Elements Magazine - Vol.4 Iss.4 Dec 2015 by Elements magazine

ELEMENTS

FUNDING CHANGE Advice for pharmacies interested in applying for grant funding

CURBSIDE PICKUP This drive-thru alternative can be a pick-me-up for your business

Phasing in Pharmacogenetics Put your pharmacy on the cutting-edge with genetic testing

VOL. 4 ISS. 4 | DEC 2015 | PBAHEALTH.COM/ELEMENTS

Benefits ’s A P C N h it w

Maximize the Value of Your NCPA Membership…or Join Today! Simplify My Meds® This free turnkey adherence program provides NCPA members with tools, training, and marketing support to implement a medication synchronization program.

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Digital Pharmacist Solution powered by RxWiki Exclusive social media support and enhancements for your website—all free for NCPA members.

Exclusive Regulatory and Legislative Updates NCPA fights for the nation’s 22,000 independent pharmacies and their patients because pharmacists play a vital role in health care.

Member Communications NCPA keeps an eye on the news, trends, and regulatory, legislative, and legal issues affecting pharmacy.

Member Forums

Front–End Overhaul

The forums are monthly live colleague-to-colleague discussions on topics of interest to you as an independent pharmacy owners and staff.

Members have access to a library of resources and unique products to help them maximize profits in their front end and stand out from the competition.

Discounts on Meetings, Education and Networking Opportunities, and more…

Dispose My Meds™ The program offers a discount on the purchase of a takeaway box, as well as information and resources for pharmacies to create a disposal program.

NASP Membership Members receive a free 90-day trial membership to the National Association of Specialty Pharmacy (NASP).

NCPA Conferences Members enjoy significant discounts on registration to all of our meetings. Continuing Education Members receive access to continuing education programs and training on a variety of subjects.

NCPA Digest sponsored by Cardinal Health

Member Discounts on Publications Staff training publications and niche service training manuals are available through the NCPA Bookstore.

A summary of selected financial and demographic information that helps members evaluate their business and illustrates the value independent pharmacists provide to their patients.

NCPA Professional Services Call NCPA toll-free to get personalized answers for your business and operations questions.

Learn more at www.ncpanet.org or 1-800-544-7447.

ELEMENTS

The business magazine for independent pharmacy

STAFF & CONTACTS Matthew Shamet – Publisher and Editorial Director Kirsten Hudson – Editor Kellie Paxton – Art Director Kathleen Barbosa – Contributing Writer Jennifer Salva – Contributing Writer Paige Fisher – Graphic Designer INTERESTED IN ADVERTISING? elements@pbahealth.com

Contents Departments 20 SPOTLIGHT:

5 NEWS:

Industry Trends The most noteworthy trends from the 2015 NCPA Digest. 6 TRENDS:

Curbside Pickup This drive-thru alternative can be a pick-me-up for your business. 8 RETAIL:

Wound Care Help patients heal with these highprofit margin products in your front end. 11 SOLUTIONS:

Working on Workflow What you’re overlooking in everyday operations could cost your pharmacy time and money.

ON THE WEB //

Mobile Monitoring A new device works with patients’ smartphones to monitor the direction their glucose is trending. 24 MONEY:

Funding Change Advice for pharmacies interested in applying for grant funding. 29 OUTLOOK:

Pharmacy Gets Creative Make a difference with innovative solutions for clinical services from Creative Pharmacist. 34 NOTES:

Stopping Shingles Improve patients’ health while increasing pharmacy revenue.

Feature:

Phasing in Pharmacogenetics

Put your pharmacy on the cutting-edge with genetic testing.

Find more strategies, tips and expert advice to improve your business at pbahealth.com/elements.

31 Customer Service Tips to Wow Your Patients

Take the customer service experience at your pharmacy to the next level with these tips. Read more at pbahealth.com/31-customer-service-tips-to-wow-your-patients.

NEWS

Industry Trends The most noteworthy trends from the 2015 NCPA Digest Do you know how your pharmacy measures up? See how your pharmacy compares to others in the 2015 edition of the NCPA Digest, an annual publication from the National Community Pharmacists Association (NCPA), which profiles the $81.4 billion independent community pharmacy market. “The Digest is the definitive financial benchmark for independent community pharmacy,” said Kevin Schweers, NCPA spokesman. “Pharmacy owners can utilize it to see how their pharmacy stacks up.” The 2015 Digest was compiled using 2014 data from more than 22,000 pharmacies nationwide. Here’s a look at the surprising, new and worrisome trends discovered in this year’s Digest. EXPANDING ADHERENCE PROGRAMS Six years ago, NCPA committed to making adherence a core competency for pharmacists by 2015, Schweers said. And that’s where it’s headed. In 2014, 76 percent of independent pharmacies offered adherence or medication synchronization services. “While our goal remains 100 percent, it’s gratifying to see the importance of medication adherence services embraced and implemented by the vast majority of independent community pharmacies,” Schweers said. SUBSTANTIAL CHARITABLE GIVING Independent pharmacies’ connections with their communities run deeper than financial contributions, but contribute they did. “According to the Digest, 63 percent of community pharmacies support five or more community-based organizations,” Schweers said. “And the typical financial contributions independent pharmacies make to their communities is $3,000 per pharmacy!” As an industry, independent pharmacy donates more than $65 million, or 2.6 percent of pre-tax profit. “If independents were one corporation, not only would it be in the Fortune 50, ahead of household names like ©Disney, Google™ and McDonald’s®, it would be one of the most generous charitable givers in all of corporate America,” Schweers said.

DECREASE IN NUMBER OF PHARMACIES AND PRESCRIPTIONS DISPENSED The overall number of independent pharmacies decreased from 22,814 pharmacies in 2013 to 22,478 in 2014. Prescriptions dispensed also decreased from 62,424 per pharmacy in 2013 to 61,568 in 2014. Schweers said NCPA is fighting these downward trends by advocating for government policies that mitigate abusive maximum allowable costs (MACs), direct and indirect remuneration (DIR) fees, and exclusionary preferred pharmacy networks. “If community pharmacies can continue to embrace medication adherence and complete their medication therapy management (MTM) cases, then hopefully their number of prescriptions filled will increase,” Schweers said. DECLINING PRESCRIPTION REVENUE Declining and negative reimbursement rates are a growing challenge, which is especially troubling as independents rely on prescriptions for 92 percent of their revenue. New regulations could help balance this trend. “Starting in 2016, Medicare is requiring drug plan sponsors, and the pharmacy benefit managers (PBMs) that administer their plans, to update MACs on a timely basis,” Schweers said. “We hope that will help and, to that end, are pressing Medicare officials and Congress to ensure proper enforcement of this mandate.” Schweers said pharmacies can also fight this trend by improving patient adherence and diversifying revenue streams with niches like compounding, long-term care or the front end. “The Digest underscores the fact that pharmacists must take additional steps with urgency to bolster their community pharmacy’s viability,” he said.

