A Voice for Community Pharmacy Senator Jerry Moran Supports Community Pharmacies
compounding: Is It Right For Your Pharmacy?
Can customers “Google” your store? Why Your Pharmacy Needs a Website
the rise of
pharmacy schools And What That Means For Your Pharmacy
VOL. 1 ISS. 2 | SEPT 2012 | PBAHEALTH.COM
The Magazine of PBA Health
8 | Compounding enables pharmacists to use their unique skills to provide a personalized service, while also earning extra revenue for their businesses.
26 | IPPE and APPE experiences allow students to further explore their specific interests in the pharmacy profession in a way that no lecture or classroom experience can replicate.
departments 5 News: The latest industry updates that matter to your
18 Active Ingredients: Quality Mangement
6 Technology: Why Your Pharmacy Needs a Website
20 More For Your Money: A Vitamin For Front End Sales
8 Bricks & Mortar: Compounding: It’s Just Good Business
24 Community: Pharmacist-Physician Relationships
If your patients can’t find you online, they may not find you at all.
Stark Edler Apothecary proves offering compounding can generate revenue.
17 Active Ingredients: Improving Adherence
How you can help your patients stick to their medication regimens.
Recent FDA changes are affecting the quality of the U.S. drug supply. Nutritional supplements and vitamins offer healthy ways to increase pharmacy profit. Why working with your local physicians will boost your business.
26 Outlook: The Rise of Pharmacy Schools
What more pharmacy schools mean for the future of the profession.
30 Notes: Create Your Own Cash Discount Card Program
Take control of your cash claim business with your own discount card program.
feature 10 A Voice for Community Pharmacy
When small town pharmacies need an advocate, U.S. Senator Jerry Moran of Kansas provides valuable support in Washington, D.C.
ON THE WEB //
Explore exclusive online content to improve your business at www.pbahealth.com.
Why PBM Discount Cards Are Never Really Free PBM-sponsored discount cards don’t do your patients or your business any good. Find out how these “free” discount cards actually work. Find the article at www.pbahealth.com/pba-scriptcard.aspx in the “Related News” section.
How The Hidden Costs Of Drugs Hurt Pharmacies Most patients have no idea what it costs your pharmacy to obtain, safely dispense and get reimbursed for their medications. See why the current reimbursement model doesn’t work. Find the article at www.pbahealth.com/pba-trinet-third-party-network.aspx in the “Related News” section.
Marketing Your Pharmacy: Why Direct Mail Works Have you considered sending out direct mailers to promote your community pharmacy? Discover what makes direct mail so successful. Find the article at www.pbahealth.com/pba-marketing.aspx in the “Related News” section.
ELEMENTS is published quarterly by PBA Health. Copyright© 2012 PBA Health. All rights reserved. Neither this publication or any part of it may be reproduced without written permission by PBA Health.
The American Pharmacists Association is encouraging consumers to consult with their pharmacist before starting a new diet plan. PBA Health’s Ordering Homepage Gets New Look We’ve updated our ordering platform to make ordering product easier than ever before. The new look of our ordering homepage puts all of the information our members need in one place. As a new feature, you’ll get exclusive daily updates on new products, price changes, patent expirations and more information that can help you order smarter—right on the homepage. If you’re a member of other services at PBA Health, you’ll also have access to those logins from this one location. We hope you enjoy the ease and efficiency of this new design! To see the new look, just log in as you normally would to PBA Online or Negotiator. Let us know what you think of the new design by commenting on our Facebook page at www.facebook. com/pbahealth. Drug Shortages May Be Lessening You’ve likely dealt with issues at your pharmacy because of the recent problems with drug shortages. A slow down point may be coming, however. According to a September 7 NBC News article, new reports of medica-
tions in short supply have dropped. As of Aug. 31, there were 123 reports of new drug shortages this year—about a third less than those recorded for about the same period in 2011. Last year was a record year for drug shortages with 267 in total. Some drugs used for basic care, including propofol for anesthesia and morphine for pain relief, continue to be in short supply. But, supply problems with certain vital medications, including some to treat cancer, are lessening. For information on current drug shortages, visit the FDA’s current drug shortages update at www.fda.gov/drugs/drugsafety/ drugshortages. DEA Provides Take-Back Locations To Encourage Participation In Initiative The Drug Enforcement Administration (DEA) has added a locator to its website to make it easier for consumers to find locations to drop off unwanted prescription medications during its upcoming National Prescription Drug Take-Back Day. The upcoming take-back day is scheduled for September 29, 2012 from 10 a.m. to 2 p.m. The locator [www.deadiversion. usdoj.gov/drug_disposal] allows consumers to find law enforcement collection sites in their area after they enter their address or zip code. Overall, the take-back program has removed more than 1.5 million pounds of prescription medication from circulation during its past two annual take-back days. Take-back sites accept tablets, capsules, and all other solid dosage forms of unwanted medications.
or physician before trying a new diet plan. Certain diet programs could result in nutritional deficiencies and adversely interact with medications. If pharmacists or physicians are not consulted before attempting a new diet, consumers may not understand how their diets could affect their mood and energy level, or cause food-drug interactions, the APhA said in a statement. Explain to your patients that certain diets can affect how medications are metabolized. Such as the adverse side effects associated with ingesting grapefruits or grapefruit juice when taken with medications used to treat hypertension, high cholesterol, anxiety or depression. Another example is how leafy greens high in vitamin K can hinder the effectiveness of anticoagulant drugs. Encourage your patients to discuss their diet plans with you, their pharmacist. Mark Your Calendar For The 2013 PBA Health Conference The upcoming 2013 PBA Health Conference will take place July 12-14, 2013 at the Sheraton Overland Park Hotel at the Convention Center in Overland Park, Kansas. Don’t miss this event created exclusively for community pharmacies. The conference will be packed with informative continuing education courses, knowledgeable speakers, an expansive vendor tradeshow, networking opportunities and more. Mark your calendar today!
