Case Studies and Pharmacy Road Trips with Bruce Kneeland

About The Author... Bruce Kneeland is a semi-retired pharmacy industry consultant living in Prescott, Ariz. He visits dozens of community pharmacies each year and delivers CE programs intended to help  pharmacy owners be more successful. He can be reached at bfkneeland@gmail.com.

Going Independent

IT IS QUITE COMMON FOR ME WHEN TRAVELING to drop in unannounced on an independent pharmacy or two. Over the past few months these unplanned drop-ins have resulted in my meeting the owners of several brand-new, start-from-scratch pharmacies.

So I started to wonder, with all the problems facing community pharmacy, why would anyone start a brand-new pharmacy, and what advice could he or she share with others contemplating doing the same? So I interviewed four pharmacists who have recently done just that. Here’s some of what I learned.

Ann Deaton Redding, Pharm.D. Crossroads Pharmacy Coffee and Gifts Smiths Station, Ala.
Ann Deaton Redding, Pharm.D. Crossroads Pharmacy Coffee and Gifts, Smiths Station, Ala.

Jason Dykstra, Pharm.D., opened Chino Valley Pharmacy, in Chino Valley, Ariz., in the fall of 2016. He says having someone who can help you create and stick to a plan is the most important advice he could offer. Since he was coming out of a grocery store pharmacy chain, he says one critical thing his mentor did was to help him choose a buying group. Together they chose American Associated Pharmacies (AAP). And, he says, once he joined AAP other things fell into place, such as which wholesaler to use and which PSAO (pharmacy services administrative organization) to join.

Ann Deaton Redding, Pharm.D., opened Crossroads Pharmacy Coffee and Gifts in Smiths Station, Ala., in March of this year. Redding had worked for years as a pharmacy and district manager for a big-box chain. So she decided to get the help she needed at the National Community Pharmacists Association (NCPA) Pharmacy Ownership Workshop. The team there helped her create a plan that has seen her pharmacy take off faster than she had originally anticipated.

Selma Alami, Pharm.D., is co-owner in Mustang Drug, in Mustang, Okla. The pharmacy opened in the spring of 2017. Alami got the help she needed from her two business partners, who also own three other pharmacies in Oklahoma.

Amy Farlinger, R.Ph., had been working for an independent for 18 years. When the owner sold to a regional chain, the small county-owned hospital approached her with an offer to open an outpatient pharmacy. She opened Cresco Family Pharmacy in Cresco, Iowa, early in 2015.

Cresco Family Pharmacy

Amy Farlinger, R.Ph. Cresco Family Pharmacy
Amy Farlinger, R.Ph. Cresco Family Pharmacy, Cresco, Iowa

Farlinger says that because of her relationship with the hospital, some of the decisions a new owner needs to make were easy for her. The pharmacy was to be located in a remodeled section of the hospital. Cardinal Health was chosen as her wholesaler, as that is the company the hospital pharmacy used. And, she says, the hospital’s procurement team had already contracted with QS/1 for her pharmacy management system. She says that all worked out great, as each of these vendors bent over backward to help make her pharmacy a success.

But Farlinger says she still had plenty of hurdles to overcome. Even though her pharmacy was owned by the well-established county hospital, it still took months to get all the licenses and permits necessary. And she advises new owners to be prepared for the frustration of not being able to get one license until you have another, which you can’t get without the first. “Creativity and persistence is a critical success factor,” according to Farlinger.

Chino Valley Pharmacy

Jason Dykstra, Pharm.D. Chino Valley Pharmacy, Chino Valley, Ariz.
Jason Dykstra, Pharm.D. Chino Valley Pharmacy, Chino Valley, Ariz.

Dykstra says one thing his community needed was a pharmacy with a professional touch. To that end, he stocks a nice assortment of home medical equipment. To further differentiate his pharmacy from his chain competition, he does medication synchronization, adherence packaging, and home delivery.

Because she was new to the area, Redding spent a lot of time talking to the “locals,” trying to understand what would appeal to the community. Her solution: putting in a first-class coffee bar and gift shop. The coffee bar features a variety of coffee blends, as well as fresh, locally produced pastries. She says the coffee bar provides her with a chance to chat with people coming in just for coffee. And Redding says doing that results in a lot of transferred prescriptions.

Crossroads Pharmacy Coffee and Gifts

Since Redding came from a chain background, she had to do some serious research when it came to selecting a pharmacy system. This included visiting other pharmacies in the area. After seeing some of them in action and talking with several vendors, she selected Liberty Software. She says she really appreciates its customer service, training on the system, and the fact that she can get to any other function the system provides from the primary filling screen.

Mustang Drug

Alami says that as a newly graduated pharmacist and a newcomer to the area, she knew she also needed to network in the community. One avenue she chose was joining the Mustang Chamber of Commerce. And much to her delight, the chamber had started a wellness program in 2015 to help improve the overall health of the community.

Selma Alami, Pharm.D. Mustang Drug Mustang, Okla.
Selma Alami, Pharm.D. Mustang Drug, Mustang, Okla.

Alami supports the wellness program with comprehensive medication reviews that include counseling on drug nutrient depletion. She says some of the enhanced care features in her Computer-Rx pharmacy system make providing this kind of service possible. When asked why she chose Computer-Rx, she says her partners also use the system, and having all four stores on the same platform helps with reports and other management services. And, she says, its customer service, training, and support in helping her get the store open was exceptional.

She also reports good success with the Ortho Molecular drug-induced nutrient depletions program and says the consumer information leaflets and educational support it provides help build front-end sales while also providing patients with reasons to recommend Mustang Drug to their friends.

Farlinger says that from the beginning her practice was going to center on helping people understand and appropriately take their medications. So she provided comprehensive medication reviews and makes the extra effort necessary to communicate with prescribers on ways to improve each patient’s medication regimen. The results, according to her, have been improved adherence and better outcomes.

I did not ask these pharmacy owners for any details on how much it costs to open a pharmacy. But most of those interviewed said getting adequate funding was essential. As Farlinger says, not only do things take longer than you planned, but they also cost more than you expected.

Dykstra advises that you not scrimp on technology. He says he shopped around and found pharmacy systems that cost less, but that after carefully contemplating initial and long-term costs he selected PioneerRx as his pharmacy system. He says it came with a built-in point-of-sale system, which has proven valuable in managing his front end. And he is glad he also has its web page facilitating internet refills.

When it comes to understanding the funding process for a new pharmacy, Alami comes with a unique perspective. As part of her residency, she did a one-month internship at Live Oak Bank. And, she says, she was also helped by being part of the University of Oklahoma’s College of Pharmacy team participating in the NCPA Pruitt-Schutte Student Business Plan Competition. So she chimes in with Dykstra in saying that you need do everything you can to secure adequate funding before you get too far into the process.

From talking with these successful startups, a few key points emerge: Have a solid plan; find and use a mentor; get to know your community; and provide that community with some unique service. Finally, realize that everything will take longer and cost more than you planned, so secure adequate funding.

Then, based on the success of these four brand-new pharmacies, it would appear that going independent could be a wise personal and professional choice. CT


Do Something Well, and Thrive, Part 1

I have good news — and that is that there are ways for family-owned retail pharmacies to thrive. How can I say this? Well, I have spoken with several pharmacy owners and managers, and a few industry observers. They all say community pharmacy is alive and well and, if handled correctly, has a bright future.

