Pharmacist and Pharmacy Owner, Chris Antypas, breaks down the future of pharmacy and the challenges facing community pharmacy.
Introduction & Opening
Speaker 1: (00:02)
Helping pharmacies grow themselves, their business and driving outcomes. This is PharmacyNow. I’m your host, Scott Vondeylen.
Speaker 1: (00:23)
All right Welcome to this episode of the pharmacy now podcast. Excited to be joined by our special guest today, Chris Antypas, who is a pharmacist and pharmacy owner out of Pittsburgh, Pennsylvania. And a longtime friend of both myself and, uh, here at PrescribeWellness. So Chris, uh, wanted to first of all, welcome to the show.
Speaker 2: (00:45)
Thank you. It’s a pleasure to be here.
Speaker 1: (00:48)
And so I wanted to give you the opportunity to give us a little bit of background on yourself. I know we’ve talked many, many times, and you are a pharmacy and a pharmacy owner of course, but if you could give us just a little bit of background on your resume, where you came from and where you’re at today.
About Pharmacist and Pharmacy Owner, Chris Antypas
Speaker 2: (01:03)
Sure. So, um, yeah, absolutely. So yes, I’m a pharmacist and I am from the Pittsburgh region, Southwestern Pennsylvania, born and raised. I’m a graduate of the University of Pittsburgh School of Pharmacy. And I’ve really, I’ve been in the pharmacy world since I was just starting out in high school. Um, my freshman, sophomore year, uh, started working at a local pharmacy, Jeffrey’s Drugstore in Canonsburg, PA, also known as gun town for those that are interested in meaningless trivia. Uh, and then, uh, made my way through high school into pharmacy school with, a desire to really stay in the community, independent pharmacy world. So I had my eyes set on owning a pharmacy as soon as I graduated, knowing that that’s exactly what I wanted to do. Uh, just out of pharmacy school though, I, I had an opportunity to work at an independent pharmacy down in Florida and I did so for a little under two years, uh, while I was waiting for an opportunity to purchase a pharmacy in the Pittsburgh market. Uh, and then an opportunity popped up and I moved back to Pittsburgh and ended up buying half of Asti’s South Hills pharmacy in the Mount Lebanon part of town. And, uh, since that point, you know, really have focused on doing as much as I can in the pharmacy world. So as DS has grown into a pretty sizeable pharmacy, we’re filling, uh, you know, 800 to 1200 prescriptions a day. We’ve got a pretty sizable workforce, over 50 employees. We have extensive delivery service. We do a lot in the pharmacy world. But in addition to the retail pharmacy that I own, uh, have a longterm care pharmacy that services facilities in the region. And we also have a specialty pharmacy that’s licensed throughout the country and credited, uh, in getting into the specialty pharmacy space and, uh, you know, heavily involved in CPESN, in the Pennsylvania network. I’m involved in our state pharmacy association as a board member. I also do employer benefits consulting. So, I mean, we’ll talk about some of these things, but really the point is that I try to do as much as I can, uh, in, in the industry to stay informed and to also help shape the future of our profession.
Speaker 1: (03:27)
Fantastic. I love it. Thank you so much for that overview of things that you’re currently involved in. And I do want to dive into a lot of those things, but I do want to ask just some basic questions up front and you talk about going to the university of Pittsburgh where you graduated as a pharmacist. Why Chris, did you decide at that point in your life, what was the main reason that you wanted to be a pharmacist?
Speaker 2: (03:53)
Yeah, that’s a good question. I actually don’t know that I have a good answer for you. I can tell you that there is a document that records, uh, something that I wrote in third grade that says when I grow up, I want to be a pharmacist and I want to live in a mansion with my brother behind my parent’s house. Uh, and half of those things are true. I’m a pharmacist, although I don’t have, I don’t live in a mansion and my brother’s not a Pittsburgh, unfortunately. Uh, but my father is actually a graduate pharmacist, uh, from the university of Damascus in Syria. Uh, and while he never practiced pharmacy in the States, I just can assume that my interest in pharmacy, uh, was through his profession. He spent, you know, 35 plus years in pharmacy industry, uh, in the manufacturing side. And, uh, so I was really just dead set. I knew before high school and during high school that I wanted to be in pharmacy and I was pretty clear in my, you know, in my desires that I wanted to own a pharmacy and kind of control my destiny and control the experience that was had within my operation.
Challenges Facing Community Pharmacy
Speaker 1: (05:04)
I love it. I love it. Absolutely. And, uh, so pharmacy has really become or has been and still is the family business. So talking about, transitioning here for a moment, you know, working, I am not a pharmacist but had been working in this industry for right around 10 years, was in the longterm care space before that, had some exposure to pharmacy. But there’s a lot of challenges going on right now in the world of pharmacy for everyone. And when I say everyone, um, as you mentioned earlier here to listeners, you are an independent pharmacy owner, so you own your business, you own your pharmacy. Um, many of the listeners out there may be familiar with the big box stores of Walgreens or Target or CVS. There’s roughly 60,000 pharmacies in the United States as we know, and around 22,000 that are independently owned and operated pharmacies. So you’re in that segment, lot of changes going on in pharmacy right now. But want to dive in for a minute, specifically when it comes to independent pharmacy, um, what are some of the challenges that you guys are facing right now?