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Starting A New Diet? Talk To A Pharmacist The American Pharmacists Association (APhA) is encouraging consumers to consult with their pharmacist
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Why Your Pharmacy Needs a Website Stand out from your competition When patients type your pharmacy’s name into a search engine, does your pharmacy even show up? More than 266.2 million people in North America are online and an estimated 97% of consumers use the web to seek out or learn more about products and services. Knowing this, it is safe to assume that your customers have already tried to find you online. A pharmacy that does not have a functioning and well maintained website loses a crucial portion of the marketplace. To add to this, many of your customers have busy schedules and will access your pharmacy’s website after business hours. Your website will represent your pharmacy’s mission and its place in the community 24 hours a day, seven days a week. A website gives customers a ‘sneak-preview’ into your pharmacy. When customers physically walk into your store, they have very likely already made the decision that they want to do business with you. Your website is also an opportunity to showcase what makes your pharmacy unique. What services do you offer that your competitors do not? Do you employ specialized staff members, such as a nutritionist? Maybe you host a visiting nurse practitioner who presents monthly health education sessions? Do you boast the only drive-thru window in town or do you have early hours three days a week? Tell customers about these exclusive services online. Important Features When designing a website, pharmacists should think about creating multiples pages or sections for their websites. The most important parts of your site should be clearly linked and always included on your homepage. Have an ‘About Our Pharmacy’ or ‘Meet Our Pharmacists’ page that links or brings up a clear description of who you are and what your pharmacy does. Also, the contact information on your website should lead to your address,
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telephone numbers, fax number, email address and links to any social media pages (Facebook or Twitter) you may be operating as well. Frequently Asked Questions or FAQs are important additions to a website as well. Devoting space to answering those often simple questions such as, ‘What are your pick-up hours? or ‘Do you offer any customer savings programs?’ is an ideal way to save both your time and your patients’. Another time saver is an online refill option for your patients. Your website is a wonderful way to announce in-store or community events. You can tell customers about current specials or deals you’re offering, too. Think of your website as an opportunity to reach out to your customers, both new and established. It is also important to remember websites do require some responsibility. They must be maintained. Regular updates are important and you can use customers’ responses to your website to gauge necessary changes. Bring Your Brand Online Think of your website as a chance to bring your brand online. Are you the friendly, hometown pharmacy, or maybe the progressive pharmacy that specializes in compounding or HRT programs? A bit of both? How do you want potential clients to see you? Once you’ve chosen how you would like your pharmacy’s brand identity represented online, stick with it. A well built website is a source of credibility for your pharmacy. It does not matter that you have been in business for more than 50 years. You still need a website. The new family in town will want to know if you’re the right pharmacy for their needs—and they’ll look up your website first.
BRICKS & MORTAR
Your Physical Pharmacy
Compounding: It’s Just Good Business Stark Edler Apothecary finds success in a world of PBMs, mail order and shrinking third party reimbursements By Kirsten Hudson
In retail pharmacy today, owners find it increasingly difficult to make a profit. National chain pharmacies and big box stores increase competition for the same patients. Mail order lures patients away from their regular pharmacy. Operating expenses continue to rise. Even so, Stark Edler Apothecary in Overland Park, Kansas doesn’t have a problem keeping its doors open. How does this pharmacy do it? By providing compounding services for patients who need more than one-size-fits-all medication. About 75 percent of the pharmacy’s net profit comes from creating specialized medications for its patients. “Putting pills in bottles does not make a profit for the pharmacy,” said Howard Stark, R.Ph and previous owner of Stark Edler Apothecary who’s currently in charge of marketing. “It all comes from compounding.” Compounding allows pharmacists to use their unique skills to provide a personalized service for patients and to earn extra revenue for their businesses. Through their knowledge, practical experience and creativity, compounding pharmacists can offer solutions for patients’ complex medication issues. “We do a lot of problem solving,” said Debra Edler, R.Ph and owner of Stark Edler Apothecary. Small retail pharmacies struggling to profit from dispensing prescriptions that patients almost always pay for with insurance should consider compounding. “As you get more consolidation of PBMs and they offer you less in dispensing fees, your answer is compounding,” Stark said. Helping those patients who can’t get what they need from commercially available medications can mean additional revenue for your business. A big commitment Offering compounding at your pharmacy can increase your profits, but it takes an initial investment and the commitment to get it started. Pharmacists looking
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to go into compounding will need to consider the expense of additional training and the other necessities of starting this service at their pharmacies. “Putting in a decent lab to do what you need to do will probably cost $50,000 to $60,000 with equipment,” Stark said. “Then you’re going to have to have compounding techs. They’re not just your $8 and $10 an hour techs; they’re eventually going to be $18 to $20 an hour,” he said. Pharmacies looking to get into compounding need to do their research. “You want to be able to offer a good product; you want to have a competitive price, but you don’t want to sell yourself short either,” Edler said. “You’re providing a service, and you’re providing the patient outcomes.” You could also consider offering your compounding services as cash only. “Some compounding pharmacies prefer to offer their compounding services as cash only, in lieu of accepting third party plans. This can help maximize your profits due to the shrinking third party reimbursements,” Edler said. FINDING RESOURCES Professional organizations can aid pharmacists’ efforts to offer compounding at their pharmacies. The Professional Compounding Centers of America (PCCA) helps train, consult and provide technical support for compounding pharmacists. “They have pharmacists there that you can call at any time if you have questions on a formula, testing behind the formula or on beyond use dates,” Edler said. The American College of Apothecaries (ACA) is another resource. The national organization provides continuing education courses and networking opportunities for compounding pharmacists. “If you really want to learn, join ACA and you’ll be in with compounders from all over the country,” said Stark, a past president of ACA. “That’s
BRICKS & MORTAR
At Stark Edler Apothecary, the majority of the pharmacy’s net profit comes from compounding. Debra Edler, R.Ph and owner, and Howard Stark, R.Ph and previous owner, grow the business by marketing their specialized compounding services to local physicians. They’ve worked for years to build trusting relationships with area physicians.
where you’ll learn and pick up tips, because we work with each other.” Get the word out Stark Edler Apothecary keeps its compounding business thriving by marketing its services to physicians. “We help them with patient outcomes,” Stark said. “When they get good outcomes and we do a lot of the work, they really appreciate it.” Stark and Edler have worked for years to build trust with their local physicians. Stark visits physicians inperson to explain about the compounding services the pharmacy offers. It also helps that the pharmacy is located in a medical building. “Medical buildings lend themselves well to compounding, but if you’re a small solo pharmacy and you have a couple of physicians around you, it’s no problem to go in and talk to them,” Stark said. “Once you establish a relationship and they’re comfortable and they trust your compounding, they’ll ask you for advice,” Stark said. “You can change patient outcomes.”