Here is some of what they had to say.

Looks Matter and Neatness Counts

Consider el Tejon Pharmacy in Bakersfield, Calif. Vice President of Operations Ty Stout, Pharm.D., and his partners believe that how nice a pharmacy looks has a direct bearing on its ability to attract patients.

Stout says that in 2001 they realized they had outgrown their location and started to look for a larger and better one. He says the first thing they wanted to do was design a facility that would appeal to customers and make a statement that they were serious about providing exceptional healthcare.

Stout says, “The people who come to see us are most often not feeling well, and they don’t want to walk a long ways.” When laying out their new facility, they deliberately placed the pharmacy front and center and made it the most visible part of their new location. And they lowered the pharmacy counter to facilitate staff-to-patient communication

What Success Looks Like

Greg Hickman, R.Ph., owner of Carmichael’s Drug in Monroe, Ga., was faced with a similar problem. Six years ago he realized he needed a larger store to accommodate some of the products and services he wanted to add. Since the hospital and many of the doctors were moving to the edge of town, he took advantage of the opportunity to remodel and move into a former grocery store, expanding his footprint from 6,000 to about 18,000 square feet.

In doing the remodeling he invested heavily in the pharmacy’s exterior appearance, realizing it is the first thing any potential new customer would see. Hickman says that in the process of expanding to his new location he tripled the size of his store and doubled his overhead — and since he made the move in 2008 at the start of the Great Recession, it was several years before he could authoritatively say it was a good investment. But he says he now knows that patients and prescribers eagerly recommend him to others, and he is certain part of the reason they do is because his pharmacy makes such a nice impression.

Beattie’s Drug in Erie, Colo., comes in at about 1,000 square feet. Someone driving by it on the major highway leading into this rapidly growing suburb of Denver might use the word “cute” to accurately describe it.

Trey Beattie, R.Ph., and his wife, Laurie, made the move to Erie in 2009. At the time they owned a pharmacy in nearby Brighton and saw the opportunity to expand. In planning for their new store they wanted it to appeal to both the young families moving into the area and those moving into several of the 55+ communities sprouting up as well.

For help they drew upon the store-planning services of McKesson and also upon the expertise of their compounding partner, Professional Compounding Centers of America (PCCA), to make sure the pharmacy looked great. One unique feature they used was a special window wrapping with pharmacy-related graphics that really adds to the curb appeal of the pharmacy.

Run an Exceptional Pharmacy

While providing cognitive services is being done by all the successful pharmacy managers interviewed, most of them say that the core of their practice is traditional dispensing.

Don Grove, R.Ph., owner of J&D Pharmacy in Warsaw, Mo., is one of them. Grove is an entrepreneur at heart and has advanced rapidly into DME (durable medical equipment), diabetes care, and other services. Still, he says, a key part of what makes these other services possible is filling lots of prescriptions.

As an owner Grove knows how unprofitable traditional dispensing has become. His solution is to increase the number of prescriptions he fills without increasing overhead. To that end he has developed a combination of technology, people, and individual workstations he calls the SmartFlow Pharmacy Workflow System, which he says allows him to fill as many as 500 prescriptions a day with only one pharmacist.

The details of this system are beyond the scope of this article, but in simple terms involve breaking the dispensing process into various subsets, providing each person in the process with an individual workstation, and using a color-coded bag system for prioritizing prescriptions. And this is held together with the extensive use of computer technology to track each step of the process. Grove credits Computer-Rx for helping him refine the technology portion of the process, but also says a major piece of the puzzle is management’s ability to train employees to work in this innovative environment.

Stout, with el Tejon, says it is important to increase prescription volume while at the same time bringing the cost-to-dispense down. To that end he has become a leader in the use of automation. He has invested heavily in an end-to-end assortment of ScriptPro technology, including a robot and IVR, all coordinated by the company’s workflow software. The end result is that he can fill prescriptions quickly and accurately, and interact with patients to talk about the cognitive services his pharmacy provides. He says a major benefit of all this is that, “I really enjoy working here.”

Nick Smock, Pharm.D.

Nick Smock, Pharm.D. and M.B.A., is president of PBA Health, the independent pharmacy organization based in Kansas City, Mo. He says that no matter how successful pharmacists become in providing cognitive services, “pharmacists still need to own dispensing, and they need to continually position themselves as the drug expert.”

While indicating dispensing is a critical service, Smock also points out that the need for cognitive services is real, and that consumers are becoming more aware of that need. One market he feels is immediately available is adults caring for aging parents. Smock says, “One thing pharmacists can do now is charge for these services.” To defend that statement he talks about how people are willing to pay for yoga classes, weight loss programs, or gym memberships. Smock sees a real opportunity for pharmacists in creating, carefully packaging, delivering, and charging for enhanced-care services.

Another aspect of running a great pharmacy is refill reminders and targeted interventions for patients who are noncompliant. Trey Beattie says he has found that the “scorecard” provided by Prescribe Wellness has helped him improve his star ratings and garner a modest but meaningful increase in reimbursement. The key to this service, he says, is the company’s ability to sort through patient records and then place prerecorded phone calls (that use his voice) to his patients who are least compliant. When they come in, Beattie says, he can address the issues of that specific patient, which both improves the patient’s care and improves his star rating.

Do Something Else Exceptionally Well

Mat Slakoper, R.Ph., runs a busy pharmacy — Mat’s Pharmacy is in Croydon, Pa., a suburb of Philadelphia. Slakoper says, “Several years ago I realized the future growth of pharmacy would not be in traditional dispensing.” So he decided to try selling DME.

Today, he says, this is a substantial part of his business. He even went through the competitive bidding process and recently won the supplier contract for walkers in his area. Part of the beauty of being in the DME business, Slakoper says, is that the people you attract are also candidates for prescriptions, and vice versa. A true win-win situation, according to Slakoper.

Perhaps the most common “expansion” of pharmacy is into the area of compounding. This is the direction Trey Beattie has taken in Erie, Colo. Beattie says he likes three things about compounding.

First, “When working with patients and prescribers on compounds, one just gets closer to each patient,” he says. And at Beattie’s customer service is their unique selling proposition. Laurie Beattie says their company mantra is to be the Nordstrom of pharmacy. She says their small footprint allows them to call each person by name as they enter the store, and she says having a personal relationship with their patients is central to their success.

Second, people who get compounds talk about the pharmacy more often with their friends and neighbors, says Laurie Beattie. She says personal recommendation has been their primary source of new patients.

Finally, Trey Beattie says, “The margins are higher” — in his case approaching 70% compared to the high teens for traditional dispensing. “For us,” he says, “compounding and traditional pharmacy are a perfect combination.”

Mike Burns, R.Ph., is president and CEO of AuBurn Pharmacies, an 18-store collection of pharmacies headquartered in Garnett, Kan. He is doing remarkable things with Zostavax and other immunizations — so much so that he has been invited to meet with Merck executives to talk about his program.

