Elements Magazine Vol. 13 Iss. 4 December 2024

Beyond Prescription Dispensing Why you should offer year-round vaccines

IT’S ALL IN THE PACKAGING How compliance packaging can help your patients

PRESCRIPTION FLAVORING The benefits of offering children tastier medicine

VOL. 13 ISS. 4 | DECEMBER 2024

CONTENTS ON THE COVER

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FEATURE | Beyond Prescription Dispensing Why you should offer year-round vaccines

DEPARTMENTS

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NEWS | Whooping Cough on the Rise The worst outbreak in a decade is infecting thousands

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TRENDS | Pill Variations and Non-Adherence

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RETAIL | The Power of Unique Endcaps

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SOLUTIONS | Prescription Flavoring

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Why the color and shape of generics matter

How impulse buys can boost your pharmacy’s profitability

The benefits of offering children tastier medicine

SPOTLIGHT | ADHD Medications High doses are linked to greater risk of psychosis

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MONEY | Phishing Scams

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OUTLOOK | It’s All in the Packaging

Don’t let the fraudsters trick you

How compliance packaging can help your patients

ELEMENTS | The business magazine for independent pharmacy | DECEMBER 2024

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ELEMENTS

ON THE WEB

The business magazine for independent pharmacy

VOLUME 13, ISSUE 4 DECEMBER 2024 PUBLISHER & EDITORIAL DIRECTOR Matthew Shamet EDITOR Gina Klein GRAPHIC DESIGNER Logan Whetzal

Cybersecurity in Your Pharmacy The world relies on digital technology.

Because of that, cybersecurity has become extremely important. When cyber security issues happen in your pharmacy, significant vulnerabilities will be exposed within specific operations.

CONTRIBUTING WRITER Cecilia Vigliaturo

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Medications can drastically improve people’s lives, especially those with chronic conditions, such as high blood pressure, diabetes, mental illness, high cholesterol, cancer, and chronic pain. But taking too many prescribed medications can be dangerous.

The Prevalence of Osteoarthritis Millions of adults suffer from chronic joint pain and stiffness known as osteoarthritis (OA). It’s the most common type of arthritis both in the U.S. and around the globe, and it’s affecting more than 32.5 million Americans alone.

Elements magazine is published quarterly by PBA Health. ©2024 PBA Health. All rights reserved.

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

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

NEWS

WHOOPING COUGH ON THE RISE The worst outbreak in a decade is infecting thousands

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hooping cough, also known as pertussis, is spreading faster than it has in years. As children went back to school in September, numbers began to climb. In fact, 291 cases were reported for the week ending September 14, according to the U.S. Centers for Disease Control and Prevention. Numbers haven’t been that high since 2015.

There have been over 16,000 cases that have been reported so far this year. According to the CDC, this is more than four times higher than the infections reported by this time last year.

U.S. health officials warned of a resurgence in breakthrough infections in older children and adults. However, it’s the unvaccinated young children and newborns of unvaccinated moms who are the most vulnerable to both infection and severe disease. The disease is most dangerous to babies, because 1 in 3 who get it require hospitalization.

According to the CDC, reported cases of those with whooping cough are returning to pre-pandemic levels, where more than 10,000 cases in the U.S. are typically reported each year. Leading in the number of cases are Pennsylvania, New York, and California, in that order. So far, Pennsylvania has recorded 2,008 infections this year, which is nearly double California’s numbers.

Why is this big outbreak happening right now? Experts say there are numerous possible explanations. For instance, doctors are testing for whooping cough more these days and identifying more cases. There’s also a possibility that the bacterium that causes the disease has mutated. Plus, during the days of the pandemic, people got behind on their vaccines and many haven’t caught back up.

One challenge with the whooping cough vaccine is that it’s a five-dose series over the course of the first six years of a child’s life. It requires regular visits to a doctor or pharmacy.

Another issue is vaccine hesitancy and parents who refuse to vaccinate their kids.

Whooping cough looks like a mild cold for the first couple of weeks. But then the coughing fits start. When babies get it, they will be “whooping” as they continuously cough. If they look like they’re not breathing at all, it can be life-threatening and a sign they need to go to the hospital. Whooping cough can also lead to pneumonia and other complications.

The most severe cases are in infants because their airways are so small and can become easily blocked. Therefore, babies cannot get their first dose of the vaccine until they’re two months old. This is why the CDC recommends that pregnant women should get the pertussis vaccine early in the last trimester of every pregnancy to protect their newborns for their first two months of life.

The DTaP vaccine is recommended for babies who are two months old and up, and children under 7 years old. Older children and adults are advised to get the vaccine as well as a booster every 10 years.

ELEMENTS | The business magazine for independent pharmacy | DECEMBER 2024

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TRENDS

PILL VARIATIONS Y AND NONADHERENCE

Why the color and shape of generics matter

our patients compromise their health when they stop taking their medications. But for many, when their pills change shape or color, it worries them, and they quit taking it.

Generic pills come in all shapes, sizes, and colors, and they make up more than 70 percent of all prescriptions given to patients. They’re the same chemically as their brand-name counterparts, and the FDA requires that generic drugs have the same dosage form, strength, intended use, quality, route of administration, and performance characteristics as their brandname versions. However, they’re not required to match their brand-name counterparts or each other in terms of physical appearance, including color, size, shape, and markings.

It can be dangerous to stop any medication regimen for many reasons. Yet, many do; and often it’s because of changes to the appearance of their medicine. Here’s why: • Perception and trust: Some patients may associate certain colors with effectiveness or safety. So, when their pill color changes, they get confused and stop taking it.