A compounding renaissance Before the days of mass manufactured medications, pharmacists compounded all prescriptions. With innovations in technology today, modern techniques and new research, compounding has seen a revival of sorts. Stark, who started compounding prescriptions in 1960, has witnessed a huge change in pharmacy compounding over the years. “In the beginning we did a lot of pediatric compounding and dermatology,” he said. “It wasn’t until about 1983 that we started making suppositories and troches and different dosage forms. Now, our depth and breadth of practice is so much different.” Today, Stark and Edler are noticing niche compounding specialties become increasingly popular. Areas they see growing in the future include, hormone replacement therapy, hospice and pain management, and low testosterone and men’s health. “These are huge areas where a pharmacist can change outcomes and help with patients’ lives,” Stark said.
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A Voice For Community Pharmacy When hometown pharmacies need an advocate in Washington, D.C., U.S. Senator Jerry Moran steps up
By Kirsten Hudson
U.S. Senator Jerry Moran understands the importance of community. And, he recognizes the need for local pharmacies within those communities. “It is that kind of hometown feel, that personal touch, where you know your patients and you know your customers that is so important,” Sen. Moran of Kansas said when he spoke at the 2012 PBA Health Conference. From a small town himself, Sen. Moran wants to preserve the singular way of life that exists in small towns and rural America—that includes supporting local community pharmacies so they don’t have to close their doors. After all, pharmacy has its roots on small town Main Street. Back when the drugstore served as the social hub of the town, people came to sip malts and gossip at the soda fountain. They stopped by the local pharmacy to get health advice. And, they of course came to the drugstore to pick up medicines specially compounded by their knowledgeable pharmacist.
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In small towns across the nation today that sense of kinship, with the community pharmacy at the core, still exists. Unlike many politicians, Sen. Moran sees the importance of keeping that hometown feeling alive. “We live our lives in communities across our regions in small town and rural America in a pretty special way. One that’s worth trying to keep around a while longer,” he said. A small town beginning Sen. Moran grew up in Plainville, Kansas. Then a town of 1,900 people, today Plainville’s population includes 2,200 people and one local pharmacy that serves the entire community. When Sen. Moran was growing up during the 1950s and 1960s, the town had two community pharmacies, one of which was where he had his first job—sweeping floors and running errands for $2 a week. His interest in politics stemmed from a concern that small towns like the one he grew up in, and the local
U.S. Senator Jerry Moran of Kansas speaks with Nick Smock, Pharm.D., MBA, president and CEO at PBA Health, and Mike Burns, R.Ph, president and CEO at AuBurn Pharmacies, at the 2012 PBA Health Conference. Sen. Moran spoke at the conference about his involvement with pharmacy issues in Washington, D.C.
businesses in them, were disappearing. With them that distinct way of life that only exists in rural communities was also vanishing. “I want to make sure that the way we live our lives out here is something that’s around for a while longer. That it’s preserved. And, that there’s another generation who have the opportunity for their kids and grandkids to live in the community that they grew up in,” he said. The importance of healthcare Before Sen. Moran was elected to the U.S. Senate in 2010, he served seven terms in the U.S. House of Representatives and eight years in the Kansas Senate. During that time it quickly became clear to him that healthcare was at the forefront of the significant issues facing the country, and especially for the small town communities that he wanted to preserve. “Young people don’t want to live in a community in which they can’t feel comfortable about the health-
care that’s going to be available for their children,” he said. “Senior citizens, who comprise a lot of our rural communities across the region have to move where there is a doctor and a hospital and access to healthcare.” “I got involved and interested in healthcare as a result of wanting to see that rural America had a bright future,” he said. In 2009 Kansas was facing a significant shortage of pharmacists throughout the state, especially in rural communities. Sen. Moran supported the Kansas Legislature appropriating funds for a major expansion of the University of Kansas School of Pharmacy locations in Wichita, Kansas and Lawrence, Kansas. At that time eight counties in Kansas had no pharmacies at all, and others were significantly underserved. “In the absence of a pharmacist in those eight counties, and the other places in which there was a great lack of pharmacy services,
we lose the access to healthcare that is so important to the wellbeing of citizens of our state and citizens of our country,” he said. The funding, which went through, enabled the school to accept nearly double the amount of students it previously could. “I got involved in the pharmacy aspect of healthcare knowing that in the absence of a pharmacist that the quality of life of both that individual and that individual’s community begins to diminish,” he said. A pharmacist’s view Mike Burns, R.Ph, president and CEO at AuBurn Pharmacies, which has locations across Kansas and Missouri, has experienced Sen. Moran’s genuine concern for community pharmacies firsthand. Burns first met Sen. Moran at a Rotary Club event in Garnett, Kansas, where they discussed pharmacy issues and Burns invited the senator to visit his pharmacy. “On several subsequent visits
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through Garnett, Congressman Moran stopped by the pharmacy as promised and we again visited about many issues, but mainly pharmacy,” Burns said. “He had always voiced his support for community pharmacy, and community healthcare in general, and the need for access to that care by citizens in Kansas.” “I’ve been following and supporting him for many years now,” Burns said. “I’ve found that he really does have an understanding of the issues facing community pharmacies today.” An advocate for pharmacy Sen. Moran has backed key legislation to help ease the challenges facing community pharmacists and their patients. He sponsored the Community Pharmacy Fairness Act of 2009, which aimed to help community pharmacies negotiate better contracts for their businesses and their patients. The bill sought to help build a more equal balance between community pharmacies and PBMs by creating a narrow exemption to the current antitrust law. Sen. Moran also supported important legislation to ease burdensome regulations for small pharmacies that supply durable medical equipment to patients. The bill aimed to exempt pharmacies from the accreditation requirements, which include significant fees, for supplying medical equipment. Other medical professionals including physicians, nurse practitioners and opticians were already exempt from the requirements. For all community pharmacies, the issue of PBM transparency is a hot one. In 2011, Sen. Moran sponsored Senate Bill 1058: Pharmacy Competition and Consumer Choice Act of 2011, which aimed to ensure transparency, accountability and competition among PBMs to provide cost-savings to patients
across the nation. The bill would also help safeguard access to patients’ preferred pharmacy. “I’m a believer in the free market system,” Sen. Moran said. “But it only works if there’s competition.” “If you narrow those that are making the decisions about what program and what drug and how much it costs to just a handful of folks with significant economic power, the free market system will not be the free market system and the result will not be the best price and the most choice—much to the detriment of community pharmacists.” Spread the word Sen. Moran also participates in regular events to educate politicians on issues surrounding community pharmacy. In August 2012, he arranged for Marilyn Tavenner, acting administrator of the Centers for Medicare and Medicaid Services (CMS), to tour several healthcare providers in Kansas to learn more about the unique challenges they face. During the tour she listened and answered questions posed by attendees of the Kansas Pharmacy Summit, a meeting that brings together members of pharmacist and physician associations, as well as PBM representatives and others, to discuss pharmacy issues. “I go to my pharmacy to get all of my education and information,” Tavenner said. “I think there is a big role for pharmacists.” Among other issues, Tavenner answered pharmacists’ concerns about the possible gaps in access to care for patients if the issue of a professional dispensing fee is not addressed. “We have expanded some of our staffing in Medicaid because we knew that states were going to get more creative around waivers,” she said. “They were going to get
U.S. Senator Jerry Moran arranged for Marilyn Tavenner, acting administrator of the Centers for Medicare and Medicaid Services (CMS), to attend the Kansas Pharmacy Summit. The summit brings together members of pharmacist and physician associations, PBM representatives and others to discuss pharmacy issues. The summit took place August 7, 2012.