He says management has to be committed enough to invest the time, energy, and other resources a successful program will require. With that as a starting point Burns called upon his home office staff, key managers, and even invited suppliers to help design a system to deliver these vaccination services to all eligible patients.

At the heart of the program is a flow chart that outlines the entire process on one page. The key to his success, he says, was putting together a structured program that addressed the patient decision-making process, employee training, and workflow implementation. This allows the AuBurn team to identify and educate all eligible patients, which in turn helps protect hundreds of people from the pain of shingles and generates a nice ROI for his company.

The program recognizes people who are “right” for the service and prompts the clerk to initiate a conversation. It recognizes that people may want to talk with doctors or family members before getting the shot, so the system puts them in a queue which later prompts store staff to follow up. It knows patients will want to know if their insurance covers the service, so it has a mechanism for providing that information. It knows doctors may need to be contacted to alert them for possible inquiries from their patients on the benefit of the vaccination. And it includes a way to provide documentation of the service to the patient’s physician(s) and/or WebIZ.

Another approach to doing something else well is what Stout has done in consultations. Stout contracted with a self-insured employer group to support a truly remarkable healthcare business. His education center has a staff of 12 specialists who do consultations in private rooms. These consultations cover diabetes, weight loss, cholesterol, and high blood pressure. The separate but closely related business has proven profitable on its own and, Stout says, has also helped both of his pharmacies fill more prescriptions.

Even More Ideas

Hopefully, you are finding a few suggestions above that will inspire you to think of new and better ways you can serve your patients and improve the profits of your pharmacy. What you have read so far are three of the six “ideas” these successful pharmacy operators mentioned. Later in the year ComputerTalk will present three more: Don’t Dismiss the Front End; Management Philosophy; and Get Out of the Pharmacy and Network. CT


Do Something Well, and Thrive, Part 2

Running a profitable community pharmacy is tough — you already know that. It is the purpose of this two-part article to show you that despite numerous problems it is still possible for community pharmacy to thrive.

In the first part of this series, we learned from remarkable pharmacy owners and managers about three of six things they do to be successful in today’s tough environment. The three ideas previously discussed were: Looks Matter and Neatness Counts; Run an Exceptional Pharmacy; and Do Something Else Exceptionally Well. You can read about those ideas in the July/August issue of ComputerTalk.

Featured Voices

A more complete background on people interviewed in this two-part series appears in the first half. To ensure you know something of the background of the people mentioned in this half of the article, here is a brief description of each.

  • Mike Burns, R.Ph., CEO and president of AuBurn Pharmacies (18 stores), headquarted in Garnett, Kan.
  • Greg Hickman, R.Ph., owner of Carmichael’s Drug in Monroe, Ga.
  • Colette Richman, R.Ph., manager of Tallman’s Pharmacy in Walla Walla, Wash.
  • Mat Slakoper, R.Ph., owner of Mat’s Pharmacy, Croydon, Pa.
  • Ty Stout, Pharm.D., vice president of operations, el Tejon Pharmacy (two stores) in Bakersfield, Calif.

Now, let’s see what else these successful managers have to say.

Don’t Dismiss the Front End

There are some in pharmacy who imply that the long-standing “merchant role” of independent pharmacy should be abandoned. While there are many notable examples of pharmacists building a solely “clinical” practice, I have great admiration for those who have found a way to combine an exceptional pharmacy with an attractive and customer-pleasing front end.

One such person is Colette Richman, R.Ph., manager of Tallman’s Pharmacy in Walla Walla, Wash. This 3,000-square-foot store has been in operation for 130 years and is an institution in that town. Tallman’s takes a serious approach to the front end.

Walla Walla is a good-sized town, and Tallman’s competes against big box, national, and supermarket chains, so they are constantly looking for a way to gain a competitive advantage. And, Richman says, the front end is one way they accomplish that. Richman says they constantly look for products they can stock and recommend that fit three criteria: one, they genuinely help people; two, they provide Richman with a decent margin; and three, they are not carried by the chain stores in her area.

Tallman’s features a clinical cosmetic line called Dermablend. The line has about 25 SKUs and Richman has an exclusive in her town. She says the line is effective in covering up bruises, birthmarks, and scars. Tallman’s doesn’t advertise the line, but they do get the local dermatologists to recommend it. She says the line is artfully displayed behind glass, and their front-end manager has been trained to provide samples and do a demonstration in about five minutes.

Tallman’s is one of the leading sellers of Columbia powder and Columbia skin cream, both of which fit Richman’s three-point criteria. While this line is nowhere near as profitable as the cosmetics line, Richman says that, “When customers want more, they have to come back here to get it.”

Colette Richman says Tallman’s attitude toward customer service, combined with its involvement in community organizations, has resulted in the pharmacy being voted Best-of-the-Best in Customer Service in Walla Walla.

Tallman’s front-end is a bit larger than most independents and is supported by a well-trained front-end manager. Richman says her candy department is a major draw. And they do a good job with cards, gifts, and traditional over-the-counter products (OTCs) — all of which they will deliver with or without a prescription included in the delivery. Delivery, she says, is a major competitive advantage, and to support it they have two delivery drivers.

Carmichael’s Drug is another pharmacy that is doing amazing things in the front-end. The store is large (18,000 square feet) and houses a complete durable medical equipment (DME) shop, carries a variety of diabetic supplies, offers the Take Charge weight loss program, and has a Hallmark card and gift shop that is supported by a Webenabled gift registry.

Several of these successful managers made positive mention on the value of their websites and social media listings. A news clip in the June 2015 issue of Money magazine reports that 45% of U.S.and U.K.-based small businesses don’t have a website. And, it says, 56% of consumers don’t trust a business without one. The 2013 NCPA Digest shows that only 76% of community pharmacies have a website, which makes one marvel at those that have not yet implemented one, as consumers clearly find them useful.

Greg Hickman, owner of Carmichael’s, says that one of the major reasons his store has remained successful over so many years is that they have learned to discontinue products that no longer sell and replace them with new ones they have reason to believe will appeal to their customer base. He says that products are constantly changing, and one of the management’s tasks is to keep up with those changes. Not only that, he says, but once you have brought them in they need to be displayed and priced right in order to generate sales.

To do that, he says, his QS/1 POS (point of sale) system has proven invaluable. But more important than having a good system is putting a person in charge of the system and training him or her on how to use it properly. In Hickman’s case his daughter, Leah Ferguson, takes care of all consumer-related technology, and that includes managing a robust assortment of social media tools.

Have A Management Philosophy

General Norman Schwarzkopf was noted for saying, “When put in command, take charge!” This comment illustrates that there is a difference between being the owner and being the person who actually runs the business. One thing that is clear about the successful managers I know is that they have a vision for what they want their pharmacy to be, and they are not bashful about asking their staff to help them get there. Mike Burns of AuBurn Pharmacies says one of the most important things he teaches his staff is, “We no longer sell anything to anyone. We simply educate. If we properly educate our patients, they will make the appropriate decision to purchase the needed products and services.”

AuBurn Pharmacies backs up that statement by providing a variety of traditional and enhanced clinical offerings, including diabetes education classes, insulin pump training, billing for supplies, diabetic shoes and fittings, a customer loyalty program, a generic discount plan, adherence and synchronization services, a free vitamin program for kids, and the immunization program mentioned in the first article in this series. Burns says that everything his company does is founded on the philosophy of “The mission before the margin.”