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• Consistency and routine: Patients get used to their pill shape and color, so when it changes, it disrupts their routine and makes them question if it’s the right medication.

• Psychological impact: Believe it or not, the color of a medication can have psychological effects. Some colors are more soothing or stimulating than others. Red and yellow pills are often seen as more potent or effective, whereas blue and green are seen as calming.

• Adverse reactions: If a patient has had a bad experience with a particular pill color or shape in the past, they will probably be hesitant to take a pill that looks like it.

As their pharmacist, there are things you can do to address issues with your patients wanting to stop their generic medications because of a color or shape change.

Emphasize that despite differences in appearance, the active ingredients, efficacy, and safety are the same.

Reassure them that changes in their medication’s appearance are often due to different manufacturers, but the effectiveness of the medication has remained unchanged. Make sure to explain the testing and approval process that generic drugs go through to meet the same standards as the brand-name drugs.

Be consistent with messaging about generics in your pharmacy with educational materials. Hang posters, post on social media, and educate patients during consultations.

Visual aids are also great for getting the message out. You can use pill identification guides to show patients the differences in appearance between generic and brand-name drugs, and be sure to highlight their chemical equivalence.

You also need to ensure that all your pharmacy staff provide consistent and accurate information about generics, so it reinforces the message and helps build patient confidence.

If a patient is still leery, work with their prescribing doctor to address their concerns. A different generic manufacturer may be a good option if your patient doesn’t feel comfortable with a specific pill’s appearance. It’s good to tailor your approach to each of your patients’ needs. Some just need more reassurance and information than others.

And by taking the time to listen and address their concerns, you can greatly improve their adherence.

COMMONLY DISLIKED GENERICS

Generic medications don’t always resemble their brand-name counterparts. This is because of variations in shape and color, which can confuse patients and make them reluctant to take them. The list below are some of the top disliked generic pills: Atenolol This often comes in a different color and shape compared to the brand-name Tenormin.

Escitalopram Generic versions may have a different look from the brand-name Lexapro.

Gabapentin Generic versions can vary significantly in appearance from the brand-name Neurontin.

Lamotrigine The generic form can differ in appearance from the brand-name Lamictal.

Lisinopril The generic form can look different from the brandname Prinivil or Zestril.

Metformin Generic versions can differ in color and shape from the brand-name Glucophage.

Omeprazole The generic form can vary in appearance from the brand-name Prilosec.

Sertraline Generic versions can look different from the brandname Zoloft.

These variations can lead patients to question whether they’re taking the correct medication. This can affect adherence to their treatment plan. You can help by educating your patients about these differences and reassuring them about the efficacy and safety of generic medications.

ELEMENTS | The business magazine for independent pharmacy | DECEMBER 2024

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RETAIL

THE POWER OF UNIQUE ENDCAPS How impulse buys can boost your pharmacy’s profitability

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hen was the last time you really looked at your endcaps? If it’s been more than a month, it’s time to change your displays. Especially if your patients aren’t frequenting them.

Endcaps are great tools for selling impulse items and bringing in profit, especially when placed in the front end. Impulse buying is purely based on desires. It happens as an unplanned decision to buy something right before making a purchase. So, when your patients enter your store, have something eye catching and interesting to draw them in to make an impulse buy.

“We do endcaps every month, and we also do a quarterly new-item endcap that’s part of our national program,” said Colleen Volheim, Category Research & Analysis Manager at Hamacher Resource Group (HRG). “It takes a little bit of advanced planning. The easiest thing to do is follow our planogram program, and it will give you all these things.

However, if you work on your own, or you want to add additional endcaps, a lot of things you can do really revolve around holidays and national months. Pick a theme for your endcap, and display products that will interest your patients or meet their needs. This helps in making sales.”

You can make your endcaps gain even more attention by using signage, Volheim said. “It’s the same silent salesman. Signage is a great tool to get your message out to patients on an endcap.”

HRG developed IN.store™ Category Management Tools exclusively for small chain and independent pharmacies.

Their experienced team of category research and pricing analysts review 24 health, beauty, and wellness categories

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each year and find items that promise success in community pharmacies based on careful evaluation.

“I don’t know how an independent pharmacy would ever manage their store without Hamacher,” Michael White, former front-end and general manager at Jasper Drug Store in Jasper, Georgia said. “They send a new planogram out for a new section every month. Just follow those planograms. If you do that, it keeps your store up to date with new products.”

Here’s how you can bring in the sales by enhancing your front end to promote both unplanned and impulse purchases: PICK A THEME AND BUILD AROUND IT Your goal is to increase sales, so display products that will catch patients’ interest or meet a specific need. For instance, in the wintertime, your patients are battling colds and flu symptoms.

You can grab their attention by setting up a flu-themed endcap that includes thermometers, cough drops, and tissues.

Here are some other theme ideas to think about: • Holidays: Whether it’s Halloween, Christmas, Easter, or Valentine’s Day, be sure to include holiday cards, candy, gift wrap, and decorations.

• Standing Up to Cancer: Feature products that will help with the wide range of treatments cancer patients may need for their symptoms. Stock some general items such as supplements that target immune boosting or energy enhancing, hand sanitizer, masks, specialty skin care, anti-nausea medications, and comfort items such as aromatherapy products.

• Heart Health Month: This is a great time to stock an endcap with aspirin products, multivitamins, and blood pressure monitors.

• Nutrition and Fitness: Set up an endcap with vitamins, supplements, protein shakes, and cookbooks.

• Healthy Aging: Feature products for the older demographic to help the challenges shared by this age group. Vitamins and supplements are always a hit, as are arthritis pain relievers, pill boxes, and incontinence products.

