PharmacyNow Podcast: COVID-19 and Your Pharmacy with Steve Hoffart

STEVEN C. HOFFART, PHARMD, received his Bachelor of Science in Pharmacy with highest honors in 1994 and Doctorate in Pharmacy from the University of Texas at Austin in 2000. He also holds a board certification and fellowship through the American Academy of Anti-Aging (A4M). In November of 2002, he saw a need for a more personal pharmacy that could make an impact in the community on a larger scale. Magnolia Pharmacy’s focus is to work with the “tri-ad”, a strong working relationship between the patient, physician and pharmacy to solve medication problems and provide real solutions for patients to achieve better health and wellness. Cultivating this working relationship has ultimately produced a unique pharmacy experience for each one of Magnolia Pharmacy’s patients.

Since 2002, Dr. Hoffart has received numerous awards and recognition for his dedication in pharmacy.

• 2006 Business of the Year Magnolia Area Chamber of Commerce
• 2008 RPMS Pharmacist of the year
• 2010 South Region GNP Pharmacy of the year
• July 2012 PCCA’s Pharmacist of the month
• 2013 Potpourri’s NW Readers’ Choice Best Locally Owned Pharmacy
• 2017 Texas Pharmacy Business Council Advocacy Award Winner
• Current Good Neighbor Pharmacy national advisor
• Member of American Pharmacies board of directors
• Member of NCPA National Legislative Steering Committee
• Current PCCA Advisory Council member

Dr. Hoffart is also a member of The International Academy for Compounding Pharmacists (IACP), National Community Pharmacists Association (NCPA), American Pharmacies buying Co-op (APRx), and the Professional Compounding Centers of America (PCCA).  In striving to achieve excellence, Magnolia Pharmacy is one of only 58 pharmacies in the state of Texas to be accredited by the Pharmacy Compounding Accreditation Board (PCAB) for compounding.

Dr. Hoffart will celebrate 17 years as an independent pharmacy owner in November of 2019. Magnolia Pharmacy has grown to offer compounding. Immunizations, health screenings and testing, hormone and nutrition consults, medication therapy management, along with traditional retail pharmacy services to complete the personalized medicine offerings by Magnolia Pharmacy.

Meet Steve Hoffart

Steve Hoffart: (01:40)
Yes sir.

Scott Vondeylen: (01:41)
Perfect. Well, so excited to have you here today. And did I get that right? You’re just, what, about an hour Northwest of Houston? Is that correct?

Steve Hoffart: (01:49)
Yeah, we’re about 40 miles Northwest of Houston. It’s 40 minutes with no traffic and about an hour plus with traffic. So…

Scott Vondeylen: (01:56)
Awesome. So really excited to have you. Obviously we’ve talked a bit off air and you are doing some fantastic things there at your pharmacy, as you always are and the different conversations that we’ve had, but particularly during this time. That you’re getting involved in some additional things that just really go above and beyond, I think the norm, excited to share some of that. But quickly before we dive into that, Steve, I just wanted to give you a couple moments to give us a little bit of your background. You’re a PharmD, you own an independent pharmacy down there in Magnolia, it’s a beautiful pharmacy. Just give us a little history of yourself, how you got involved in independent pharmacy, you know, where you came from and where you’re at today.

Steve Hoffart: (02:40)
Awesome. Yeah. So Magnolia Pharmacy is a hybrid pharmacy. We opened up in Magnolia, Texas in 2002, so come this November, it’ll be 18 years. We do all your traditional services when you think of regular pharmacy. We do med synchronization, medication therapy management. We have a very robust compounding lab that we do both sterile, and non-sterile compounding. We are PCAB accredited. And then we also offer a host of other services for immunization. We do hormone, weight loss, nutrition consults. We do patient classes where we educate on how to eat. We educate on some of the compounding solutions that we have. So we try to be a one stop shop and provide all the necessary items that a pharmacy customer would need. I opened up in 2002 with a philosophy as if you take care of patients as a side effect, you’ll make a living and, knock on wood, I’m still here today and still going strong.

Scott Vondeylen: (03:38)
Awesome. Awesome. So one of my favorite questions to ask all of our guests when they come on, especially those who are pharmacists is, what is your favorite part about being a pharmacist?

Steve Hoffart: (03:51)
Being able to take the knowledge that I got in pharmacy school and actually impact patients directly every day is the most awesome part about being a pharmacist. I am very grateful because I honestly wanted to be a physician coming initially into college. But once I learned about what pharmacy can provide and especially being an independent pharmacy where I get to practice at the top of my license and do the things that I enjoy every day doing, making an impact on patient lives is really what I enjoy the best.