In addition to a “take charge” management attitude, all of the owners and managers with whom I spoke have a passion for what their practice does to help people. Richman of Tallman’s Drug says that they know that other stores in their area offer many of the same products they do, so to compete they focus on customer service. Now, customer service is the attribute almost every community pharmacy touts as its competitive advantage, but when many owners are pressed on what that means, they struggle to paint an adequate picture of what customer service looks like.

Not so for Richman. She says customer service means they have people in the store who can help customers find the products they are looking for and explain how to use them. She says, “We know if they or a loved one has been in the hospital.” And that they are ready with hugs or congratulations when someone has had a baby or if a child has won an award. These are the types of things she says customers not only appreciate but that get them to talk about her pharmacy to their neighbors or friends.

Get Out of the Pharmacy and Network

Perhaps Mat Slakoper, of Mat’s Pharmacy, says it most clearly: “You have to get out of the four walls of the pharmacy and talk to people.” Slakoper grew up in the blue-collar neighborhood where his store is situated and thus has a lifetime of friends in and knowledge of his trade area. And he says taking advantage of these relationships has been elemental to his pharmacy’s success.

Slakoper takes this notion very seriously and hired a fulltime marketing person several years ago. He admits that getting into the DME business drove that decision, but maintains that having a dedicated, trained, and motivated marketing person has helped him grow all three parts of his business: traditional dispensing, special packaging for residential care facilities, and DME.

El Tejon’s Ty Stout makes specific mention of how important it is for him and key staff members to get out and meet with prescribers in their offices. In making that comment he explains that he uses the word prescribers because physician assistants and nurse practioners are a big part of his success and he makes it a point to get to know them, too.

Stout says that his ability to get out and network led to being selected to serve a 5,000-person self-insured employer group. The program includes a combination of diabetic, weight management, cholesterol, and high blood pressure services. These kinds of opportunities, he says, are much more likely to materialize when one is outside the pharmacy and working closely with others.

Colette Richman says that Tallman’s is involved in Walla Walla’s “shop small” program and that this pays off by bringing in many new customers and by encouraging current customers to shop in her store more often. And, she adds, Tallman’s attitude toward customer service, combined with its involvement in community organizations, has resulted in the pharmacy being voted Best-of-the-Best in Customer Service in Walla Walla.

Well, there you have it: excellent advice from some of the nation’s best pharmacy owners and managers. This is provided with the hope that some portion of what they say will help you successfully navigate the challenges that face community pharmacy. After all, if one pharmacy can do it, so can you! CT


Road Trip Reveals Secrets of Successful Pharmacies in Alaska

All of the pharmacies visited are different in ownership, size, and markets served, and in the products and services they offer. But like pharmacy owners everywhere, the owners of these pharmacies all face stiff chain and mail-order competition, deal with inadequate third-party reimbursement, and struggle to hire and retain good employees. What follows are four elements of success that emerged from this trip.

Bruce’s other trips include:

April 2008 – The Coast to Coast: Point Pleasant, N.J., to San Francisco; sponsored by Good Neighbor Pharmacies.

May 2010 – The Frontier: South Dakota, North Dakota, Montana, and Wyoming; sponsored by QS/1.

April 2012 – Route 66: Chicago to Los Angeles; sponsored by Epicor.

April 2013 – The Great Northwest: Washington, Oregon, and Idaho; sponsored by the Independent Pharmacy Cooperative (IPC).

May 2016 – Mid-America: Arkansas, Colorado, Illinois, Indiana, Kansas, Missouri, Nebraska, and Texas; sponsored by the Independent Pharmacy Cooperative (IPC).

The Front End Can Be a Healthcare Department, Too

Justin Ruffridge, Pharm.D., is the manager of Soldotna Professional Pharmacy in Soldotna. Coming in at 6,000 square feet, Soldotna Pharmacy is reported to be the largest independent pharmacy in Alaska.

Soldotna’s home healthcare department stands out as noteworthy. To help ensure that the right amount of inventory is on hand, and the items are priced to meet the delicate balance between competitive pricing and profit, Ruffridge relies on his Retail Management Solutions (RMS) point-of-sale system.

Ruffridge says the home medical equipment department helps strengthen the pharmacy’s image as a healthcare provider. The key to success, according to Ruffridge, is having enough items to make a statement. Then, he says, you need to train staff members on how the products work so they can explain them to patients and caregivers. One major plus, he says, is that most items are sold for cash so he has no third-party issues. And, he says, working with his suppliers who help promote the products to local physicians is also a real plus.

Stan Watts, R.Ph., owns Ron’s Apothecary Shoppe in Juneau. While prescriptions and compounding are the heart of his practice, he has also discovered the benefits of making the front end a healthcare department.

As a compounder, he has crafted a line of over-the-counter (OTC) compounds. They are displayed on a shelf next to a window that allows patients to see into the compounding lab. Carefully packaged and labeled, the products are formulated to relieve migraines, diaper rash, bug bites (they have a lot of mosquitoes in Alaska), and a dozen other ailments.

Ron’s Apothecary also measures and fits compression hose and sells homeopathic products and essential oils. To maximize the benefit of all this, Watts has implemented a customer loyalty program. Using the Retail Management Solutions (RMS) point-of-sale system, the pharmacy tracks all pharmacy purchases and provides points that can be redeemed on front-end purchases. “This,” according to Watts, “really helps tie the pharmacy and the front end together and boosts sales of both departments.”

Pharmacy Can Be Much More than Pills

Great Land Infusion Pharmacy in Anchorage is an impressive example of making patient care the focus of the pharmacy. Doug Noaeill, R.Ph., opened this pharmacy from scratch in 2006 and takes pride in providing home infusion, oncology, hospice, HIV, sterile compounding, and other clinical services.

Noaeill says the most critical success factor for his practice is developing relationships with providers. “But,” he says, “that doesn’t just mean doctor detailing.” He says the key to winning over prescribers is taking care of patients. That means providing exceptional pharmacy services as well as being able to work with payers to get these services covered. To help with that he trains his staff to go above and beyond by taking rejected cases over the head of first-line customer service agents and by carefully getting physicians and health advocates involved in making the case to the insurance company.

Bruce and Barry Christensen, both registered pharmacists, are a father-and-son team that owns Island Pharmacy in Ketchikan. The pharmacy is one of the oldest continuously operating pharmacies in Alaska. It started in a trailer in 1974, but is now housed in a modern building on the main street of this tourist town.

The Christensens are excited by the success they are having in specialty pharmacy. Barry, the son, says that serving patients on very expensive medications like Enbrel, Humira, and Risperdal requires extra attention to purchasing, handling, patient care, and prescriber relations. He finds this aspect of his practice rewarding and profitable. Barry adds that having doctors know they can help with these kinds of medications generates referrals for traditional dispensing, which is still the backbone of the pharmacy.

Watts, of Ron’s Apothecary, is also experimenting with a new type of service. He has enrolled in a program by the American Academy of Anti-Aging Medicine to provide metabolic and nutritional medicine. He says this is another way to differentiate his pharmacy from the chains by helping people get the precise nutritional support they need based on their age and physical condition. Eventually, he envisions turning this into a fee-based consultative practice that will enhance his role as a healthcare professional. 