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A Timeline of U.S. Senator Moran’s Advocacy For Pharmacy 2007 As a member of the U.S. House of Representatives, Sen. Moran helped found the first Congressional Community Pharmacy Caucus. January 22, 2009 Then a representative, Sen. Moran helped introduce H.R. 616, a bill to add pharmacists to a list of exempted medical professionals supplying medical equipment to patients. This bill was assigned to a congressional committee on February 10, 2011. The committee will consider it before possibly sending it on to the House or Senate as a whole. February 25, 2009 Then a representative, Sen. Moran introduced the Community Pharmacy Fairness Act of 2009.
U.S. Senator Jerry Moran and Nick Smock, PBA Health president and CEO, get together at the Kansas Pharmacy Summit. The summit took place at the University of Kansas School of Pharmacy in Lawrence, Kansas.
The bill aimed to build a more equal balance between community pharmacies and PBMs by creating a narrow exemption to the current antitrust law. The bill died in committee, but was reintroduced in 2011. May 26, 2009 An expansion of the University of Kansas School of Pharmacy breaks ground. Sen. Moran supported the Kansas Legislature appropriating funds for the expansion to help ease the shortage of pharmacists in Kansas. November 2, 2010 Sen. Moran was elected as a U.S. Senator for Kansas. May 24, 2011 Sen. Moran helped introduce Senate Bill 1058: Pharmacy Competition and Consumer Choice Act of 2011, which aims to ensure transparency, accountability and competition among PBMs to provide choice and cost-savings to patients. This bill was assigned to a congressional committee on May 24, 2011. The committee will consider it before possibly sending it on to the House or the Senate as a whole. July 1, 2011 Sen. Moran helped create the first ever U.S. Senate Community Pharmacy Caucus. June 23, 2012 Sen. Moran spoke at the 2012 PBA Health Conference.
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more creative around their approach to pharmacy and pharmacy pricing. So we have added some staff, including pharmacists, to try to help.” Making a difference Perhaps one of the best ways Sen. Moran has advocated for community pharmacists is by giving them a voice. In 2011, Sen. Moran helped create the first ever U.S. Senate Community Pharmacy Caucus. The purpose of the caucus is to promote community pharmacy issues, while also serving as a clearinghouse for ideas and information about the important role community pharmacies play in the delivery of healthcare. The caucus complements the Congressional Community Pharmacy Caucus, which Sen. Moran helped found in 2007 as a member of the U.S. House of Representatives. The caucus brings members of Congress together to hear about community pharmacy issues directly from the source—the pharmacists. One recent event featured a pharmacist from Kansas and a pharmacist from Montana. The pharmacists spoke to members of various senators’ staff about what it’s like to earn a living as a community pharmacist. “You might think that’s something that people would know, but it’s not,” Sen. Moran, who serves as co-chairman of the caucus, said. Politicians in Washington, D.C. don’t understand what it’s like to face the issue of not having basic services, like a pharmacy or a grocery store, in their town. They don’t realize that could ever be an issue, Sen. Moran said. “So, telling that story is the purpose of the caucus,” he said. Mike Burns of AuBurn Pharmacies recognizes Sen. Moran’s efforts to advocate for small town businesses, such as pharmacies, in Washington, D.C. “Sen. Moran has helped to at least open other legislators’ eyes to what goes on in the real world of rural America and the small businesses in it,” he said. “His efforts have given me hope that there are legislators that care,” he said. “Sen. Moran has become my ‘voice of reason’ in Washington.”
scription will work or how their medication may interact with other medications or their diet. The cost of a patient’s medication is another very real issue in adherence. Even with insurance, some of your patients are unable to afford their co-pays or they may consider ‘stretching out’ their maintenance medications by splitting pills. Efforts to change these problems are being approached through online monitoring programs such as the NCL’s Script Your Future program and the National Community Pharmacy Association’s (NCPA) Simplify My Meds program, which coordinates patient’s medications so that these medications are filled and ready at the same time each month. You might also consider creating a similar program in your own pharmacy, offered along with other wellness services you provide for your patients.
Improving Adherence Prescription medication adherence is a very real issue, but not necessarily a new one. As long as people have been prescribed medications, there have been problems with patient’s taking their medication correctly, or at all. According to a study done by the National Consumers League (NCL), “nearly three out of four Americans report that they do not always take their medication as directed, a problem that causes more than one-third of medicine-related hospitalizations, nearly 125,000 deaths in the United States each year, and adds $290 billion in avoidable costs to the health care system annually.” Daily Doses There are multiple reasons why patients aren’t taking their medications correctly. Non-compliance to the correct regimen of prescriptions varies from person-to-person but Merek’s Pharmaceuticals AdherenceEstimator® program has effectively narrowed the adherence issue down to three healthcare-related problems: commitment, concern and cost. Patients are often prescribed their medication without being told how it will specifically help assuage or cure their ailments. If a patient feels ‘better’ and quits taking a medication, he or she runs the risk of negating the benefits of that medication. Or, often times, patients fail to voice their concerns about how quickly their new pre-
What Your Pharmacy Can Do There are several methods you can implement at your own pharmacy to address the problem of non-adherence. Not only can these methods improve the quality of life for many of your patients, these practices also provide an opportunity for you to grow your business in a way that can change lives. As of 2006, the Medicare Modernization Act requires Medicare Part D prescription drug plans to include Medication Therapy Management (MTM) services delivered by a qualified healthcare professional, namely pharmacists. Consider creating marketing materials that emphasize the availability of this service. Too often, patients are unaware that this service is even available to them. Another way to steer your patients in the right direction is to post a list of questions they might consider asking you. Getting patients into the habit of asking important questions about their medications is one more way you can encourage adherence. By reinforcing patients’ responsibility toward their medications, you may save time in the long run and also improve their health.