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TRENDS

Curbside Pickup This drive-thru alternative can be a pick-me-up for your business

A leg up on your pharmacy’s competition might be found in an unexpected place—the curb. “Curbside pickup gives the independent pharmacy an alternative solution to a drive-thru,” said Mike Gross, vice president of sales and marketing at Retail Management Solutions (RMS), a pharmacy point-of-sale technology company. “Almost all big box store pharmacies offer a drive-thru for their customers,” Gross said, but a drive-thru isn’t feasible for many independent community pharmacies. Limited space, non-conducive building layouts and remodeling expenses are hurdles for independents that want to put in a drive-thru. But curbside pickup can offer patients the same convenience of picking up prescriptions without leaving their car, while also helping your business compete with drive-thru services. “It levels the playing field,” Gross said. LEVERAGING TECHNOLOGY To operate a curbside pickup program, pharmacies need

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point-of-sale technology that allows them to process payments outside of the pharmacy’s checkout area. Gross said RMS offers pharmacies a technology payment solution that does just that—EvolutionPOS. This device allows employees to capture payment information and signatures at the patient’s car. Here’s how it works. Patients call the pharmacy and mention the prescription they need to pick up and tell the pharmacist if they need any front-end products. Or, patients can sign up to receive the same set of products each month. Before the patient arrives, an employee scans all of the items being purchased, and that information is saved on the device. When the patient arrives, an employee brings the prescription and the EvolutionPOS mobile device curbside and collects the patient’s payment at the curb. The device accepts cash, checks, credit and debit cards, and house charge payments, making the transaction flexible and simple for patients. “Not only can you get real-time credit card approval,

TRENDS

Curbside Pickup Checklist

Get your curbside pickup program ready to go with these steps. Designate a space Mark a space in your pharmacy’s parking lot with a sign that reads “Reserved for Curbside Pickup.” Get the technology Talk with your point-of-sale (POS) vendor about acquiring a mobile POS tool that enables curbside transactions. Train employees Designate and train your employees to deliver prescriptions and counseling to patients picking up their prescriptions curbside.

but you can also print a receipt on the spot,” Gross said. “The employee is literally bringing the cash register to the patient.” This technology also allows you to record notes and counseling conversations, just like you normally would at the pharmacy counter. “Once the transaction is completed, all the transaction information is sent in real time back to the point-of-sale server inside the store, which then can be communicated back to the pharmacy management system.” CURBSIDE AND YOUR PHARMACY Gross said pharmacies should consider a couple of criteria to determine if offering curbside pickup is right for them. First, examine your competition. If your competition offers a drive-thru or home delivery, providing curbside pickup might be a good idea to stay competitive. Next, examine your patient base and your patients’ needs. For example, patients who might benefit from a

curbside pickup option include patients with young kids who want to avoid the hassle of getting their kids out of their car seats to pick up a prescription. Elderly patients who might not want to leave their car during inclement weather, and patients who might have difficulty getting out of their vehicles would also benefit. GETTING SET UP If offering curbside pickup seems like a good fit for your pharmacy, you only need to complete a few steps to get started. Begin by designating a parking space in your lot for curbside pickup. Make sure your designated spot doesn’t block any handicap spaces, and that you comply with any local regulations. Then, be sure to clearly mark the spot with a sign. Also, allow enough space next to the designated spot for your employees to deliver the prescription. Once you have a parking spot, the sign, and the necessary software and hardware set up, it’s time to promote the service to your patients. “It’s important that the pharmacy gets the word out, whether that’s through a local newspaper or radio ad, or just word-of-mouth,” Gross said. Spread the word by stuffing flyers into pharmacy bags that go out with each prescription, and also target patients who would benefit from the service the most, such as elderly patients, patients with mobility challenges and patients with kids. “Curbside pickup addresses certain patient needs that may not be currently addressed,” Gross said. Ultimately, incorporating a curbside pickup service into your pharmacy can enhance your customer service, and it gives patients another reason to stay with your pharmacy. “I’m a believer that once customers experience this new level of service, they’ll never take their business elsewhere,” Gross said. For a limited time, RMS is offering a free curbside pickup sign with purchase of its EvolutionPOS device. Learn more at rm-solutions.com.

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RETAIL

Wound Care Help patients heal with these high profit margin products in your front end From simply healing scraped knees to finding specialty bandages for post-surgery, patients are likely looking to your pharmacy for the wound care and first-aid products they need. Expanding beyond the essentials to make your wound care section a niche is an opportunity to help your patients—and grow your business. But it takes work. “If you have a niche and it’s easy, it’s not going to be a niche much longer,” said Gabe Trahan, senior director of store operations and marketing at the National Community Pharmacists Association (NCPA). “Wound supply is a commitment. If it was such a great, easy thing to do everybody would have it.” But, Trahan said, adopting this niche in your pharmacy can be well worth it. BUSINESS BENEFITS Wound care and first aid is unique among front-end categories because patients usually purchase the products as a result of an acute need, and they’re not price-sensitive. Products in this category are seldom featured in advertisements or sales circulars, and the need for them is reoccurring, so pharmacies can rely on this category for consistent, large profit margins. “First aid and wound care can offer a profit margin of over 40 percent,” Trahan said. SET YOUR BUSINESS APART If you’re going to offer a wound care section, Trahan recommends making the most of it and offering specialty wound care products that aren’t available in the dollar store down the street. That means going beyond traditional first-aid tapes, gauze dressings and bandages. Consider stocking scar treatment products, antiparasitic products, skin protectants, anti-itch products,

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Section Size How much front-end space you devote to your wound care section depends on how invested you want to be in the category, and how much expertise you’re comfortable providing. Here’s a guide to determine how much space to devote to your section. Beginner Start with a section 4 feet long by 54 inches high. Emerging expert Grow into a freestanding gondola that’s 8 feet long and 54 inches high. Specialist Specializing requires a section that’s 8 to 16 feet long and 54 inches high.

RETAIL

antibiotics, dressings for burns, wound drainage products, bed sore creams, diabetic ulcer healing cream and products for general wound healing. And, highlight your section by keeping it top-notch. Dusty, dirty and empty shelves look unsanitary, and unappealing. It’s also important to keep your section well stocked. “When you’re out of a product, that’s just a big sign that says ‘Go somewhere else,’” Trahan said. “And when you carry only one of each item, you’re saying to the customer, ‘I’m not really too sure about this stuff.’” LEVERAGE YOUR EXPERTISE Patients looking for wound care and first aid items often have multiple questions and concerns. “These inquires usually involve a one-on-one conversation with a pharmacist,” Trahan said. “That’s where the community pharmacist’s accessibility, compassion and knowledge shines.” Devoting time to counsel patients about wound care and first-aid products can give your pharmacy a competitive edge. “Being able to assist the patient in making the right

choices in this department will provide you with an important advantage over the chains,” he said. PROMOTE THE SECTION “‘Build it and they will come’ only works in the movies,” Trahan said, so a successful wound care section requires marketing. “The problem with community pharmacists is when they bring in something new, they don’t necessarily tell anybody,” he said. Trahan suggests reaching out to local physicians, home health providers and athletic coaches to learn what products and brands their patients need. Also, refer to the local clinics and caregivers who initially treat patients’ injuries. “Finding out what types of products and brands caregivers prefer and suggest is a valuable step,” Trahan said. Ultimately, Trahan said advising patients about wound care should bridge into your pharmacy’s other services and offerings. “Assisting a patient with wound care questions should always end with the pharmacist asking this question: ‘Now, do you have any questions about medication that I can answer for you?’” Trahan said.

