Elements Magazine - Vol.6 Iss.1 March 2017

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ELEMENTS

Staying Relevant How to grow your pharmacy in today’s rapidly changing health care environment

Continuum of Care How Integrity Pharmacy improves patient outcomes with home visits and medication management

Nutrient Depletion The benefits of counseling patients on drug-induced nutrient depletion and vitamin supplementation

VOL. 6 ISS. 1 | MARCH 2017 | pbahealth.com/elements

Dimensions: 21.5” x 15.5” x 7”

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ELEMENTS

The business magazine for independent pharmacy

STAFF & CONTACTS Matthew Shamet – Publisher and Editorial Director Kirsten Hudson – Editor Kellie Paxton – Art Director Analisa Bregant – Contributing Writer Torrie Wright – Contributing Writer Paige Fisher – Graphic Designer Interested in advertising? elements@pbahealth.com

Contents Departments 5 NEWS:

20 SPOTLIGHT:

Heart Health How two new resources can help pharmacists improve outcomes for patients with hypertension.

Deterring Abuse How independent pharmacists can help combat the opioid epidemic.

24 MONEY:

6 TRENDS:

Online Marketing How to make marketing your independent community pharmacy a snap.

Top 10 Pharmacy Accounting Questions to Ask Your CPA What your CPA wishes you were asking.

29 OUTLOOK:

8 RETAIL:

Common Interest Add value to your independent pharmacy by forming unusual community partnerships.

Continuum of Care How Integrity Pharmacy improves patient outcomes with home visits and medication management.

34 NOTES:

11 SOLUTIONS:

Nutrient Depletion The benefits of counseling patients on drug-induced nutrient depletion and vitamin supplementation.

ON THE WEB //

A Non-Toxic Alternative Diversify your pharmacy’s retail wound care offerings with a natural wound-cleansing product.

Feature: Staying Relevant

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How to grow your pharmacy in today’s rapidly changing health care environment.

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

How to Help Patients Better Understand Health Savings Accounts (HSAs)

Health savings accounts (HSAs) help patients with high-deductible health plans save money. Here’s what your pharmacy needs to know about HSAs, plus tips to help patients better understand them.

Read more at bit.ly/understandingHSAs.

Elements magazine is published quarterly by PBA Health. Copyright© 2017 PBA Health. All rights reserved.

Neither this publication nor any part of it may be reproduced without written permission by PBA Health.

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NEWS

Heart Health How two new resources can help pharmacists improve outcomes for patients with hypertension

By Analisa Bregant

Pharmacists can play a valuable role in improving outcomes for patients with hypertension.

And now two new resources compiled by the Centers for Disease Control and Prevention’s (CDC) Division for Heart Disease and Stroke Prevention, the American Pharmacists Association (APhA) and the American Medical Association (AMA) can help. The resources provide pharmacists with information on the treatment—and prevention—of high blood pressure.

“The resources are an opportunity to help pharmacists manage their patients’ health and establish that pharmacist-patient relationship that supports the engagement of effective communication of patients, family members, caregivers and the patients’ physicians,” said Stacia Spridgen, Pharm.D., LTC (ret), USA, director of the APhA Federal Pharmacy Program.

Using the hypertension resources The resources offer pharmacists instructions for managing the patient care process and tips for developing community partnerships.

One of the resources, “Using the Pharmacists’ Patient Care Process to Manage High Blood Pressure: A Resource Guide for Pharmacists,” is a management tool to help oversee the patient’s medication process and therapy.

The other resource, “Methods and Resources for Engaging Pharmacy Partners,” outlines strategies that help state health departments establish and expand pharmacy services. It explains how pharmacists can form community partnerships to aid in addressing hypertension. For example, partnering with the YMCA to offer programs that use exercise to help people manage their hypertension. Or, how pharmacists can reach out to state health departments and local physician groups.

“I encourage community pharmacists to use these resources and try to translate them into their everyday practice for their patients,” Spridgen said.

By the Numbers

Despite its prevalence, many patients are uninformed of their blood pressure measurements and whether they’re atrisk for hypertension. Here’s a look at hypertension in the U.S. 1/3 - About one in every three U.S. adults has high blood pressure 2 – The percentage of individuals at risk for hypertension and who are aware of their condition 46 billion – National costs of health care services and medications used to treat hypertension Sources: Centers for Disease Control and Prevention; American Journal of Hypertension

A health care team Uniting all forces can help improve patients’ health.

“Patients with high blood pressure often have other conditions, such as diabetes and high cholesterol,” Spridgen said. “The goal is to address all the patient’s medication needs and health problems rather than just focusing solely on one condition.”

The resources equip pharmacists with the tools they need and provide them with an opportunity to engage in partnerships to address hypertension management.

“Everyone has the same goal: improving patient health,” Spridgen said. “Developing those relationships with physicians, families, caregivers and public health departments all work together to improve patient outcomes.”

The resources are free to download at pharmacist.com.

Follow Elements magazine on Facebook and Twitter for pharmacy business tips and advice, news announcements, industry information and exclusive offers.

Elements | pbahealth.com/elements

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TRENDS

Online Marketing How to make marketing your independent community pharmacy a snap What if you could manage your pharmacy’s social media, website and marketing emails all in one place?

For many independent community pharmacies, marketing is last on the ‘to-do’ list. This is usually because marketing takes a lot of time. If you don’t have tools to make marketing more efficient, it just doesn’t happen.

But marketing—especially online marketing—is essential to stay relevant in today’s crowded marketplace.

“All generations, not just the younger ones, are looking to receive clinical content and updates from their pharmacist through email and social media, along with using a website to quickly answer questions,” said Steven Turkovich, marketing manager, product and analytics at SnapRx, a digital marketing platform for independent pharmacies. “Online marketing is a must-have in order to be successful in today’s competitive marketplace.”

Finding an all-in-one approach If you had an online marketing tool that was easy-to-use and drove results, would you use it?

SnapRx is an all-in-one marketing solution for independent community pharmacies to easily manage their online marketing efforts. They can create and schedule emails to patients, manage their social media channels, create fully-responsive branded websites and access e-commerce tools and clinically-developed content.

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“Our goal is to help pharmacists plan all of their marketing communications in one place by saving time, staying top-of-mind and building meaningful connections with patients within their communities,” Turkovich said.

For the less marketing-savvy owners, managers or pharmacists, the integrated marketing platform is easy-to-use. And, it includes organizational tools, like a planning calendar to easily keep track of the content you’re sharing with patients on Facebook, Twitter and Pinterest. You can even drag-and-drop a pre-created idea or generate your own idea to any date.

“Our entire platform is designed to help maximize marketing efforts while minimizing time investment and online marketing know-how,” Turkovich said.

