I JUST DROVE 3,992 MILES and visited nine remarkable pharmacies in Arizona, Utah, Idaho, Montana, and Calgary, Canada. The good news is that what I saw proves community pharmacies can find practical, professional, and profitable ways to grow. The route I drove was inspired by U.S. Route 89, often called America’s most scenic highway as it goes by the Grand Canyon and through Zion, Yellowstone, and Glacier national parks.

MELROSE PHARMACY, Phoenix, Arizona

Teresa Dickinson, R.Ph., opened Melrose Pharmacy in a densely populated and ethnically diverse Phoenix neighborhood in 2005. The pharmacy motif features classic wooden shelving, an open ceiling with exposed wooden beams, and an old-fashioned refrigerated soda case. It all works together to create a 1950s‘ feeling of nostalgia.

But when it comes to the pharmacy, everything is cutting-edge. The pharmacy features an RxSafe and an EyeCon pill counter. Dickinson’s Vow phone system supports text messaging to improve adherence.

To further help with adherence, she has a Parata PASS. Home delivery and an active compounding lab round out the pharmacy’s offerings.

But to focus on the technology and look of the pharmacy would be to miss the point. Dickinson runs a people-friendly pharmacy and devotes a lot of time to supporting the community. In 2016 she was named the 2016 Greater Phoenix Chamber of Commerce Entrepreneur of the Year. She has served as a Luminary for the Arizona Chapter of CPESN, and just completed a three-year term as president of Pharmacists United for Truth and Transparency (PUTT).

Bruce Kneeland extends special thanks to the sponsors whose financial support made this trip possible.
American Associated Pharmacies, AAP, Scottsboro, Ala., www.rxaap.com
FLAVORx, Columbia, Md., www.flavorx.com
GRX Marketing, West Des Moines, Iowa, www.grxmarketing.com
PioneerRx Pharmacy Software, Shreveport, La., www.pioneerrx.com
PerceptiMed Systems, Mountain View, Calif., www.perceptimed.com
WSPC — formerly the Western States Pharmacy Coalition, Tigard, Ore., www.westernstatesrx.com

Perhaps the single most impressive thing Dickinson does is to provide several enhanced care services and charge patients a fee for participating. As part of her compounding services, she does female hormone counseling; to support that service, she offers a saliva test program. She enrolls patients in the 13-week TAKE CHARGE weight loss program that assists patients in weight loss by providing accountability, suggestions for proper meal planning, and lifestyle education. To support these programs she has a professional counseling room adjacent to the pharmacy.

She also uses the services of GRX Marketing. This pharmacy marketing agency worked with her to create a comprehensive marketing plan that includes helping define her core message. They produce, print, and send out the brochures, flyers, and other marketing materials she needs. Dickinson says all these things have proven useful in helping patients understand the value of her enhanced services.

Dickinson says, “In my opinion, one thing more pharmacy owners ought to do is hire a marketing professional or work with an agency.” This is especially important for pharmacists looking to charge out of pocket for the services they provide.

CHINO VALLEY PHARMACY, Chino Valley, Arizona

While born and raised in Michigan, Jason Dykstra, Pharm.D., went to pharmacy school in Phoenix. He says that about five years ago he started to dream of opening his own pharmacy. After doing his homework, he opened Chino Valley Pharmacy in the fall of 2016. Chino Valley is a rapidly growing town of about 15,000 located 20 miles north of Prescott, Ariz.

In preparation for opening, he renovated an old bank on the corner of the town’s main street, U.S. Route 89. The building is attractive, visible from the highway, and has a drive-up window. The front-end features OTCs (over the counters), a nice assortment of cash-and-carry home medical equipment, and a children’s play area. Two niche areas he has ventured into with some success are pet meds and essential oils.

One thing Dykstra said during our visit that resonated with me was, “You can provide people with exceptional customer service. But if you’re not making money, you won’t be able to keep the lights on.”