Compounding Hand Sanitizer

Scott Vondeylen: (04:18)
Love that. And thank you for sharing. And so many others, the thousands of independent pharmacists that I’ve talked to over the years share the same sentiment, they’re in it to help patients. And I’ve heard actually a lot of others share the same thing. They got involved originally to be a physician and then ended up, you know, being a pharmacist, which is fantastic. So thank goodness for everyone there in that community that you chose being a pharmacist because 18 years, clearly you picked the right profession and you’re doing something right. So congratulations on all of your success thus far. Want to jump into the hand sanitizer topic. We talked about this, incredible stuff. You mentioned there to the listeners that you’re a full service pharmacy, which also includes your compounding side of the business where you’re, you know, making specialized medications and we can dive into that a little bit more. But particularly around this hand sanitizer, you were able to get FDA approval on hand sanitizer and on its face, when you say that out loud, and when you bring in the FDA that adds a huge layer to even the average listener. But when you say that on it’s face, well, hand sanitizer, but you and I walked through this and there is quite a bit that goes into this that is so fascinating. And then of course you add on the extra layer right now of COVID-19 and the shortage of so many different supplies, whether it’s, you know, of course we’ve all seen in the media, toilet paper and paper products that have just disappeared. But more importantly, you know, over the counter products, hand sanitizer being one of those. So tell me a little bit, let’s start at the beginning of this story. Tell me a little bit about why you started compounding or how long ago did you start compounding hand sanitizer and what does it look like today?

Steve Hoffart: (06:12)
Yeah, so immediately when this whole COVID-19 crisis started, we had many patients come in through our drive through looking for things like gloves and masks. But one common thing that came up quite commonly was hand sanitizer. Unfortunately, the past compounders in the FDA, maybe we haven’t always seen eye to eye, but I’ll be honest with you, this whole pandemic has opened up a level of communication and an ability for compounders like myself to compound hand sanitizer with the FDA guidance. And it’s really a neat situation where we as compounders and pharmacists are able to partner with the FDA and do something in a time of need. And that’s really what compounding is all about. It’s coming up with customized solutions to solve problems when needed. And this was a problem because patients don’t have access to hand sanitizer. I’m still amazed today how we still have a shortage of hand sanitizer and this has been going on for weeks. So the FDA put out a guidance document that told us of two particular formulas that we as compounders could compound for FTA distribution. When we think of compounding, it is typically a personalized solution for a problem for one particular patient. So it’s very, what we call patient-specific. Well, OTC compounding is a little different. We’re making a big batch of something that basically is made in our labs, but instead of being for one patient, we could distribute it to many patients. And also typically those prescriptions that we compound have to have one patient’s name. The FDA gave its guidance and said if you follow our specific formula, you have the ability to basically create a large batch of something. As long as it’s properly labeled with all the requirements that they want on the label, you can sell it as an over the counter item. Now it still goes through the same process in our lab as if we’re doing a customized formula for a patient. We’re most often times using pharmaceutical grade ingredients. We’d go through the processes, we have formula logs that are checked by pharmacists and made by technicians. They have quality checks before and after. And then we have the ability to put it in whatever type of dispensing bottles that we can find. The good and the bad is right now it’s kind of hard to find bottles. So we’ve been having to go from different plastic dispensing devices, from spray bottles to flip top bottles. But it’s allowed us basically to offer and provide hand sanitizer to our community in a time of need. And then the real thing from that came was, we had many emergency care responders, policemen, firemen, constable’s office that were coming by our store asking, we need help. We’re in the field, we don’t have access to water. Trust me, hand-washing is the best thing we could do but when they are dealing with a patient or apprehend a suspect, they have no way to wash their hands and they had no hand sanitizer. So we were talking to some different groups and one of the ideas was why don’t we compound this OTC hand sanitizer and provide it to first responders? And from there this kind of whole campaign took off.

Scott Vondeylen: (09:14)
That is fantastic. Congratulations, really again to you and stepping up and figuring this thing out quickly. Pivoting in a time of crisis to do something that’s truly having an impact. Talk to me, I was so intrigued because I am not a pharmacist by background, I was a business major, so talk to me about in layman’s terms, because you had mentioned not everybody truly understands what goes into a medical grade compounded hand sanitizer versus your kind of everyday off the shelf hand sanitizer that you might find at your local 7-11 or you know, grocery store. What are the ingredients that go into that, that really kind of differentiated. And then if you could also at the same time talk a little bit about what is, you mentioned you’re doing bulk production, what does one batch create in terms of the overall volume so that you can actually provide for many patients in one batch?

Steve Hoffart: (10:17)
Yeah, so the FDA provided us two formulas. One was an ethanol formula which use ethyl alcohol, which is 95% alcohol or what we call 190 proof. The other is isopropyl alcohol based, which is a 75% solution. But you start actually out with a 99% isopropyl alcohol. The key is, we have to make these and keep these above a certain alcohol level to make sure that they kill the coronavirus or basically any type of bacteria. But as you mentioned, when it comes to compounding for humans, we use what are called USP grade chemicals, United States pharmacopeia. There’s a certain standard that those type of chemicals have to comply with versus what I’ll use, we called food grade alcohol, so everybody I’m sure has heard of Everclear. Everclear is the exact same thing as the USP ethyl alcohol that we receive in our compound lab. The difference is the food grade is quite a bit less expensive than the USP grade. So that’s kind of a challenge for us as compounders are using some of these USP grade chemicals to make hand sanitizer to try to sell at a reasonable price. So we don’t get looked at like we’re trying to overcharge. But part of our challenge has been is that these chemicals have not been available at the USP grade, so the FDA actually, after the initial guidance, allowed us to use what we’re going to call food grade chemicals. So I can tell you I made many runs down to the liquor store to buy Everclear and to be able to provide that hand sanitizer because unfortunately the USP grade chemicals weren’t there. So the basics of these formulas from the FDA, and granted there are very liquidy formula. They’re not what you typically think of like a Purell or something like that. They’re nothing but a certain amount of alcohol, a little bit of hydrogen peroxide to make sure that we kill the spores potentially within alcohol there’s a little bit of glycerin, which adds an amolin effect. Unfortunately, if you put alcohol in your hands all day long, they’d get very dried out. So the glycerin provides an amolin effect. And then lastly, you finally finish out the batch with a little bit of, what are either considered sterile water or irrigated water for irrigation or distilled water. When that’s all said and done with that gallon of alcohol, we can produce about 4,500 milliliter bottles of hand sanitizer. Lately it is nothing for us to go through 5, 10, 12 gallons of alcohol in a day. So this past week we actually kind of had a challenge that we put out and with that within, we were producing about 400 bottles of hand sanitizer a day, which we’re not a production plant, we’re a compounding pharmacy. So it’s a little bit of a challenge, but you know what, right now this is what our community needs. This is what our first responders need. So we’re going to step up and do our best.