Speaker 2: (06:07)
Yes. You know, there’s, every business owner, you know, has challenges that they face. It’s, that’s the beauty of the American dream and the economic system that we operate in. And you can go on your own way and start a business and it’s not easy to do that. There are obviously risks involved and you’ve got to bring something unique to the market. But in pharmacy, we do have our own set of unique challenges that I would say, uh, go above and beyond what, you know, the standard business owner has to face. Um, you know, we have our fair share of regulatory issues where we’re, you know, regulated by federal agencies, by state agencies. Uh, and you know, we have boards of pharmacies that regulate our profession, federal controlled substances, the DEA, et cetera. The list goes on really. Uh, and you know, the biggest challenge is that the reality that we offer, we dispense medications, right? In, in many cases I have, I’ve compared what goes on at a pharmacy to a vending machine, right? You’ve go to a vending machine, you put in a piece of paper, your money, uh, and out of that vending machine comes a product and you walk away from that vending machine and enjoy that product. Uh, pharmacies have, you know, the industry has been really the paradigm today is that we are a commodity industry where you come in and get a product and you walk out with that product and hopefully you’ve been told how to use that product accordingly. But the reality is that there’s a lot more that goes into medications than just actually just receiving that product in your hand as a patient. So, uh, we offer a significant number of services and education and, and ways to improve medication use. And to tie this back to our challenge, the challenge is that the economics of our business are solely focused around product. Uh, and that doesn’t leave a lot of room for us to do as much as we can. On the other side of that, without some significant risks and as our economic challenges Mount, you know, everybody’s concerned about drug prices and we’re getting squeezed from those organizations that we have to contract with pharmacy benefit managers. Uh, and that narrowing of the, the compensation for the products, uh, and the margin there with it makes it really difficult for us to do all of the great things that we can do. So that’s probably as few words that I can use to articulate that it is an economic challenge that we face. But it really encompasses so many more things cause it’s not just about making more money. It’s about being able to cost justify all of the other things that we can do to help improve the health of the people that we serve.
Speaker 1: (08:54)
Yeah. So hear you loud and clear there Chris. And what I hear you saying, right, it’s a commodity business. Um, you’re a dispensary of medication. You give the great analogy there of, you know, putting your money into a machine and getting a product back. But of course knowing how to use that product properly, especially when it comes to medications that we’re putting into our bodies. So the margins are being squeezed. That side of the business, it’s harder to make the same money that you were maybe making at one point on the dispensing side of the business. So it sounds like to me that you’re trying to make up for some of that. On the other side of the business, whether it’s front end merchandising, OTC products or perhaps getting involved in, you know, non dispensing services. Um, that I, that I want to dive into here as well a little deeper. Um, but before I do that, and again, I appreciate the outline there of some of the challenges of pharmacy. You’re obviously very, very passionate. You talked about it earlier, graduating from school, you had some goals in mind, you wrote them down on that piece of paper when you were in the third grade, I believe you said, um, and some of them came true and some of them you’re still working on, but what are some of the things that you feel independent pharmacy, uh, has gotten right or, or is doing correctly over the other, you know, 40,000 pharmacies that are out there today that are not independent pharmacies? Because I know in talking to a lot of independent pharmacy owners, they’re passionate about their business, but more importantly they’re passionate about helping their patients. But if you could kind of elaborate on that, what do you, what do you think it is that you guys are doing doing right these days?
Speaker 2: (10:23)
Yeah, I think that, you know, across the board in the industry there is, there’s definitely a dynamic. There’s, there is, there’s a pharmacist that really does believe in their ability to make an impact. Uh, and then there’s a pharmacist that doesn’t, or they just don’t embrace that. So, you know, when I look at what’s right in the industry, I see it every day. I get to experience it every day. I really view the position that I’m in as a community pharmacist and especially a pharmacy owner, it’s a position of privilege, right? We’re privileged to have the opportunity to take care of other people and be paid to do it. Uh, there’s not a greater feeling in the world. I mean, there are very few, right? I won’t say it’s the greatest, but there are very few that are greater than the, the feeling that you get when you, you’d have somebody that you’ve serviced in some way, giving them medication, solving a problem for them, that the, the sincere gratitude that they relate to you for your help, like the feeling of helping somebody, uh, is a profound feeling. And it’s truly rocket fuel, I would say for thousands of pharmacists throughout this country. Uh, and it’s a feeling that you can only really appreciate if you’ve been involved in delivering care, uh, that is impactful. So, you know, I know that in, you know, any, any town USA, right? Pick a community. I’m sure there’s a pharmacist in there, whether they work at a chain or not. I mean, the, the independent pharmacy is easier platform for this kind of impact to be had. Uh, but regardless of the setting, you’ve got pharmacists that are really making an impact in the lives of other people. And I think that’s a tremendous thing. I think it’s a privilege as I’ve said. As I see it, I think that it’s something that we need to find a way to perpetuate, to ensure that that continues regardless of what’s happening, uh, in the world of economics and shrinking you know, margins of the industry.