Technology Opens New Doors

The first licensed telepharmacy in Alaska, Alaska Family Pharmacy Healy Telepharmacy, opened in June. Healy is a town of about 2,000 halfway between Anchorage and Fairbanks and is 100 miles from the nearest pharmacy. The telepharmacy is owned by Leif Holm, Pharm.D., who also owns three pharmacies in the Fairbanks area.

To support the telepharmacy, Holm purchased a system from TelePharm that is connected to the Computer-Rx system in Holm’s Prescription Center Pharmacy in Fairbanks. The telepharmacy is staffed by a pharmacy technician who greets customers and then fills and labels prescriptions in the remote location. All the technician’s actions are monitored over a secure and encrypted link to the host pharmacy. When patients present for their prescriptions, they are video linked to the pharmacist, who counsels them and then double-checks all the relevant actions of the technician.

In his three traditional pharmacies, Holm says, they use PrescribeWellness’s happy birthday outbound call program. And he uses PrescribeWellness software to monitor and contact people to remind them to request or pick up their prescriptions. Holm says his staff is often delighted when a patient comes in to say thanks for the extra attention.

One overlooked area for technology is in the will-call bin. Bernie’s Pharmacy, owned by Terri Hall-Klouda, has done something noteworthy. The pharmacy, located on the second floor of a three-story medical office building, has installed a large, custom-built, and impressive-looking will-call bin.

The bin has 162 slots, organized by number. When a prescription is filled, the pharmacy’s PioneerRx dispensing system and embedded point of sale assigns the prescription to a randomly generated open slot. Then when a patient comes in to pick up the prescription, the clerk types in the person’s name and the system points the clerk to the correct bin. The clerk then scans the item and doubles-checks the medication. Hall-Klouda says the system eliminates the need for storing items in alphabetical order and speeds up the process. And, she says, the impressive-looking will-call bin is often a topic of conversation and seems to give people a reason to tell their friends about Bernie’s Pharmacy.

These Pharmacy Owners Find Ways to Work Effectively with Their Trading Partners

With three pharmacies in the Fairbanks area, Holm’s competes with major chains such as CVS and Fred Meyer, a large Walmart-type chain in the Northwest. One tactic that works for him is using the Good Neighbor Pharmacy (GNP) Prescription Savings Club. This program is supported by AmerisourceBergen’s pharmacy services administrative organization (PSAO), Elevate Provider Network, and provides patients with the opportunity to get generic medications at prices that compare favorably with the large chain programs.

Another modest but meaningful GNP program Holm mentions is GNP’s Healthy Kids Free Vitamin Program. Holm says they work the program aggressively in the store and get out into the community to share its benefits with clinics, day care centers, and schools.

Dirk and Trish White, both registered pharmacists, own Harry Race Pharmacy and White’s Pharmacy in Sitka. They say one of the patient care services they provide is medication synchronization. To support this service they use the PrescribeWellness StarWellness module. Trish White says medsync has helped improve patient compliance while at the same time helping them better manage their time and inventory.

Soldotna’s Ruffridge says he has had some positive experience with PrescribeWellness, too. By closely monitoring the company’s performance dashboard and taking action on carefully identified patients, he has improved his star ratings by nearly one point. The system has also allowed him to make changes that have reduced direct and indirect remuneration (DIR) fees by several thousand dollars a quarter.

One final example of working with trading partners is mentioned by James Manners, general manager of Bernie’s Pharmacy. Manners says he finds attending his wholesaler trade show to be a profit builder. At last year’s AmerisourceBergen ThoughtSpot show, he says, he benefited in three ways.

First, he says, he got to meet managers for various technology solutions he was interested in purchasing. Indeed, he purchased a new PioneerRx pharmacy system at the show in 2016. Second, he gets to take advantage of deals on generics and OTC items that he says provide savings far in excess of the cost of attending the show. Finally, he feels that meeting with other pharmacy owners and managers and attending the educational session has been a major help to his career. His advice: “If at all possible I’d encourage every pharmacy owner to find a way to get to a major pharmacy event at least once a year.”

So there you have it: A brief overview of what pharmacy owners in Alaska are doing to be successful — all current examples that it is possible for a well-managed community pharmacy to succeed. Hopefully, you will find something here you think will benefit your pharmacy. CT


Some of The Best in The Great Northwest

This road trip took place April 15–26, 2013, and was sponsored by the Independent Pharmacy Cooperative (IPC). The purpose of the trip was to uncover strategies successful pharmacy owners use and to share them with ComputerTalk readers. It should be noted that while IPC sponsored the trip and helped identify some of the pharmacies visited, it did so without regard to IPC membership; indeed, only five of the 11 pharmacies visited were IPC members. I wish to thank IPC for making this trip possible.

Yogi Berra, the famous Yankee baseball player and oft-quoted philosopher, once said, “You can observe a lot just by watching.” Since I get to watch a lot of pharmacies, I would like to make an observation — that being, based on a two-week road trip I took in April, community pharmacy is alive and well, and the future looks bright!

How can I say that? Because in April I drove 2,331 miles and visited 11 remarkable pharmacies that, despite low third-party reimbursement, egregious audits, and hostile PBM practices, are doing quite well.

What follows are short vignettes in which I highlight one or two things that the managers at each these pharmacies do to help them succeed. The trip was organized to make sure I saw stores in urban, suburban, and rural locations, and within a variety of economic and demographic conditions. The hope is that as you read these short summaries you’ll find an idea or two you can adopt or modify to meet your unique circumstance and use to help you grow your practice.

Lind’s Freeland Pharmacy

Ron Lind, R.Ph., owns two pharmacies on Whidbey Island just north of Seattle. The island is home to 60,000 residents, as well as to several chain, mass merchant, and grocery store pharmacies.

Lind’s flagship store in Freeland is an impressive 17,000-square-foot facility. He recognizes that the primary competitive advantage of the store is the pharmacy, and he staffs it with professionals who provide the extra attention people in a small town expect. To help with this, the pharmacy has a QS/1 pharmacy system and POS coupled to a voiceTech IVR and ScriptPro robot.

To set his pharmacy apart Lind is also a retailer, and constantly looks for ways to bring in products or services that will serve his current customers well and give them reasons to recommend his store to others. To keep the store properly merchandised, he and his wife, Pam, spend six weeks a year at various trade shows.

Take, for example, jewelry. Lind says it all started because they sold costume jewelry. Next, they added fine watches. Pretty soon they were bringing in real jewelry — with gold and diamonds. Then they added a jeweler and started doing repairs and creating their own custom-designed items.

One thing that immediately jumped out at me in the jewelry department was the large number of items in the jewelry workroom. It is clear that the unique selling proposition for their jewelry department is the repair and custom design work they do, as people have a need for the repair and resetting of their finer items or commission a unique piece of their own. Intrigued? Check it out at www.lindsjewelry.com.

Lind’s store in Freeland staffs professionals who provide extra attention to customers.