Scott Vondeylen: (13:02)
That is awesome. And I know I keep using that word, but it really is. The fact that again, you guys are able to pivot and really transform is so many other businesses and we’ve heard the stories here over the last few weeks is this is unfolded in front of us, but you know, from Jersey manufacturers and clothing manufacturers turning into manufacturing masks. And I have a personal family friend of mine in New York that owns a t-shirt company that they’re creating masks. But you’re able to pivot like so many other companies are and start using your compounding lab there to start producing hand sanitizer for not just your patients but for the community and other first responders. Just amazing, amazing work by you and your staff. And thank you so much for everything that you do. That is, on behalf of everyone there, in your community in Magnolia, Texas. That is absolutely fantastic. And so thank you for, for all of your dedication, hard work truly on that front. Now you’re telling me that there you’ve actually gone down to the liquor store and purchased Everclear because of the shortage of, I guess the regular alcohol that you may use a medical grade alcohol. So what I’m hearing here is this, this is almost like moonshine for hand sanitizer.

Steve Hoffart: (14:25)
Well and that’s exactly right. And that’s one thing in this country we’re not short of and especially down here in Texas, we are not short of distilleries. So with the crisis going on, you know, you would think there’s one thing in this country would run out of is alcohol. But anyway, it’s been a challenge lately. But with that said, many of the distilleries have been able to grant licenses just like the hand sanitizer makers to be able to produce large amounts of this also. So you know, it’s taken all of us to kind of come up with the solution. But you’re exactly right. We have to procure and get alcohol however we can as long as it’s quality. Once again, the FDA initially did not allow us to, but later come back and said, Hey, it’s okay if you have to use food grade alcohol if and only that’s what you can get because we want you to be able to fill this void right now. And so you know, I mean in the past, compounding has really gotten a negative light and this has been an awesome way for compounding to be able to show that we are here. We do provide a tremendous value and what we can do. And I think it’s a chance for us, like you said, to put a really good positive light. The whole compounding handoff, a campaign that got started. It’s amazing. I saw a post on that last night about how much that has exploded and the amount of gravity and amount of spread that’s got across the country. So it’s quite phenomenal to see what compounding or compounders are doing and all their unique localities.

Scott Vondeylen: (15:50)
Yeah. And so while you are talking there, I did the math because again, I’m not that smart of a guy, but you had mentioned it makes about 45 bottles of 100 millilitres, which is around three ounces per bottle. And so my question is, you know, like many of us during a non-crisis period, we probably are pretty liberal with our usage of hand sanitizer. I know I have four children, so I’m, you know, just dumping it on their hands when we’re out in public places before we’re eating lunch somewhere, etc. But what is, and I don’t want this to sound like a dumb question, but during this time, I mean, you’ve got a three ounce bottle of hand sanitizer, maybe you’ve got two of them, but what is the proper amount, in your opinion, as a pharmacist that you should be using to ensure that you’re killing anything that may be on your hands? Is it something that’s a dime size, a quarter size? What’s your recommendation?

Steve Hoffart: (16:41)
You know, the ones we’re making are very liquidy. The key is you need to liberally cover your back of your hands, the front of your hands and between your fingers. As long as you can get a good liberal coverage of all those areas. That’s really all it is. I’ll tell you for me, I keep a little one of these free bottles in my pocket that I spray a hundred millilitres of that will last me. I’m going on one right now. It would probably last you about two weeks if you use a spray bottle to be abused as a flip top cap where you’re dumping it in your hands, it may not last quite as long, but I mean you can easily get, you know, out of a three ounce, you can easily get seven to 10 days easy on that. And that’s using it pretty liberally actually.

Marketing During COVID-19

Scott Vondeylen: (17:22)
Okay. The other thing that I was so impressed with during our conversation off the air was, you know pivoting without hesitation. You’re doing what needs to be done, but yet at the same time, keeping the true entrepreneurial spirit as an independent pharmacy owner. You found an ingenious way, in my mind, to provide opportunities for other businesses and a marketing opportunity in the midst of this global pandemic and compounding hand sanitizer. Can you tell the audience here what you’ve also been doing? And you made a Facebook post about this as well, but what you’re doing with the sanitizer for marketing opportunities?

