Keith Loria

It’s been a strange few years for independent pharmacies. From the COVID-19 pandemic accelerating innovation to the rapid uptake of technology across health care spaces, many independent pharmacists have needed to change how their pharmacies operate.

A 2022 report published by Prescryptive Health titled “Rewriting the Script: Independent Pharmacy Trends” looked at trends thathave already led tobig changes in the pharmacy landscape and examined why now is the time for independent pharmacists to evolve and seize those opportunities.

Paige Clark, RPh, vice president of pharmacy programs and policy for Prescryptive Health, noted that despite some challenging headwinds, most independent pharmacies are in a great position for growth.“Within the next decade, a physician shortage and aging population means that the demand for healthcare services will outpace supply,” she said, adding that while one-quarter of US adults are currently without a primary care provider, more than 50% of the population takes a prescription medication at least once a month. That means opportunity for pharmacists.

“Things are changing so fast in our pharmacy ecosystem that it became imperative that we, as partners to community pharmacy, absolutely understand what is happening,” Clark explained. “We had the ability not only to look nationwide and determine the most important factors that ultimately will impact not only the profession, but to also address the profitability challenges.”

Erin Koenemann, senior director of marketing at Prescryptive Health, was instrumental in putting together the report, collecting timely and important information designed to help independent pharmacists continue to thrive. “Part of our approach was to also understand consumers; a lot of their behaviors have been impacted by the pandemic and there’s more openness to using their mobile phones,” Koenemann said. “We knew that technology was really important to pharmacies but we didn’t realize how important it could be to their business and also for the consumers who frequent the pharmacies.”

A 2022 report by the Kaiser Family Foundation (KFF) revealed that 3 in 10 American adults have, at some point during the past year, not taken a medication as prescribed because of cost.

 This followsearlier reporting from KFF showing that half of adults—approximately 4 in 10—in the United States have difficulty affording the costs associated with accessing health careand have delayed or gone without care as a result.

Exorbitant health care costs are also 1 reason technology has become such an important tool for many, with individuals across the country turning to the web to order prescriptions and find better deals at different pharmacies.“Consumers want to have more control overtheir prescriptions and technological innovation can help them find that control,” Clark said.

According to Prescryptive’s report, 95% of consumers were at least somewhat aware that medication could be priced differently amongpharmacies, with 72% of respondents indicating they would be likely to use their mobile phone to compare drug prices and shop around. “We saw a growing rule of consumerism and the need for technology in pharmacy,” Koenemann said.

For consumers, the benefits of this access to pricing information are myriad. The report noted that 90% of consumers would appreciate knowing the price of medication before actually getting to the pharmacy;an additional 85%indicated that having this knowledge would improve their pharmacy experience overall. What’s more, 73% of those surveyed said they would talk to their health care provider about prescription cost—if they knew these numbers in advance.

“Empowering discussions at the point of prescribing vsthe point of dispensing could help patients become more adherent to their medications, especially when cost is a concern,” Clark explained. “Our findings show that not only are a large majority of consumers hungry to shop—especially with mobile devices—but that the ability to do so will help retain business.”

Clark added that the tipping point for this consumerism has been the COVID-19 pandemic, which has accelerated consumers’ adoption of technology at a rate that pharmacy hasn’t experienced.“ When I talk to pharmacists today, it’s no longer about just trying technology, but about getting in line right now because this is happening,” she explained. “Community pharmacy is going to live or die depending on how quickly they adapt and we’ve never had to pivot this quickly before.”

Decision-makers at independent pharmacies understand the need for convenience and expertise and are starting to recognize how technology can help maintain and exceed their existing standards while driving profitability.

In fact, more than 90% of pharmacists who responded to the Prescryptive survey believe that technology canhelp improve their pharmacy’s profitability and also improve the entire patient experience when used the right way. But despite this belief, the survey results show that only 53% of pharmacists are actually utilizing the technology necessary to compete for patients and 40% of pharmacists are not using technology to their fullest potential.

These results, then, set up a significant opportunity for pharmacists willing to embrace technology to the fullest in the coming year.

Another trend that has integrated itself in the pharmacy world is new cash pay options, an area in which pharmacists and consumers alike are still learning more.

“We are at the beginning of a new year; we don’t want community pharmacists getting 6 months into the year before they pick their heads up and realize how dramatic the shift has been in increased deductibles,” Clark said. “Understanding different cash options is the most urgent trend to keep our community pharmacies healthy when it comes to AI [artificial intelligence]-optimized pricing.”

Based on recent numbers, approximately 10% of prescriptions were paid utilizing cash discount programs in 2021, an increase from 6% five years earlier, though more than 50% of those purchases were made with discount cards. Many pharmacists, dismayed by the exorbitant fees, lack of reimbursement, and overall messy situation created by discount cards, have stopped accepting them.But despite this decision, pharmacists are frequently required to honor certain drug discount cards due to contracts with pharmacy benefitmanagers. As 1 survey respondent described it, “The fee to process discount cards, coupled with the low copay rate, leads to a financial loss for the pharmacy the majority of the time.”

