.com/elements
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OUTLOOK percent said three would discourage them. The most effective—and expensive—deterrents include timedelay safes, bullet-resistant barriers, locking door mechanisms, pass-through drawers, and guards.
HARM’S WAY
How safe is your pharmacy from a robbery?
Your staff stands on the front line during robberies, so it’s essential they know how to react during one. Conduct annual training with your employees. If you want to outsource the high-stakes instruction, private companies like Veritas Training Consultants and PharmaSafe offer pharmacy-specific online courses. Some state and local organizations have created similar
As America’s opioid epidemic rages, the risk of pharmacy robberies
programs to help business owners prepare for the possibility of
and burglaries is rising. New regulations mean prescription opioids
burglary or armed robbery.
are increasingly difficult to acquire legitimately. But demand hasn’t waned. That leads to a big opportunity for illicit drug dealers to
KEEP A KEEN EYE
profit from providing narcotics to the millions of Americans who
Seventy-two percent of offenders reported they had visited the
abuse the addictive substances.
targeted pharmacy before the crime, and most did so while
Since 2001, at least 5,014 robberies and 2,541 burglaries
filling a prescription. Because of that, Pharmacists
occurred at pharmacies, according to RxPatrol, a national database
Mutual recommends watching for suspicious
that tracks, analyzes, and provides information on pharmacy crime.
behavior, including “people avoiding
In 2016 alone, pharmacies reported 1,268 burglaries and 822
eye contact, and folks who have
armed robberies.
an unusual interest in the
“It’s the only place of business in today’s society that you
cameras, motion detectors,
can go in and steal the product that it offers and get more than
and layout behind the
what it’s worth,” said one convicted thief to sociologist Tara
counter.” Take notice of
O’Connor Shelley, PhD, in a multi-year study from Colorado State
calls asking about specific
University on pharmacy robbery and burglary. The majority of
opioids by name or asking
study participants called pharmacies “easy targets” because of a
other suspicious questions.
perceived lack of security.
Make a note each time
Even if your pharmacy’s insurance covers theft, it still harms
these calls occur. If you
your business in several ways. Missing stock means reduced
notice several of them in a
cash flow, lost sales, and potentially lost patients. Plus, you suffer
few days, give the police a
opportunity costs for the time you’ll spend restocking, managing
heads up.
insurance claims, and dealing with employee and patient unease. And beyond your business, the consequences of losing opioids
Crime risk varies widely from town to town and
to theft are steep: Opioids contributed to 42,249 overdose deaths
even block to block. Check
in 2016 and an estimated 49,060 in 2017.
the violent and property crime rates in your area to assess your risk.
PROTECT YOUR PHARMACY
When considering taking more expensive
The Colorado State study said 42 percent of pharmacy robbers and
security measures, weigh the upfront cost against
burglars targeted a locally owned store. Many of them perceived
your area’s specific risk.
“mom and pop” stores as having more security weaknesses they could potentially exploit. Prove the perpetrators wrong with some preventive measures.
Resist the urge to rely on your idea of your neighborhood as a “safe” or “unsafe” place. Opioid addiction occurs in communities of all kinds, which means illicit opioid sales are likely to occur in
More than half of the offenders said cameras outside the building
communities of all kinds—making pharmacy theft a possibility
would deter them from the crime. Only half said an alarm system is
virtually anywhere.
an effective deterrent, but a silent alarm allows your staff to calmly comply with the robber’s demands while ensuring help is on the way. The fewer staff working, the higher your vulnerability—90 percent said a lone employee would encourage a robbery and 67
34
pbahealth.com/elements
USP <800>... Are you Ready? The official date for compliance with the USP <800> Hazardous Drugs - Handling in Healthcare Settings is December 1, 2019. However, some state boards of pharmacy are taking a soft approach to enforcement. So there is still time to prepare, right? Maybe not. Pharmacies licensed in multiple states are required to comply with the regulations and standards of those states. Many state boards will adopt USP <800> in December, 2019, and others have already begun to inspect pharmacies based on USP <800> standards and state regulations for hazardous drug handling that pre-date USP <800> . By being proactive and having all your USP<800> questions answered, pharmacies can reduce the potential risk of non-compliance.
Let Spectrum Help You Become Compliant Spectrum offers 2-day and 1-day USP <800> courses in which you’ll learn to: • Describe the components and strategies available to protect all compounding and administration personnel in handling HD’s • Outline three major characteristics of a fully compliant HD compounding location / pharmacy / physical plant • Understand the critical characteristics of a compliant HD storage plan
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