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►

SOLUTIONS

Working on Workflow What you’re overlooking in everyday operations could cost your pharmacy time and money Drop off, input, fill, verify, dispense. Everyday pharmacy workflow may seem straightforward, but every pharmacy does it differently. And many pharmacists don’t actively think about how to make improvements. Without putting additional, meaningful thought into your workflow, your business can become inefficient, inaccurate, and can even drop in Star Ratings, according to Jake Galdo, Pharm.D., BCPS, CGP, clinical assistant professor at Samford University in Birmingham, Ala. “I think the biggest thing is just putting quality into the workflow,” Galdo said. STANDARD OPERATING PROCEDURES The most common workflow mistake is not having clearly articulated—and written—standard operating procedures, Galdo said. Creating codified operating procedures ensures that each employee understands his or her role in the pharmacy, and how to execute that role in harmony with the rest of the team. “If I’m the pharmacy owner or the manager, and I don’t tell you how I expect you to work or what your job description is, then it’s going to be chaos,” Galdo said. How detailed your operating procedures need to be depends on your pharmacy’s size. A pharmacy with 100 employees will need more specific procedures than a location with just one pharmacist and one technician.

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SOLUTIONS

Depending on the size of your location, the kinds of tasks outlined in your manual will vary. For a smaller staff, you may only need to outline large responsibilities, such as assigning an employee to be responsible for inputting prescriptions and describing when that changes based on volume of fills. A larger staff may need more specific procedural guidelines, such as what greeting to use when answering the phone, which Galdo said is similar to what’s found in manuals at national chain pharmacies. “It’s like a cookbook,” Galdo said. “That way everybody knows what’s in their scope of practice.” Once you create and implement your standard operating procedures, and make them available for employees to reference, Galdo suggests reviewing them once a year, or when you hire a new employee. COMMUNICATING CHANGE Thinking that your workflow can’t get any better is another big mistake pharmacy owners and managers make. Without improvement, operations grow tired and stale. Once you do make the effort to institute change, it’s equally important, Galdo said, to practice what you preach. “If I’m the owner, or I’m the manager and I’m trying to tell my workers that we need to change, I can’t force that on them. It needs to be something that I believe in as well, and that I’m willing to adopt, too,” Galdo said. Once you’ve created and implemented your standard operating procedures, it’s important to follow them carefully. Galdo said the best way to give the new workflow procedures legitimacy is to lead by example. “If you always make exceptions to what you’ve established, then you really haven’t established anything,” he said.

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CHANGE IT UP Take a hard look at your workflow and don’t be afraid to mix it up—even if that means going against the norm. For example, Galdo said to consider having a pharmacist do the inputting, instead of a technician. “When I work at a pharmacy that has a pharmacist doing the inputting and dispensing drugs, I absolutely love it,” Galdo said. “He knows why the patients are on what therapy. He knows what they’ve tried in the past. He knows who to counsel and how to counsel them—it’s a very efficient system.” Also worth considering is how to incorporate clinical services into your workflow. One option for integrating clinical services is to have technicians complete patient-intake for medication therapy management (MTM). The technician records the patient’s symptoms, gets his medication list and reviews his medical records. Then, the pharmacist completes the visit. “That’s very similar to how physicians practice in the clinic setting,” Galdo said. “You have a nurse who checks your blood pressure and talks to you about your medication, and then the physician comes and talks to you.” TAKE ADVANTAGE OF ANALYTICS If you want to improve your workflow, Galdo advises thinking about what outcome you want to achieve and how workflow can help. Then, work toward that outcome by monitoring and tracking your outputs to see what adjustments you need to make to meet your goal. For example, your goal could be to get each prescription from drop off to dispensing in seven minutes. To reach that goal, track how quickly you can

SOLUTIONS

dispense a prescription, and then identify barriers preventing you from reaching your goal time for every fill. “You set an idea of, ‘This is what I want to do; this is my goal,’ and then you fix it,” Galdo said. Tracking is key, no matter the goal. Every pharmacy should look at eliminating waste in order to improve workflow, Galdo said, and one way to do that is to increase efficiency by measuring—and monitoring—your cost of dispensing. Measure your cost of dispensing by dividing all of your expenses by the number of prescriptions filled in a given period of time. “That tells you how much money you’re spending to get one drug out the door,” Galdo said. Then, use that number to improve your workflow by eliminating waste wherever possible. “I worked in a pharmacy that was co-located as longterm care and retail. Long-term care probably generated about the same amount of money as the retail, but retail had eight pharmacists and long-term care had two,” Galdo said. “We could have saved money on the retail side by putting some of those pharmacists in the longterm care side. We would’ve been able to dispense those drugs faster, which would have cut down our expenses.” Galdo also advises pharmacy owners to make changes gradually, so they can pinpoint which operational tactics are working—and which aren’t. “You don’t want to do a thousand things at once,” he said. “You want to do one thing at a time, and look at the impact of that one thing.”

helps patients stay adherent to their medications by synchronizing their refills to a single day each month, and it allows the pharmacist to know what to order and when. “If you know you need to order this expensive Sovaldi® or this expensive Tobi® or Atripla®, you get it and have it in stock to dispense it that day or the next day, as opposed to leaving all these random baskets hidden throughout the pharmacy because they all have partial fills,” Galdo said. THE BIG PICTURE Adopting the appointment-based model, is also a prime example of using workflow to meet a larger goal. Pharmacists today know the importance of Star Ratings, quality measures set by the Centers for Medicare & Medicaid Services (CMS), and meeting the metrics defined by them. “The appointment-based model is a great example of changing workflow to both meet Star Ratings’ metrics and to improve your business,” Galdo said. “You’ve changed workflow in the fact that you’re planning ahead on what medications you’re filling and when. And, you’re improving adherence because you’re pre-selecting patients to sync all of their medications and having them come in and talk to you.” “We shouldn’t approach Star Ratings as something that’s burdensome,” Galdo said. “We need to approach it as something that can be built into our workflow and how we practice, so that what we do is quality—we’re not just striving to achieve a metric.”