• Summer Skin Protection: Set up bottles of sunscreen, lip balms, bug sprays, and first-aid items.

• Pet Products: Set up an endcap with collars, leashes, natural treats, pet toys, and flea and tick medication.

• Locally Made Products: Find local artisans who would be willing to have their products sold in your pharmacy (e.g. lotions, soaps, jewelry, honey, etc.).

CLEAN AND DECLUTTER ENDCAPS When you incorporate endcaps into your pharmacy, be sure you use them to your advantage and stay on top of changing the products you display.

“A lot of people hear the word endcap, and they make two mistakes with that. The first is they have a space, and the second is they put a couple of products on it,” Dave Wendland, Vice President Strategic Relations at HRG, said. “First of all, they don’t manage the space, and it ends up empty or

disheveled. That can send a bad message to the consumers who frequent the store. The second mistake is they turn it into a permanent department. Instead of putting skincare products in a traditional spot, they put it on the endcap. The problem with that is no one will pay attention to it.”

At the same time, make sure your endcaps aren’t cluttered with too many things. A cluttered endcap can overwhelm patients. Instead, choose a few key products that align with the theme of your endcap, and stock them deeper with at least four facings to fill the shelf. Displaying too many products, however, can defeat the purpose.

“I think every trip to the pharmacy should be an adventure,” Beverly Schaefer, owner of Katterman’s Sand Point Pharmacy in Seattle, Washington said. “I think you should find something new to see every time you go into the pharmacy, whether that’s an endcap display or something lying on the counter. It’s a topic of conversation when you get there. Pharmacists need to recognize the profitability of impulse buying. We always want to have something displayed that people don’t know they need.”

Katterman’s Pharmacy also runs a robust travel clinic with a surprising number of items they sell that are related to travel.

“All pharmacies have travel items. They just have them scattered all over the store. Why not make a travel endcap?”

Schaefer said.

If you’re ready to promote impulse and unplanned purchases in your pharmacy, here are some great tips to get you on your way to profit:

ELEMENTS | The business magazine for independent pharmacy | DECEMBER 2024

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USE SIGNAGE Signage and visuals are important in attracting patients to your displays. Include a sign that educates patients on the products in your display. If you’re offering discounted products, put up a sign that highlights the price change. And don’t forget to use bright colors and decorations to go along with the theme of the display.

PUT TESTER PRODUCTS ON DISPLAY Patients love to try a product before they buy it, so why not use your endcaps to offer samples. You can set up tester hand lotions or wrapped cough drops to attract patient interest.

However, make sure you stock plenty of the testers. This will pique more patients’ interest and drive them to impulse buy.

REFRESH ENDCAPS OFTEN Because endcaps are promotional, they eventually lose their appeal. So, be sure to refresh your endcaps at least once a month. Assemble a “pharmacist recommends” endcap, too.

Customers will enjoy seeing new themes and products on the endcaps.

“We happen to seek out good, oddball products. So, don’t be afraid if something catches your fancy somewhere else. Just seek a story for it and put it in your pharmacy,” Schaefer said.

“You might also consider stocking products your customers make, such as lip balms, hand soaps, or little things like that.

Be adventuresome!”

CAREFULLY POSITION PRODUCTS You need a strategy when figuring out how to arrange your products. Here are some tips to encourage shoppers to buy: • The checkout area: Small, affordable impulse items like candy, gum, magazines, and batteries are great near the checkout line.

• High-traffic areas: Try positioning impulse buys near frequently purchased medications or popular items.

• Eye-level displays: Set up easy-to-see, eye-catching displays to highlight impulse products.

What you don’t want is a cluttered endcap. That will only overwhelm your patients, which means they may not stop to browse.

GET THE WORD OUT While your endcap displays will speak for themselves, it never hurts to generate awareness. Use the power of

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suggestion. Encourage your employees to suggest products on display. You might also ask them to endorse the ones they’ve tried and liked.

If you’re going to have an endcap program in your store, make sure your customers understand that your special endcaps are ongoing. That way they’ll know with each season or holiday, you’ll have specials to browse and purchase.

Refresh endcap displays at least once a month. If a theme is still relevant, simply change the products you’re currently displaying.

“What I recommend as a merchandiser, analyst, and store owner is rotating every 30 to 45 days. It just keeps things fresh. There are always different themes you can use. Keep things fresh no matter what,” Schaefer said. “And if you don’t have something new to put out, then rotate something that you have from one location to another and freshen it up.”

With the right products and the right placement on your endcaps, your impulse shoppers will be more apt to buy, and your pharmacy will increase its profits.

SOLUTIONS

PRESCRIPTION FLAVORING The benefits of offering children tastier medicine

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o one enjoys taking bitter medication, especially kids.

It’s hard enough for parents to get children to eat their vegetables, so why not make their medication something they’ll want to take.

Offering a tastier alternative to awful-tasting medicine will make the kids and the parents happy. Plus, happy customers will continue to come back.

If you don’t already have a medication flavoring program, you’re missing out on perks for your pharmacy. FLAVORx is a company that makes medication flavoring for pharmacies like yours, and their well-run program offers some enticing benefits for your pharmacy, such as: BETTER ADHERENCE When you allow kids to choose their favorite flavor, they play an active role in the process. FLAVORx also provides compliance charts and medicine-taking tips to help parents and their kids get through their medication regimen. You’ll also get sugar-free lollipops to hand out to patients as an incentive to finish their medication.