Success doesn’t happen by accident. Lind understands the need to advertise, and he does this in several ways. He has a contract with his local newspaper and runs an ad every week, rotating various features of his store along with coupons for the special of the week. The store provides ample fodder for ads, as it has gifts, kitchenware, toys (a great assortment of those), DME, OTCs, books, a full-service photo department, and women’s clothing.

His latest promotion supports the pharmacy and introduces the Healthy Savings Plus Prescription Card. Designed in-house, the program boldly announces the availability of 400 generic drugs for $1 a week each for a 90-day supply and also includes discounts on private-label products and other store services.

Kusler’s Pharmacy

Janet Kusler, R.Ph., and her partner Mary Pat Connors own a 4,000-square-foot pharmacy in the Seattle suburb of Snohomish, Wash. The exterior of the pharmacy provides a great first impression that only gets enhanced when one walks in the front door. It is clear these two women understand the importance of curb appeal.

While Kusler’s features a well-merchandised front end, with gifts, kitchenware, fine chocolates, and OTCs, it is clear that clinical care is the primary focus of the pharmacy. Kusler and her staff wear white lab coats, and the compounding lab is visible to all who come to the pharmacy counter.

Kusler knew from the outset that compounding would be the differentiator, and proudly mentions her PCCA (Professional Compounding Centers of America) affiliation. One thing she says she does in regard to compounding is to make sure she works with prescribers, not against them. She says perhaps the most important asset she has is that her prescribers trust her to prepare compounds that stay away from questionable ingredients or processes. Her highest compliment, she says, comes when a doctor calls her and says, “Please call so-and-so, and after you visit with her let me know what I should prescribe.”

But the truly unique thing Kusler has done is to expand her immunization service and take it to a full-blown travel services practice. Under the direct supervision of Dawn Ipsen, Pharm.D., they devised a 24-page collaborative practices agreement and got it approved by the state board, signed by a prominent physician, and approved by their liability insurance provider. This lets them provide a service that includes review of the needs of travelers tailored to the location they are visiting; deliver and document the proper vaccinations; prescribe appropriate medications to prevent malaria or traveler’s diarrhea; and provide other health-related supplies the traveler may need. They have a cognitive services fee they charge for the full-blown service.

Kusler says that while the direct financial impact of the travel service is minimal, it covers the costs of the program. Providing the service adds to the overall philosophy of her entire practice: “Take care of the community.” She says that providing the service fits nicely with her compounding and dispensing practice and provides reasons for patients and doctors to recommend her pharmacy.

Brewster Drug

Brewster Drug, in Brewster, Wash., is a truly unique retail operation. Until two years ago the now-current owner, Brian Johnson, Pharm.D., served as the director of pharmacy in this rural town’s community health clinic. During that time he developed a relationship with Ron Anderson, R.Ph., the former owner. As Anderson was looking to sell, Johnson fulfilled his contract with the clinic and purchased the store, which houses the only retail pharmacy for 20 or more miles in any direction.

This is a 10,000-square-foot True Value store with pharmacy (complete with drive-up window) that supplies much of the merchandising needs for this community: hardware, farm/ag supplies, toys, cards, and gifts, as well as packaged foods and seasonal and general merchandise. When asked, Johnson says his primary goals are to provide the community with a place they can do “one-stop shopping and to keep my prices as low as possible.”

To do this he buys from more than a dozen suppliers but lists McKesson, True Value, and Promotions Unlimited as the major ones. He says his staff consciously works to find the best price “this time” among items available from multiple suppliers. Johnson says doing this takes extra time, but he feels it pays off by allowing him to save his customers a few dollars on essential items.

The pharmacy is busy and is supported by a Pharmaserve pharmacy system, a Parata robot, and a TeleManager IVR. An Epicor POS supports the front end, which in this case is a meaningful part of the store’s consumer appeal. Johnson says another thing that helps in the pharmacy is being able to accept electronic prescriptions from the dozen or so doctors who staff the small hospital and care for his customers. “Most of the time, we can have a patient’s prescription done before they arrive, which eliminates waiting and allows me to focus on counseling,” he says.

Johnson brings a couple of personal attributes that serve him well as he tackles the challenges of ownership. First, he is pleasant and outgoing. During my visit he made several trips from behind the counter to help a patient with a question or product recommendation. And he speaks Spanish. This is a bonus, as Brewster has a large number of Spanish-speaking residents whose numbers expand several times a year with seasonal laborers who work in the apple and cherry tree orchards that are the economic backbone of the area.

Kettle Falls Pharmacy

One trend I have noticed over the past couple of years is the number of nonpharmacists who own pharmacies. Kevin Herda is one of these. Herda owns three pharmacies in central Washington. His grandfather and father were pharmacists, and he has taken over and expanded on what they started, using his business degree to help this small chain prosper.

I met with Herda in his pharmacy in Kettle Falls, where it was apparent he has become proficient in both pharmacy and retailing. To build prescription sales he networks with local doctors; indeed, his third pharmacy, which he started from scratch, was done at the behest of a few doctors who felt the need for a pharmacy of his type in their small town.

Herda says he attracts pharmacists by offering them a competitive wage, and then trumps the chains by giving them a say in the practice, along with the tools they need (a Parata robot, an HBS pharmacy system, and TeleManager IVR) and hours they want (closed Sundays). He sends his pharmacists out to consult with the local Native American tribes one day a week. The pharmacists find this rewarding, and it also builds pharmacy sales as he serves the tribes with a no-postage-fee mail-order service. He also contracts for 340B services to the tribes.

But Herda’s sweet spot is as a business owner and merchant. He says he loves going to trade shows to find new things he can bring in that appeal to his customers. The Kettle Falls store is well laid out, and the two larger stores, the one in Kettle Falls and the flagship store in neighboring Chewelah, have been remodeled to expand popular departments while shrinking others. The remodeling also made the stores brighter and more inviting. The stores attract customers with a monthly circular and billboard, and provide them with photo developing and a free gift-wrapping service.

Herda believes that to succeed it is important to get involved in community issues. He sits on the board of the Chamber of Commerce and chaired the school district’s efforts to get voter permission to pass a capital improvement bond effort — a task about which he frowns as he says the effort failed, but then smiles as he says they will try again in the near future. He also is a big proponent of the “shop local” campaign and wishes more locally owned businesses would join in this initiative. Small changes in consumers spending behavior can make a huge difference in the community, he says.

Cheney Owl Pharmacy

Fritz McGinnis, R.Ph., owns four pharmacies in the Spokane area. The store I visited is a community icon, as the pharmacy opened in 1889. McGinnis purchased it in 1971. It is large — just over 5,000 square feet — with a full basement used to warehouse items for this and other stores in the chain.

McGinnis clearly understands he is in both the pharmacy and retail business, and has found ways to weave these two together to better serve patients and build sales. For example, on more than one occasion during our interview he said, “The core business here is pharmacy, but if people like shopping here, they will come back.”

To ensure people like shopping with him, he makes sure his employees like working there. I was introduced to several people who have been with him for 20 years or more. When asked how he gets and keeps good people, he says he provides competitive wages and benefits (he offers a 401(k) plan and medical benefits). But more important, he says, “is quality of life.” So he finds ways to make sure people can get time off for significant events such as school plays or church gatherings.