One tool he uses to remain profitable is the Scan & Toss. This is an ordering system provided by his group purchasing organization, American Associated Pharmacies (AAP). Because AAP runs its own warehouse, Dykstra says he can use the barcode reader provided and scan any item needing to be reordered. If the item is stocked in the AAP warehouse, he gets it from them at a lower price; if not, the item will come from his primary wholesaler.

To help improve profitability, he watches his cost of goods and reimbursement amounts on every script. When he sees he is about to get a low or negative margin, he digs deeper to find out why and what can be done to mitigate the loss. That includes double-checking his cost from various vendors or contacting the prescriber to discuss alternatives.

Dykstra says that balancing all the factors to find the lowest cost of goods while also maximizing his AAP and Cardinal Health rebates is critical to his profitability. But while buying right and managing to the numbers is critical, he is quick to add that building a team is even more important. He says that pharmacy is a people business — and that finding ways to gain the confidence and respect of his team, and then having them provide professional and friendly service to customers and prescribers, is the key to his success. As proof of his ability to build a team the pharmacy was just given “The People’s Choice Award” by the area’s daily newspaper.

HURRICANE FAMILY PHARMACY, Hurricane, Utah

Hurricane is a small but rapidly growing community in southern Utah, just outside of St. George. Cliff Holt, R.Ph., owns this pharmacy, along with three others in the region.

The Hurricane location is nothing short of amazing. Starting 10 years ago with four employees, Holt now has a team that includes six pharmacists, two full-time registered nurses, 16 technicians, and three delivery drivers. The pharmacy also operates four delivery vehicles.

Holt has acquired a lot of technology: a robot, a pick-to-light will-call system, a pill-pouching system, and even a pick-to-light inventory storage system. He also has a state-of-the-art compounding lab. Still, he says, “I am not a technology guy. I only buy technology when it fills a real business need.”

At the heart of his technology suite is his PioneerRx pharmacy system. Holt was an early customer of PioneerRx, and says that central to his need for a pharmacy system is that it integrate well with other technology he uses. He rates PioneerRx high on that attribute.

Holt is an outgoing, results-driven guy, and his charismatic personality is clearly a key element of his success. He also is a big proponent of getting out of the pharmacy and meeting with prescribers and healthcare agencies, and speaking at senior centers.

He says. “In order to make these visits effective you have to have something to say that lets them know you can help them solve their problems.” For example, he says, doctors tell him they only hear from a pharmacist when they call for refills or to relay a problem with insurance coverage. So when Holt visits, he or one of the RNs working for him comes prepared to talk about how his med sync program can dramatically reduce the number of refill request calls his staff needs to make. He also says that since drug representatives can no longer bring note pads and pens, he does this, and they are well received.

Speaking of medication synchronization, Holt says his PioneerRx system’s special module has empowered his pharmacy to be able to sync 70% of its prescriptions. “Syncing not only helps us with physicians and patients, it also helps with our delivery program,”he says. His delivery drivers make 80 to 90 stops a day, and being able to schedule one delivery to a household per month helps control costs.

THE APOTHECARY SHOPPE, Salt Lake City, Utah

The Apothecary Shoppe is located in a densely populated downtown section of Salt Lake City, Utah. And as such it provides Kevin DeMass, R.Ph., its owner, with some unique challenges and opportunities.

The pharmacy is located in the basement of Salt Lake Regional Medical Center — one of the major hospitals in the area — and doesn’t even have an exterior sign.

Still, the pharmacy is well laid out and attractive. The front end is clean, artfully merchandised, and well lit. In addition to the normal selection of OTCs, DeMass stocks refrigerated beverages, frozen microwave meals, and snacks that bring in members of the hospital staff. This is especially useful as networking with physicians helps the pharmacy with referrals for patients with complicated medication needs, such as for transplant, HIV/AIDS, fertility, and mental health issues.