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INCREASED BUSINESS AND PROFITS According to FLAVORx, it’s estimated that an individual store could gain 16-24 new customers a year and generate $51,000-$78,000 in new business by offering custom-flavoring services. Therefore, flavoring can provide a good profit margin. And while you’re busy offering flavoring to the little ones, you can also promote the service to local physicians and daycare centers. And don’t forget that over-the-counter liquid medications for allergies, colds, and flu can also be flavored.

TAP INTO PET MEDICATIONS Kids’ prescriptions and medications aren’t the only medications you can add flavor to. You can also offer the service for pet medications. Simply promote your pharmacy as a place for pets to get deliciously flavored medication.

Spread the word to patients and veterinarians in the area that you can customize medications to taste like chicken, bacon, peanut butter, beef, or tuna for pets.

AMP UP YOUR MARKETING Promote your flavoring service to local prescribers, patients, and vets using marketing tools such as social media. While

signage is great, there needs to be something that’s spoken to customers when they come to drop off or pick up the prescriptions. Some great lines you could use to suggest your patients add a flavor to their medication include, “This drug has a really bad taste to it, so we highly recommend adding a flavoring to it,” and “How would you like this medication to taste? We can customize it for you.”

ALL IN GOOD TASTE Providing this family-friendly service is now as easy as can be with FLAVORx Auto. The Auto fully automates the reconstitution and flavoring process, leaving you with more time to focus on patients. Especially as liquid prescription volume rises during cough, cold, and flu season. The FLAVORx Auto and flavoring service help pharmacies attract families, provide great customer care, and improve workflow.

Some pharmacists are hesitant about suggesting this service to their patients because it’s an added charge. However,

making sure kids follow their medication regimen through the entirety of their course of treatment is important, as is offering tips and tricks to help parents get their kids to take their medicine as prescribed. This will set your business apart from the rest.

Though it can be a chore to get children to take their medicine, your pharmacy can help parents keep their kids adherent. Here are some tips you can offer parents: • Pinpoint a child’s issue with the medication. Do they not like the taste of the medication? Do they have difficulty swallowing pills? Are they experiencing any negative side effects from the medicine? Once you know the issue, you can work together to find a solution.

• Offer medication flavoring. You can improve adherence by removing taste as a discouraging factor. By letting kids choose their favorite flavor, you’re allowing them to make choices about their medicine. This gives them a sense

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of ownership and responsibility, and this can increase adherence. With the Auto, you can easily customize the taste of liquid medication and help kids take ownership of their medicine-time experience.

• Start a rewards system for kids. Every time they visit your pharmacy with their parents, give them a small reward such as a sticker, a fun eraser, or a decorative pencil or pen.

This will make them feel at ease, and from that point on, they’ll be excited to visit your pharmacy.

Offering to add a flavoring in patients’ medications shows that you care about their experience. You’ll enhance customer satisfaction and loyalty because patients truly appreciate your extra effort to make their medicine more tolerable. And if your service is great, word will get around town, and you’ll attract new, young families to your store. Plus, with social media, they’ll advertise for you via online reviews.

With the busy cough, cold, and flu season approaching, consider integrating the Auto and flavoring service into your pharmacy’s workflow. It can have a significant impact on your business in the coming months. Differentiate your pharmacy from the competition and offer families an outstanding experience that benefits kids, parents, and the pharmacy staff. Visit flavorx.com for more information.

WANT TO LEARN MORE? Here are some great statistics about flavoring prescriptions:

• Even though awareness of medication flavoring is low, demand for custom medication flavoring services is high. The customers who receive custom flavoring are more likely to recommend the pharmacy to friends and family.

• In 2022, the pharmaceutical flavors market was valued at over $1 billion. Over the next decade, it’s expected to grow over 5% annually.

• FLAVORx has flavored over 100 million prescriptions across the United States. It’s available in over 46,000 pharmacies, including CVS, Walgreens, Rite Aid, and Walmart.

• 50 of 52 Boards of Pharmacy have determined that USP 795 nonsterile compounding standards do not apply to the simple practice of medicine flavoring, with most Boards saying they do not consider flavoring to be compounding at all.

The FLAVORx Auto

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FEATURE

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BEYOND PRESCRIPTION DISPENSING Why you should offer year-round vaccines

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nce upon a time, everyone depended on their primary care providers to administer their vaccines. Today, however, they’re relying more and more on pharmacies like yours to provide the vaccines they need.

Your pharmacy is used to administering a handful of vaccinations that patients need, such as the flu shot and COVID-19. So, why not offer a wider range of vaccines that will cover various diseases and age groups? By doing so, you can significantly enhance the health and well-being of your patients and expand your clinical service. For instance, your patients will have the convenience of getting vaccinated at your pharmacy that provides more flexible scheduling than doctors’ offices. Plus, patients can combine their vaccination visit with other pharmacy services, such as picking up a prescription or getting health consultations.

Your patients will have access to personalized care from your pharmacy, unlike doctors’ offices that require an appointment

weeks in advance. Your pharmacy oftentimes has walk-in availability for vaccinations and provides immediate service when needed. You and your staff also take time to educate your patients about the importance of vaccines, dispel myths and misinformation, and ensure your patients understand the benefits and potential side effects of each vaccine. Plus, you can maintain and update patients’ vaccination records, ensuring that they’re up to date with their immunizations and receive reminders for future vaccines.

If your pharmacy doesn’t have a vaccine program just yet, but you’d like to start one, it will involve several important steps: • Know your state regulations Every state has specific regulations on which vaccines pharmacists can administer and any necessary certifications or protocols. Check your state’s guidelines and guarantee cooperation with any requirements.

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• Implement an efficient scheduling system Set up a system for scheduling vaccine appointments to manage patient flow effectively, including online booking, phone scheduling, or walk-in services.