Speaker 1: (12:18)
I have a, on a side note, I’ve got some immediate family actually that are nurses and I’ve always been extraordinarily passionate about being able to have interaction with patients and that daily feeling of truly having an impact on other people’s lives. Um, and in the same obviously is true for independent pharmacies and their owners. One of the things I want to ask, you know, we’re talking about some of the challenges right now in the industry, Chris, and you’ve gone over a few of them. And I know there’s many more in some of the other owners that I’ve talked to and executives throughout the, uh, industry, DIR fee shrinking reimbursements, right? The, the, the game is changing, the rules are changing. We, you know, you hear rumors of Amazon out there on the horizon trying to take over now, uh, you know, dispensing of all medications and perhaps delivering medications, uh, by drone one day. Um, but what do you think right now is the difference between an owner who’s going to continue to thrive and make it as an independent pharmacy and be able to continue to serve that patient population in that community today and one who ultimately is not going to be able to make it in this competitive landscape?
Speaker 2: (13:31)
Yeah, so I mean, it’s, it’s not, I don’t believe that this can be isolated down to one thing, right. But I do feel that there are some core principles that have to be met in, in my opinion, for a pharmacy and the pharmacist to be able to, uh, thrive. I mean, I think a lot of pharmacists and pharmacy owners are just trying to survive. You know, I’m connected with message boards and other groups. I mean, it’s truly, I mean, it’s heartbreaking to see what’s going on out there in the industry. I think sadly, uh, things may have been a little too easy in recent history for someone to own and operate a pharmacy business and, and make it, I think that, uh, you know, the contraction in the market has resulted in those that were not really very fit pharmacy owners. They weren’t really managing a PNL effectively. There were passionate people that care about their patients, but they weren’t strong. Uh, on the business side, those are individuals and businesses that are, that are really struggling today. And I would say that a necessity is to really, you know, hone in on some of the key elements on the contracting side and those elements that’s, that can’t be ignored. But what I will say is that we are in an, in a healthcare climate that is, it’s truly a necessity to have improved clinical outcomes to achieve clinical outcomes. Not even improve, but to achieve a clinical outcome whereby, you know, thousands, millions of people are prescribed diabetic medication with an ultimate goal of reducing their A1C. Because when you reduce A1C, you improve blood flow and you reduce the likelihood of kidney damage and you know, small blood vessel damage and neuropathy and all these other things, uh, and we have not done a great job as a healthcare system ecosystem to really have any level of accountability to that outcome. And so now as healthcare costs are rising at an unmanageable pace, there is a clear cut need in the industry to have providers of any kind that can achieve a clinical outcome. And so while there are many folks that are just pharmacists, the pharmacy owners that are just consumed by the, what I would call whining and complaining about things that are outside of our control, I mean we can fight to an extent reimbursement challenges, but I will say that that is far more difficult of a fight than it is to ensure that your patients are taking their medications, they’re taking them correctly and that they’re achieving a clinical outcome, a desired clinical outcome. And that if they’re not achieving that outcome, you as a pharmacist, as their pharmacists are doing something about it. Uh, and they’re to me in lies the key ingredient to get us way past survival and into a place where we are thriving as key contributors to our healthcare system, uh, in ways that I don’t believe other healthcare providers are even capable of doing. While on one hand it’s, it’s easy to get hung up and caught up in the, in the challenges that we face. I am multiples times more encouraged by the position that we are in as pharmacists to be able to influence an outcome and then truly be recognized by the system for that contribution, both with the gratitude that we see from our patients as well as the potential, you know, financial benefits, uh, that are only a portion of what we’ve contributed to production in healthcare costs.
Speaker 1: (17:19)
So it sounds to me, Chris, like your saying that everyone in this industry should probably spend more time focusing on finding a solution as opposed to looking at the obstacles in front of them.
Speaker 2: (17:31)
I mean, that’s not easy. That’s not easy, right? Let’s get real. I’m not living in a dream world. I know that you have to tackle the issues that are in front of you, but to completely ignore the fact that you have, you know, you have power as a pharmacist to influence an outcome and that outcome matters. Uh, I think that that’s a really a foolish approach and we can do better than that.
DIR Fees – What Are They & The Challenges
Speaker 1: (17:55)
Yeah, I agree. So for the lay person out there who doesn’t have any experience in this industry, can you in a nutshell explain to the listeners what exactly is a DIR fee and how does that impact your business?
Speaker 2: (18:13)
Yeah, so I mean that really, you think of any concept in pharmacy, most of them are, are they have seven or eight extra folds in them that you have to open up to really understand what’s going on. But you know, a DIR fee is a retroactive fee that pharmacies are paying. Uh, that is a calculation based on factors that may or may not be in the pharmacy’s control, such as the percentage of generics that you dispense, uh, or the adherence to medications of your patients. And it’s a fee that comes after the fact. So when we dispense prescriptions, right, again, we’re in a commodity based industry at least at this point, if to a high degree, meaning, uh, we’re a retail shop, we buy product for X and for us to make money, we have to sell that same product for X plus an amount. Uh, and you know, in the pharmacies I said, I have, you know, some days over 1200 prescriptions I fill in a day, but let’s say I filled a thousand prescriptions today. Uh, those, that’s a thousand transactions that took place and I need to ensure that all of the product that I sold, I actually purchased for less than what I sold it for. I mean it’s a pretty simple concept and you think, I think you buy the person who sell it to you had to buy it, pay less than what they sold it to you for. Uh, but what’s challenging in the pharmacy world as it relates to DIR is that for some of those prescriptions that we dispensed, um, the pharmacy benefit manager, the organization that’s responsible for contracting and facilitating payment to the pharmacy, uh, they have some methodology by which they determine a quote unquote performance level of the pharmacy and a prescription that, you know, let’s say it had a $20 gross margin on it, meaning I sold it for $20 more than I purchased the product. Uh, I could have a fee, a DIR fee that could be $50 for that transaction and that would render that prescription $30 at a $30 loss. And Oh, by the way, uh, that fee comes, is levied on my account months later. So I oftentimes don’t even know which claim it was attributed to. So it’s a very convoluted, complicated, uh, scenario that if I were to draw a comparison to it, uh, you know, and I’ve had multiple conversations with individuals about, you know, grocery store or a hardware store. It’s like you buying $100 worth of groceries from your local grocery store, uh, that, you know, I’m the grocer, I sell you $100 in groceries, but two months later somebody takes $30, the amount of money that I collected from you as a customer and now I’m left with a negative transaction that renders a business to not be functional.