“While many programs exist to help create and send emails, none are focused on saving time or putting the entire digital marketing mix into one solution,” Turkovich said. “You need to use one program to create emails, another to schedule social posts, and a final one to update your website. The time required is much too high, and that’s where SnapRx is different.”

TRENDS

The cost to simplify If your pharmacy has a limited marketing budget, an all-inone marketing approach can be beneficial.

“Our basic subscription gives pharmacists access to curated clinical content, email marketing, social media management and a dedicated marketing guru,” Turkovich said. “And, our premium subscription includes our powerful website builder.”

Check out the basic and premium subscription options for SnapRx at snap-rx.com.

The benefits of marketing automation SnapRx differs from other marketing automation tools because it offers pharmacy industry-specific content.

The platform includes a library of content created by health care professionals at the university level and that’s designed to help you market your pharmacy and save time. More than 1,300 professional stock images and graphics are also available for use.

“We provide ready-to-send clinical email and social media templates that allow pharmacists to quickly make any edits with a few clicks,” Turkovich said. “Our website builder uses the same easy drag-and-drop editor.”

SnapRx can reduce the time you spend on marketing and still improve customer engagement for your brand.

“We give pharmacists access to email, social, website and e-commerce marketing tools designed to help increase engagement with digital generations,” Turkovich said.

“They can see real results with higher engagement on social networks and increased open rates to more prescription refills and front-end sales.”

The platform also provides continual marketing education for its users. “We offer webinars, downloads and weekly email tips focused on marketing for independent pharmacists,” he said.

If you already have a website and social media accounts, you can build on what you’re already doing with SnapRx. “If a pharmacist is already using social media, they can easily link their accounts to SnapRx and start posting online immediately,” Turkovich said. “They’ll quickly see that our pre-created clinical content will save them hours of time. SnapRx makes it easier than ever to stay top-of-mind with patients on social media and through email.”

Getting into E-Commerce

Many independent community pharmacies are looking to increase their front-end sales. With SnapRx, a comprehensive digital marketing platform for independent pharmacies, your pharmacy can get into the world of e-commerce. You’ll be able to: Sell through email with PayPal. Turn emails into sales opportunities by integrating with PayPal. You won’t need a full e-commerce website to sell products with this option.

Create an online store with Shopify.

Connect SnapRx to Shopify, an online e-commerce platform, and add a complete online store to your pharmacy’s website. Product and patient information are instantly synced between your SnapRx and Shopify accounts.

Send targeted emails to drive patients to purchase online.

Convert patients into paying customers with highly targeted emails based on purchase history with SnapRx.

Elements | pbahealth.com/elements

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RETAIL

Common Interest Add value to your independent pharmacy by forming unusual community partnerships When your pharmacy forms partnerships, you probably look to physicians or local community centers. But other—more unusual—partnership opportunities exist in your community that could benefit your pharmacy and your patients.

“I think if pharmacists looked around their community, they would see a tremendous amount of opportunity for unusual partnerships and alliances that help with the holistic care of the patient,” said Dave Wendland, vice president, strategic relations and member of the owners group at Hamacher Resource Group, a leading partner in category management, business strategy and marketing services focused on consumer health care at retail.

Wendland believes consumers today are looking to

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stay well (prevent illness), get well (recover from an illness) and live well (learn to live with a chronic condition.)

“If you think about those three states—stay well, get well and live well—it involves more than just pills or lotions as a temporary fix,” he said. “It’s really an environmental question about what you’re putting in your body, on your body and around your body.”

When you consider these environmental factors, innovative partnerships emerge as a way to bring added value.

“Selecting a partner business that has a common goal can be so valuable,” Wendland said. “Your investment is lower and you’re tapping in to another locally-owned business, which helps the whole community rise.”

The benefits of partnerships Wendland said the biggest benefit of an unlikely partnership with another local business is the increased value to the patient. “It gives them confidence because you’ve done the legwork for them and identified other ways

RETAIL they can improve their health and wellbeing,” he said.

When other businesses promote your pharmacy, it broadens your reach. For example, consider the goodwill that would result from your pharmacy partnering with a local florist to send flowers to patients when they’re discharged from the hospital.

Unlikely partnerships also affect patient loyalty.

“When customers are taken care of beyond just receiving a prescription over a counter, it shows there’s compassion there and that pharmacist’s loyalty quotient goes up significantly,” he said.

Forming unusual partnerships Finding a partnership that makes sense for your independent community pharmacy requires research.

“First, pharmacies should look at the need states of their current customers, and identify things beyond what their

5 Unexpected Pharmacy Partnerships

Dave Wendland, vice president, strategic relations and member of the owners group at Hamacher Resource Group, a leading partner in category management, business strategy and marketing services focused on consumer health care at retail, recently wrote a blog post for Drug Store News titled “Newfangled Collaboration” that explored unexpected partnerships for pharmacies to consider.

We asked him to expand on those ideas and provide additional examples.

1. Paint store Your pharmacy could refer patients to the local paint store during home remodels to choose color palettes that invoke health, calmness or invigoration. The paint store could refer patients to your pharmacy for products that assist with wellbeing, such as aromatherapy candles, eye masks or exercise aids.

2. Hardware supply store Your pharmacy could refer patients to the local hardware store for supplies required to complete home modifications, such as adding

pharmacy provides that their customers may require,” Wendland said.

He also suggested considering the type of relationship. “It could—and should be—a two-way relationship,” he said.

Pharmacy owners shouldn’t think of the partnership as a legal arrangement, but rather a spirit of alliance.

“It’s an informal handshake and business relationship under a common interest,” Wendland said.

New opportunities for partnerships exist all around us, but the key is to take the time to find them.

“To remain relevant in any industry, especially a fastmoving, morphing industry like pharmacy, companies need to stretch their horizons,” Wendland said. “My advice to pharmacy is to define where it can bring value to its customers, assess how to achieve that, and once that’s done, fill the voids with alliance partners.”

ramps, after they’ve been discharged from the hospital or after a loved one with certain limitations moves in. The hardware store could refer patients to your pharmacy for additional products they’ll need to treat their condition and readjust to life outside of the hospital.

3. Florist Your pharmacy could gift flowers to patients recently released from the hospital or refer loved ones to the flower shop. The florist could send customers to your pharmacy for other comfort needs following a patient’s discharge.

4. Travel agency For patients looking for travel supplies because they’re going on vacation, you could align with a local travel agency. Similarly, the travel agency could refer travelers to your pharmacy to receive vaccinations and to buy travel supplies.

5. Mattress store Imagine creating a symbiotic relationship to help patients suffering from body aches and pains, bed bug or dust mite problems, or discomfort during pregnancy who may first visit the local mattress store. The mattress store could refer customers experiencing these same problems to your pharmacy for additional solutions.

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Collaboration.

Innovation.

Synergy 2017.