McGinnis is also a marketer. Not a fancy type, but a roll-up-your-sleeves and “get it done” type of guy. He artfully merchandises toys, women’s apparel, and other items that bring people to the store. He says the toys are popular with grandparents looking to bring something special to a sick child. And he ties into community events. For example, this year’s high school prom had a masquerade party theme, so he had an end cap of party masks and promoted them on his outdoor changeable letters sign.

He also produces handbills to promote special products, services, and events. None of them would win awards on Madison Avenue, but he says they do the job of bringing people into his store. Then, he says, finding ways to have merchandise that people want on the shelves is important, so he programmed an iPad that lets him walk his shelves and better manage his inventory. McGinnis realizes personal attention to consumers is critical and trains his people to go the extra mile. He points with some pride to being recognized for best customer service for a mid-sized business by the West Plains Chamber of Commerce.

Medicine Man

The Medicine Man chain is a collection of nine apothecary pharmacies in the Idaho panhandle area. The group has done an impressive job of branding its company and creating a presence in the area. You’d be well-served to check out its web page: www.medmanpharmacy.com.

Barry Feely, R.Ph., is one of the partners, and I visited his store in Hayden. Joining me on the visit was his partner, Don Smith, R.Ph., and talking with both of these well-seasoned pharmacy owners made me think I was talking to two newly minted Pharm.D.s, as they shared examples of some of the things they are doing.

For example, they sponsor and aggressively promote monthly health classes held at the local community center. The content changes each month and is supported by presentations and handouts made available from a company their wholesaler has recommended. The classes are promoted on television and with bag clippers and an impressive email and Facebook campaign.

Feely and Smith showed me their plans for remodeling the store to expand their on-site medication review efforts. They brought out new marketing materials in development to support a medication compliance program that will draw on the power of a new Parata PASS unit scheduled to be delivered next month. These guys are excited about the future of pharmacy and are investing heavily in it.

As I was about to leave, Feely said he wanted to show me one more A collection of nine apothecary pharmacies in the Idaho panhandle, the Medicine Man chain has done an impressive job of branding its company and creating a presence in the area. thing. This turned out to be (with the exception of their enthusiasm) the most impressive thing I saw and one I would invite every pharmacy to consider, modify, and deploy: their URock employee development program.

The genius of the program is its simplicity. Staff members are given a set of URock tickets and then trained on how to spot and immediately recognize exceptional service. When they see another staff member doing something noteworthy, they fill in the person’s name, the date of the event, and a one-word reason for giving him or her the ticket. They then award that co-worker between 500 to 1,000 points, depending on how remarkable the event was. The points are “booked,” and as they accumulate can be redeemed for a cash bonus. The core philosophy is that good behavior noticed and rewarded will be repeated.

Well, this is the halfway point. The next five stores will be featured in the September/October issue of ComputerTalk and include a few closing comments and observations gleaned from the trip. CT


Engineering Success: Pharmacies of the Great Northwest

This road trip took place April 15–26, 2013. It should be noted that while IPC sponsored the trip and helped identify some of the pharmacies visited, they did so without regard to IPC membership; indeed, only five of the 11 pharmacies visited were IPC members. I wish to thank IPC for making this trip possible..

In April of this year it was my good fortune to make a two-week road trip and visit 11 remarkable pharmacies in the American Northwest. The trip was sponsored by the Independent Pharmacy Cooperative (IPC), the large buying group headquartered in Sun Prairie, Wis. The purpose of the trip was to uncover tips, tactics, and techniques used by these remarkably successful pharmacies that might inspire ComputerTalk readers to try something new that will help them grow.

What follows are short vignettes on the things I learned while visiting the last five stores on the road trip. You can read about the first six stores in the July/August issue of ComputerTalk.

Rosauers

Rosauers is a regional grocery chain with 21 stores (16 with pharmacies) headquartered in Spokane, Wash. I was able to visit with Gary Glennie, R.Ph., director of pharmacy, in the home office to get a better understanding of how Rosauers views the relationship between grocery and pharmacy. Glennie then authorized a visit to the chain’s one-year-old, start-from-scratch location in Boise, Idaho.

Stephen Nadler, Pharm.D., manages the Boise pharmacy, but he understands that as a grocery store pharmacist his duties do not end at the pharmacy counter. During my visit I saw Nadler and others on his staff make several trips out front to talk with customers, help them select an OTC, or discuss a private issue of some sort.

When asked how he attracts patients to the pharmacy, Nadler started by telling me about his company’s “Blue is Better” campaign. Using guidelines from various health agencies, including the American Diabetes Association, Rosauers places a prominent blue shelf label below products with lower fat, sodium, and carbohydrates, making it easier for consumers to make healthier choices. The program also highlights whole grains, fresh fruits and vegetables, and other healthy foods. And it draws attention to the pharmacy itself, a key ingredient in the success of any supermarket pharmacy.

Another tactic Nadler successfully uses is his custom-crafted Rosauers Wellness File. Here, Nadler and his staff carefully extract pertinent healthcare data from their HBS pharmacy management system and use that data in concert with his counseling of participating patients. The program provides these patients with a health record that contains information on medications being taken, immunizations received or needed, and drug allergies; there’s even room for data on selected medical conditions such as hypertension, diabetes, and BPH, and for special notes.

This is all organized on a one-page form folded to fit in a wallet or purse. Nadler says the file has proven useful in helping patients understand the meds they take and to be more compliant. And, he says, since it is often pulled out in a doctor’s office, the file has prompted doctors to suggest that others visit the pharmacy and get one, too.

Does all this work? According to Bethanie Powell, store manager, the Boise store’s pharmacy is beating its sales and prescription count projections. No one thing can account for this, but Nadler says the Wellness File card has been well received.

Red Cross Drug Store

Robert Coulter, R.Ph., owns a remarkable pharmacy in La Grande, Ore. As the major town in this rural area, La Grande has its share of chain competitors, such as BiMart, Rite Aid, and Walmart. So to succeed, Coulter has built a pharmacy hitting on all eight cylinders.

Here’s what I mean. Think of any enhanced service mentioned as a key to pharmacy success, and Coulter is doing it. He has a beautiful store on a busy intersection. Coulter takes full advantage of technology, using an Innovation robot, an Eyecon counting machine, and an Rx30 pharmacy system tied to an RMS POS to support his well-merchandised front end.

He even has a PickPoint will-call bin system where the bag holding the prescriptions being called for glows with a color-coded LED light directing the clerk to the right bag. Coulter does compounding, provides immunizations, and services LTC, assisted-living, and residential-living facilities with unit-dose packaging.

So to take his practice to the next level, Coulter has implemented an Rx-synchronization program that he says has made a positive impact on his practice. Most importantly, he says, his customers love the program; he has over 600 people enrolled.

Every day the pharmacy’s staff runs a special report created by Rx30 that prints out all the medications a participating patient is taking, along with his or her contact information and “cycle” date. Red Cross has opted for a 30-day refill cycle, meaning people come back in on the same date each month, not on the same weekday, as in a 28-day cycle. A participating patient whose medications are due for refill then gets a personal phone call with a brief but detailed medication review to ensure all medication changes are accounted for. After the review, prescriptions are entered into the pharmacy system in a holding queue, which then pops up on the day the prescriptions are scheduled to be filled; the staff does these during slower walk-in demand times. If the medications are in the robot they will be batch filled, making it easy for all the medications for each patient to be put in a color-coded container and made ready well before the actual pickup date.