Speaker 1: (21:11)
Yeah. So that is unbelievable to me. And I don’t know how, what was just explained as a business owner, you can accurately then forecast, uh, your quarterly annual revenue, um, based on your output of, as you mentioned, prescriptions and your case that if somebody is dipping back into your bank account or your pocketbook months after the fact, and you’re saying that that’s based primarily on performance or you called, you said adherence. So the amount of medicine that the patient is taking versus what they should be taking. Um, and then there’s some sort of score that’s put together behind the scenes by the PBM or pharmacy benefit manager and then they dip into your pocket a couple of months later and they take dollars out of your bank account.
Speaker 2: (22:01)
That’s essentially right. Yeah. So it’s, it’s factors that are, in some cases I would consider the patient taking their medication correctly defined as medication adherence. Uh, I would argue that that’s something that is somewhat in the pharmacy’s control because we can monitor for that. We can do something about it there. And that unfortunately, is the smaller percentage of those fees are based on adherence measures like that. There are other measures that have nothing to do with my individual pharmacy. It’s, uh, it’s quite astounding. And every time I’ve talked to legislators, I’ve talked to other business owners, individuals in my community, uh, the response, the single response that I get that is consistent from all of those sectors is that can’t be correct. That can’t be right. Uh, but it is a reality. It’s something that we face. And sadly, those DIR fees do increase drug costs for Medicare beneficiaries. In addition to causing significant financial hardship for the pharmacies that are dispensing meds.
Speaker 1: (23:05)
I just, it really is unbelievable when I have had this conversation with many others throughout the industry, but a, again, and we’ve just told the story that, you know, how can you really run a business, um, without being able to predict how much money is possibly going to be taken away from you, um, by some arbitrary formula. It’s gotta be incredibly frustrating for you and for all of the owners and independent pharmacy who are fighting against this. Tell me what is there, is there some hope? Is there some light at the end of the tunnel? Is there legislation that’s pending? You know, what, what do we do? What is the industry, what are those 22,000 independent pharmacies doing today to try and combat that and, uh, and hopefully reverse that trend?
Speaker 2: (23:53)
Yeah. So they’re, I mean, they’re absolutely all at all times, both at a state level and a federal level. This is a federal issue. Uh, so it’s being addressed and really battled at the federal level with both, you know, Congress and introducing of legislation that that would address this as well as, uh, CMS and, you know, working with the department of health and human services to issue rulings that certain things have to be applied at the point of sale. Certain fees have to be applied at the point of sale. And so there’s a lot of advocacy that’s going on there. NCPA obviously is leading the charge for the independent pharmacy contingent, but it’s, it’s beyond NCPA. Uh, and it’s really all pharmacies are facing these challenges. If you are, uh, you know, dispensing medications and billing Medicare, you’re subject to DIR. And so this is a unified issue that’s affecting pharmacies. But that, as I said, is, that’s a difficult battle, number one. So anything you talk, any issue that we try to address legislatively, uh, these are not issues that find immediate resolution. So, uh, I don’t think that that strategy alone is sufficient. Okay. And the point about how can any business survive when that’s going on? You know, a part of me, my, my real, my realistic side, my taxpayer side is to say, well, you know, it’s not, I mean, that’s the issues that face the industry. Everybody’s facing it. It’s, you know, why, why should I care if that pharmacy doesn’t make it? There are a bunch of other pharmacies you can go into. Uh, but the key, the very key ingredient here is that what pharmacists and pharmacies are doing, especially most notably independent pharmacies, uh, the services that they’re providing and the access to care that they are bringing to individuals, uh, is, is something that is not really truly recognized in the healthcare world. And the cost to lose a community pharmacy an, independent pharmacy, uh, is it could be significantly impactful to the community of individuals that are living in and around and being serviced by that pharmacy. So there is a reason for many other parties to be interested in addressing the issues that are plaguing independent pharmacies. Because if an independent pharmacy closes or sells, it’s not just sad. You know, the independent business owner didn’t make it. Uh, there are some serious consequences that can, that can happen downstream to really, uh, patients that are underserved, that rely on home delivery or the personalized care to get access to their medication or the other clinical services that the pharmacy is offering that keeps them out of the hospital. So, I mean, this is a very complex subject, but I can tell you that they’re, the interests expand well beyond just the pharmacy owners themselves. The entire communities really need to be concerned about addressing these sorts of problems because, uh, community pharmacies play a massive role in the healthcare of those that live around them.