June 23-25, 2017 Kansas City, Missouri Get ready to optimize your pharmacy’s business success through collaboration and teamwork at the 2017 Synergy Conference hosted by PBA Health, Pharmacy Providers of Oklahoma (PPOk) and the Oklahoma Pharmacists Association (OPhA).

Register now at pbahealthconference.com!

PBA HEALTH • PPOK • OPHA

SOLUTIONS

Nutrient Depletion Common Drug-Induced Nutritional Deficiencies

The benefits of counseling patients on drug-induced nutrient depletion and vitamin supplementation Did you know the medications your patients are taking could potentially be harming them?

“A surprising number of the drugs that we dispense as pharmacists have the potential of causing drug-induced nutritional deficiencies,” said Jeff Robins, R.Ph., FAAFRM, ABAAHP, former owner of Essential Wellness Pharmacy in Peoria, Ill., and owner of Optimum Health Solutions, a wellness consulting firm, and Summit Functional Counseling, a consulting firm that creates profitable business models for independent pharmacies.

Robins said the depletion of vital nutrients can cause the body to start breaking down. Fortunately, your independent community pharmacy can help patients on these medications stay healthy by recommending the appropriate vitamins to boost nutrient levels.

As a trusted and accessible health care resource, pharmacists are in an ideal position to counsel patients on prescription and over-the-counter (OTC) medications that can cause nutritional deficiencies. “It’s just good medicine,” Robins said. “We know these things happen, so we’re truly caring for our patients.”

And, recommending the appropriate vitamins and supplements can increase your pharmacy’s front-end sales.

“It’s a true economic boon to pharmacies to sell these nutrients that their patients absolutely need,” Robins said.

Here’s a look at some of the most common prescription and over-thecounter (OTC) medication classes that cause nutritional deficiencies.

• • • • • • •

Statins deplete CoQ10 ACE Inhibitors deplete Zinc Beta Blockers deplete CoQ10 Biguanides deplete Folic Acid and Vitamin B12 Antacids deplete Folic Acid, Vitamin D, Zinc, Calcium, Magnesium, Chromium and Iron H2 Inhibitors deplete Folic Acid, Vitamin B12, Vitamin D, Calcium, Iron and Zinc NSAIDS deplete Folic Acid, Vitamin C, Iron and Potassium

A growing problem “Drug-induced nutritional deficiencies can happen with the top 200 drugs that we dispense every single day,” Robins said.

The nutrients being depleted are essential in creating all the compounds that our bodies need. “We have to have vitamins as cofactors to make those nutrients for our bodies,” he said.

And OTC medications can contribute to the problem, too.

Acid-blocking drugs are a common class of OTC drugs that deplete a number of nutrients and can be harmful to patients, for example. “We don’t tend to associate disease

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SOLUTIONS

states with people taking antacids,” Robins said. “But the data is very clear; there’s tons of research showing that it actually happens.”

The benefits of vitamin supplementation Most health care providers aren’t taught about these potentially serious nutritional deficiencies, which puts pharmacists in a unique position. “We can be the advocates for our patients and really protect their health,” Robins said.

Counseling patients on nutrient depletion can set your pharmacy apart from the competition, because no national chain or big box stores are doing this, Robins said.

“For independent pharmacies, they’re going to set themselves apart and be seen as the drug experts,” he said. “It will deepen and create more trust between the patient and the pharmacy.”

It can also increase the pharmacy’s profitability, especially considering the growing number of patients interested in vitamin supplementation today.

“Every other patient who walks through your door is buying nutrients,” Robins said. “Are they buying them from your pharmacy, and are they buying quality nutrients that are actually helping their health?”

He said that as tough as it is economically for pharmacies these days, it benefits their bottom line to sell patients high quality nutrients and help prevent nutritional deficiencies. “It’s a total win-win,” he said.

“You make $2 selling a patient a statin drug, and then

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you make $15 selling the Coenzyme Q10 (CoQ10) that his body has to have.”

Robins learned first-hand the benefits of vitamin supplementation by counseling patients in his own pharmacy. “It can help move the pharmacy from a place of scarcity to a place of abundance, where you can pay more to get better employees,” he said. “And, it’s so much fun to take care of your patients that well.”

Learning more Robins will go into more detail on drug-induced nutrient depletion during his continuing education (CE) session at the 2017 Synergy Conference hosted by PBA Health, Pharmacy Providers of Oklahoma (PPOk) and the Oklahoma Pharmacists Association (OPhA) this June in Kansas City, Mo. Robins said the purpose of the course is for pharmacists and pharmacy technicians to get a working understanding of some basic biochemistry, so they feel comfortable talking to their patients about drug-induced nutritional deficiencies. Attendees will also learn how to recommend vitamins and supplements to patients.

He’ll also discuss the systems that are available to help pharmacists identify which vitamins patients should be taking and how to address those needs.

“This is something that can impact your patients’ health and your bottom line within a week,” he said. “You don’t have to go through training; this is stuff that we already know but we forgot as pharmacists.”

Learn more at pbahealthconference.com.

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Staying Relevant How to grow your pharmacy in today’s rapidly changing health care environment

By Torrie Wright

How do you stay ahead of changing patient needs, evolving technology and new competitors—all while still providing patients with top-notch care?

Independent community pharmacies today are faced with fierce competition from national chain and big box pharmacies. They deal with new industry challenges constantly, like retroactive direct and indirect remuneration (DIR) fees and limited drug pricing transparency. But despite these obstacles, many independent community pharmacies remain resilient, and manage to keep the doors open.

How? They’ve learned to adapt to the changing marketplace and adjust their business models when necessary.

“The growth and consolidation of pharmacy chains created upheaval in the pharmacy marketplace throughout the 1980s and 1990s,” said B. Douglas Hoey, R.Ph., MBA, CEO of the National Community Pharmacists Association (NCPA). “Since then, the number of independent community pharmacies has stabilized in part because of their adaptability.”

In order to stay relevant in today’s marketplace, independent community pharmacies need to continue to adapt and find ways to be successful in spite of the pressures weighing them down.

“It’s a matter of survival,” said Scott Brunner, CEO of the Georgia Pharmacy Association (GPhA). “The dispensing-based models that for years enabled pharmacists to care for their patients and earn a decent living simply don’t work in today’s world of thin margins.”

Today, the independent community pharmacies that find ways to redefine their place in the industry are the ones that are going to survive.

“Our profession is evolving so quickly that if we don’t adapt to change, we could very easily look up and have no patients left to serve,” said Tripp Logan, Pharm.D., vice president of Logan & Seiler, Inc., and senior quality consultant at MedHere Today, a pharmacy quality and performance consulting group.

Hoey shared a similar outlook. “Independent community pharmacies that don’t adapt to change are destined to struggle financially,” he said. “They need to consider diversified revenue and other opportunities to transform their practice settings.”