• Train your staff members Be sure that all pharmacy staff who are involved in the vaccination program are properly trained to administer vaccines, educate patients, and keep records. This will require time and resources along with ongoing education to stay current with best practices.

• Promote your vaccine program You’ll need to use marketing materials, social media, and community outreach to spread the word around town about the availability of vaccines at your pharmacy. Partner with local healthcare providers and organizations to increase awareness around town.

• Complete certification Pharmacists and pharmacy technicians need to complete an immunization training course accredited by the Accreditation Council for Pharmacy Education (ACPE). Also, CPR/BLS certification and bloodborne pathogen training are often required.

• Get a standing order or protocol If your state requires it, get a standing order from a licensed physician. It’ll allow you to administer vaccines according to a physician-approved protocol without a direct prescription.

• Complete a state board application If required, turn in the necessary application and documents to your state board of pharmacy. You might need your proof of certification, training, and standing orders.

• Acquire vaccines Get to know vaccine suppliers to ensure a steady supply of vaccines. You may need to negotiate contracts and understand storage requirements.

• Proper storage facilities It’s important to invest in the necessary refrigeration and freezing equipment to safely store vaccines. You will also need to monitor and document storage conditions to maintain vaccine efficacy.

• Set up an area to give immunizations Designate a specific area in your pharmacy for vaccinations that is clean, private, and comfortable for patients. Make sure it meets all safety and privacy requirements.

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• Educate patients on vaccine benefits Talk with patients about the availability of various vaccines your pharmacy offers and the benefits of vaccinations.

• Maintain detailed records Record keeping is important, so be sure to include all the details of administered vaccines and secure compliance with any reporting requirements to local health authorities, including entering vaccine information into state immunization registries.

VACCINES YOU CAN PROVIDE FOR YOUR PATIENTS

Listed below is a comprehensive list of vaccines you can typically provide in your pharmacy, depending on the state you practice in:

• Tetanus, diphtheria, and pertussis (Tdap) Vaccine Recommended for older children, adults, and pregnant people between the 27 and 36 week of pregnancy.

• COVID-19 Vaccine

• Varicella (Chickenpox) Vaccine

• Diphtheria, Tetanus, and Pertussis (DTaP) Vaccine Recommended for all infants and children younger than 7 years old.

• Haemophilus Influenzae Type B (Hib) Vaccine • Hepatitis A Vaccine • Hepatitis B Vaccine • Hepatitis A and B Combination Vaccine (Twinrix) • Human Papillomavirus (HPV) Vaccine • Inactivated Poliovirus Vaccine (IPV) • Influenza (Flu) Vaccine • Measles, Mumps, and Rubella (MMR) Vaccine • Meningococcal B Vaccine • Meningococcal Vaccine • Pneumococcal Conjugate Vaccine (PCV13) • Pneumococcal Vaccines • Polio Vaccine • Respiratory Syncytial Virus (RSV) Vaccine • Rotavirus Vaccine • Shingles (Shingrix) Vaccine

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Be aware that some states have specific requirements for vaccines your pharmacy can administer. Some also have age restrictions for which vaccines pharmacists can administer. In fact, there are 18 states that do not allow pharmacists to administer routine vaccines to patients under the age of 7.

Vaccines that you can administer are listed on the CDC’s Adult Immunization Schedule. However, your patient must be at least 12 years old and meet certain conditions. You can also administer vaccines that are prescribed by a practitioner for a specific patient.

If you have any questions on vaccinations, here are some sources you can check out: • CDC online cdc.gov • FDA online fda.gov • ACIP online cdc.gov/acip/index.html • NCPA online ncpa.org • APhA online pharmacist.com

You will also want to implement several strategies that will make it easier for you and your patients, such as providing flexible scheduling. When you provide extended hours and offer flexible scheduling, you make it so much easier for patients to get vaccinated at their convenience. This will also help increase the number of vaccinations administered.

Lastly, collaborate with local healthcare providers to refer patients for vaccinations. This can help increase how many patients come to your pharmacy for immunizations.

Educate your community by reaching out. Engage them in a community outreach program and educate the public about the importance of vaccines. Host vaccination clinics, partner with local schools, and participate in health fairs to reach more people. Health fairs are a great place to advertise your immunization program. You should also consider posting on social media regularly, sending out email newsletters, and setting up in-store promotions to inform your patients about the vaccines available and their benefits. These tactics can lure in more traffic to your pharmacy.

GETTING THROUGH THE CHALLENGES With all the great benefits of a vaccine program, there are also downsides. For instance, setting it up requires an initial investment in training, equipment, and inventory.

The upfront cost can also be quite discouraging. Vaccines often need specific storage conditions, such as refrigeration or freezing. So, you’d have to invest in the proper storage equipment and have your employees trained to handle vaccines properly. Staying compliant with state and federal regulations is also important and can be complex and timeconsuming. Therefore, you need to keep up to date with changing laws and make sure they meet all requirements, including proper documentation and reporting.

Are your pharmacy operations up to par? If not, it’s time to modernize them. Implement efficient workflows and use technology to manage appointments, track inventory, and handle billing. You can make payments less painful for your patients by offering various payment options and working with insurance providers to guarantee vaccines are covered.

This will make it much easier for your patients to afford vaccinations and will improve your patients’ experience.

You will also need to navigate insurance reimbursement for vaccines and understand billing procedures and work with various insurance providers. Supply chain management is also important and a bit challenging. You will need to ensure a consistent supply of vaccines, especially when there is high demand or during supply chain disruptions. It’s important to have strong relationships with your suppliers and contingency plans in place.