Commonly (Un)asked Questions • How often should I take the medicine? • What should I do if I forget to take my medication? • Should I take my medication with or without food? • Will this medicine be safe with the medications or vitamins I am already taking? • Will I need a refill when my prescription runs out? If so, how should I go about getting my refill?
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Quality Management How recent U.S. legislation covers quality control in the drug supply By Kelsea Nore
An estimated 80% of all prescribed medications in the United States are for generic drugs. This percentage is expected to continue to rise as more brand name drugs lose their patents in the coming years. A huge percentage of the active ingredients in generic drugs originate outside of the United States, namely in countries such as China or India. For the Federal Drug Administration (FDA) to monitor the hundreds of drug manufacturing centers requires substantial overhead and personnel. Recent legislation by way of the Congressional and Executive reauthorization of the Prescription Drug User Fee Act (PDUFA) includes the Generic Drug User Fee Act (GDUFA) Amendment. This critically important piece of legislation is a meaningful opportunity to continue to develop the structure of prescription drug safety and quality in the United States. Legislative Results Originally introduced in 1992 and passed in 1993, the Prescription Drug User Fee Act or PDUFA was created in response to drug companies’ frustrations over the long waiting periods they encountered during the FDA drug approvals. The administration was understaffed and underfunded and in turn, unable to handle the amount of drug reviews presented to them. PDUFA authorizes the FDA to collect fees from the drug manufacturers that produce certain human drug and biological products. Since the initial passage
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of PDUFA, user fees have played an important role in expediting the drug approval process. An April 2012 Washington Post article reported that “the new funding stream from pharmaceuticals has reduced FDA drug review times by nearly half...the average approval time dropped from 27 months to 14 months.” The annually collected monies under PDUFA are application fees, establishment fees and product fees. These user fees from the drug companies made up nearly 62 percent of the United States 2011 ‘drug budget’, which is approximately $931 billion dollars. To date in 2012, PDUFA user fees have provided $702 million to the FDA (less than 1% of the combined 2010 net profits of the top ten largest pharmaceutical companies), according to a study published by the Union of Concerned Scientists. Signed on July 9, 2012, the fifth reauthorization of PDUFA, specifically in terms of the GDUFA Amendment, addresses the considerable regulatory challenges that new generic products have introduced into the healthcare industry. Concerns about foreign inspections and the rising number of ANDAs (Abbreviated New Drug Applications) are addressed. In a testimony before a U.S. House of Representative’s subcommittee on health, Dr. Janet Woodcock, M.D., Director at the FDA’s Center for Drug Evaluation and Research through the Department of Health and Human Services stated that “The [GDUFA] proposal focuses on quality, access and transparency. Quality means ensuring
Purchasing your generic products from a reputable, reliable source like the PBA Health Warehouse is one more way that you can personally help ensure quality for your patients.
that companies, foreign and domestic, that participate in the U.S. generic drug system are held to the same consistent high-quality standards and that their facilities are inspected biennially, using a risk-based approach, with foreign and domestic frequency parity.” Generic Quality Concerns about quality often touch on the tiny differences between generic and brand name drugs. The generic must be bioequivalent, which means that the generic drug must have the same active ingredient(s) as the brand-name drug (also known as bioequivalence), the same labeled strength, and the same dosage type (i.e.: pills, patches or liquids). Bioequivalence can be measured in the time it takes for the generic drug to absorb into the bloodstream and the concentration of the active ingredients upon arrival. To pass FDA standards, “the generic version must deliver the same amount of active ingredients into a patient’s blood stream in the same amount of time as the pioneer drug.” However, the average difference in absorption into the body between the generic and the brand name is 3.5 percent. While all generic products must pass rigorous FDA active ingredient requirements, generic drugs do not need to contain the same inactive ingredients as the brand name product they mimic. Patients who report experiencing negative side effects when they switch
from brand to generic drugs or when their usual generic medication is switched out for a different manufacturer’s product may find that the issue is rooted in a difference in the binders, or inactive ingredients, used in the products manufacturing. “Quality is important in any product one purchases for consumption but especially pharmaceuticals,” said Nick Smock, pharmacist and CEO of PBA Health. “Quality pharmaceuticals for a patient means the product will work in a similar fashion each and every time the medication is taken and look identical each time the prescription is refilled regarding, size, shape, and color.” When you ensure that your pharmacy’s generic products are available and unchanging, you’re providing an important, high-quality element of service for your patients. PBA Health Cares Purchasing your generic products from reputable, reliable sources is one more way that you personally can help ensure quality for your patients. Rick Mingori, Director of Trade Relations at PBA Health, adds, “As part of our due diligence for product purchasing, we only work with manufacturers who have a history of consistent supply, quality products and few—if any— GMP infractions.” To learn more about how you can purchase quality products directly from PBA Health, call 816-245-5700 today.
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MORE FOR YOUR MONEY
A Vitamin For Front End Sales
Nutritional supplements and vitamins offer healthy ways to boost pharmacy profit By Kirsten Hudson
Your patients expect their community pharmacy to supply the products they need to get healthy and stay healthy—and not just the ones found behind the counter. Vitamins and nutritional supplements are in demand for consumers like your patients. According to a 2011 report by Global Industry Analysts Inc., the global market for vitamins is growing. It’s predicted to reach $3.2 billion by 2017. Your patients trust their hometown pharmacy, which means they’ll be hitting your pharmacy’s store shelves to find the vitamins and nutritional supplements they need to maintain a healthy lifestyle. Give them what they’re looking for! A well-stocked front end complete with the latest vitamins and supplements can add value to your store. A fit for pharmacy Before the days of marginal third party reimbursements, mail order, and huge competition from national chains, pharmacies didn’t need a front end to stay in business. Enough profit came from prescriptions. Now, a front end can be one of your most valuable sources of revenue. You can go back and forth all day about what to offer in your front end. Should you stock cards and gifts? What about snacks? With vitamins, you don’t need to deliberate. Vitamins will always suit a pharmacy, no matter your market. Whether you’re located in a rural or an urban environment; whether your customers prefer to purchase camping gear or high-end cosmetics, vitamins are likely to do well in community pharmacies. “It’s part of the business that pharmacists have had for years,” said Bruce Burns, vice president of independent retail sales at Windmill Health Products.