Steve Hoffart: (18:03)
Yeah. So what happened was we had some alcohol on back order and I’m not going to lie, unlike a lot of compounders, I don’t know what they’re doing. We’re selling, I’ve given out probably more free than I’ve charged for what we’re recovering. Costs really is, really doesn’t cover my cost, but at this point it’s community service and anything we can do to help our community, we will. And we were using food grade alcohol, well on back order. I ended up getting about eight gallons of a USP grade alcohol, which means if I was going to make this and sell it, my costs actually doubled. And I am very conscientious right now about not creating a perception that we’re trying to overcharge people. So another pharmacist and I were talking and we came up with the idea, we know businesses are struggling right now, but there are some businesses that want to do good in the community. You have everybody asking, Hey, what can I do to help? How can I pitch in? So we created a social media campaign and we put a challenge out. We had eight gallons of alcohol and we said, if you’ll sponsor a gallon of alcohol, we will basically do three things. One, we will re-market that and we produce that bottle of alcohol, we’ll do all the proper FDA labeling. But on that we’re going to put partnered with either your individual name or we’re also going to put your business name on that bottle of alcohol so that everybody that receives it know that you participated in our campaign. You want to help the community and you want to make a difference. The other thing that we did was we allowed them, if that business wanted to, they could keep all the bottles of alcohol or option B, let’s say they wanted to keep, you know, and it produced one gallon, like I said, produce 45 bottles. They could keep as many as they want. The rest could come back to the pharmacy and if they like, we would hand them out to our patients and then through that what we did is we promoted that business and say, Hey, here’s a free bottle of hand sanitizer sponsored by this particular individual or this company. We would really love for you to go on their social media and give them a like or a thumbs up. That would be so awesome. The last thing is, we did a massive post recognizing these businesses talking about how they stepped up, how this campaign was so successful. Like he said with those eight bottles of alcohol, we produced almost, those eight gallons of alcohol. Sorry. We produced almost 450 almost 400 bottles of hand sanitizer. A lot of the businesses, some of them kept it, some of them gave it back to us to give back to first responders. And I will tell you that media post the other day really blew up on our Facebook and we had a great message. We also shout it out to our staff for getting it done in a timely manner. I happen to have two pharmacy student interns here that, thank God, they were here to help us turn the batches over and get it done in a timely manner and there was a tremendous amount of shares, a lot of positive comments. I’m not going to lie. These businesses and an economic crunch got a lot of publicity for their businesses, but also too, it was a good community come together to basically solve a problem for me cause I had some high dollar alcohol I wanted to get rid of. I created a good vibe. It had a good look and we all became out winners in this solution. So I like you said, it was a winner.

Scott Vondeylen: (21:10)
That’s exactly what I was going to say. That sounds like a win, win, win all the way around. And so, again, fantastic work to you and your staff and just always so impressed. You know, in talking to independent pharmacy owners across the country that they truly are entrepreneurs. And even again, in a time with COVID-19, you have figured out a way to make it a win-win for everybody. So I love that story. I hope listeners, you know, can kind of take a page out of your book. There are other pharmacies and perhaps do the same exact things. So want to transition here a little bit, Steve, talk about, you know, some of the work and support I think that you’re getting from other organizations. And so for those listeners who don’t know, you know, every pharmacy has a GPO, a group purchasing organization. Every pharmacy has a PSAO that handles basically the reimbursements for claims to, in layman’s terms, right, to make sure that you’re getting made whole, if you will on the prescriptions that you’re dispensing, etc. But talk to me a little bit about how you’ve worked with your GPOs PSAOs, and I think you even mentioned something about PBM. I know that that’s kind of a four letter word at times in this industry because of what’s going on there. But if you want to dive into that a little bit and share with me the story that we had talked about.