Still, respondents saw on average a 38% increase in discount program usage over the last 2 years, with 56% accepting cash and/or discount cards.“People are unaware that many of the popular discount cards can potentially harm independent pharmacies,” Clark noted.

Perhaps surprisingly, the report found that 31% of consumers paid out of pocket for medications and 61% of consumers paid cash—despite having insurance. The reasoning? Respondents indicated that their medication was less expensive with a discount card than with their insurance.

Essentially, Clark explained, patients are extremely loyal to their pharmacists and many don’t understand how these discount cards hurt. In fact, 75% of consumers indicated that they would be willing to pay slightly more for a medication by using a discount card that didn’t negatively impact their home pharmacy. "This shows consumers are more inclined to prefer pharmacy-friendly options when theyare educated about the negative impacts of cash discount programs,” she said. “Additionally, 88% of consumers said they would be willing to switch discount card programs if the discount card company was selling their personal data, even if it meant paying slightly more.” Therefore, a technology-driven cash discount solution that benefits both parties is the solution that could strengthen independent pharmacies’ financial position while delivering on consumer demands.

“There’s a lot of inconsistency from the independent pharmacy’s point of view in how they have a price strategy,” Clark said. “Many have price matching for discount cards, but we believe [that strategy] results in the lowest price and the race to the bottom, which would mean more profitloss.”

What’s the solution, then, as independent pharmacies are trying to grow and become more profitable? One possibility, Clark noted, is a smart pricing solution driven by AI that can keep customers happy and boost a pharmacy’s bottom line. Prescryptive’sdata show that 93% of pharmacy decision-makers believe they offer competitive prices; 16% revealed they try to be the lowest-cost pharmacy available to consumers—but knowing for certain if that’s true is a challenge. AI pricing can take the guesswork out of drug pricing by using data-driven insights and expert analytics to provide accurate, 

 that flexes by drug and fairly positions a pharmacy against other stores, big and small.

As changes to the industry show no sign of slowing down, forward-looking report data are helpful to predict what might become a reality for independent pharmacists over the next 2 years. According to Clark, some of the data points from the report reveal the key differentiators that can set pharmacies apart based on what consumers are seeking.

A whopping 93% of pharmacist decision-makers believe that pharmacists will play a biggerrole in serving the health care needs of their communities over the next few years—and that technology will be a key driver of the changing role. At the same time, 91% of consumers expect technology to be the reason pharmacies retaintheir business.

“Decision-makers are focusing on improving or providing exceptional customer service, improving their pricing strategy, and adopting advanced technology,” Clark said.

1. Rewriting the script: independent pharmacy trends. Prescryptive Health. 2022. Accessed January 23, 2023.

https://prescryptive.com/2022-pharmacy-study/

2. Hamel L, Lopes L, Kirzinger A, et al. Public opinion on prescription drugs and their prices. Kaiser Family Foundation. October 20, 2022. Accessed January 23, 2022. 

https://www.kff.org/health-costs/poll-finding/public-opinion-on-prescription-drugs-and-their-prices/

3. Montero A, Kearney A, Hamel L, Brodie M. Americans’ challenges with health care costs. Kaiser Family Foundation. July 14, 2022. Accessed January 23, 2023. https://www.kff.org/health-costs/issue-brief/americans-challenges-with-health-care-costs/

Articles

A new report unpacks some of the challenges that independent pharmacists may face in the years ahead.

2023 Technology Trends: Examining the Impact on Independent Pharmacy 

Historically, persons living with HIV (PLWH) have relatively poor responses to hepatitis B virus (HBV) vaccination with seroprotection rates ranging from 35%-70% following a 3-dose series.

However, a new study found that a 3-dose course of the hepatitis B vaccine HEPLISAV-B fully protected adults living with HIV who had never been vaccinated against or infected with the HBV.

“This study was designed to study the effectiveness of HEPLISAV-B, which is a newer vaccine product that contains recombinant HB surface antigen and a CPG based Toll-like 9 receptor agonist,” said study chair Kenneth E. Sherman, MD, PhD, of the University of Cincinnati College of Medicine in Ohio. “Two main groups with HIV infection are under evaluation. The first are those who failed to respond to prior vaccination efforts with standard HBV vaccines and the other group are HBV vaccine naïve.”

He explained that HBV is spread primarily through sexual contact and sharing of contaminated needles, causing chronic hepatitis B infection which can lead to progressive liver disease. People living with HIV, including those who are taking antiretroviral therapy, are at greater risk of liver-related illness and death when co-infected with HBV.