Speaker 1: (27:04)
Yeah, I hear you on that as well. I grew up in rural Ohio and I remember as a, as a child when we grew up, we went to an independent pharmacy still there today. And I remember as a young boy walking in and, uh, my mom buying products for us as kids, OTC products or perhaps, uh, picking up, you know, the occasional prescription, but talking to that pharmacist behind the bench and having conversations with him around, you know, medications that she’s giving her children and, and really getting that consultation and advice is a trusted healthcare advisor, more so than I ever remember her getting information from a primary care physician or my pediatrician. It was always the pharmacist. I feel as though we went there almost once a week to stop in for different things. Uh, my mom, you know, struggle with some, some headaches and migraines and things of that nature. So we were always stopping to the pharmacy. Right. Um, and, uh, you know, if that pharmacy had not been in business and to what you’re alluding to, I don’t know where we would have gone. Um, and because even though there are some larger big box stores in my hometown, uh, outside of, again, rural Ohio outside of Cincinnati, um, if you go just 10, 15 miles further out from where I grew up, there’s nothing there. Uh, and there is a, there is a population that’s serviced, uh, by some other independent pharmacies that I’m aware of and if they close tomorrow, to your point, and I’m not, you know, the expert on this, but I don’t know where they would go, uh, to continue to get their medications. And so, um, yeah, I can see that having a real impact on potentially millions of Americans, um, if, if some of those pharmacies were to go out of business. Now I do want to ask another question. Chris, you mentioned something there that really peaked my interest. I’d like for you to speak to, uh, for the listeners here. You mentioned getting involved in additional services. I know from some of the facts that I have here in front of me on this sheet that it says independent pharmacies, over 80% of them now offer immunization services. I don’t know if a lot of, um, you know, patients are, or Americans really know that they can go to their local pharmacy or independent pharmacy and get a flu shot. Um, but what other services outside of immunizations, I think that was a big step, but according to some of the experts I’ve talked to, a big step forward for pharmacy to be able to offer immunization services to get that legislation passed and to get that licensing, you don’t have to go to a doc now you can have a standing order and a CPA in place to provide immunization services to patients. But what other services, um, on top of immunizations are you already involved with or thinking about getting involved as you guys move forward?
The Future of Pharmacy
Speaker 2: (29:43)
Yeah, so I would agree. I think immunizations really were a jumping off point for awareness of additional healthcare services that you could receive in a pharmacy. Uh, but I will tell you that the, the additional services outside of immunizations, they can be quite profound. I mean, and they can, there could be so many of them. I mean in our pharmacy alone, uh, we offer home delivery, uh, which, you know, some of the big box pharmacies are getting into that. Some are charging a fee, some are using the postal service. Uh, but home delivery for homebound patients is a pretty critical service to offer. Uh, in addition to home delivery, clinical medication synchronization, which is, uh, the act of organizing a patient’s medications all to be filled on the same day, uh, but more than just organizing them to be all filled on the same day. Uh, our pharmacy team contacts those patients in advance of when their meds are due. So if I know your meds are all do together on the same day on January 1st, and I’ve given you a 30 day supply of medicine, I know that if you’re taking all of your medicine, you’re going to be needing your medications on January 31st. Uh, so if I call you at the end of January, let’s say the 23rd or 24th, and I say, Scott, you’re due for your meds. Uh, can I get them ready for you? I can deliver them to your house or where I can have them ready for pickup. And you as the patient are saying, well, you know what, I actually have a couple of weeks worth of my medicine left or I have a couple of weeks of my cholesterol or my diabetes medicine left. I’ll get everything else while I know that something’s not quite right. And that can trigger an intervention to you to say, Scott, what’s up? Are you not taking your cholesterol medicine? Uh, you have taken your diabetes medicine? And because I know you and I have a relationship with you as nearly all independent pharmacies do with the vast majority of their patients, uh, you’re going to be honest with me and tell me that you, you know, you don’t take that because you don’t like the way it makes you feel. And as a result, I can then have a moment of intervention to say, Scott, I appreciate that. Uh, but I can tell you that it’s really critical that we keep your cholesterol under control so that God forbid in 10 years you don’t have a heart attack or maybe two years for five years. Uh, and we can then work to a solution where we can either change the drug, change the dose, but we ultimately get you on the right track. The power of clinical medication synchronization is profound. And if you think of the impact that can make, multiply that by a hundred when you utilize our adherence packaging service whereby we not only sync your meds together and get them ready for you at the same, you know, every, every 30 days. But we are now packaging your medications where all of your morning meds are packaged together, all of your afternoon, your evening, your bedtime doses are all packaged. So now you don’t even have to look at your bottles. You simply just need to punch the hole through that blister with all of your morning meds and take them in the morning before work or before your day of whatever it is that you’re going to do that day. And, uh, the adherence packaging service has a monumental impact on a patient’s ability to take their medications correctly, take them every day, not miss doses. And those are just a handful of the services that we offer. I mean, I, I could occupy the entire time with you talking about the services that we offer, like comprehensive medication reviews like diabetes, self management education or our diabetes prevention program or smoking cessation or opioid utilization management program. The fact of the matter is this, as I’ve stated, our patients and our communities need to be healthier for their own benefit and also for the benefit of a system that can’t afford to continue to pay for people to be unhealthy. And so we have made a concerted effort to do anything and everything we can to improve their use of medication, reduce the bad things that happen from medications, and ensure that we are being accountable to achieving a desired outcome of whatever it is that they’re putting in their body.