Collaborating with Pharmacy Organizations

Steve Hoffart: (22:37)
So about three weeks ago, I have a good pharmacist friend in Washington, which was kind of the epicenter when things started here. And I called her up and I’m like, look, we’re three or four weeks behind you guys tell me what you’re doing. And she kind of shared their best practices. And one of the things we immediately realized is we have got to protect our patients and we have to protect our staff. So me and a couple of pharmacy students I have here sat here and come up with a plan about ways to do our business but not have to directly interact with customers, touch items outside the store. Immediately, one of the first thing was is collecting signatures for prescription pickups, collecting signatures for credit cards. Figuring out if we want to try to limit the number of people in our store, can we offer delivery through shipping services? I don’t have delivery personnel, we do a lot of shipping, but many of the PBMs won’t allow shipping because of contract violations. At that point it was like, what do we do? So it kind of made sense to contact our PSAO who has relationships with many of these PBMs and say, listen, during this crisis you’re gonna have to relax some of the signature requirements that you have. As long as we good documentation, how many prescriptions are picked up, where it was picked up at, as long as we got a time, date and that type of stuff that’s available. So we show in good faith we are doing what we should be. Then we need some guidance immediately and we would like for you to reach out. Knock on wood. The PBM really came through, the PSAO spoke out for us and we started getting some guidance. It was kind of slow. Granted it kind of trickles in and who knows what the future holds, but at least we got a little reassurance that they understand the predicament that we’re in. You know, the next big thing that came up for us then was the aspect of what we can do in terms of emergency prescription refills. That’s where our GPO come in. We reached out to them to reach out to our state boards of pharmacies and say, Hey, what can we do in a time of crisis regarding license renewals in terms of emergency prescriptions. If we can’t reach practitioners, if they’ve cut their hours and their staff, can we do emergency refills? Also to, you know, as soon as all the hydrocodone stuff went out, we had a mass, a number of doctors, veterinarians dentists wanting to call in gobs of this hydroxychloroquine and we needed some guidance from our state board to say, wait a minute, we need to kind of create some guidelines. And it was also partnering with, like you said, our PSAO and our GPO to give us some guidance. I’ll tell you something else that happened this week that I think is phenomenal. Our GPO, we asked them, could you please produce a one pager that we can give to our employees to let our employees know, Hey, with all this Cares Act, these are the things you need to be making sure you’re taking advantage of, looking for your stimulus rebates to come, looking for abilities to push your tax burden down the road later. Being able to tap into 401k’s. It was awesome. They produced a one pager that we were able to give out. The other thing they were able to do is they were able to produce the documents that were nice and concise on the CARES Act about us filing for the payment protection program, the EDIL through the SBA program. And so thank God we have these partners because you’re right, we’re at the front lines fighting this battle every day. When I go home at night, I’m exhausted. But it’s nice for them to be able to have the resources to be able to do some research to help us out. So we can help keep our patients safe, but also take care of our employees during this time too. Because just like us as owners, it’s a lot of work. But without our staffs, we are nothing. And we have to have good quality staffs that are motivated to come to work every day and want to do their best.

Protecting Patients from Coronavirus

Scott Vondeylen: (26:09)
That’s great. You know, I know a lot of the GPOs and PSAOs that are out there in the industry, obviously there’s several different options for pharmacy these days and so that is love hearing that story that everyone was able to hop on , you know, the bandwagon, so to speak to support the network of pharmacies within their respective networks. You know, for your PSAO and GPO, etc. And allow you guys to, as you mentioned, do what you do best and focus on your business right there and most importantly your, and it sounds like you’ve got a rock star staff in place and just coming in every day with that enthusiasm and getting it done. So that is awesome. What you had mentioned, you guys came up with a system. So you know, these things that we just take for granted in our everyday lives of just the simplicity of signing off on a credit card transaction when paying for a prescription. Right. And normally coming into the store, interacting with the staff and being able to, you know, peruse the front end of the pharmacy. Can we just talk a little bit about, I understand you’ve closed the main doors of your pharmacy, if I remember correctly from our conversation and you’ve kind of come up with a whole system and you’ve got various steps that everybody has to go through. I know you mentioned the credit card receipt and the signing of that to make sure that, you know, we’re not the possible exchange of the virus etc., But what does that look like right now today and how you’re operating in your pharmacy?