New opportunities Brunner said that while the old dispensing model is slowly dying, opportunities are opening up for pharmacists who are willing to be creative.

“Independent pharmacists who want to thrive in this evolving health care environment are going to have to get out from behind the counter and think more broadly about what patient care means,” he said.

How to Have More “Aha” Moments Sometimes you find a solution when you least expect it. Follow these research-backed steps to help you have more “aha” moments, so you can find inspiring ideas to improve your independent community pharmacy— more often.

Take some quiet time Take a break from your busy schedule and make time for some peace and quiet. For example, find time between tasks to get out of the pharmacy and go for a walk.

Let your mind wander During your downtime, avoid focusing on work or using electronics and allow yourself to daydream. Schedule a time each day where you unplug from all distractions.

Stay positive Relieve anxiety and put yourself in a good mood before brainstorming or making an important decision. If you feel stressed out or frustrated, do something that makes you happy and relaxed, such as having lunch with a friend.

Don’t deliberate Rather than thinking long and hard about the problem or decision at hand, distract yourself with another activity. For example, get some exercise or read a book.

Source: Harvard Business Review

Hoey said independent community pharmacies can distinguish themselves by offering niche services that cater to specific patient needs, such as compounding, medication therapy management (MTM) and diabetes education classes.

“These small business health care providers are not constrained by corporate headquarters, like their publicly-

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traded chain counterparts, in terms of what they can offer patients to best serve their needs,” he said.

NCPA has seen significant growth in immunizations in recent years, which has become the most popular patient care service offered by independent community pharmacies. “Providing improved access and convenience without a doctor’s appointment will continue to drive patient adoption and uptake,” Hoey said.

More independent community pharmacy owners and pharmacists are using their training and expertise to solve health care problems in their communities. “And in so doing, they’ll not only improve their business, they’ll also improve the quality of life in their community,” Brunner said.

For example, a local pharmacist in Valdosta, Ga., provides diabetes care management services to employees of a large local employer. And, the service has more than tripled employees’ medication adherence over the past year, Brunner said.

Additionally, pharmacists are engaging in coordinated care models to help improve patient outcomes and reduce overall health care costs by driving greater medication adherence.

“Transitions of care programs have allowed community pharmacies to team up with hospitals to help discharged patients better adhere to their prescribed medication,” Hoey said. “This can greatly reduce the likelihood of readmission, yielding substantial savings for both hospitals and health care payers.”

Logan said pay-for-performance programs are another force driving independent community pharmacies to make changes.

“In our experience, we’ve seen the quickest adaptation to change occur within true pharmacy-driven incentive programs,” he said. “If a pharmacy can be adequately incentivized for enhanced service delivery, we’re seeing these enhanced services rolled out and rolled out quickly.”

Staying relevant By expanding their scope of practice and adapting their business models, independent community pharmacies can continue to stay relevant and competitive in the marketplace.

Tim Connor, a full-time professional speaker and business consultant who is the keynote speaker at the 2017 Synergy Conference, June 23-25, 2017 in Kansas City, Mo., hosted by PBA Health, Pharmacy Providers of Oklahoma (PPOk) and the Oklahoma Pharmacists Association (OPhA), said independent community pharmacies have to understand how relevance should

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influence the products or services they offer to better meet customers’ wants and needs.

According to Connor, there are three fundamental things customers want: service, low price and quality.

“It’s not necessarily the product that you’re selling that determines your relevance, it’s your ability to stay consistent with what people want in the marketplace,” he said.

For independent community pharmacies, staying relevant means staying in touch with your patients and your competition, as well as payers and prescribers.

“You have to pay attention to what trends are impacting your industry and your customer base,” Connor said. “You have to know what their concerns, their needs and their desires are.”

Even though you probably won’t adapt to every expectation, you need to know what patients want in order to make effective changes.

“We must occasionally step out from behind the pharmacy counter, and engage payers and prescribers in our communities,” Logan said. “Looking outside of our walls to engage other health care stakeholders isn’t an easy thing to do, but in today and tomorrow’s health care environment, we must do just that.”

It’s also important for independent community pharmacies to expand their scope of practice to combat the financial squeeze they face due to inadequate prescription reimbursements from pharmacy benefit managers (PBMs).

Without finding another way to increase margins, it’s impossible to keep a competitive edge.

Hoey said diversified revenue streams facilitated by expanded scope of practice will allow independent community pharmacies to maintain some control over their bottom line without being beholden to PBMs. Logan agrees. “There are many pharmacies out there that are taking advantage of the growing number of valuebased, non-prescription-dispensing-dependent, non-PBMdriven revenue streams that help them increase patient access, revenue and opportunities,” he said.

Evaluating your business Embracing change means being willing to take a hard look at your business—regularly.

Jan Makela, Gallup-certified strength coach and a mentor with SCORE, a nonprofit association dedicated to educating entrepreneurs and helping small businesses through mentoring in partnership with the U.S. Small Business Administration (SBA), recommends conducting a SWOT analysis to evaluate your pharmacy’s business

Diversified Revenue Opportunities

In today’s ever-evolving, competitive health care environment, independent community pharmacies are looking for ways to distinguish their businesses. Consider some of these diversified revenue opportunities.

Diabetes care services Provide services to assist patients with diabetes, such as hosting diabetes education classes, providing self-management training and offering products like therapeutic shoes, some of which can be covered under Medicare Part B. Health screenings Offer health screenings to help patients detect serious undiagnosed conditions, such as diabetes and hypertension.

Immunizations Administer immunizations and vaccinations at your pharmacy to attract new patients and offer convenience to those who don’t have time to visit a doctor’s office.

Pet medications Become a destination for pet lovers in your community by offering pet medications, compounding services and education for pet owners about safe usage and side effects.

Point of care (POC) testing Provide POC testing to aid in disease screening, diagnosis and patient monitoring for diseases such as strep, influenza and HIV. Smoking cessation Help patients quit smoking by offering smoking cessation classes and carrying products to aid in the process.

model and the current market. A SWOT analysis is a business tool that stands for strengths, weaknesses, opportunities and threats, and it can help you take an objective look at your business.

Makela said pharmacies need to reinvent themselves and stay relevant in areas where they can compete and be successful. “They should look outside their own

Specialty pharmacy Care for patients with complex conditions by dispensing specialty medications and providing medication therapy management (MTM).

Transitions of care Improve patient outcomes and help reduce health care costs by assisting patients with their transition from the hospital to the home setting.

Travel health Offer travel immunizations and make medication recommendations to patients before and after their travels to ensure quality of care.

Wound care Help patients determine whether self-care for their wounds is appropriate and assist them in choosing—and using—the correct wound care products.