Speaker 1: (33:58)
That’s great. And, uh, another, you know, thing that I can relate to there, Chris and you talk about medication synchronization. Um, and really the overall, um, impact that, that can have on a patient’s outcome. A family member of mine, my mom actually who was diagnosed with multiple sclerosis back in 1994 and has been on, I don’t even know how many medications, uh, since then and to this day. And, and she goes to a pharmacy that does not offer medication synchronization, which means that she’s going to her pharmacy four, five, six times per month, depending on how many, you know, OTC she’s picking up and, uh, on top of her regular prescriptions. And she, I think like a lot of patients has the little pill box, you know, with the, the Sunday through Saturday, uh, you know, seven day pill box and she sits down on Sunday nights, um, and sorts through all of her medications. Brings out the bin. The basket is a, we call it, they’re the basket of meds and sits down and counts on all of her tablets and her pills and puts them in little piles, if you will. And then puts those into the, into the pill box. And that’s what she’s done now for, you know, since 1994, so, however many years that is. And I’ve watched her do this. Plus she has injections, which is separate, right? She’s taken in the past, uh, for uh, to try and um, you know, put, uh, the multiple sclerosis and readmission, you know, with thinking about that and having that close personal connection to a patient, my mom who had that experience growing up, the fact that she could go into a pharmacy like yours once a month to pick up all of her medications and they’re already prepackaged, would have been life altering for someone like her. And so I would assume that’s the experience that you’re having as you’re syncing these patients. And then of course the added bonus of having a monthly conversation to see how they’re doing.
Speaker 2: (35:49)
Yeah. It’s, I will tell you that it is life altering. I could produce hundreds of videos of customers. Fact, one example is a patient, a family, they actually live not too far from where my parents’ home is. So my dad, he’s one of my partners here at the pharmacy and we work together. He delivers their medications to them and he would, prior to us getting them enrolled in our adherence packaging program, he was going there once a week, the gentleman’s a heart transplant patient, he’s probably on 18 medications. Uh, and most recently my dad sat down and they’ve been on our program for at least 18 months now. Uh, and they pulled him into the house that he can’t make a delivery without spending a half hour in patient’s homes. And I’m in the same boat. I make multiple deliveries every night. I have a stack of deliveries to take on my way home here this evening to engage with my patients and really make that connection and stand up, stand out from, their other options that they have to get their products. But this particular gentleman, just a few weeks ago, was literally in tears sitting at his table, holding my father’s hand. Uh, just expressing gratitude after gratitude and just literally sobbing to him to say like, I wouldn’t be alive if you did not help me. And I can tell you it’s, I couldn’t do it justice on this podcast. Even a video probably couldn’t do it justice. The feeling that you know that you’ve helped somebody in that way is a pretty unbelievable feeling. And I think it’s, as I said, that we’re in a privileged position to be able to do these things. So I don’t know, I not only think it is the right thing to do, uh, from a business perspective, but it is, I think we have a responsibility to do these sorts of things.
Speaker 1: (37:43)
That’s awesome. I, uh, I got chills hearing this story. Um, you know, having that kind of, again, that type of an impact on anyone’s life. And you are so fortunate because of the profession that you’ve chosen and your father obviously being involved following in his footsteps and your brother. And it’s amazing to be able to have that sort of impact on another human beings and helping them. And so, uh, and again, just speaks volumes about not just your pharmacy, but how important it is for independent pharmacy, I would say, uh, to continue to thrive as a whole. So Chris, another subject I wanted to talk to you about, we talked off the air. Uh, you have been involved in some pharmacy consulting, uh, here recently and I, it was very, very intriguing to me when you kind of gave me the brief overview prior to getting on the air here, uh, specifically around employee benefits. And you’ve been working with a group, uh, called Henderson Consulting, uh, out of your area there in the Pittsburgh area. If you could go into some details and share with our listeners what exactly it is that you’re doing.