Steve Hoffart: (27:42)
It really focuses around protecting our patients and then protecting our staff. Protecting our patients started with closing the front door and everything comes through drive through. I’ve got a lot of pharmacy colleagues who don’t have a drive through. They’re going full curbside. The challenge is where I normally can run my front end of my store with two people right now it takes four drive to gets stacked up. It’s trying to educate through social media and placards on our wall at the store, signs in the parking lot saying Hey, call ahead your credit card before you get to the drive through. It makes it a lot faster. If you can let us put your card on file in our secure methods so that we don’t have to get your credit card, cause I have a hunch this is going to go on for another three or four more weeks and people are going to come in here more than once to say this time, how can we limit interactions? How can we limit pass throughs through our thing or trying to take no cash, go all credit card and educate somebody on that before they get to our store. Because there’s nothing worse than you have to tell a patient, sorry, I don’t want your cash. Normally I would want cash all the time. But it’s, I mean credit card, credit card fees are going to be astronomical but you know, trying to get that word out so people don’t get shocked when they come to the store and realize what’s going on. You know we have runners that runs things out to curbside when the drive through get stacked up, we go out there, we wear gloves to make sure they see that we’re doing our part. We actually wear masks when we go out to make sure we’re doing our part. We’ve got now we don’t even take and we were actually handed a tool now we’ve got, we actually lay it on, we’ll tell them ahead of time before we go out. We’re going to lay it on the hood of their car and let them get out and get an after we walk away. Cause I don’t want to expose the patients to us and we don’t want to expose our employees to the patients. I mean we’ve got patients now getting prescriptions we know are COVID positive or coronavirus positive and I just want to limit that exposure. But we also got to find a way, we as pharmacists, especially independent pharmacy, we live on our front end cells, so we have to find a way to make our supplements accessible. We’ve created sheets of supplements we recommend during this time, but we want to make that readily available so they could call it in advance and have them ready for pickup. So there’s a lot of other things we’ve done for patients, but that’s the main thing. It’s trying to limit our exposure to them so that we don’t cause them harm. In terms of my employees, and I think this is what’s key, you’ve got to create an environment where your employees feel safe. I do think, and I’ve talked to several businesses, they are struggling right now where it’s like, you know what? I don’t want to go to work or I don’t want to come to work and bring something back to my kids or my family and I fully understand. I can honestly say, I think in our work environment right now it’s probably safer and more protected than somebody’s house because when every employee comes in every day, a pharmacist does a temperature screening. When they come in the door and the morning when they go out and come back from lunch, if they leave at lunch and when they go out for the day. We’re trying to look for fevers. I do realize patients can be asymptomatic for four to five days before they ever show a fever. But this is one way we screen every day. We come in, we have about nine different symptoms of coronavirus. We ask them, have you or your family experienced these? If you have, then we will not allow them to come to work if we have family members with these issues. We’ve sent a couple of employees home just because we don’t even want to bring the common cold or flu in here cause we don’t know what’s what nowadays. So, unfortunately we’ve had to be super strict, but our employees have been understanding when people come in, we have dedicated workstations, we have dedicated telephones throughout the day. We set an alarm every hour on the hour, we’re cleaning our workstation, cleaning our phones. We don’t share those workstations. The other thing that we do is when we come to work to are also dawning and wearing surgical masks throughout work. Cause I’ve done decided the only way that’s going to really take us down at work if somebody brings this virus in at home. And I don’t doubt at some point if you figure a large percentage of the population may get it before it’s over, I want the ability to know we did all we can solve. Ultimately somebody tests positive. Hopefully it’s far enough down the road where there’s rapid testing. So we have the ability to shut our pharmacies down, shut our pharmacy down if we need to go have the whole staff tested, hopefully we’ll mitigate the amount of exposure because we’re wearing masks doing all these things. We lose a very small portion of our pharmacy staff and we can come back to work after a thorough cleaning. We got guidelines on fact in terms of what the CDC says, how to clean if that happens. We’ve gotten guidelines for basically how to wear our mask and how often and we got a rotation schedule here cause you’re right, masks are limited. It’s quite a challenge. But we try to create a work environment where everybody on the staff knows that if you do these things you’re going to limit your risk by coming to work. And we had a lot of fun with it. Every now and then they’ll play the hand washing song. Alexa’s got a really fun hand-washing song. People kind of joke with just to get a laugh. And the other thing is too, you still got to have fun at work. You know, don’t cut the newsletter. Watch that all day. We put the music on. We may turn it up a little louder cause there’s nobody in the store. But I mean we really got to keep a good morale because we’re all under a lot of stress. We’re dealing with a, but you got to really create a good work environment where your employees feel like they’re being screened, they’re being listened to and that you’re looking out for their best interests.

Scott Vondeylen: (32:47)
I love it. That is a very comprehensive, so comprehensive. I think, you know, you hit the nail on the head. It’s if somehow somebody brings it into the pharmacy, it’s because somebody’s family because you guys are going through I think every possible guideline and, and or precautionary measure is what I was looking for. You guys are going through every precautionary measure to ensure that, you know, that is not the case and that no one brings hopefully the virus into the pharmacy. So that’s incredible. Now is that just kind of a combination of different guidelines that you’ve pulled together too, that you’ve decided sort of independently Steve, to incorporate into the daily, you know, kind of precautions if you will, and into the pharmacy or kind of where is it? Was it a mixture of information that you were getting or how did that all kind of come together when you decided to do all these things?

Steve Hoffart: (33:43)
Yeah, the weekend before we went live with the closed door, we come in and did as much research that we have the time on coronavirus in terms of like how long somebody has to be gone before they can come back if they test positive. But then that was version one. That was about three weeks ago. We’ve been very fortunate. I’ve been on multiple, one of the best things has been webinars with pharmacy colleagues in the evenings where we share best practices. That has been a God-send, you know, NCPA has had some tremendous webinars. CPESN has done some webinars where we’re all discussing best practices. Every day we come to work, we learn new things, and so it turned into version two, then version three, version four. Right now we’re on version 10 after three and a half weeks, we don’t do major overhauls, but there’s little changes that keep, what can we do to make things better? I’m not going to lie. We weren’t wearing masks until this week and then this week we decided I think there’s enough information we should be wearing masks. So you know it’s evolved. You know, even at the point where we’ve gotten this policy, what happens if I go down, who’s going to be in charge, who kind of runs a show? Because once again, we hope nothing goes wrong. I’d rather be more cautious than not, but I think it’s a liability issue for pharmacies. We need to have a plan to show that we protected our staff and our patients. So down the road, if there’s any ever negative consequences, if somebody says, well, the pharmacy didn’t do this or this happened to me because they didn’t do, I think it’s something that every pharmacy needs to be conscientious of and really not kind of fly by the seat of their pants and put something in writing to protect themselves. But it really has been a work of art. I really try to listen as many webinars and do is follow as many things as I can just to put the latest information as possible in that.