Source: National Community Pharmacists Association (NCPA)

communities for examples of community pharmacies that are doing well,” he said.

For example, Brunner said more than 70 independent pharmacies in Savannah, Ga., have partnered with the Savannah Business Group, which offers group health purchasing for employers in the Savannah region. The partnerships created a generic dispensing group that

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not only saves employers money, but also generates a significant amount of revenue for the pharmacies.

Similarly, Connor suggests creating employee focus groups and surveying customers to determine your pharmacy’s strengths, weaknesses and challenges.

You have to find relevant and current ways to discover what your customers want, what they like, what they expect, what they’re uncomfortable with and what they want to see changed, he said.

For Logan, it’s about staying informed. Pharmacy owners and managers should attend conferences, engage with peers, read newsletters, educate their employees and ask questions.

“Independent pharmacies need to understand that we’re competing for access to patients, not competing with other pharmacies,” he said.

Embracing change While you may have heard that people tend to resist change, Connor said people don’t resist change; they resist losing control.

For example, one reason independent community pharmacies may resist change is due to an ego-driven owner or manager. “Their attitude is, ‘I started this business, so it’s my way or the highway,’” Connor said.

Similarly, Brunner said the biggest impediment to adapting to change is the stubborn notion among some owners and managers that if they wait long enough, and keep doing what they’ve always done, things will get better.

Logan notes that change isn’t easy. “Change is scary when it rarely happens and we attempt to change too much too quickly,” he said. “If change comes gradually and regularly in the form of evolution, it isn’t quite as scary.”

In his pharmacies, patient-centered programming, workflow and the overall pharmacy practice approach are in a constant state of evolution.

Looking at the bigger picture can help pharmacy owners and managers start to understand the need for change—and accept it.

“I think the most difficult aspect of embracing change is being able to look beyond the day-to-day challenges and pressures and see what it will take to be successful long term,” Hoey said.

And it takes time. “Embracing change requires time, brainpower, hard work and, yes, some discomfort,” Brunner said. “If you want to discover the next big thing, you have to overcome your affection for the status quo.”

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Creating a culture The owner or manager can’t do it alone. Keeping an independent community pharmacy relevant means forming a company culture that embraces change.

Pharmacy owners and managers need to train their employees to support change.

Logan said owners and managers can prepare their employees through education, exposure, reinforcement and leadership.

“Pharmacy staff needs to have a basic understanding of the pharmacy environment, be re-engaged with evidence of this environment regularly, and know that their leaders and colleagues fully support the changes that will allow the pharmacy to evolve along with our rapidly changing health care system,” he said.

Hoey said change is about the betterment of business performance, so that should be a motivating factor for employees. “A more robust and efficient business will make a greater difference in the lives of the patients these pharmacies serve, which should be a point of pride for any employee,” he said.

Keep in mind that culture doesn’t just change overnight. “Pharmacy owners need to have a culture of trust and show they truly care for their employees,” Makela said.

The time is now Brunner said independent community pharmacies need to understand that if they’re waiting for provider status legislation to change their world, they may be waiting a while.

“As great as it will be when pharmacists are finally considered providers, there are nearer-term ways for enterprising pharmacists to expand their practice,” he said.

And, new models for pharmacy patient care and profitability aren’t going to be handed to pharmacies on a platter, ready-made. “They must be created, one-by-one,” Brunner said. “Each independent pharmacy is in control of its destiny, and it will take work and creativity to achieve that destiny.”

Connor said the bottom line is that people need to stay in touch.

“Start getting in touch with what’s really going on with the customers in the marketplace, even if that means the pharmacist has to get out from behind the counter and meet with patients,” he said.

Because when a business model isn’t consistent with the expectations or demands of the marketplace, ultimately that business will close its doors.

A Creative Approach

Pharmacists can stay relevant in today’s marketplace by tapping into their creative sides If you’re just traditional, you’re essentially dead, said Jake Galdo, Pharm.D., BCPS, CGP, assistant professor and director of the community pharmacy residency program at the McWhorter School of Pharmacy at Samford University in Birmingham, Ala. Staying at the forefront and advancing care means independent community pharmacies need to create new ways of doing things.

But Galdo said it’s not just about offering new products or services, it’s also about eliminating waste. “There’s the clinical services that you see, but oftentimes the innovation within a business could be how they eliminate their waste more effectively,” he said. “Creativity is ultimately how you do quality improvement.”

Galdo challenges independent community pharmacies to figure out how to approach a reduction in errors in their pharmacy. “That’s not something that most people will see, but I think it could be very creative,” he said.

Galdo’s advice? “Don’t listen to your peers.

Or, listen to new peers,” he said. “Find people in a different business model that may do something similar.”

If you want to improve your pharmacy practice, then you need to go outside of your bubble and figure out how to do something different, he said.

Sparking creativity Galdo said in order to start getting creative, pharmacies have to get outside of their realm.

But some independent community pharmacy owners and pharmacists may not know how to step out of their comfort zone and tap into their creative sides.

The bottom line Creativity is necessary for independent community pharmacies to maintain a competitive advantage.

And, Galdo said it’s time for pharmacies to step up and recognize that they can do a better job.

He suggests looking at your workflow and what yours goals are in order to determine how you can approach things differently.

“Continued downward pressure on prescription reimbursement is placing a lot of pressure on low to mid-volume dispensing-based practices,” Logan said.

If these pharmacies don’t add enhanced services, prescribers and payers will steer patients to other pharmacies that offer those enhanced services, he said. While pharmacies may not feel the effect of this

Embracing failure You have to be willing to fail in order to succeed in creativity and innovation. “Try something, let it fail and then grow,” Galdo said.

But, Galdo recognizes that many small businesses don’t have a lot of money to throw down the drain on trial and error.

For independent community pharmacies that are afraid to take the monetary risk, Galdo said to budget for it. “Go ahead and put $100 to the side every month as your ‘creativity money,’” he said. “Money that is earmarked simply to be wasted, so that way you don’t feel bad about it.”

immediately, they’ll gradually lose access to patients over time.

“If you don’t adapt, you will likely perish in today’s environment,” Makela said. “Look at your marketplace and understand that standing still is not an option going forward.”

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SPOTLIGHT

Deterring Abuse How independent pharmacists can help combat the opioid epidemic The opioid epidemic is a health crisis that’s taking the nation by storm.

Drug overdoses involving an opioid accounted for more than 33,000 deaths in the U.S. in 2015, according to the Centers for Disease Control and Prevention (CDC).

Kelley Waara-Wolleat, Pharm.D, MBA, associate director, medical science liaison, Purdue Pharma L.P., said our society is now challenged by two serious public health problems: the need to treat chronic pain and the abuse of opioids.

“Many people living with severe chronic pain are suffering because their pain is not effectively treated,” she said. “However, the opioid prescription pain medications can lead to tragic consequences, including addiction, overdose and death.”