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Vitamins and supplements naturally complement a retail pharmacy, where you can cross-merchandise your products. As you know, when patients take an antibiotic they can experience unpleasant side effects, like an upset stomach. If they take a supplement, such as a probiotic, it counteracts those negative side effects, which means healthier patients and a healthier bottom line for your business. “Not only are vitamins and supplements a profit center, they’re also a great way of keeping your patient compliant,” said Steve Sabella, vice president of sales at Windmill Health Products. “Pharmacists are in the business to help people. I believe that this is just another avenue to help.” The right mix With competition from health food stores and other pharmacies, you have to give patients a reason to buy from you. Even though you can likely beat expensive health food stores on price, you don’t have enough purchasing power to offer the same discounts on brand name vitamins that health food stores, grocery stores and national chain pharmacies can offer, which is usually buy one get one free. You need to team with the right vendors to offer the right mix of vitamins and supplements for your business. “You may just have one bottle of Centrum, for example, but you should also have several bottles of Centrumcomparable vitamins at an affordable price that are also being promoted,” said Gary Pigott, senior vice president of sales and marketing at Mason Vitamins. That way you can offer a limited quantity of the products consumers recognize, while also providing more affordable, compa-
MORE FOR YOUR MONEY rable options. Pharmacy owners can’t wait until they get a request for a certain product to stock it. “Then, they already lost the sale,” Pigott said. Promoting your products Keep in mind that you can’t just line up a bunch of vitamins and supplements on your shelves and expect sales to skyrocket. “The key for community pharmacy is to promote it. Don’t just offer it,” Pigott said. Promoting your vitamins starts with simply using your knowledge to educate your patients. Your patients trust your healthcare advice. After all, pharmacists were voted the second most-trusted profession in America in 2011, according to the annual Gallup survey. Whether you have a patient who is concerned about vision health or who wants to know the best supplementary sleep aids, come out from behind the counter and talk to your patients about the right vitamins for them. It will mean a sale for your business, and a happy patient. “Pharmacists’ ability to talk to their patients about the products that they’re taking is a huge advantage,” Burns said. “You don’t get that in food stores or a lot of the other outlets that are grabbing percentages of sales in vitamins today.” You can also take advantage of the promotions your vitamin vendors offer to market your vitamins. Both Mason Vitamins and Windmill Health Products provide pharmacies with regular promotional opportunities. “Whatever the vendor has accessible to you as marketing materials, it’s crucial that you utilize it,” Pigott said. “Don’t just let it gather dust.”
Instead of simply displaying vitamin brochures on a stand or on the counter, Mason Vitamins suggests that once a month pharmacy owners place educational material about vitamins in every bag that leaves the store, including scripts and front-end purchases. Windmill Health Products works to make its vitamin line attractive to consumers by offering it at discounted pricing to pharmacy owners. “It’s very important to be promotional to make the product move off the shelves,” Sabella said. Stay trendy When it comes to vitamins and nutritional supplements you can also increase sales by paying attention to the trends. “If you want to capture the nutritional business, you need to be on top of the hot trends,” Burns said. For example, Dr. Oz is huge in the vitamins and supplements world right now. “We actually have sections we put up in the store now talking about ingredients that have been promoted by Dr. Oz and some of the supplements we have that contain those key ingredients,” Burns said. Working with your vendors to promote vitamin and supplement trends in your store can mean a more successful front end. “Staying timely is important in the nutritional business to get your share,” Burns said.
Should You Offer Private Label Vitamins At Your Pharmacy? While it might look nice for your pharmacy shelves to display rows of vitamins with your pharmacy’s name stamped on them, the cost likely isn’t worth any smaller benefits. “In the independent pharmacy world, you would have to buy more vitamins than you could possibly sell to put your name on it,” said Steve Sabella, vice president of sales at Windmill Health Products. “It’s cost-prohibitive.” Gary Pigott, senior vice president of sales and marketing at Mason Vitamins, agrees. “The truth is, an owner cannot afford to maintain that inventory,” he said.
If pharmacy owners do plan to offer their own private label vitamin line, Pigott said that they must make sure to have product liability insurance documentation on hand from their private label vendor governing those products. Otherwise, you could get in serious trouble if the vitamins are contaminated in any way. “I can get my product from whoever and tell them to put my name on it, but they should make sure they’re conforming to what the FDA requires and have product liability coverage—minimum $5 million per occurrence,” Pigott said.
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Pharmacist-Physician Relationships Develop a professional relationship with the physicians in your area and watch your business grow By Kelsea Nore
The April-June edition of the Journal of the National Medical Association carries the reprint of a speech given by F.W. Raglan, RPh., at the Alabama Medical, Dental and Pharmaceutical Association Meeting. “…Let the physician and the pharmacist come into closer relationship with each other, work for the good of each other and all concerned will be better off.” Raglan delivered this speech in March 1909—more than 100 years ago. The matter of the pharmacist-physician relationship is still as relevant today as it was in the early twentieth century. When you’re able to clearly communicate with physicians in your area, you gain a valuable advantage for your business and even better, you can help your patients achieve optimal health outcomes. Common Barriers Successful, open and frequent communication between healthcare professionals is the best way to not only avoid the frustrations that accompany busy schedules, but it also fosters an environment of respect. When both physicians and pharmacists value the other’s expertise, they are better able to treat patients. A major barrier in the creation of strong pharmacistphysician relationships is the fact that physicians and community pharmacists work in physically separate environments. Because of this division, their interactions are rarely face-to-face and each fails to understand what the typical ‘day-in-the-life’ of the other is like. Negative stereotypes about what the other does all day, such as ‘she’s just counting pills’, needlessly flourish without an empathetic understanding of each other’s practices or businesses. Ignorance isn’t the only issue preventing the formation of these important relationships. Many negative confrontations between pharmacists and physicians occur because of a lack of time. Pharmacists and physicians (and nurses and technicians) are all extremely busy.
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When there’s a prescription error, a hard-to-read script, or a possibly dangerous interaction, a consultation is necessary. Unreturned phone calls or long hold times are frustrating for anyone, but doubly so when a patient feels pressed for time as well. Healthier Patients If patients are directly referred by their doctor to your pharmacy, there is a better chance that they will follow the ‘doctor’s orders’ and pick up their prescription. When they’re doing that, they may have questions about their medication that their physician was unable to answer but that you are more than capable of answering.