The end result, according to Coulter, is improved productivity, a higher level of customer care, better compliance, and, not to be overlooked, increased prescription sales.

Len’s Drug

Greg Armstrong, R.Ph., owner of Len’s Drug in John Day, Ore., gives a whole new meaning to the phrase “community pharmacy.” He and his wife Marla have as one of their key goals helping to build up this entire rural community, not just their drugstore.

Len’s is a large, 10,000-square-foot store, complete with HME, sporting goods, books, cards, and gifts, along with garden supplies and packaged foods. And the store accepts Supplemental Nutritional Assistance Program (SNAP) cards for these food purchases. Armstrong also owns a Subway sandwich shop and a local dollar store, and plans to open a coffee house that will serve as a place for twenty-somethings to gather other than at a local bar.

Still, at the heart of everything Armstrong does is pharmacy, and to better run that he has invested in a SuiteRx system that takes a picture of each pill and scans an image of the prescription so each prescription can be easily checked. His workflow system barcode-scans each step of the process, and he makes sure two sets of eyes review each prescription. To provide the time for this, he has a ScriptPro robot and a Kirby Lester pill counter.

Armstrong sees the future as bright.“People will always need pharmacists,” he says. He quickly adds that the role of the pharmacist is changing, but that he does not see that as a threat but an opportunity.

Armstrong is a member of a citizens advisory board helping local government and community organizations provide a variety of health benefits and prepare for the implementation of the Affordable Care Act. Armstrong points out that Oregon is undertaking an initiative that may allow all government agencies and even many private businesses to enroll their employees in the Medicaid program, with the goal of strengthening the system, improving care, and reducing costs.

Armstrong also talks with pride of his healthy-heart class. Each month he promotes and presents a one-hour program at a local community center where he helps people understand health issues and shares recommendations on how to prevent or treat them. He says he seems to capture people’s attention as he tells them that one of his goals is to get people off as many medications as possible.

He sees the future as bright. “People will always need pharmacists,” he says. He quickly adds that the role of the pharmacist is changing, but that he does not see that as a threat but an opportunity. As proof of the pharmacy’s ongoing commitment, his daughter graduates from pharmacy school this year and plans to work at Len’s Drug.

Hirons Drug

Hirons boasts two 10,000-square-foot drugstores in Eugene, Ore. Both locations are near the University of Oregon campus and, as you’d expect, find several ways to tie into the college. Steve Hirons is the grandson of the founder and serves as VP of operations, as well as a partner with his father, John Hirons, and uncle, Larry Hirons, a physician.

While not a pharmacist, Steve Hirons is passionate about pharmacy and is actively involved in finding ways to attract more patients to the pharmacy. And in true entrepreneurial style he is doing this by understanding the unique aspects of his market and taking advantage of opportunities it presents.

Perhaps the most notable is a program he is about to embark on with the University of Oregon. Any athlete prescribed a medication by the team doctor can come to Hirons and have his or her prescription filled using the family’s prescription benefit plan. Rather than charge the athlete the co-pay, Hirons will bill the athletic department each month. Hirons’ idea is that athletes are more likely to comply with medication if they don’t have to bear the cost. He has also contracted with two 340B-covered entities in Eugene.

Hirons is the most artfully and fully merchandised store I have ever seen. Merchandise of all sorts is displayed from floor to ceiling, and I do mean ceiling, as many items are hung from the ceiling — capturing your attention and providing a truly amazing shopping experience.

The store has a robust collection of college paraphernalia. It stocks an assortment of locally produced chocolates that Hirons says are a big draw. Hirons sources products from True Value and Hallmark, attends a number of trade shows, and even brings in live plants and garden supplies from four nurseries.

While walking the store it was my good fortune to meet Nicole, the front-end manager, freshening up a section in one of the aisles. While trying to take in all I was seeing I asked her, “How do you keep up with all of these items?” Her reply astounded me in its simplicity as she said, “You go through an aisle and clean it every day.” Clearly not rocket science, but it works.

One final note: I asked Hirons if he had a business philosophy he lives by. Without a moment’s hesitation he said, “If you don’t ask, you don’t get.” When pressed for more detail he explained he has learned to always ask for an extra discount, dating, free goods, etc. — a trait that has served him well.

Central Drugs

Central Drugs is located right in the business center of Portland, Ore. This location provides some unique opportunities and challenges to partners Gary Lundgren, R.Ph., and Shelley Bailey, C.Ph.T. and M.B.A.

It is a pleasant looking and well-merchandised 3,000-square-foot store. Bailey says front-end sales are not all that good, but that an attractive front end helps communicate to their customers that this is a real drugstore and that they are there to help. “Looks matter,” she says.

To really succeed in this market they have worked aggressively to build a specialty pharmacy business, and in doing that they have done some amazing things. As to the “worked aggressively” idea, Bailey says they currently bill a state-specific AIDS assistance program only because when they were first rejected due to a mail-order-only initiative, Bailey contacted community leaders and legislators and educated them on the value of community pharmacy. Her efforts won the right to be included in the program.

About three years ago they brought in a design firm to upgrade the look of their store. In doing so they set aside prime retail space to add a 12-seat classroom right next to the pharmacy. This classroom has become the focal point of some remarkable patient care and marketing services.

Many pharmacies have found ways to engage patients in health classes, but the direction Central Drugs has taken puts a whole new twist on the idea. To help build demand for their specialty pharmacy and 340B program support, Bailey says they have developed an effective doctor-detailing program.

The educational classes provide reasons for visiting with doctor’s offices, and when calling on these offices Bailey has a professionally produced packet with her. In the packet are forms the doctors can use to provide information needed for the pharmacy to enroll patients in prescription assistance programs. Bailey says she learned early that taking this bureaucratic task out of the doctors’ hands was a great way to win their support.

But she doesn’t stop there. She has found ways to win over pharmaceutical representatives, too, and get them involved with the classes. She says the reps provide refreshments and educational materials, along with co-pay discount cards and other aids that enhance the effectiveness of the classes. And since the classes help build more-compliant patients, the reps also take Bailey’s materials to the doctors in the area and explain how Central Drugs can help patients get, pay for, and benefit from the medications the pharmaceutical representative provides.

Well, there you have it: ideas, suggestions, and examples of ways pharmacy owners are engineering success in their communities. Seeing these pharmacies prosper in urban, suburban, and rural settings convinces me that success in pharmacy is possible. That often means finding a way to provide a product, program, or service that extends your pharmacy beyond the practice of filling prescriptions. It also means realizing that your job as a professional is to help people live happier, healthier lives.

Community pharmacy faces numerous challenges, and finding ways to overcome these challenges and succeed will never be easy. And after 40 years in this industry, I can say it never was. If there is one final observation I would make, it is this: Far too many pharmacy owners spend too much time lamenting the loss of the past and fail to search for the new, better, and more profitable things to do. These can be found. How do I know? I saw 11 pharmacies doing it. CT

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