As the country continues to battle this epidemic, pharmacists have an opportunity to play a pivotal role.

“Pharmacists, along with prescribers, have a corresponding responsibility to ensure that the prescription is issued for a legitimate medical purpose and by an individual practitioner acting in the usual course of professional practice,” Waara-Wolleat said.

Along with pharmacist intervention, the prescribing of Opioids with Abuse-Deterrent Properties and Claims (OADP) may be a viable option for helping to prevent drug addiction. Though not completely abuse-deterrent, OADPs are less susceptible to abuse than the opioid formulations that lack abuse-deterrent properties.

But Waara-Wolleat said abuse-deterrent technologies are only one part of a comprehensive intervention strategy to promote safe prescription opioid use. “Additional components, including governmental, community and educational initiatives, are also needed,” she said.

Opioids with abuse-deterrent properties In 2015, the U.S. Food and Drug Administration (FDA) issued a guidance, “Guidance for Industry: Abuse-Deterrent Opioids – Evaluation and Labeling,” that allowed opioids to be labeled as having abuse-deterrent properties and associated claims. The labeling was based on the product’s abuse-deterrent attributes and studies demonstrating a meaningful reduction in abuse.

There are currently nine FDA-approved extended release/long-acting (ER/LA) OADPs on the market with properties that are expected to deter some forms of abuse.

But Waara-Wolleat said no opioid on the market today is completely abuse-deterrent.

“All opioids can be ingested in excess quantities resulting in adverse effects, including death,” she said.

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SPOTLIGHT

Educating Pharmacists and Patients About Opioids The Extended-Release and LongActing (ER/LA) Opioid Analgesics Risk Evaluation and Mitigation Strategy (REMS) is a strategy required by the U.S. Food and Drug Administration (FDA) to manage known or potential serious risks associated with ER/LA opioid analgesics. The strategy strongly encourages prescribers and pharmacists to do the following.

Complete a REMS-compliant education program Pharmacists should complete an ER/LA opioid analgesics REMScompliant education program offered by the accredited provider of continuing education (CE) for pharmacy.

Provide patient counseling Pharmacists should use the REMSprovided document to discuss the safe use, serious risks, storage and disposal of ER/LA opioid analgesics with patients or their caregivers.

Use the medication guide Pharmacists should encourage patients and caregivers to read the medication guide they receive when an ER/LA opioid is dispensed to them.

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“OADP does not mean the product is abuse-proof and none of the opioids, including those with labeling indicating their abuse-deterrent properties, will prevent addiction.”

And, OADPs may not be right for everyone.

Patients who have an increased risk of developing an opioid addiction, such as patients with a personal or family history of substance abuse, need to be evaluated before an OADP is dispensed to them.

“Clinician judgment will determine whether an opioid with abuse-deterrent properties is appropriate for a patient with a past medical history of addiction and clinicians should consider consulting substance use disorder specialists and pain specialists for these patients,” she said.

Combatting the epidemic Waara-Wolleat said OADPs will have a maximum publichealth influence only when substantially all opioids have abuse-deterrent properties and claims in their Full Prescribing Information (FPI).

In the meantime, pharmacists can still work to prevent opioid abuse by educating themselves and their patients, and collaborating with prescribers.

“Pharmacists should be part of the interdisciplinary team managing patients with chronic pain by ensuring collaboration through corresponding responsibility and providing medication therapy management as appropriate for patients,” Warra-Wolleat said.

Additionally, she said pharmacists are encouraged, and in some states required, to check their state’s prescription drug monitoring program and to help identify possible doctor shopping.

Learn more about OADPs Waara-Wolleat will discuss the use of OADPs and the pharmacist’s role in combatting the opioid epidemic in more detail during her continuing education (CE) session at the 2017 Synergy Conference in Kansas City, Mo., hosted by PBA Health, Pharmacy Providers of Oklahoma (PPOk) and the Oklahoma Pharmacists Association (OPhA) this June.

She said pharmacists can expect to learn about why OADPs are important innovations, the FDA’s direction to those developing OADPs, where to find abuse-deterrent properties and claims, and some of the technologies that are employed or under study for OADPs. Learn more at pbahealthconference.com.

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MONEY

Top 10 Pharmacy Accounting Questions to Ask Your CPA What your CPA wishes you were asking

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It’s well into the new year and if you’re like most independent community pharmacy owners, you’re waiting for your CPA to tell you how your pharmacy performed last year and how much you have to pay in taxes from your already tight cash flow.

“Instead of waiting, you need to be proactive now,” said Scott Sykes, CPA, of Sykes & Company, P.A., an accounting firm focused on independent community pharmacies.

While it’s too late in the season for most tax planning mitigation strategies, you can still be proactive by making sure your CPA has an understanding of your pharmacy and what’s vital for proper accounting, advisory and tax, Sykes said.

We talked with Sykes about what CPAs wish independent pharmacy owners knew and what questions owners need to be asking their CPAs. Here are the top questions.

Do I need an updated inventory balance?

For an independent pharmacy owner, the answer to this question should be ‘yes,’ and you need

MONEY

to ask this question often throughout the year. Without an accurate inventory figure, you may be grossly overstating or understating your margins and net bottom line. “You’re lost from a managerial perspective without a good grasp of your gross margin,” Sykes said.

How do I compare to my peers?

By understanding where you stand compared to your peers, you can have confidence in what you’re doing—and find areas in which you can improve.

For example, ask your CPA how you compare to your peers in gross margin. For a normal independent pharmacy, gross margin should be steady. This is a great starting point to see what you’re doing—or aren’t doing— compared to other pharmacies.

You might also want to know how you compare to your peers in rebates as a percent of revenues. For example, your rebates may be 3 percent (a minimum,) but your peers’ rebates with the same wholesaler may be 10 percent. What are they doing differently?

And, what’s the trend in the industry regarding revenues? Is there growth in the industry as a whole and, if so, how does your pharmacy compare? The answers to, and analysis of, these questions may give insight into areas where you can perform better.

What key ratios should I be focusing on?

Every independent pharmacy owner needs to understand several key ratios. “Knowing what those ratios are, where you stand compared to your peers and the average is important,” Sykes said. “It starts the conversation on what you’re doing right or wrong.”

For example, you need to know your current ratio, which is current assets divided by current liabilities. This ratio tells you how many dollars of current assets you have for every dollar of current liabilities. A ratio at or above three to one is ideal for a pharmacy. “Without good balance sheet reconciliations and integrity, this ratio has no value,” Sykes said. “Getting your accounting fundamentals in order is key to utilizing this analysis tool.”

Should I be reporting accounts receivables from third parties on my taxes?