“…Let the physician and the pharmacist come into closer relationship with each other, work for the good of each other and all concerned will be better off.” Or, perhaps patients have some maintenance concern such as lifestyle or diet changes, or long-term care issues that they are addressing with you (who they associate with their medication), but not their physician (who they associate with examinations, surgeries or other clinical treatments). Pharmacists’ records are more likely to have a patient’s information and prescribed treatments from both primary care and specialty physicians, which paints a broader picture of the patient’s medication history.
COMMUNITY PHARMACY The mutual benefits of building a strong professional relationship with the physicians (and nurses) at the clinics and hospitals in your area are obvious to your patients; these working relationships reassure their already deep trust in their healthcare providers, which can lead to healthier outcomes. Healthier Business Your friendly association with local doctors and nurses not only makes your patients healthier— it can make your business healthier, too. Mike Bellesine, R.Ph and owner of El Dorado TrueCare Pharmacy in El Dorado, Kansas, understands the inherent value of creating strong relationships with local physicians and the nurses and PAs on their teams. “We have a reputation among local physicians as being very easy to deal with. Many chain pharmacies have corporate policies that make little sense and only result in increased headaches,” Bellesine said. “But before we implement any new policies, we carefully consider whether they’re really needed and what their true impact will be.” One example of this forethought is El Dorado TrueCare Pharmacy’s delivery service. The delivery service isn’t just for the patients who need extra care; it has a positive impact on El Dorado physicians and their office staff. “If a doctor forgets to sign a Schedule II controlled substance prescription, most pharmacies would simply force the patient to return to the doctor’s office to have the prescription signed. At our pharmacy, however, we’ll usually have our delivery person take the prescription over to be signed.” Bellesine’s simple solution benefits the patient, the physician and the pharmacist. Creating and implementing services that big box or national chain pharmacies are unwilling to provide is another valuable ability. Being on-call 24/7 is another special feature that El Dorado TrueCare Pharmacy offers physicians (and patients). “Local doctors know they can call us at home if they have a patient in need, even during holidays or weekends when other pharmacies are closed,” Bellesine said. “We don’t limit this service to just our patients as we have found this to be an excellent tool to start developing brand loyalty to our pharmacy.” Bellesine added, “We promote the fact that they can call us with any pharmaceutical-related question and we will drop everything and research it for them, sending them any relevant articles and web reference sites.” Physicians who know that you’re ready and willing to answer their questions about medication are far more likely to ask you those important questions (and answer yours as well). A back and forth relationship is a healthy one to have.
Mike Bellesine, R.Ph and owner of El Dorado TrueCare Pharmacy in El Dorado, Kansas, understands the value of building and maintaining a strong pharmacist-physician relationship. Marketing Your Pharmacy Specialty services and programs and exclusive arrangements with local physicians are great ways to build relationships that help improve your pharmacy business. However, the physicians and nurses at the clinics and hospitals in your area will never know about what you’re doing unless you tell them! Introducing yourself to physicians is the first step. The next essential step is marketing your pharmacy’s services. This is a surefire way to expose your business to physicians and patients. Creating materials that give a clear and consistent message about who you are and what your pharmacy offers is a fundamental business practice, and PBA Health can help. Call 816-245-5700 to learn more about how marketing your pharmacy will improve your business. “A question we’re always asking ourselves is, ‘What do we want to be when we grow up?’” Bellesine said. “We think about what we can do to stand out, how we can honestly help our patients and bring in new customers, too. Giving is what makes us different. When we offer new services and go above and beyond expectations, we’re growing in the right direction.”
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The Future of Pharmacy
And what that means for your community pharmacy... By Kelsea Nore
The expansion of pharmacy schools in the United States has caused alarm for many people in the profession. Major concerns are centered on the establishment of proper resources like educational faculty and staff in these schools and their sustainability. Available sites for rotation and residency are another concern. The increase in pharmacy schools will also have an effect on the many economical changes that will likely occur in the near future, such as healthcare reform and job market saturation. Most importantly, there are concerns about how the high number of pharmacy school graduates will learn about and respond to the numerous changes predicted in the future of the profession. Pharmacy is quickly becoming far less focused on strictly dispensing medication and is instead working toward direct pharmacistinvolvement in the healthcare team of each patient. By The Numbers Many believe that this increase in pharmacy schools was a direct result of the pharmacist shortage in the 1980s and 1990s. Another driving factor in the growth of pharmacy schools is the fear of another shortage brought
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on by the impending retirement and aging of the Baby Boomer population, a sub-group of future patients numbering approximately 76 million men and women. But, many also believe that it’s not the population numbers that gave rise to so many new schools of pharmacy. Instead, it’s the numbers that make up the amount of tuition dollars. A 2010 opinion article in the Connecticut Post written by former American Association of Colleges of Pharmacy (AACP) president Nicholas G. Popovich said that “Pharmacy school tuition can cost anywhere from $100,000 to $350,000 depending on the program.” The broad appeal of the pharmacy profession to students and the high tuition rate make the implementation of pharmacy schools at private and for-profit universities noteworthy. Popovich continued, “We believe that these academic institutions…are creating pharmacy programs to take advantage of the premium tuition students must pay to earn a pharmacy education.” As of February 2012, there were 129 accredited (full or candidate status) schools of pharmacy in the United States. In July 2010, there were 115 similarly accredited schools. In the mid-1980s, the number of
The Future of Pharmacy
pharmacy schools stood at 72 institutions, marking the increase of pharmacy schools today at approximately 79%. In almost 30 years, this huge increase of students and practitioners of pharmacy undoubtedly reflects the many changes that have occurred within the profession. Academic Issues While schools seem to have few problems getting students to enroll in pharmacy programs, an issue is who will instruct these students and where they will rotate during their time in school. Faculty shortages across the country are contributing to these problems. The amount
on an ongoing basis. Every pharmacy school’s curriculum must include Introductory Pharmacy Practice Experiences (IPPE) courses. Additionally, in the final year of school, students must complete Advanced Pharmacy Practice Experiences (APPE) courses. These important courses make up a significant portion of the pre-and post-graduate curriculum. For pharmacy students interested in community pharmacy, their IPPE and APPE experiences allow them to further explore their specific interest in this important area of the pharmacy profession, in a way that no lecture or classroom experience can.