Scott Vondeylen: (35:23)
That’s great. Yeah. And these, you know, uncharted territory almost right with a global pandemic and so many of us in so many businesses really unsure. And I’m sure to your point there will a fallout to some extent with certain employers and hopefully not a lot for everyone’s sake. But you know, again, not knowing exactly what policy to go by because so many companies and businesses didn’t have any sort of really framework in place for a global pandemic and making sure that your employees are safe. I know many companies out there like ours have sent everyone home indefinitely until this is over and no one knows exactly when that period of time is going to be, but clearly is being on the front line of healthcare. You guys are definitely the exception to the rule or an essential business, right, that you have to be open to serve your community and patients and you guys truly, it sounds like you’ve done and continue to do and evolve as you mentioned, everything you possibly can to ensure the safety of your staff and of your patients. So again, fantastic. I’ve said it three or four times, but really it’s just an amazing job that you guys have done there. And I’m glad to hear that the NCPAs and CPESNs of the world have, you know, also allocated efforts and resources to setting up these webinars and providing that information that is desperately needed for everyone involved in this during this period of time because you know, where else were, like you said, you’re just trying to serve your patients. So the fact that you’re getting that information and you’re taking the time every night you’re on addition 10, just, you know, speaks again volumes about your commitment to your staff and your patients patients, which is fantastic. So you had mentioned a little bit earlier, Steve, I think you touched on this, but I did want to come back for a second cause it caught my ear. And again, I’m not a pharmacist, but you mentioned medications I believe. I did want to bring it up. How are you managing the demand for COVID-19 medications? What is that emerging market look like to the lay person? Talk to me a little bit about that and how that’s impacting your business and then a little bit, you know, more globally than that. Cause I don’t have an understanding. I don’t think a lot of the listeners have a full understanding because we’re still waiting for that, you know, silver bullet of what’s going to cure all this, what’s going to bring it to an end. But what does that look like for you today?

COVID-19 Medications

Steve Hoffart: (37:56)
Yeah, so right now we’re pretty lucky in Texas. I mean, I think geographically many Texans are spread out, so that kind of helps prevent the spread versus like a high dense area like New York. So we really haven’t had a lot of coronavirus positive patients get prescriptions yet. I will tell you for the first two or three weeks, the supplement run was incredible. I have never sold more supplements in my life. We tried to put together a list of what the latest science was saying that’s been updated four or five times. So the supplements have been our biggest seller so far. We did see the studies early on, weeks before it was ever mentioned by the white house about hydroxychloroquine. So we did stock up on that and it’s probably a good thing because soon after that happened, it all got wiped out. So we actually have a stock of that now. Through the wonders of PCCA, they were able to get us hydroxychloroquine powder. So if at some point we run low in our commercial available stock and it’s still unavailable, we then will have the ability to compound. The FDA would, you traditionally can’t compound something that’s commercially available, but in this case, the FDA this week, put that on the list that says if it is commercially unavailable from your wholesaler and patients need it, you have the ability to compound it. So that’s one of the really neat things that’s going on, that’s going to allow us, I think, moving forward to be able to fill a void. Once again, we saw a kind of a hoarding of medications to a point by practitioners when that first went out for their protection of their families at all, which that was a little bit of a challenge, not to like make practitioners mad but let them know, look, this needs to be kept for patients that are going to need it in a time of need. We don’t want to deplete our supplies just by people stockpiling it and affording it. So that was a little bit of a challenge at first. But we have the medications. I think we have a lot to learn. We need to have some good quality trials. I am to the leaning, I’m on the wellness, health type side that says at this point, you know, some of these do have some data. If somebody is critically ill, we need to do something. I’m more the fact, I think some of this is maybe safe to try as long as it practitioners are following all the protocols. But, the challenges is some of these drugs are very expensive drugs. They’re orphan drugs, they’re drugs that aren’t readily available. So that’s going to be the other challenge that we have. I do think we’re going to learn a lot more over the upcoming weeks cause some of the trials going on. But I do think we do have the ability to repurpose drugs and find solutions at least to hopefully mitigate some of the damage that this coronavirus does to the body.

Scott Vondeylen: (40:29)
Yeah, that’s as you mentioned, there’s so much. I mean, all you have to do is turn on the television, right? There’s so much information out there and whether you listen to Fox or CNN or you’re listening to a podcast or which doctor you might be tuning into our website, you’re going to, you know, there’s just, it’s so overwhelming and you’re not sure what direction to turn. And you mentioned right, that now everybody’s wearing a mask or just, you know, a week ago, maybe not, not everyone was taking it that serious. And I, you know, I happened to go out to the grocery store because I had to, just a few days ago, to stockpile some additional groceries after my two and a half weeks supply ran out for my family. And, I think I was the only guy not wearing a mask. And so, you know, that’s become the norm. And so this thing does continue as you mentioned, to evolve. You know, before I wrap this up here, Steve, I just wanted to give you the opportunity to kind of speak as well on any other topics or point out to any other additional resources where patients or pharmacies can go during this time.