In most cases with independent pharmacies, the answer to this question is, ‘yes.’ There may be a very small

percentage of owners who are excluded, but 99 percent should be reporting receivables from third parties on their taxes (and books.) It’s required!

If I have more than $10 million in revenue, should I be concerned about Section 263A rules?

If you’re an independent pharmacy owner with revenues of more than $10 million, compliance within IRS Code Section 263A may be required. Section 263A requires resellers, or pharmacies, including controlled groups, with average gross receipts for the prior three years of more than $10 million to capitalize costs into inventory. “It’s like a hidden tax hike on those larger businesses,” Sykes said.

What are average gross wages for a pharmacy?

Depending on the type of pharmacy you operate, there are averages for payroll that you need to be aware of—and strive to obtain. “Payroll is one of your largest expenses and it has a material effect on cash flow, so you should first focus on managing your payroll costs,” Sykes said.

How can I improve my back office accounting processes?

The accounting industry is changing, just like the pharmacy industry. Your accounting should include technology enhancements to streamline your efforts and to make your accounting more efficient, timely, accurate and transparent. Also, the CPA industry is moving toward a more niche-based service model, which will make it easier—and prudent—to find CPAs who specialize in pharmacy accounting.

Would you like to see my script dispensing logs?

The information gleaned from these audit logs serves many purposes to an experienced pharmacy CPA. Sykes said key areas he reviews using audit logs include revenue trends compared to what the accounting is showing; new scripts versus refills, which give an indication on whether the pharmacy is growing or dying; and gross margins and how they compare to the pharmacy’s books. Any differences between these logs and what’s reflected on the books can add insight that you may otherwise have overlooked.

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MONEY

What tax strategies can I implement?

It’s a good idea to ask your CPA this question far in advance. Unfortunately, it’s too late for tax planning for 2016, as most meaningful strategies require advanced planning. Instead, focus on 2017 and putting a system in place, so you can avoid this scenario next year.

This plan should include updating your accounting, implementing key fundamentals and putting an experienced pharmacy team in place, including lawyers, bankers and CPAs. “It’s no secret that pharmacy is an extremely complex industry,” Sykes said. “Having a team of professionals who understand your business can save you time, money and headaches.”

For example, most bankers don’t understand how a pharmacy operates with slim margins. And, most won’t lend to pharmacies as a result of this lack of understanding, among other reasons. Find bankers who understand the cash flow models of pharmacy. As well, it’s best to heed the expert advice of lawyers who specialize in pharmacy law to avoid issues from inexperienced lawyers.

CPA firms are another area where you need expertise.

“A lot of CPAs only work with a couple pharmacy clients.

And, most owners have to ‘teach’ their CPA the ins and outs of the business,” Sykes said. “Find a CPA who can speak the language, understand the rules with regard to pharmacy reporting and add value with industry insight.”

Why are accounting fundamentals so important for my pharmacy?

With margins as tight as ever, below-cost reimbursements and an inherently complex industry, you must have accounting fundamentals in place to manage, track and understand your pharmacy. “Waiting each year for information that’s not reliable doesn’t work. Those pharmacy owners who fail to understand this are having serious trouble,” Sykes said. “Use accounting as an asset for success.”

“These questions should help you get a good feeling of your CPA’s experience and comfort in being your trusted advisor,” Sykes said. “With the pharmacy industry everchanging, you must change with it and think outside small town America. Seek the experienced industry professionals

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you need to grow and succeed before you find yourself scrambling to mitigate taxes for the next year.”

For more than 35 years, Sykes & Company has helped independent pharmacies with every aspect of pharmacy accounting, including tax and business advisory needs. Learn more at sykes-cpa.com.

Financial Resources

Get your questions about the financial side of your independent community pharmacy answered with these helpful websites.

Federal Tax Forms Quickly find and download current tax forms, instructions and publications. irs.gov/uac/Forms,-Publications,-and-OtherTax-Products Pharmacy Accounting Video Blogs From corporate tax return deadlines to top questions about pharmacy taxes, these video blogs clarify accounting issues for independent community pharmacies. sykes-cpa.com/news-blog Pharmacy Information Request List A listing of the documentation independent pharmacies should compile when meeting with their CPA for the first time. sykes-cpa.com State Tax Forms An online directory of state tax forms.

Search by state.

50states.com/tax Where’s My Refund?

Easily check the status of your tax refund. You’ll need your social security number or ITIN, filing status and exact refund amount. irs.gov/Refunds

OUTLOOK

Continuum of Care How Integrity Pharmacy improves patient outcomes with home visits and medication management Continuum of care services through medication management is becoming increasingly important in improving patient outcomes.

When patients are discharged from the hospital, they often aren’t prepared for the transition to the home setting. This can result in medication errors and nonadherence, increasing the risk of readmission.

Many patients can benefit from medication management, not just those getting out of the hospital.

Medication nonadherence takes the lives of 125,000 Americans annually and costs the health care system nearly $300 billion a year, according to the American Heart Association.

“A complete continuum of care is the key factor in a patient’s successful outcome,” said Marcus Wilson, R.Ph., CEO and co-owner of Integrity Pharmacy, an independent community pharmacy that provides comprehensive medication management services in Springfield, Mo. Integrity Pharmacy provides a complete continuum of care for patients by incorporating home nursing, the patient’s medication manager (a nurse or other caregiver,) medication synchronization, refill management and medication reconciliation into its program.

“We’re trying to keep patients from being readmitted or having medication issues simply because they may not have anybody to assist them,” Wilson said. “Our model is designed to help reduce medication errors, readmissions and overall health care costs, while improving and maximizing healthy outcomes for the patients we serve.”

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OUTLOOK

Medication management Wilson said one of the main reasons a newly-discharged patient becomes a readmission statistic is because of mismanagement of prescription medications.

With the health care system lacking clear communication between providers, especially regarding medications, the Integrity Pharmacy team recognized the pharmacy as the one place where a patient’s care coalesces.

“We’re passionate about communicating with the other providers involved in a patient’s care to ensure we’re all operating with the most accurate knowledge about that patient’s circumstances,” Wilson said.

While the pharmacy’s program, which has operated for nine years, started with patients recently-released from the hospital, it’s now designed to help any patient managing medications.

For example, a home visit may benefit a patient only taking two or three medications but who has difficulty seeing or getting to the pharmacy. And, a patient taking 25 different medications can likely benefit from medication synchronization. Continuum of care services can help both of these patients.

How the program works The process starts with a home visit. A registered nurse with Integrity Pharmacy visits the patient upon admission to the continuum of care program.

The nurse assesses the living environment to look for social or financial barriers to medication adherence and provides medication training, to train patients on using medications such as inhalers or insulin pens.

Patients’ medications will also be synchronized, so all of their medications come due for refill at the same time.