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Adding a vaccine program into your pharmacy operations is challenging, but if you manage scheduling, patient flow, and administrative tasks efficiently, you will avoid disrupting other services.

If demand for vaccines fluctuates, you might face financial risks related to overstocking or underutilizing vaccine supplies.

However, despite the challenges, numerous independent pharmacies have implemented successful vaccine programs by careful planning, investing in the necessary resources, and keeping up with best practices and regulatory requirements.

While all 50 states allow pharmacists to administer immunizations, there are limitations in some states.

These may include the types of vaccines that can be administered and patient age limits. Find out if your state is required to have a collaborative practice agreement, protocol, or standing order. If your state doesn’t provide a sample standing order, you can find model standing orders available at immunize.org, the Immunization Action Coalition’s website.

CLINICAL SERVICES THAT CAN IMPROVE COMMUNITY HEALTH

Chronic Disease Management You can help your patients manage chronic diseases such as diabetes, hypertension, and asthma by offering specialized counseling, education, and monitoring services. This helps your patients effectively navigate their conditions. Build long-term relationships with patients by checking in regularly and providing lifestyle advice and medication adjustments. Not only will you create long-term relationships with your patients, but you’ll see an increase in prescription fills and loyal customers.

Compounding Services Differentiate yourself from the larger chain pharmacies, provide personalized care, and address the unique needs of your patients by offering compounding services. Compounding helps expand a pharmacy’s customer base and increases revenue through individualized medications. It can provide your pharmacy with a competitive advantage.

Medication Synchronization & Adherence Provide immediate diagnostic information to your patients by offering point-of-care testing services, such as flu tests, blood pressure monitoring, cholesterol screening, and blood glucose testing. Interpret test results, provide guidance on adjustments to medication or changes to lifestyle, and when necessary, refer patients to appropriate healthcare providers.

Medication Therapy Management Hire skilled pharmacists to conduct personalized medication reviews, identify potential drug interactions, and address issues with adherence.

These services not only help your patients achieve better health outcomes, but also provide additional revenue through consultation fees and medication recommendations.

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SPOTLIGHT

ADHD MEDICATIONS High doses are linked to greater risk of psychosis

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new study has found that high doses of stimulants like Adderall can increase the risk of psychosis or mania by more than fivefold.

In recent years, prescriptions for amphetamine stimulants to treat ADHD (attention-deficit/hyperactivity disorder) increased significantly. These medications increase levels of neurotransmitters, which help improve attention span, reduce hyperactivity, and manage impulsive behavior.

Some of the ADHD drugs include Adderall, Vyvanse, and generic amphetamines, such as dextroamphetamine. And while the link between amphetamines and psychosis isn’t new, amphetamines increase levels of dopamine in the brain.

The neurotransmitter plays many roles in the body, such as impacting memory, affecting attention, regulating mood, controlling movement, and managing emotions.

According to recent reports in the American Journal of Psychiatry, patients who were hospitalized control subjects had a nearly 63% increased risk of psychosis or mania if they took any prescription amphetamine within the past month.

Patients on heavy doses of amphetamines were shown to be at even greater risk of a psychotic episode with an 81% risk.

Dose is a factor in psychosis risk, yet stimulant medications don’t put an upper dose limit on their labels.

Prior research established the link between psychosis or mania and amphetamines. However, the latest study shows new details on how dosing may impact risk. The highest risk reported was among people taking 30 milligrams or more of

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dextroamphetamine. This is the equivalent of 40 milligrams of Adderall.

current dosage and evaluate the need for any adjustments based on symptoms and any side effects.

Medium dosage was linked to a 3.5 times higher risk:

KEEP A DIARY OF THEIR MEDICATIONS By documenting any side effects caused by the medication, they’re helping the doctor make informed decisions. It’s also important to note side effects, mood changes, sleep patterns, or other symptoms that show up after having taken the medication.

• Adderall: medium dosage is 20 milligrams to 40 milligrams • Vyvanse: medium dosage is 50 milligrams to 100 milligrams • dextroamphetamine: 15 milligrams to 30 milligrams The two types of stimulant medications that are readily prescribed for patients with ADHD are amphetamines and methylphenidates. Those who are prescribed the methylphenidate medications, such as Ritalin and Concerta, were not linked to a higher risk of psychosis or mania. Increased risks are limited to stimulants like Adderall and Vyvanse.

According to an analysis of national insurance claim data, around 6% of patients who take amphetamines are prescribed the highest dosages. About 22% are prescribed the medium dosages. And while the risk of developing psychosis from an amphetamine is rare, around 1 in 1,000, it’s important that people who take high doses are aware of the risks.

In the U.S. alone, stimulant use has skyrocketed in recent years, especially among adults. According to a study published this year in JAMA Psychiatry, prescription rates for amphetamines for attention-deficit hyperactivity disorder (ADHD) rose 30% from 2018 to 2022 in people ages 20 to 39. For those people 40 to 59, rates rose 17%.

When counseling your patients who have a family history of serious mental illness, including bipolar disorder with mania or schizophrenia, be very careful about how much of these stimulant medications they use and the doses.

If one of your patients is on a high dose of an ADHD medication and is concerned about it, they should consider the following steps: TALK WITH THEIR PRESCRIBING DOCTOR Talking with their doctor or a mental health professional is the most important step. That way, they can review the

ASSESS SYMPTOMS Talk with their healthcare provider to find out if the current dosage effectively manages ADHD symptoms. The doctor may lower the dose or switch them to a different medication that may work better for them.

CHECK OUT NON-PHARMACOLOGICAL TREATMENTS Try natural approaches such as behavioral therapy, counseling, lifestyle changes (diet, exercise, sleep hygiene), along with a long-term plan on how that may improve their ADHD symptoms without having to rely on medication.