Speaker 2: (38:51)
Yeah, so Henderson Brothers is insurance brokerage and consulting firm located here in Pittsburgh and a little over a year now. I have been close to a year and a half. I’ve been the director of pharmacy solutions. So going back five years prior to my time at Henderson Brothers, I, you know, I look at the world and I, I say, you know, times are tough. What can I do about it? And just like, I have the position of, uh, conducting enhanced services to improve outcomes and, and prove to health plans and, you know, Medicaid plans. And CMS that, uh, pharmacies are needed, not just because we’re, you know, being mistreated. We’re needed because we can help people. Uh, the same, same concept, uh, is when, you know, I, I made the same approach towards a commercial space and to employers because they too are funding healthcare, uh, and they’re also interested in reducing costs. So five years ago I made an effort to become an expert in employer benefits and pharmacy benefits consultant and I started talking to employers and talking to brokers and that led me down a path where ultimately I established enough knowledge and experience in the space where a brokerage firm wanted to bring me in house to be their expert on pharmacy. So for the last year plus I have been working with medium and large sized employers in the greater Pittsburgh region and I’m helping them to determine what benefits structure they should have, uh, for pharmacy. Which pharmacy benefits manager should they work with, what programs should they have? And because I have this deep and intimate knowledge of how to take care of patients, uh, it has really helped me guide employers down a path that is very different from the information that they’ve been fed previously. Where as any pharmacist or anybody in the in the industry knows, most employers think that mail order pharmacy is the best and lowest cost option for them to get their employees medication. Uh, but they believe that because that’s what they’ve been told and nobody’s educated them on the fact that, you know what mail order can lead to a tremendous amount of waste. And I know that because I have countless people bring me boxes and boxes of unused meds and they say mail order just kept sending it and I tried to tell them to stop, but they just kept sending it and it’s tens of thousands, hundreds of thousands of dollars worth of medication that was just shipped to them and not use. And employers that are paying for that have no idea that that goes on. And beyond that you have employers that a handful of really, really sick folks. And when you’re sick, when you have a chronic disease or in most cases, multiple chronic diseases, you’d think that you would want that individual to interface with their pharmacist as often as possible. And what happens in mail orders, they actually don’t even talk to the pharmacist and they only interact with somebody at that, you know, mail order facility on the other side of the country four times a year for given medication. So those are a few examples of ways that I’ve enlightened employers to say there is a better way to deliver care. There are ways to save money. There are pharmacy benefits managers out there that are interested in delivering a transparent, uh, and really fully disclosed pass through arrangement that will benefit them financially. It will improve the health of their membership and also help to support those providers in the communities where their employees live and work. Uh, and it’s truly a win-win that I believe that this could be a part of the prosperous future for community pharmacy in working with employers.
Speaker 1: (42:37)
And that was going to be my next question that you found success, um, in implementing this into your business model, so to speak. So you do feel as though this is something, uh, for a lot of the independent pharmacies who are out there looking for additional revenue opportunities for their pharmacy, you feel like this is something that’s, I don’t want to say the word easy, but uh, that with the right knowledge, with the right education and opportunity that they also could capitalize on within their, um, area where their pharmacy resides and also a benefit from this.
Speaker 2: (43:12)
Yeah. So I would attest that I am probably a rare breed in the pharmacy world. There are not many community pharmacists that are in a position that I am, that is the, essentially the trusted advisor for large employers to determine what they should do. Essentially, I’m, I’m in a, the, the quote unquote dream position to really help influence and it is not easy. It took me over five years to really achieve the level of knowledge that I have today, where I can truly feel comfortable in any board room speaking to any CFO, CEO or anybody in an HR or benefits, uh, department on their pharmacy benefits. Um, but I, I do believe that there is opportunity out there. It’s, I don’t believe that any pharmacy owner can just walk into their local employer and be able to have success. Uh, the broker is a key ingredient to this. And so I am actively in the process of trying to figure out how I can collaborate with others and, you know, bring others up to speed as quickly as possible. Right? It’s not, we don’t have five years, but, uh, condensing the information that I know in a way where this can perpetuate working with CPESN, uh, in this effort is a really key ingredient. And, and I will say that the enhanced service network, CPESN, that is a pathway in my mind to success. It may be the only pathway to success where we come together as pharmacies that are delivering a higher level of care. And we’re able to speak in a voice loud enough that matters because all of those great things that we talked about, all of the services that we offer, all the fine things that I can do for an employer as a single pharmacy, it’s just not enough. You have to be a part of something bigger if you want to survive in this industry. And there are only a handful of pathways to get a voice loud enough that employers care about it. Medicaid agencies care about it. Uh, CMS or national payers care about it. The aggregation of likeminded and pharmacies that are offering like services that make a difference is an absolute key ingredient and it applies to the employer space just as much as it applies to any other space.
Speaker 1: (45:35)
And for listeners that are out there, Chris, that are independent pharmacy owners that may, uh, want to find out more, uh, or, or find more information or even contact you, uh, it’s kind of the subject matter experts. Uh, what would be the best way to get in touch with you, Chris?
Speaker 2: (45:54)
Yeah. So I mean I assume I’m pretty easy to get ahold of. They can, they can outreach to me. I, as I said, I’m, I realize that there is a massive knowledge gap out there in our industry and, uh, you know it behooves me to share that knowledge and do so in a way that it’s really impactful and meaningful. So I’m in the process of trying to figure out how to disseminate my knowledge to others in other parts of this country because I do believe that a grassroots effort to educate, uh, you know, in towns all across this country is a way to really begin a transformation, uh, of a paradigm that currently exists today where most large employers don’t have anything to do with independent pharmacies. They’re mostly using mail order, uh, and the restricted in the pharmacies that their employees can go to. So, uh, just outreaching to maybe an email at this point, I’m happy to connect where I can. Obviously I’ve, I’ve got my plate full with the multiple hats that I wear, but, uh, I am actively pursuing pathways to, uh, to share this knowledge. And to bring others up to speed where they can also make similar impacts in their communities.