Using Social Media

Steve Hoffart: (41:37)
You know, I think one of the greatest things is if you’ve got a local pharmacy in your area that’s got a very robust social media page, you laugh. But there are some pharmacists doing some phenomenal things on social media, getting the word out, doing Facebook lives, providing local information like from their community County situations from their States. That’s one thing. If you have that pharmacy in your area, I think that’s a great place for patients to go. I think us as pharmacists, I will, I have to say the cdc.gov site has done a great job about getting additional information, updated information out there. So that’s one of the places that I go a lot to pull a lot of the guidelines in terms of cleaning, if somebody turns up positive, proper ways for mass, things like that of using mask and reusing mask and stuff. The other thing is too, I found out today too, ASHP has put a lot of their COVID-19 resources out free. They’ve got some phenomenal references regarding some of the latest information, drug treatments, therapy trials that you can get and access free. That’s another place. I’m not gonna lie, I’m all over the internet. I try to go to pub med or Google scholar on every couple of day basis. I type in COVID-19, and I sort of buy the most recent and I just start reading. I am kind of a book nerd. I like to learn, I like to have the latest information. And so that’s typically what I’ll do. And I just, I’m on some really great sites with other pharmacists that I think are good. I’m on a COVID-19 position group, so there’s a lot of great share. That’s the awesome part about social media nowadays. Don’t get me wrong, there’s a lot of garbage out there, so you do have to pick where you go, but there’s some really awesome sites, have some great information share among my pharmacy colleagues and physicians to really educate ourselves and stay up to date on what’s going on.

How Pharmacists Can Get Involved

Scott Vondeylen: (43:29)
Thanks for sharing that. And I did have one other question for you as well. You know, not every pharmacy is a compounding pharmacy. We know that, right? I don’t know what the exact percentages according to NCPA or other organizations, but in not every pharmacy wants to necessarily get involved with or is even set up for providing the testing for COVID-19. But what in your opinion, do you think other pharmacies that aren’t a compounding shop that can’t create hand sanitizer right inside their businesses, that don’t have testing kits available to them because there is a shortage or they’re just, they’re not set up, you know, as an organization to mobilize, to be able to do that. How else can pharmacies get involved right now And try and do the right thing or have an impact during this period of time?

Steve Hoffart: (44:21)
That’s a fabulous question. I honestly think our worlds have changed to a point that the way business looks now, it’s not going to look the same when all this is over. And you’re right, every pharmacy in their community is their own unique individual personality, services they provide. And you’re right, not everybody provides the same thing. Testing is one thing that I believe is something that could be useful. If your staff and you’re comfortable with doing that and you have the ability to do it so you can protect your staff and it doesn’t increase risk. I know there’s a lot of controversy on that, I have a business coaching friend that brought up something the other day. We saw a peak in business and I think we’re going to see a little bit of a fall of business over the next couple of weeks. And I think what every pharmacy needs to do with downtime is versus sending people home. We only had to pick up the phone and call 15-20 of our customers a day and ask them how they’re doing and ask them what we as a pharmacy can provide to them. What are their needs right now? Because that’s an awesome thing that pharmacy has ability to do is fill the gaps we’re the most accessible healthcare providers that’s available. And we need to use this opportunity to let the public, and especially our patients know, Hey, we have a lot to offer. And you’re right, it doesn’t have to be a compound. It can be a bias. It could be supplement recommendations. It can be a new service that we don’t even know exist or exists today that Hey, maybe we ought to start providing it. And that’s something that I want to do because some of these things, how we’ve changed our business today are going to shape what our businesses look like tomorrow. And I think that’s different for every single pharmacy, like you said, because we each have our own unique set of skills and practice sites and abilities to do it. We can do. And I do think that’s one way that I know we’re going to. We’ve kind of seen our Monday, Tuesdays are real busy. Our Wednesday, Thursday, Fridays fall off, we’re going to start assigning technicians to pick up the phone and call some of our patients, ask them that one, let them know you’re there and you care. But two, is there something we can do to help you out right now that would make your life easier? And that’s where pharmacy I think will really fill the void and come through as a shining light and all that.

Scott Vondeylen: (46:23)
Yeah, I couldn’t agree more. I mean, we know the statistics, right? The average patient sees their pharmacist five times more, if not greater than that, then they see their primary care physician. And we’ve always said that you guys truly are the front line of healthcare because of that right there, the relationship that a pharmacist has with a patient is above and beyond that. And no knock on any physician that may be listening, they obviously have their place and do an incredible job and managing patients as well. But the fact is that patients, either a pharmacist are far more frequently and those recommendations are absolutely critical when you talk about asking for OTC recommendations or alternative medications or whatever it may be. So another couple of places that I just wanted to mention as well to the listeners in terms of resources is first of all, we’ve got the PrescribeWellness Blog, so prescribewellness.com click on the blog. We’ve got just dozens of links to other resources. Some of the ones that you mentioned, Steve, around CPESN and NCPA, the FDA, the CDC, APhA, and many, many more. And so, you know, really want to wrap this up. I know you’re an extremely busy man right now. And you’ve probably got some additional webinars to catch you up with the latest information on COVID-19 over the last 24 hours because I know you were working today at your pharmacy. So Steve, I want to thank you so much for being here on episode three of PharmacyNow. This was absolutely fantastic, an episode that is just chocked full of information during such an important time for pharmacy and for their patients. You are not alone, my friend. We have, you know, 22,000 independent pharmacies out there as you know, that are fighting this battle. And you are definitely in the top tier there. And so I hope this information can be utilized and repeated by your colleagues out there to also find success and to serve their patient populations in their communities to the best of their abilities. So thank you so much, Steve Hoffart for your time and yeah, you know, best of luck down there as we continue to fight this battle in Magnolia, Texas at Magnolia pharmacy. Thank you so much.

(48:50)
Thanks for having me.

(48:51)
Thanks Steve.