The pharmacy specializes in immunizations, and DeMass networks in the community to find niche markets he can serve. One niche is foster parents. He has a referral relationship with one of the agencies that manages the area foster parent program and works with the foster parents to administer the vaccinations and provide the documentation they need. He also mentions that he pulled out all the stops, contacting dozens of clinics, health agencies, and other organizations to acquire enough SHINGRIX vaccine to administer the second dose on time to hundreds of patients, despite the shortage.

One of the most important management skills DeMass mentions is the need to know how everything in the pharmacy works. That includes how to use the pharmacy computer, fix the phones, work the POS (point of sale) and IVR (interactive voice response), manage inventory, handle human resource issues, manage accounts receivable and payable, and fix rejected insurance claims, etc. He says, “Someone needs to know how to change the toner

in the fax machine, reload printer labels, and discuss the therapeutic endpoints for insulin utilization with newly diagnosed diabetic patients.”

DeMass is the chairman of the board for WSPC (formerly the Western States Pharmacy Coalition), his GPO (group purchasing organization). One major service he uses is the GPO’s purchasing scorecard and alert system, which helps him maximize rebates from his primary wholesaler. He also tracks his EQuIPP scores and uses the PrescribeWellness refill reminder calls to improve his Star Ratings. He says that by getting his staff to understand the importance of managing to “the numbers,” he was able to raise his Star Ratings from 2.8 last year to 5.0 this year.

HARMONS, Farmington, Utah

Harmons is an upscale family-owned grocery chain with 19 locations in the Salt Lake metropolitan area — and 18 of the stores have pharmacies. The Farmington location I visited is about 20 miles north of Salt Lake City and is impressive.

Rocky Parker, Pharm.D., is the pharmacy manager. The pharmacy is located in the front corner of the store and features a nice patient waiting area. Parker and his team provide patients with a number of enhanced care services, including a full array of immunizations, an automatic refill program, and a loyalty program. One thing he and the team are big on is medication flavoring, for which they use the FLAVORx program. He says they find that doing this not only improves customer relations but also helps kids to complete their full course of therapy. And, he adds, the team feels the flavoring is valuable enough that they charge $2.99 for the service.

Parker says that being in a grocery store provides him with some unique opportunities — one being having a registered dietician to provide professional nutritional counseling services. She offers one-on-one consultations on issues involving diabetes and weight loss. She also supports a program that puts special notices on shelf tags that highlight foods that are especially healthy, gluten free, or low in sugar.

Parker says that a major management tenet of Harmons is that employees come first — the idea being that if the company treats its employees right, they will treat the customers right. To that end the pharmacy department offers smoking cessation and weight loss classes to Harmons’ employees. The weight loss program runs for 12 weeks, with one of the classes being taught by a pharmacist. The pharmacist discusses how a change in lifestyle can facilitate weight loss, as well as the medications recommended and their side effects. The program is only currently offered to employees, and if they complete the course and stop smoking, they get a meaningful discount on their health insurance premium.

As a certified specialty pharmacy, Harmons is approved to dispense a wide variety of medications designed to treat inflammatory diseases, irritable bowel syndrome, and migraines. These programs require special certifications and for the pharmacy to follow carefully designed protocols, including face-to-face counseling and documentation. Parker says, “These new services are truly helping our customers get the medications they need, right here in our community.”

If you’ve ever traveled with kids you’ve heard the cry, “Are we there yet?” Well, no, we are just halfway done. In the next issue of ComputerTalk we’ll visit four more pharmacies, including a visit to a pharmacy in Calgary, Canada. And you’ll be introduced to Josh Morris, Pharm.D., who owns the first telepharmacy in Montana.

While each pharmacy covered in this article, and the four to come, are all different, I think you’ll see that they share some common attributes, and they have all found ways to adjust to diminished reimbursement by providing new, more, and better services. CT

Bruce Kneeland specializes in helping independent community pharmacies increase sales, improve profits, and simplify their lives. He writes regularly for ComputerTalk. He can be reached at BFKneeland@gmail.com.