INVENTORY IMPROVEMENTS To a large degree, workflow is having the right drug at the right time for the right patient. Galdo said effective inventory management not only improves workflow, but prevents unnecessary costs, too. Many unnecessary costs come from ordering too much and having to pay to return the drugs to the wholesaler. “I was talking to a pharmacist recently and their pharmacy paid $10,000 to return overstock to their wholesaler in the last fiscal year,” he said. “That $10,000 is an expense, and if you cut that expense out, then it’s all net income.” One workflow strategy to prevent the problem of over-ordering is the appointment-based model, which

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Phasing in Pharmacogenetics Put your pharmacy on the cutting-edge with genetic testing

Is pharmacogenetic testing a service you ever thought you’d offer in your independent community pharmacy? It’s not a goal for the future; it’s here today. Independent community pharmacies across the country are already offering this service to their patients to minimize the pain and frustration that comes with the trialand-error process of finding the proper medication. Pharmacogenetic testing provides insight into which medications will work best for patients based on their genetic makeup. It pinpoints what medications will and won’t work for that person, and which ones have the potential to improve that patient’s outcomes. Independent community pharmacists have a trusting relationship with patients and are known for convenience, which makes them the ideal health care professionals to explain pharmacogenetic testing and to counsel patients about their lab results. And because pharmacogenetic testing can improve the efficacy of a patient’s medication therapy, it can also boost adherence rates, positively influence Star Ratings and increase patient loyalty. Health care professionals have been slow to adopt these tests because of the high costs associated with them, and these tests weren’t found in pharmacies—until now. Genetic tests are making their way into the marketplace, and now could be an optimal time to integrate them into your independent community pharmacy practice. How independent community pharmacists handle genetic testing is still relatively new. We talked with two pharmacogenetic testing companies that offer genetic testing to patients through pharmacies—and

the pharmacies using them—to get the scoop on how pharmacists can incorporate this innovative service into their practices. TAKING THE FIRST STEP RxGenomix, a pharmacogenomics research company based in Franklin, Tenn., helps health care providers understand the science of pharmacogenetics and how to incorporate it into their businesses. “The first step in incorporating pharmacogenomics into pharmacy practice is having the knowledge and expertise to apply the science into practice,” said Angela Tice, Pharm.D., co-founder of RxGenomix. In August 2015, the company began a pilot program in partnership with MaxusRx. The pilot program includes a 16-hour continuing education program for pharmacists to learn the basics of pharmacogenetic testing and step-by-step guidance for implementing genetic testing in their pharmacies. Through the program, MaxusRx works with pharmacists to process test samples, to teach them to administer the tests in their practices, and to help them reach patients and physicians in their area. Then, RxGenomix pays pharmacists for consulting with patients on the results of the tests. The program is funded through a grant from the NACDS Foundation. The program currently offers four test profiles: psychiatric medication, pain medication, cardiology, and a comprehensive test for all three categories. Participation in the pilot program comes at no cost to the pharmacy, and patients’ insurance is billed for the test.

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The no-cost investment, opportunity to improve patient outcomes, and ability to save patients and pharmacy staff time and money on ill-suited prescriptions attracted Osterhaus Pharmacy, an independent community pharmacy located in Maquoketa, Iowa, to participate in the pilot program. “It’s truly moving us into personalized therapy,” said Matt Osterhaus, pharmacist and owner of Osterhaus Pharmacy, which offers a variety of advanced services to its patients such as a full-line of adult immunizations and medical equipment, including sleep apnea services, postmastectomy services and prosthesis fittings. And now, genetic testing. “If we can make a significant impact on how a patient responds to therapy by tailoring those medications that specifically work for them, or avoiding the ones that aren’t going to work for them, that’s a significant impact that we can have in enhancing patient care, and in the long-run in keeping the cost of health care down.” “If we’re not wasting our time using medicines that don’t work, or using medicines that are going to adversely affect someone, we’ve got a lot of money to save down the line,” he said. By participating in the pilot program, Osterhaus Pharmacy gets paid a fee for gathering the patient’s saliva sample, and another for completing the initial assessment of the results. Each patient’s genetic test results are displayed in the program’s portal, and pharmacists interpret the results using the training they received during the continuing education program. Osterhaus Pharmacy began exploring options for pharmacogenetics testing in December 2014. After completing the continuing education program through RxGenomix, the pharmacy has recently started offering genetic testing to patients. “We got results back from our first three patients in the last few weeks,” Osterhaus said. And it’s already proven its value. “The first patient we got results back for, we figured out that the antidepressant the patient was on was not likely to work well in her, so we were able to contact the physician and make a change,” he said. “Right off the bat we’re already seeing where this can really have an impact on patient care.” Osterhaus said he looks forward to continuing

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to participate in the pilot program. “We think that pharmacogenomics belongs to the pharmacist,” he said. “As the information available gets more robust and there are more medications that there’s information on, we really think genetic testing is going to be an essential part of taking care of our patients in the future.” EASY GENETIC TESTING Harmonyx, a pharmacogenetic testing company based in Memphis, Tenn., offers a different approach to integrate pharmacogenetic testing into pharmacies. The company provides pharmacies with genetic testing kits, which currently can test for four families of medications: antiplatelets, statins, and those used to treat ADHD and pain. Using the testing kit is simple. The pharmacist consults the patient and supervises while the patient takes his or her own genetic sample by swabbing the inside of each cheek for 15 seconds. The patient places the swab back in the kit and the pharmacist seals the envelope. The pharmacist enters the patient’s information into the Harmonyx portal for the lab order, including the name of the treating physician and a signed consent form. The order is then sent electronically to a licensed physician who reviews it upon arrival of the test kit. The physician then orders the test on behalf of the patient. “Really all the pharmacist does is place the order into a queue for a network physician, and they’ll get the results back within 24 hours of when we receive the swabs,” said Robert Bean, founder and CEO of Harmonyx. Copies of the lab results are returned to the pharmacist and to the treating physician. Patients can request their results when they purchase the test at the pharmacy and they’ll receive a copy through a patient portal, myHarmonyx. Test results are organized into three color-coded categories that indicate how likely a patient is to metabolize a medication, in what Bean calls a “bin system” based on the patient’s genetic compatibility with the medication. The green bin means “try as directed,” yellow is “try with caution,” and red means “try an alternative.” “We’re trying to keep our results very brief, very simple, and understandable so that people can actually

apply this information to their lives,” Bean said. The test for pain medications costs patients $99, which covers 21 medications; $89 for ADHD, which tests the efficacy of nine medications; $59 for antiplatelets, which tests the efficacy of the drug Plavix® (clopidogrel); and $49 for statins, which identifies if a patient is at risk for painful myopathy as a side effect of ZOCOR® (simvastatin). “We think that by breaking up the genes that are relevant for that particular class of medication, it makes affordability for the patient more realistic,” said Todd Poley, marketing director for Harmonyx. “A child that’s on an ADHD medication doesn’t need to know if their antiplatelet medication is going to work or not work, so we give results based on that particular class of medication.” And, offering Harmonyx comes at no cost to the pharmacy. Harmonyx also provides online training for pharmacists beginning genetic testing, which requires them to complete a series of training materials before they can order their first test. WHY PHARMACISTS? Tice of RxGenomix said that genetic testing is well-suited for independent community pharmacists. Unlike other aspects of medication therapy management (MTM) that involve disease states, pharmacogenetics is specific to medication use, where pharmacists are the experts, Tice said. “This presents an enticing business opportunity,” she said.