The increase in pharmacy schools will also have an effect on the many economical changes that will likely occur in the near future, such as healthcare reform and job market saturation. of years of school necessary for one to teach at the professional level is approximately eight or more. Also, smaller salaries and recruitment by private institutions like hospitals or insurance companies and government positions account for the faculty shortage at many schools. It is interesting to note that many professors have been called to teach after retiring from the retail pharmacy environment, bringing both experience and knowledge to the classroom. However, students must also venture outside the classroom before they graduate with their Pharm.D. degree. Apprehension about the availability of quality rotation sites and willing preceptors at these sites is a concern that several pharmacy associations and organizations are addressing
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Practical Experience The University of Missouri-Kansas City (UMKC) School of Pharmacy in Kansas City, Missouri recognizes the importance of practical experience for its students. Peggy Kuehl, Pharm.D., FCCP, BCPS, is a clinical associate professor and the Community Pharmacy Coordinator and Director of the Community Pharmacy Residency Program at UMKC. She explained that at UMKC there are eight ‘core competencies’ for APPE students at any of the advanced community sites. “Each pharmacy school is different, of course,” Kuehl said. The UMKC core competencies requirements include health screenings, immunization delivery, medication adherence assessment, medication therapy management,
OUTLOOK and provision of written therapy recommendations and/or documentation of care to patient’s physician, among others. “For students entering a post-graduate residency, it’s important to remember they are being hired to learn,” Kuehl said. “They’re encouraged to create and explore new programs and practices at these pharmacies. We want our residents to not only replicate the services they’re using at these residency sites, but to be leaders in the innovation of new services that will help move the profession forward.” Afton Wagner, Pharm.D., National Community Pharmacy Association (NCPA) Director of Management and Student Affairs spoke of the opportunities for students to gain an education in the business aspect of community pharmacy as well. Wagner discussed the great success of participants in the Good Neighbor Pharmacy NCPA Pruitt-Schutte Student Business Plan Competition. The goal of the competition is to have active NCPA-member students create the blueprint necessary for buying an existing independent community pharmacy or to develop a new pharmacy. “It’s mutually beneficial for students and community pharmacists,” Wagner said. The top three finalists present their plans at the NCPA Annual Convention and winners receive a cash prize for their schools and the opportunity to attend the yearly Multiple Location Conference, along with the prestige and knowledge gained by competing. Changing Roles Students aren’t just taking classes in medicinal chemistry; they’re also getting an experiential education with courses such as Introductory Pharmacy Practices. These courses involve far more patient-interaction and touch on one of the most important changes the profession is experiencing. A 2010 discussion paper prepared by the American Pharmacists Association (APhA) and the American Society of Health-System Pharmacists (ASHP) addressed the issue of the changing roles in pharmacy directly: “It is likely that fewer pharmacists will be needed for traditional dispensing and drug product distribution activities because of automation, standardization of dispensing and distribution processes, and expanded use of auxiliary workers. While there is immense need for pharmacists to engage in medication therapy management and other clinical activities, current reimbursement systems are stifling the growth of the numbers of practitioners in these areas. It is uncertain how quickly the financial basis for pharmacy practice will change.” The same APhA and ASHP discussion paper ap-
proaches the idea of pharmacists becoming more directly involved in patient-care with “more emphasis… placed on the team-based approach to patient care.” Many have forecasted this change for the pharmacy profession and envision a future involving a patientphysician-pharmacist collaborative relationship that also helps prevent negative healthcare outcomes, thereby lowering costs and improving overall health nationwide. (For information on building relationships with physicians in your area, turn to page 24).
“We want our residents to not only replicate the services they’re using at these residency sites, but to be leaders in the innovation of new services that will help move the profession forward.” – Peggy Kuehl, Pharm.D., FCCP, BCPS
Getting Involved The need for rotation sites and preceptors is evident, so how can an independent pharmacy like yours get involved? First, every interested pharmacist must decide if he or she has the time to put in with each student. First through third-year students doing a short rotation will undoubtedly have many questions, so pharmacist involvement is absolutely necessary, and also for the evaluations and assignments the students may have. In the higher-level residency programs, it’s important to note that students, while on the payroll, cannot perform as cheap labor. For instance, through UMKC certain requirements include the students writing a collaborative drug-theory protocol with a physician and the implementation of this program, along with a researched-and-written business plan for this new service. “We look for very progressive sites for residencies, pharmacies that are changing and growing, just like the profession,” Kuehl said. Wagner suggests that community pharmacies interested in becoming rotation or residency sites should contact the NCPA or the schools of pharmacy in their area. “Patient care is central to community pharmacy,” Wagner said, “When students are able to interact with patients in a unique, personal way, they gain experience that they wouldn’t have otherwise.”
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Create Your Own Cash Discount Card Program With diminished third party reimbursement rates and today’s increasing operational costs, keeping (and gaining!) cash patients can easily boost your community pharmacy’s profits. Uninsured patients who pay cash for their prescriptions mean a stream of revenue for your business that’s immediate—no waiting around for PBMs to reimburse you. Offer your cash patients maximum value by starting your own prescription discount card program at your pharmacy. You can easily start a discount card program that works for your pharmacy with ScriptCard, a prescription discount card program offered by PBA Health. Discover what this cash discount card program can do for your business. Cut Out Costly Admin Fees When your pharmacy accepts discount cards offered by PBMs and other companies, it costs your business money. You get charged administrative fees—often $2 to $6—for every claim you run that processes
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those cards. Over time, those small administrative fees can add up to significant expenses. With ScriptCard, you can mirror the discounts offered by PBM discount cards for your patients without paying those costly transaction fees. Compete On Your Terms Your pharmacy has no control over the discount rate offered on PBM discount cards. With ScriptCard the power goes back to your pharmacy. Through ScriptCard your pharmacy can decide to either match the discount rate on the card or create your own discount rate, whichever you decide is more favorable to your business—and your patients. Build Customer Loyalty When your patients get a good deal on their prescriptions, they’ll associate those savings with the PBM discount card they used—not with your pharmacy. Prove to your cash patients that you offer comparable (if not better) prices by offering them your own discount card program with ScriptCard. When patients
“see” their savings, they’ll want to come back to your pharmacy again and again. Expand Your Options With ScriptCard Plus If you like the idea of starting your own cash discount card program, you’ll love the customization options available to you with ScriptCard Plus, an expanded version of the basic ScriptCard program. With a customizable formulary of approximately 400 generic drugs and multiple pricing tiers, the ScriptCard Plus program provides you with even more competitive pricing options to keep customers coming back. You can even tie in your own loyalty rewards program to create even more value for patients. Take control of your cash claim business. Call 800-333-8097 or email us at scriptcard@pbahealth. com to start your ScriptCard program today! Find out more online at www.pbahealth.com/ pba–scriptcard.aspx.