WATCH FOR SIDE EFFECTS Report any and all side effects to their healthcare provider.

Keep an eye on potential side effects that may include mood swings, anxiety, insomnia, or any other unusual behavior.

CONSIDER A TAPERING PLAN If they need to lower their dose of medication, their healthcare provider might recommend a gradual tapering plan that will help avoid withdrawal symptoms while monitoring how their body reacts.

TALK WITH FAMILY MEMBERS If appropriate, they may need to involve family members when discussing medication. Family can provide support and help monitor changes in behavior or mood.

SEEK A SECOND OPINION If the treatment plan is significantly concerning, they should seek a second opinion from another healthcare professional.

There are alternative drugs that treat ADHD that do not have the mental health risk, such as methylphenidate (Ritalin).

In fact, there is very limited evidence that high doses of prescription amphetamines are more effective. So, consider less risky medications, especially if a patient has a high risk of psychosis or mania.

ELEMENTS | The business magazine for independent pharmacy | DECEMBER 2024

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MONEY

PHISHING SCAMS Don’t let the fraudsters trick you

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e’ve all received a text or an email that seemed a little fishy, whether it came from a suspicious name or a supposed company. There are fraudsters out there who try to trick you into sharing your personal information with them. To keep your business safe, learn how to recognize what’s legitimate and what’s phishing.

Some scammers will send a link they want you to click that is most likely a fake website that looks somewhat legitimate.

The link might even be malicious software, and if so, your computer could be harmed and your information stolen.

And once someone else has your information, they can get into your existing accounts or open new accounts under your name.

According to Healthcare Distribution Alliance (HDA) Pharmaceutical Cargo Security Coalition (PCSC), there are three types of phishing scams making the rounds within the pharmacy industry: • Product recall fraud (pharmacy/manufacturer): Posing as an employee of a legitimate manufacturer, scammers call a pharmacy distributor first. While on the call, the scammers indicate there’s been a product recall and that pharmacy needs to send the alleged “affected” product back.

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• Pharmacy/wholesaler fraud: Scammers pose as a legitimate pharmacy and place an order from the wholesaler.

The wholesaler then sends the product to the pharmacy and the scammer contacts the pharmacy and poses as the wholesaler to say they’ve shipped the product to the pharmacy in error. They then ask for the wholesaler to ship it back to them.

• Bank account/payment fraud: Scammers pretend to be a legitimate wholesaler, and through a business email compromise, contact the pharmacy to let them know the terms of payment for product orders have changed and there’s a new account routing number they need to use when making a payment for an order. The new account is actually the scammers’ account and not where payment should be made.

You need to protect your pharmacy against phishing. You don’t want to fall victim to such an attack, so be sure to avoid clicking suspicious links. If an email or text message feels a little suspicious, take these following steps: CALL THE COMPANY Attempted phishing via text message is sometimes referred to as smishing. It’s a lot harder to notice a smishing scam right

away. If a site has the URL start with “https,” don’t trust that it’s secure. Scammers can buy security certificates for their own fake websites. This is their way to trick you into thinking they’re legit.

If an email, text, or website seems real, or if the communication wasn’t something you were expecting from the company, call their customer service and double check. It may seem like a waste of time, however, making that phone call could save you a lot of time and energy in the long run– especially if it keeps you safe from identity theft and the recovery process.

Never use the email address or phone number that the suspicious email provided. Instead, go to the company’s website directly and get the correct contact information.

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Report to customer service what you received, whether it was in a text or an email, and the phone number or email address it came from.

EVALUATE THE CONTENT It’s common for phishing emails to employ urgency or fear tactics to get you to act immediately. Be wary of urgent messages demanding responses or threatening you with consequences for not taking action. Keep an eye out for awkward phrasing, grammatical errors, or generic greetings.

These are phishing attempts.

BE WARY OF DOMAINS THAT ARE SHORTENED OR MISSPELLED Some scammers will use web addresses that are similar to well-known companies, so always check that the URL is

correct. Oftentimes, they have a URL that’s off by a single character, and if so, it might take you to a cloned website that looks identical to a company’s website. Scammers want you to enter your personal information so they can try to use it for fraudulent purposes, such as taking out lines of credit in your name.

Be cautious with links in your emails and be aware that many email providers provide a way to preview a link’s full web address without clicking on it. Have you ever seen a suspicious link in an email? If so, hover over it with your mouse cursor. By doing so, a pop-up or line should show up on your screen showing you the full address so you can see if it really belongs to the company.

SOCIAL MEDIA PHISHING IS ALSO A THING Phishing scams also happen on social media. Never click on a link from a person you do not know. If a friend or family member shares a link with you that you don’t recognize, be wary. Their account may be compromised, and they may not know. Therefore, they may not realize they’re sharing a fraudulent site. So, if they send something your way that is unusual, contact them offline or through a different platform about the questionable message.

BE CAUTIOUS OF ATTACHMENTS Attachments may seem innocuous, but they can have malware or ransomware that’s designed to take over your system. Only open attachments from sources you trust, and even then, scan them with a reliable antivirus software before accessing. As for unexpected attachments or unfamiliar senders, be cautious and don’t open them.

HOW TO PREVENT PHISHING EMAIL ATTACKS

• Delete and report suspicious emails Promptly delete any emails that are suspicious or appear to be phishing. Report them to your IT contact or email provider to investigate and block similar phishing attempts.