“From a business perspective, providing pharmacogenomic testing for patients can be a differentiator for their practice and can help develop patients’ loyalty to their practice,” Tice said. Bean of Harmonyx agrees that pharmacists are the health care professionals perfectly suited to provide genetic testing to ensure medications will work as intended for patients. If a patient begins a medication that has a genetic test available and the patient doesn’t find out if his body can metabolize the drug, he could be wasting his time and money, or even damaging his health, Bean said. “There’s no economic incentive in those tests for physicians,” Bean said. “They can’t do it in their offices, so they can’t bill insurance and make a profit on it, and no one is requiring them to do it. The only other person in the patient’s life who can stop the misuse of medicine is the pharmacist.” PHARMACOGENETICS IN PRACTICE Currently, 1,750 pharmacies use Harmonyx, including Burnham Drugs in Gautier, Miss. Burnham Drugs is the third location of a ninepharmacy regional chain that has been in business for more than 100 years. The pharmacy offered its first Harmonyx test in 2014. Greg Spanier, Pharm.D., owner of Burnham Drugs, said he had no idea that pharmacogenetic testing was

Pharmacogenetics vs. pharmacogenomics What’s in a word? While “pharmacogenetics” and “pharmacogenomics” are often used interchangeably, the two terms do have subtle differences. Pharmacogenetics is considered the branch of pharmacology concerned with the effect genetic factors have on a patient’s reaction to drugs, while pharmacogenomics is regarded as

the science of ways to compensate for those genetic differences. However, both are still loosely defined and one is often substituted for the other. Sources: “Pharmacogenetics and Pharmacogenomics,” British Journal of Clinical Pharmacology; Merriam-Webster

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available for use by community pharmacists until a representative from Harmonyx contacted him and he learned how it could help his patients, and thought it was worth a try. “If your medication doesn’t metabolize well in your body, you’re just wasting time and money, and can put yourself at risk,” Spanier said. “An example would be a poor metabolizer of Plavix and increased risk for stroke, clot or another coronary event.” Flower Mound Pharmacy in Flower Mound, Texas, has also offered Harmonyx for more than a year. The pharmacy is a fullservice compounding and retail pharmacy that specializes in bioidentical hormones, food sensitivity and nutrition. Because of the pharmacy’s focus on whole health and patient outcomes, Dennis Song, R.Ph., owner of Flower Mound Pharmacy, said integrating pharmacogenetics aligned perfectly with the services his pharmacy already provides. “It’s more of a personal and custom medicine profile, and that’s what we do with compounding, so this is customization of the non-compounded medication,” Song said. “It’s a lot more cost-effective, and it’s time-effective.” He said it highlights that his pharmacy can do more than dispense, and it complements his pharmacy’s other niche services, like nutrition counseling and hormone therapy. “We always like to be cutting edge, and this has really enhanced that,” Song said.

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Flower Mound Pharmacy orders about 30 genetic tests per month, which Song attributes to the partnership with Harmonyx that helps them market to physicians. He said most of their patients who order tests come to their pharmacy after a physician referral. “We make it a routine to visit the physicians and tell them that this is a service we offer that no one else does,” Song said. Rx Unlimited, LLC, an HIV specialty pharmacy in Beverly Hills, Calif., only orders about two tests a month through Harmonyx, but because it’s no cost and no liability, the pharmacy still sees value in offering the testing. “We’ve seen some ADD or ADHD patients asking, ‘What’s a better form of treatment?’ and ‘What might work better?’ because their dose is no longer effective or not as effective,” said Brian Goldstein, owner of Rx Unlimited. “The test costs $89, so for a better result and a happier life, patients are willing to risk that $89.” A MOVE FOR BETTER BUSINESS Providing in-pharmacy genetic testing may not be a high revenue service yet, but it does offer other benefits. While Harmonyx does include a small revenue opportunity—15 percent of the price of each test the pharmacy sells—the real monetary gain from genetic testing comes indirectly, according to Bean. As adherence becomes an important factor in how

insurance companies reimburse pharmacies, Bean said genetic testing matters because patients who take medications that are pharmacogenetically matched to their bodies are more likely to refill their prescriptions. “If you take a statin and you experience muscle pain because you have the mutation in the SLC01B1 gene, you’re likely not going to keep taking that statin after your body aches. You’re just going to quit,” Bean said. “So, the adherence to statins is directly linked to the ability to metabolize the drug.” Bean said independent community pharmacies are especially well suited to take advantage of genetic testing and to recommend it because of their strong relationships with patients. “If it were just about getting a bottle of pills filled, it could be done anywhere,” he said. “Independent pharmacists have the all-important relationships with those patients.” Spanier of Burnham Drugs said he believes the tests do increase patient adherence, especially the statin and antiplatelet tests. “Since you can’t feel your blood thicken or your cholesterol go down, if you have the test and you are shown proof that, genetically, your body is metabolizing the medication well, you would be more apt to take the medication as prescribed,” Spanier said. The adherence benefits of genetic testing stretch to ADHD medication, too. Song of Flower Mound Pharmacy said parents are often apprehensive about their child beginning a medication treatment program in this class and a test could help ease their minds. “Now, they can be assured that their child is on the right medication—and that it’s going to work,” Song said. “With that drug class alone, it increases adherence.” Providing pharmacogenetic testing for patients can be a differentiator for your practice, and it can help develop loyal patient relationships, said Tice of RxGenomix. Patients will easily see that no other health care professional is talking to them about how their DNA could affect their medication—the area where pharmacists are the experts. “This is an emerging market. If pharmacists seize

the opportunity to establish this capability within their practices, they could significantly increase their role in the health care process,” Tice said. COMMUNICATING WITH PATIENTS Spanier said that his patients are generally welcoming to the idea of pharmacogenetic testing after a simple explanation. “This is a godsend,” he said. “You just don’t realize how many times families have to try out a medication that is expensive—even with insurance—just to have to try a new one two weeks later.” Song said his patients were also surprisingly receptive to genetic tests, and are happy with the price point of the tests, too. “I was thinking they would be a little apprehensive about having their genes tested and their DNA shared, but no, no,” Song said. “There is full trust, and the test is confidential and secure.” THE FUTURE OF PHARMACOGENETICS Bean said he believes that it’s just a matter of time before pharmacogenetics goes mainstream, and that independent community pharmacies are the early adopters who can make genetic testing a part of regular treatment. “Just like independent pharmacies were pioneers with vaccinations in the pharmacy setting, they are paving the way for pharmacogenetics and personalizing prescription therapy,” Bean said. Bean said Harmonyx is planning to bring more tests to the market over the next few months, including a folic acid test and an antidepression test. And to the degree that science supports it, Bean said Harmonyx will continue to expand the variety of tests it offers. “It’s going to be counter-cultural for a long time, but it’s about patient rights. It’s about patients not being subjected to trial-and-error prescriptions,” he said. Interested in incorporating pharmacogenetics into your independent community pharmacy? Learn more about Harmonyx at harmonyxdiagnostics.com and about RxGenomix at rxgenomix.com.