“We utilize all that information to create a complete picture of patients’ medication adherence and utilization,” Wilson said. “Then, we can further educate them on how they can become more compliant and adherent, and reduce their risk for readmission or medication errors.”

The pharmacy staff regularly interacts with their

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patients to make sure they’re on track with the program and to address any problems that arise or that potentially could be avoided. “We stay in touch with them at a minimum of once a month, and we also send out our nurse as often as needed,” Wilson said.

Initially, the nurse spends a minimum of one hour in the home, but it can take up to two to three hours, depending on the patients’ needs. Throughout the month, the staff calls each patient to discuss refills, follow-up appointments, insurance issues, medication therapy management (MTM) or comprehensive medication review (CMR) possibilities, medication outcomes and any concerns he or she may have.

Integrity Pharmacy also provides a CAREpack® to each patient enrolled in the program. The CAREpack contains a complete 30-day supply of all the patient’s maintenance medications, packaged by clinical pharmacists.

“Each pack is both time and date stamped and organized by the day,” Wilson said.

Additionally, the pharmacy can supply pre-packed medications along with the CAREpack, such as inhalers or eye drops. The CAREpack can also include over-the-counter (OTC) items.

These services don’t cost patients anything beyond the price of their prescriptions. “The majority of the patients we see in need of a service like this in our area are low income,” Wilson said.

Not wanting to exclude patients due to financial barriers, the pharmacy decided to offer the program at no extra charge to patients.

Improving patient outcomes While it’s a slow process, people are starting to recognize Integrity Pharmacy for the continuum of care services it offers, Wilson said.

“We’ve had many physicians’ groups, hospitals and accountable care organizations (ACOs) reach out to us for assistance with their patients, especially those who are about to be discharged from the hospital and those who are high risk for medication errors,” he said.

And, by tracking their patients’ progress, they

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OUTLOOK

By the Numbers Medication nonadherence is a growing problem, resulting in poor patient outcomes and increased health care costs for individuals as well as the health care system. Here’s a look at the statistics.

125,000 – The number of preventable deaths each year as a result of medication nonadherence $290 billion – The amount of avoidable costs spent annually on medication nonadherence $1.3 billion – The amount of health care costs associated with multiple mismanaged medications by seniors Source: The American Heart Association

found that their patients have significantly lower readmission rates due to increased medication adherence and compliance.

“The outcomes experienced in regards to a specific disease state are significantly better when a patient is enrolled in a medication management program compared to a non-enrolled patient,” Wilson said. “We are able to make a significant difference in the lives that we serve with our medication management program.”

Wilson’s advice for other independent community pharmacies wanting to establish a similar program is to go slow, and recognize that it’s a process.

For example, don’t try to implement medication management, medication synchronization, immunizations and education all at the same time.

“Pick one and refine the process. Then, add on additional services,” he said.

Looking to the future Integrity Pharmacy is always looking for new ways to improve patient outcomes.

Currently, the pharmacy is working on incorporating pharmacogenetic testing, also known as MedTek21, into its continuum of care process.

Pharmacogenetic testing provides insight into which medications will work best for patients based on their genetic makeup.

According to Wilson, more than 75 percent of people have genetic variations that determine how their bodies process and use drugs, including prescription medications, OTC medicines and herbal and dietary supplements.

Because of these genetic differences, two people can take the same dose of the same drug, but respond in very different ways.

“Reactions to prescription drugs are a major cause of falls, hospital admissions, emergency room visits and other negative outcomes,” Wilson said.

“Patients with certain genetic variations face potential danger from many widely-prescribed drugs, including some common antipsychotics, anticoagulants and pain medications.”

Even if a drug was prescribed correctly by a doctor and used correctly by the patient, it could still cause an adverse reaction as a result of that patient’s genetic makeup.

And, these adverse reactions and events can damage providers’ scores on quality measures mandated by the Centers for Medicare & Medicaid Services (CMS), otherwise known as Star Ratings.

Pharmacogenetic testing can improve the efficacy of a patient’s medication therapy; therefore it can boost adherence rates, reduce overall medication costs and positively influence Star Ratings, Wilson said.

Integrity Pharmacy’s pharmacogenetics program safeguards at-risk patients by alerting caregivers of potential drug-gene reactions, indicated by the patient’s genetic variations. “The program integrates with systems to enable providers to proactively reduce adverse events, save time, improve outcomes and boost quality scores,” Wilson said.

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NOTES

A Non-Toxic Alternative Diversify your pharmacy’s retail wound care offerings with a natural woundcleansing product As patients are increasingly looking for solutions to their health problems that are safe and effective, independent community pharmacies are searching for products that can fill this void.

The wound cleanser from Pure & Clean, a maker of anolyte water products, is an overthe-counter (OTC) non-cytotoxic cleaning and debriding hypochlorous solution that could make a unique addition to your pharmacy’s front end. It’s safe for use on adults, children and even pets, and is a more natural option to add to your wound care and first aid section.

Dr. John Buckner, MD, chief medical officer at Pure & Clean and a general trauma surgeon at CoxHealth in Springfield, Mo., said the product is natural, nontoxic and effective.

“I don’t know a pharmacy or consumer demographic that it doesn’t appeal to,” he said.

A non-toxic solution More patients are looking for all-natural products to use on their bodies today, creating a strong market for products free of harmful chemicals.

“If you can get anything that’s all-natural and nontoxic, people are eating it up,” Dr. Buckner said. “They love the fact that they don’t have to worry about putting something harmful on their children or themselves.”

Dr. Buckner said the chemical used in the Pure & Clean wound cleanser is a naturally-occurring chemical our own white blood cells make when they destroy bacteria.

“There’s a natural reaction that occurs in our white blood cells that produces hypochlorous acid and destroys bacteria, fungus and viruses in our bodies when our immune systems are working right,” he said.

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A unique front-end addition The U.S. Food and Drug Administration (FDA) has approved the Pure & Clean wound cleanser for a number of wound and skin infections, including first and second degree burns. It can also be used on post-surgical wounds and diabetic ulcers.

Trent Freeman, president and CEO of Pure & Clean, said the product has many uses that pharmacists can relate to. “It’s great for pharmacists because it’s effective against things they deal with all the time, like poison ivy and bug bites,” he said.

Freeman and Dr. Buckner recommend independent pharmacies set up a kiosk to display the product in their front end and include information sheets to educate patients. “It’s key to educate patients, so they understand what they’re getting,” Dr. Buckner said.

According to Dr. Buckner, now’s the perfect time to bring this solution to patients, since the FDA recently banned certain chemicals used in other wound care products, such as iodine complex.

“Pharmacists should be proud to offer patients an alternative to the dangerous chemicals currently on the shelves,” he said.

Pure & Clean’s line of products also includes a first aid solution and a disinfectant. Learn more at pureandclean.us.

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