• Educate your pharmacy employees Be sure every team member who has access to your pharmacy networks knows about the risks and signs of a phishing attack. Be sure they know the proper procedure for reporting suspicious emails. Hold a training session and send out reminders so everyone is on high alert for scams.

• Install a firewall A well-managed pharmacy firewall solution is important for keeping your pharmacy’s network infrastructure safe against cyber threats and phishing attempts. With a properly configured firewall, you can block unauthorized access and filter out malicious email traffic. This will enhance your cyber security and keep patients’ sensitive information protected.

BEWARE OF REQUESTS FOR PERSONAL INFORMATION Phishing emails fool people into believing they’re legitimate institutions, such as banks or government agencies.

Reputable organizations will never ask you for confidential details in an email. Always contact the organization or person directly through verified channels to confirm the legitimacy of the request.

Don’t feel bad if you accidentally clicked on a link that you think was fraudulent. If you believe you’ve given a scammer your information by accident, visit identity.gov to start your recovery from identity theft. You can place a credit freeze and fraud alert on your credit report right away to protect your data. You’ll have additional steps to recover from the fraud, such as contacting any companies where the fraud occurred and reporting it to local authorities. The quicker you respond to a phishing attack, the better.

ELEMENTS | The business magazine for independent pharmacy | DECEMBER 2024

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OUTLOOK

IT’S ALL IN THE W PACKAGING

How compliance packaging can help your patients

hen was the last time you really looked at your prescription packaging? If it’s been awhile, take some time to really study it. Then ask yourself if it’s simple and easy for your patients.

How you package prescriptions really does matter. If you don’t already, consider using compliance packaging solutions.

They help you sort, organize, label, and track patients’ medications. In fact, you can improve your patients’ lives— especially those who take complex drug therapies.

While the package itself isn’t the focal point, it’s always about making it easy for the patient. Yet, the package is critically important when there are multiple medications being taken.

The same thing goes for multiple doses at various times throughout the day. Medications should be organized all in one package with correct labeling, the correct dosage, at the right time, and color-coded by time of day.

PACKAGING SOLUTIONS You want to stand out from your competitors. You work hard to improve patient care and tirelessly strive to grow your profits. So, be sure to keep up with technology. For instance, add the next-level medication packaging solutions that also promote medication synchronization. By doing so, you can differentiate your business from your competitors, improve patient care, and grow your profits.

Compliance packaging often is used as an extension of medication synchronization, where patients pick up all their

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medications for the month at once. Compliance packaging bundles them all together instead of patients getting individual bottles for each medication.

Patients who stay adherent due to compliance packaging will have better health outcomes. When patient adherence rises, you will see positive outcomes for your pharmacy’s profits as well.

Pharmacies can select from several systems to put together medications for compliance packaging, such as:

Your patients who stay adherent while using compliance packaging will come back for two or three more refills than they would without compliance packaging. With patients taking multiple medications, that can add up to more revenue for your pharmacy.

• Hot seal packages that are effective at keeping moisture out of medications • Cold seal packages that use pressure to seal up medications, ideal for drugs with sensitivities to heat • Multidose packaging that accommodates both the storage and labeling of multiple medications, which can come in hot seal and cold seal formats There are some pharmacy robotics systems that can assist with the creation of compliance packaging. This makes it a less labor-intensive process for pharmacy staff.

HOW TO MARKET YOUR COMPLIANCE PACKAGING You may need to educate your patients who aren’t used to taking medications out of blister packs. Get them on board by creating a marketing campaign that lets your patients know this service exists at your pharmacy and what it entails.

Get the word out about your compliance packaging service with these ideas:

With compliance packaging, you’re subject to the same labeling requirements as regularly dispensed prescriptions.

When using multidose packaging, you’ll find that the information presented often gets crowded on the label, so many pharmacies use a grid or chart to clearly present the necessary prescription information.

• Use a sample package for display: You may have many patients who haven’t used compliance packaging before.

And if you only verbally explain what it is, you’ll most likely have patients who don’t understand completely. So, keep a sample compliance package as a visual aid on your pharmacy counter. A tangible object patients can pick up and examine will help them learn what they’ll be getting if they decide to switch to compliance packaging.

Be aware, however, that not all medications are well-suited for compliance packaging, such as liquids and creams.

Medications that are only to be taken “when needed” are also not to be included.

• Ask for testimonials: Do you have a patient who has had success with your compliance packaging service? If so, ask them if they would be willing to provide a testimonial on how it’s improved their life.

IMPROVING PATIENT OUTCOMES Compliance packaging, along with medication synchronization, simplifies the prescription refilling process for your pharmacy. It can also improve your patients’ lives, especially those who are on complex medication regimens. Any patient who is on a multidose medication regimen, including those who take multiple vitamins a day, can be a great candidate. Elderly patients in assisted living facilities can also benefit, along with professionals on the go who are looking for organization and convenience.

After you collect testimonials, include them in your marketing materials. Testimonials don’t feel like a hard sell, so they’re especially convincing. Patients prefer a real human’s experience on how it has improved their life.

Patients probably don’t know that they can benefit from compliance packaging. That’s where you come in. You can display and sell your unique medication packaging services by creating marketing materials to hand out and share with patients and physicians.

You can also market to attendees at health fairs or by working with hospitals post-discharge to aid in transitions of care. There are plenty of opportunities to advertise and sell the service.

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• Include FAQs: Put together a document of frequently asked questions that will help educate patients about your service. Then post it online so your patients can find it while browsing your website. You can also send it out in a marketing email, and for patients who learn about the service while in your store, create a handout version to give them.

The simpler your packaging is for patients, the more adherent they will become with their medications.

Compliance packaging solutions will help you every step of the way as you better the lives of your patients.