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SPOTLIGHT

Mobile Monitoring A new device works with patients’ smartphones to monitor the direction their glucose is trending Continuous blood sugar readings are now available via smartphone. The Dexcom G5™ Mobile Continuous Glucose Monitoring (CGM) System sends glucose readings directly to patients’ phones every five minutes, and indicates which direction their glucose level is trending. Regular glucose updates means fewer finger sticks and more convenience for patients, according to Jorge Valdes, chief technical officer for Dexcom, a San Diego-based company that develops, manufactures and distributes continuous glucose monitoring systems for diabetes management. “Finger sticks have been around 20 or 30 years, so our system, which minimizes finger sticks, is a leading-edge technology,” Valdes said. “The benefit of pharmacies having it is they’ll be carrying an innovative product that showcases where diabetes treatment is headed.” HOW IT WORKS The Dexcom G5 Mobile CGM System includes a sensor and a transmitter that sends readings to a patient’s smartphone or to a Dexcom handheld receiving device. The sensor is about as thick as two human hairs, and the patient inserts it with a needle applicator a quarter-of-aninch beneath the skin of the abdomen (or upper-buttocks for ages 2-17). The needle is removed, leaving behind the small sensor, and a plastic base above the skin where the transmitter is attached. An adhesive patch secures the plastic base to the body.

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SPOTLIGHT

According to the Food and Drug Administration (FDA), the sensor must be removed and replaced each week. Patients are able to swim, shower and use an insulin pump while wearing the device. To detach the device, patients simply pull on the adhesive patch. Each time patients reapply the sensor, they should choose a different spot on their abdomen or buttocks—similar to rotating the placement of an insulin pump. Inserting the sensor is less painful than finger sticks, Valdes said. “Unless you hit a nerve, you really don’t feel it,” he said. “The needle is a really small-gauge needle, similar to what diabetics use to put their insulin in.” MORE INFORMATION, BETTER DECISIONS The continuous readings that monitor the direction of a patient’s glucose allow patients to make better-informed decisions about how to maintain a normal glucose level. For example, Valdes said a glucose reading of 80 that’s trending down would require the patient to eat carbohydrates, while a reading of 80 that’s trending up would alert the patient that no action is needed. “The problem with stick therapy is, just knowing the value and not knowing which direction you’re going in doesn’t really give you all of the information you need to make a decision about what to do at that point in time,” Valdes said. Another advantage of the Dexcom G5 Mobile CGM System is that it minimizes the number of finger sticks patients have to take. Instead of the average four to six finger sticks per day, the system only requires two finger sticks per day to calibrate the device. Valdes said the calibration points are necessary to collect accurate readings because the sensor’s sensitivity to glucose drifts over time. SHARING TO SAVE LIVES The Dexcom G5 Mobile CGM System includes a feature that allows patients to share their glucose level and trend information with up to five people through a smartphone app. Valdes said the share feature gives children with diabetes more independence and helps ease anxiety for parents. For example, kids can go to sleepovers, and their parents can still receive updates about their blood

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sugar through the app. The share feature has even saved lives. Valdes said he received an email from a man who passed out in his home after mowing his lawn because his blood sugar had dipped too low. No one else was home, and no one would have known that he needed help without the system. “Because he was wearing the share system, multiple family members saw where his blood glucose was. They tried calling him, but he wasn’t answering, so they ended up calling 911. Responders went into the house and found him passed out,” Valdes said. IMPROVING DIABETES CARE Valdes said the Dexcom G5 Mobile CGM System allows pharmacists to take their diabetes care services to the next level. “Since pharmacists are trying to provide more wellrounded solutions, it’s another way to get a patient into the pharmacy and engage with them, which is good for their business,” Valdes said. And it’s more convenient for patients. If patients order the Dexcom G5 Mobile CGM System through durable medical equipment, it takes about 20 days to complete the insurance paperwork, to obtain necessary approvals and to ship the product. But, if patients order it through their pharmacy, the process only takes 24-48 hours, even if the product isn’t currently in stock. “From a patient pointof-view, it’s way more convenient to pick up the product at a pharmacy,” Valdes said. “And from the pharmacy side, they can provide more full-service for patients.” Find out more about the Dexcom G5 Mobile CGM System at dexcom.com.

MONEY

Funding Change Advice for pharmacies interested in applying for grant funding By Kathleen Barbosa

Grant funding isn’t only available for nonprofits, charities and schools. Your independent community pharmacy is eligible to receive funding for research or for a special project, too. “We encourage submission of all grant application ideas,” said Anne Marie (Sesti) Kondic, Pharm.D., executive director and grants administrator for the Community Pharmacy Foundation (CPF), a national nonprofit organization. The CPF provides grants and funding for special projects and studies directly associated with community pharmacy practice and the advancement of patient care services by pharmacists. The foundation has already awarded research and project grants worth more than $6.7 million since 2002. More than 140 grant-funded initiatives—including research examining the effect of pharmacist-directed cardiovascular medication management, and a project involving pediatric medication therapy management in urban and rural settings—have recently received funding. Your idea could be next.

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Here’s how to apply for—and earn—grant funding to put toward making a difference in your community and in the industry. APPLICATION PROCESS The grant process starts with an idea, but you need more than just that. “Community pharmacy practitioners are encouraged to submit a project or research idea that addresses unmet needs,” Kondic said. If you don’t have an idea for a grant project, use the CPF mission statement as a starting point. Or, Kondic said you could replicate a previously completed CPF grant project in your community. Once your idea is set, it’s time to apply. CPF’s grant process starts with an online application, which is open for submissions year-round. Kondic said the CPF board meets five times a year and reviews submissions. When reviewing submissions, they ask questions such as: Does the research meet the CPF mission and vision? Is it new research, or has

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MONEY

5 Grant Application Tips

Make the most of the grant application process—and get your idea noticed— with these tips from Anne Marie (Sesti) Kondic, Pharm.D., executive director and grants administrator for the Community Pharmacy Foundation (CPF). 1. Be relevant Review the organization’s vision and mission to ensure your grant topic aligns with the organization’s core purpose.

2. Propose a variety of ideas Organizations, such as CPF, appreciate seeing a variety of ideas for projects in grant applications.

3. Submit often, and resubmit If the organization doesn’t limit submissions, submit multiple ideas and consider resubmitting modified ideas that were previously rejected.

4. Collaborate Work with a nonprofit, an institution of higher education, such as a college of pharmacy, or, partner with another health professional organization, to apply for, implement and support your grant project idea.

5. Follow the criteria Examine the organization’s criteria for funds and carefully follow these guidelines during the application process.

CPF already funded the topic? Does the research or project highlight new innovations in patient care? And, is the grant sustainable, replicable and transferable? If the board approves the submission, applicants are asked to submit a more detailed grant proposal. If approved, they’re also given a grant agreement defining the conditions for financing, and assigned a grant administrator to monitor their progress and authorize issuance of grant dollars.