Speaker 1: (47:01)
So Chris, I do have, I think maybe a little bit more of a challenging question for you because I’ve, I’ve sat and listened to everything you’ve said very intently and I hear you talk about CPESN specifically, and I know a little bit about CPESN and talking from some of the other owners out there, uh, of independent pharmacies. And in that, you know, having that collective voice, uh, to try and get things done because again, independent pharmacies, for our listeners, they’re independent. They’re owned and ran by a completely separate individuals with their own agendas. You guys are not the CVS of 5,000 locations on one big mother ship. You are independently owned and operated. So coming together collectively to try to have that voice. But I gotta be real honest with you, Chris. Uh, in the thousands of independent pharmacy owners that I’ve talked to over the last really eight years, I’ve gotten a lot of negativity back from some of them that really, I don’t feel if I’m being honest, are willing and, or in any way ready to like make a change and flip their business model around. Can you, can you talk to me a little bit about that?
Speaker 2: (48:10)
Yeah. And I, I’m, I, I hear you and I know those pharmacy owners, many of them I’ve had conversations with them, although I feel pretty confident in my ability to, you know, convince a pharmacy owner that they’re, you know, this is not, at least in my opinion, an option. Right? I’ve heard conversations about, I, you know, I’m paying X dollars a month. Where’s the ROI? Where are the contracts? You know, I’m spending all this money, but I just don’t see a return on that investment. I’m sure that’s what you’re hearing in the conversations you have as well. Uh, you know, and this is the reality and I’ll put this as succinctly as I can. The, the fact of the matter is this, the walls are closing in on our industry and we can all agree to the points that I’ve made earlier that this, the system, the healthcare ecosystem needs better outcomes. Uh, but they also need it in a scalable fashion. One pharmacy on one street corner in Southwestern Pennsylvania isn’t going to cut it. And even if you have thousands of those pharmacies doing their own thing their own way, if you can’t somehow bring that together to a unified voice, you just have a lot of noise out there. It’s just a lot of noise and nobody can really, no big payer, no employer, no health plan. They can’t really zero in on how to make that work for their population at large to the tune of hundreds of thousands or millions of human beings. And therefore, in my humble opinion, uh, we have to make it easier for them. We have to invest in this future. I said multiple times that we’re living in a pharmacy paradigm where we are paid for product and we have to operate in a way where we have to sell product for a greater dollar amount than we purchased that product. And that is a really, it’s a losing battle. We will not win that because at some point the, the, the equation is going to flip. And when more of our transactions are at a loss than at are at a positive, then we close our doors and go away. But if we can shift to a pharmacy economic system where we are paid for the quality and care that we deliver and we are no longer in this game of supply and demand and purchase price plus X, uh, to make our business survive, to allow our business to survive, uh, we can thrive, as I’ve said in that environment. So the return on investment is not, I pay X dollars today and I get Y dollars tomorrow. It’s invest the financial element of getting your business involved in a participant in this network. And it’s also invest in the effort to influence outcomes because in 12 months or in 24 months, if you’re still able to be here, your value will be immeasurable as it compares to what else is going on in the marketplace. So it’s really a longterm play. And if you can connect the dots, as you know I’ve described and as many others have described, uh, you can truly see that, you know, if you’re going to go down, let’s say CPESN isn’t right, uh, there’s not a very bright future for the industry if it’s not, because we can only play the game of supply and demand for so long before we run out of rope. So I appreciate the challenge, but I can say very confidently that if you’re not feeling this as a pharmacy owner, call me and I’ll make sure I help you become successful and understand what has to be done for us to really persevere together because we certainly need one.
Speaker 1: (52:00)
Okay, well, well said. And, uh, I’m buying in so you know, whether you believe you can or whether you believe you can’t, you’re probably right. And you definitely, Chris are someone that believes that not only you, but independent pharmacy as a whole can, so really, really appreciate having you on here today. Extremely informative, um, very insightful information. I of course, wish nothing but the best for you, for your pharmacy, for all of your patients. Uh, so, so excited to have had you on here as a guest, uh, and the passion that you have for independent pharmacy as a business owner. Um, and also I think more importantly for having an impact on your patient’s lives, uh, has been truly inspiring and I really, really appreciate the time that you’ve dedicated here today. Uh, for myself and to the listeners, Chris.
Speaker 2: (52:55)
Scott is truly my pleasure and I, and I have to say that, you know, a lot of the great things that myself and especially all the credit for what we do in our community goes to my team, my partners, Dan at Jen Asti and, uh, Samantha Petrella, Amy who all my, my crew that run the show here, my father, my family. But, uh, there are a lot of partners out there in the industry and if I have to make a plug, you know, th I don’t have to make a plug, but I want to make a plug to those that have helped. Uh, my business succeed here. PrescribeWellness and many other organizations, uh, have really helped us to improve our business, to be able to succeed here. But I, I truly am a fan of the community pharmacist, the independent community pharmacist that, uh, like I said, like I described our patient who’s crying, uh, with gratitude for the service that we provide them. This is something that goes on everywhere and for all of you out there that are listening, I appreciate what you’re doing for those in your community and I really encourage you to get involved and work with those around you collaboratively in your community and across the country to help elevate our profession where it is rightfully deserving to be. Uh, and you know, I really look forward to fighting this battle with you all and look forward to the journey ahead.
Speaker 1: (54:09)
Well said, Chris, to all of our listeners, I hope you enjoyed our debut episode of PharmacyNow. Please subscribe and share, and if you love this episode, feel free to write a review. I’m Scott VonDeylen and on behalf of the whole PrescribeWellness team, thank you for listening. We’ll see you next time.
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