GRANT PARTNERSHIPS If you’re not comfortable applying for a grant alone, seek out partnership opportunities. For example, the NACDS Foundation gives grants to nonprofits and institutions of higher learning that partner with pharmacies to complete research, according to Kathleen Jaeger, president of the NACDS Foundation. “Independent community pharmacies can work with academic institutions to submit a research proposal,” Jaeger said. “Or, pharmacies can respond to a call for interested pharmacies to participate in a specific research project.” Pharmacies have contributed valuable information to many projects about accountable care, transitionsin-care, point-of-care testing, and more, Jaeger said. Or, you can partner with an academic institution directly. Kondic said CPF also encourages independent pharmacies to collaborate with a college of pharmacy. “The partnership can bring additional research strength and staffing support to implement and monitor the project,” Kondic said. ANSWERS TO A CHANGING INDUSTRY Grant-funded projects and research really come down to the same goal for everyone: improving patient care. Kondic said CPF evaluates grant projects and research proposals based on how well they highlight new innovations in patient care, ideally addressing compensation models for delivery of care. Once grant-funded research and projects are completed, Kondic said the findings are posted on the CPF website at communitypharmacyfoundation.org. CPF also works with the American Pharmacists Association (APhA) to maintain a reference library of pharmacy topics, articles and resources on the CPF website. These findings often address today’s big issues such as care transitions, adherence, MTM and patient safety. This research demonstrates how pharmacists and CPF grants are creating solutions to health care issues, Kondic said, and CPF grants continue to support pharmacy practitioners as they seek to improve patient care. “CPF is an organization whose primary purpose is to assist community pharmacy practitioners by providing resources for research and development to encourage new capabilities and continuous improvements in the delivery of patient care.”

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and many more options available!

OUTLOOK

Pharmacy Gets Creative The co-founder of Creative Pharmacist explains how to improve clinical outcomes with a little creativity Jump start your creativity—and your business—with help from Creative Pharmacist. Creative Pharmacist provides clinical pharmacy solutions designed to help pharmacies improve patient outcomes and find new revenue streams. The company offers programs for diabetes, heart health, asthma and COPD, transitions of care, weight loss and immunizations, and it gives pharmacies the tools, technology and marketing to provide these clinical programs and services in their stores. David Pope, Pharm.D., CDE, chief of innovation and co-founder of Creative Pharmacist, talked with us about his business, the pharmacy landscape and why pharmacists need to get creative. HOW DID CREATIVE PHARMACIST START? Creative Pharmacist was born out of a partnership

between myself (a pharmacist) and my college roommate, Dan Lawson, (a computer major.) We saw a strong push in the marketplace toward chronic care management, and as the nation struggled to find a way to reach people in rural areas with quality programs for diabetes, heart health, COPD, smoking cessation and the like, we found that community pharmacists are the primary professionals to do that. In small towns throughout the country, there’s almost always a community pharmacy, so we combined the pharmacy-side with the technology-side to give pharmacies throughout the country chronic care management tools. WHAT’S THE AIM OF CREATIVE PHARMACIST? We want to empower pharmacists to engage with their chronic care patients and to improve their outcomes. We

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OUTLOOK

use a variety of tools to do that. In all things, our aim is to grow pharmacists’ clinical abilities so they have a more informed decision-making process. WHAT MAKES YOUR SERVICES UNIQUE? Within the pharmacy landscape everyone is asking pharmacists to do something outside of their comfort zone, from adherence programs to diabetes education. We package those programs with a bow on top, so it’s all completely done for them. We’ve combined technology tools, word-for-word scripts for pharmacists and our business expertise, so all the pharmacist has to do is unwrap the package. HOW DID YOU DECIDE WHAT CLINICAL SERVICES TO FOCUS ON? I’m a pharmacist myself and I serve a low-income population that has a high incidence of chronic disease, which is echoed throughout communities across America. We looked at the primary drivers for chronic disease first, and identified which ones offer pharmacists a strong return when they invest time or money into a specific disease state. WHY IS FOCUSING ON CHRONIC CARE PATIENTS IMPORTANT? Pharmacists are in an ever-changing landscape, and in order to avoid getting caught in the cracks, pharmacists need to not only improve outcomes, but they also need to have a strong return on investment. We know that when pharmacists get involved, patient outcomes improve. But we also know that when a pharmacy attracts a chronic care patient, they are, in essence, your dream patients. Not only can you change their outcomes, but they also spend more in the pharmacy than any other type of patient, so it’s worth your time to focus on them. WHAT DO YOU WANT PHARMACIES TO KNOW ABOUT CREATIVE PHARMACIST? Creative Pharmacist allows you to compete in today’s new landscape, and not just survive, but thrive. We offer a lot of tools, and not everyone will use every tool, but we have programs for different levels of investment of time. The more time you invest in the program, the better the return. Regardless, every tool is available at no

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additional cost. We also have a team of Pharm.D.’s, nurses and marketing experts who work with you to ensure your success. The other thing that we want pharmacists to know about Creative Pharmacist is its simplicity. We’ll give you the right tool, at the right time, for the right purpose. HOW CAN PHARMACIES BENEFIT FROM THE TOOLS AND RESOURCES CREATIVE PHARMACIST OFFERS? Creative Pharmacist is a game changer for the independent pharmacy. They’ll see both an improvement in patient outcomes, which is a requirement in today’s landscape, and they’ll also see a strong return on investment, as much as 40 to one, with each of our individual solutions. WHY DO PHARMACIES NEED TO FOCUS ON CLINICAL SERVICES—TODAY? The rest of the world is focusing on it now. If we want to continue to get paid in new ways, and to compete in today’s landscape, then we have to be able to show strong clinical outcomes. We’re leading the charge to develop and provide new payment models for pharmacists, but we can’t do that unless our pharmacists are clinical in nature. WHAT’S NEXT FOR CREATIVE PHARMACIST? We’re working on several new payment models for pharmacists. We’re working with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to develop a new payment model so pharmacists can get paid for managing patients with COPD. We’re also working with the Centers for Disease Control and Prevention (CDC) on a new pre-diabetes program for pharmacists that we’ll be launching this winter. We also have some incredibly cool technology pieces coming out that make immunizations simple, and allow pharmacists to connect with their patients in new ways.

David Pope, Pharm.D., CDE, is the chief of innovation and co-founder of Creative Pharmacist, a company dedicated to providing community pharmacists with tools to improve the outcomes of chronically-ill patients. Find out more about Creative Pharmacist at creativepharmacist.com.

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OUTLOOK

Forward-Thinking Services Creative Pharmacist offers a variety of programs and services to help independent community pharmacies complete—and get paid for—chronic care services. Here’s a quick look at the services Creative Pharmacist offers and how they can benefit your pharmacy. Air Ways Air Ways is a three-pronged program that includes fully scripted quarterly COPD and asthma curriculum and a complete smoking cessation program. Creative Pharmacist worked with the Centers for Disease Control and Prevention (CDC) to create its nationally recognized smoking cessation program. Air Ways also features a 2-minute consultation for asthma patients via iPad. The Beat Attracting one heart failure patient to your pharmacy can result in more than $6,000 per year in total sales, according to Creative Pharmacist. The Beat is a heart health solutions education program to help pharmacies attract patients with heart failure, hypertension and other heart-related issues. The program includes a two-hour continuing education and certificate program on heart failure and fully scripted monthly curriculum so pharmacies can offer their own heart health classes. Jump Starts The Jump Starts program encompasses immunizations, transitions of care and weight loss: three building blocks of clinical practice that are both clinically and financially beneficial. For those pharmacies that don’t immunize, Jump Starts is a starting point, and for those that do, the program takes pharmacies to the next level with comprehensive immunization reviews. Jump Starts also helps with transitions of care by creating partnerships between pharmacies and local

hospitals. Creative Pharmacist provides pharmacies with materials to create an agreement with a hospital, and will even work with your pharmacy to pursue an agreement. And, the weight loss portion of Jump Starts includes curriculum for pharmacists, and technology to connect patients with recipes, workouts and support from their pharmacist to help them lose weight. The Sweet Spot The Sweet Spot is a diabetes education solution for pharmacists. You start by taking a two-hour continuing education and certificate program on diabetes, and then the Sweet Spot provides you with everything you need to offer diabetes education classes once a month. It’s a one-hour-a-month solution for pharmacies to attract new patients with diabetes and positively influence their outcomes with education. It includes scripted curriculum, patient handouts and marketing materials. For pharmacies that want to go further, there’s the Sweet Spot Evolution, which enables pharmacies to bill for diabetes education by helping pharmacists attain accreditation through the American Association of Diabetes Educators. Spark The newest offering from Creative Pharmacist is a patient management system that increases communication and information sharing between pharmacists and patients. Spark enables patients to provide their pharmacist with weekly updates about their progress on diet, exercise, blood pressure readings and more. The web-based platform asks patients diseasestate specific questions, so pharmacists can hold patients accountable, provide support, and identify and intervene to fix problems earlier. The Spark platform is also available through the Spark Health app for iPhone and Android.

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NOTES

Stopping Shingles Improve patients’ health while increasing pharmacy revenue Offering the shingles vaccine at your pharmacy can do more than keep your patients healthy; it’s a savvy business move as well. AuBurn Pharmacies, a regional independent pharmacy chain headquartered in Garnett, Kan., has offered Zostavax® ever since the Food and Drug Administration (FDA) approved the vaccine in 2006. Mike Burns, R.Ph., president and CEO of AuBurn Pharmacies, decided to provide the vaccine because it sets AuBurn Pharmacies apart from the competition, and it’s a good source of revenue. Most importantly, the vaccine prevents or minimizes the pain and complications of shingles for patients—something Burns knows about first-hand. “I’ve already had shingles twice in my life,” Burns said. “So, obviously it makes me even more aware of the dangers of shingles.” A SOURCE OF REVENUE Offering Zostavax is an opportunity uniquely suited to independent community pharmacies, Burns said, because the vaccine must remain frozen at a monitored temperature, and many physicians don’t want to deal with that extra burden. From a profitability standpoint, offering the shingles vaccine is a

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good idea. Burns said each shot yields margins of about $30 with the administration fee. That revenue is well earned, as it takes extra time to educate patients and to make sure they know the dangers of not receiving the vaccine. Burns recommends letting reluctant patients know that they can get the vaccine right then and there. He then suggests you tell patients the facts: Nearly 40 percent of anyone who has had chickenpox will get shingles, and nearly one-third of those patients who get shingles will suffer nerve pain after the rash heals. “After we convince them, then the biggest question is, ‘What’s it going to cost me?’,” he said. AuBurn Pharmacies are proactive. They identify eligible patients ahead of time, bill the insurance they have on file to see what the co-pay will be and reverse the claim. They then input the information into their pharmacy software system to create an alert for the next time the patient comes in to fill a prescription. MARKETING THE VACCINE The market potential for the shingles vaccine is huge. Anyone over the age of 50 is eligible for the vaccine, according to the FDA. Burns said the first step in

marketing the shingles vaccine is reaching out to local physicians to let them know that you offer the vaccine. It’s also vital to educate patients. Burns said some of his pharmacies even call eligible patients who they know have a $0 co-pay for the vaccine. “That’s an easy sell,” he said. “It’s our duty as pharmacists to educate patients to better take care of themselves,” he said. “I think if we do a proper job of educating patients, the majority will make the right decision.”

By the numbers - Portion of Americans who will develop shingles in their lifetime 1 million - Number of Americans who experience shingles each year

½ - Portion of all shingles cases occur in people 60 years and older Source: The Centers for Disease Control and Prevention

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Colchicine 0.6 mg once or twice daily. When the script reads “colchicine 0.6 mg once or twice daily”... consider the capsule — and its cost-saving possibilities. Prescriptions of “colchicine 0.6 mg once or twice daily” frequently do not specify a brand or dosage form. Scripts written this way provide you with an opportunity to dispense West-Ward’s low-cost colchicine 0.6 mg capsule — adding choice, accessibility, and the potential to save money for your adult patients who take colchicine for prophylaxis of gout ﬂares.

Important Safety Information

• Colchicine 0.6 mg capsules are contraindicated in patients with renal or hepatic impairment who are currently prescribed drugs that inhibit both P-gp and CYP3A4. Combining these dual inhibitors with colchicine in patients with renal or hepatic impairment has resulted in life-threatening or fatal colchicine toxicity. Patients with both renal and hepatic impairment should not be given colchicine capsules. • Fatal overdoses have been reported with colchicine in adults and children. Keep colchicine capsules out of the reach of children. • Blood dyscrasias such as myelosuppression, leukopenia, granulocytopenia, thrombocytopenia, and aplastic anemia have been reported with colchicine used in therapeutic doses. • Monitor for toxicity and if present consider temporary interruption or discontinuation of colchicine. • Drug interaction with dual P-gp and CYP3A4 inhibitors: Co-administration of colchicine with dual P-gp and CYP3A4 inhibitors has resulted in life-threatening interactions and death. • Neuromuscular toxicity and rhabdomyolysis may occur with chronic treatment with colchicine in therapeutic doses, especially in combination with other drugs known to cause this eﬀect. Patients with impaired renal function and elderly patients (including those with normal renal and hepatic function) are at increased risk. Consider temporary interruption or discontinuation of colchicine capsules. • The most commonly reported adverse reactions with colchicine are gastrointestinal symptoms, including diarrhea, nausea, vomiting, and abdominal pain.

Indication

Colchicine 0.6 mg capsules are indicated for prophylaxis of gout flares in adults. The safety and effectiveness of colchicine capsules for acute treatment of gout flares during prophylaxis has not been studied. Colchicine 0.6 mg capsules are not an analgesic medication and should not be used to treat pain from other causes. Please visit www.west-ward.com for Full Prescribing Information and Medication Guide for colchicine 0.6 mg capsules. Manufactured by: West-Ward Pharmaceuticals Corp., Eatontown, NJ 07724 ©2015 West-Ward Pharmaceuticals Corp. All rights reserved. WW00179