The ACTG 5379 clinical trial was developed and implemented by the AIDS Clinical Trials Group (ACTG) which is funded by the National Institute of Allergy and Infectious Diseases (NIAID)at the Natoinal Institutes of Health.

Beverly Alston-Smith, MD, chief of the complications and co-infections research branch within NIAID’s division of AIDS, noted while HBV is largely preventable with vaccination, chronic HBV infection is difficult to treat and may require lifelong treatment.

“It is important to develop HBV vaccines that are efficacious for all, especially those at high risk of infection or known have a less response to vaccines,” she said.

The researchers tested a 3-dose course (at weeks 0, 4, and 24) of HEPLISAV-B among 68 adults living with HIV at 38 sites in the United States, South Africa, and Thailand. None had a history of HBV vaccination or evidence of prior HBV exposure. Participants achieved 100% seroprotection.

Alston-Smith noted she was surprised by the 100% seroprotection rates as previous studies of vaccination in PLWH had rates in the 30%-70% range.

“No unexpected safety issues were observed,” she said. “This is the first clinical trial to show high seroprotection rates with HEPLISAV-B in persons living with HIV.”

The authors presented their findings at the Infectious Disease Society of America, focusing on the latter group, and presented data through week 28 (4 weeks post third dose). The results were powered and compared to historical controls from a prior ACTG vaccine study. In the vaccine naïve group, 100% achieved effective anti-HBs titers for seroprotection after 3 doses. After 2 doses and before the third, 98.5% achieved protection.

At 8 weeks after the second dose, 94.4% of participants achieved seroprotection; this percentage increased to 98.5% by week 24 prior to the third dose. The most common side effects related to vaccination were injection site pain, malaise, fatigue, muscle aches, and headaches.

“The viral titers after 3 doses were exceptionally high with over 80% achieving levels >1000 IU/ml,” Sherman said. “This is an important correlate of vaccine durability and was much higher than levels seen with other vaccine preparations.”

Based on the result, Sherman believes it’s likely that use of this vaccine product will be preferentially recommended in this treatment group. The preliminary findings were also shared with the Center for Disease Control Advisory Committee on Immunization Practices and the researchers await their recommendations.

The ACTG 5379 study will continue as planned to examine the effects of 2-dose HEPLISAV-B, as well as a 3-dose regimen of another hepatitis B vaccine (ENGERIX-B, manufactured by GSK) among adult participants with HIV who were previously vaccinated against HBV but who did not achieve an adequate immunologic response. The clinical trial is estimated to complete vaccinations in the spring of 2023.

Previously hepatitis B vaccines have offered lower levels of protection for people living with HIV. New research indicates that a 3-dose series could offer much better protection.

Three-Dose Hepatitis B Vaccine Regimen Can Protect Those With HIV

Studies show that vaccinations among children are going down—especially since the COVID-19 vaccination was added to the mix. However, it’s important for parents to vaccinate their children and a pharmacist can play a key role in getting these numbers to increase.

Obviously, vaccine hesitancy isn’t new, but it’s a movement that is steadily gaining traction.

Rebekah Diamond, MD, assistant professor of Pediatrics at Columbia University and author of “Parent Like a Pediatrician,” noted parents are facing unprecedented challenges in finding good information about vaccines and disinformation only increased dramatically during the COVID-19 pandemic, making the challenge even harder.

“There are many other contributing factors, and it all has led to declining vaccination rates,” she said. “The problem is huge and is a main reason that rates of serious infections including COVID-19 and flu are up in children.”

Patricia Pinto-Garcia, MD, MPH, a pediatrician with more than a decade of experience in academic medicine, noted it’s natural to feel uncertain and hesitant about any new technology, including vaccines. However, it’s also hard for parents to process the overwhelming amount of information circulating.

“There’s so much medical information available right now which isn’t always vetted and contains misinformation,” she said. “For parents, it’s important to have trusted resources to turn to for accurate information. Pediatricians, the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics are trusted sources of information when it comes to vaccinations.”

The best thing a parent can do is to make sure their child is up-to-date with routine checkups. A child’s primary provider or pediatrician always reviews whether a child is up to date on vaccines during a routine check-up.

“However, if you can’t make it to a checkup or if your child’s primary care provider doesn’t offer all vaccinations, there are other resources that can help,” Pinto-Garcia added. “School-based health clinics, local and chain pharmacies, and local departments of public health offer vaccinations, some at no cost.”

Parents can also use the CDC’s vaccine schedule infographic for a quick review of which vaccines children need at certain ages. After all, it’s helpful for parents to keep copies of their children’s vaccines. This gives parents peace of mind that their children have the appropriate levels of vaccination for school enrollment, sports teams, and higher education.

Although most providers will have these records, they can sometimes be tricky to track down as health systems are not always well connected to one another and technology is constantly evolving.

For many people, pharmacies provide a convenient location to receive some of the common, seasonal vaccines.

“If parents are unable to get to a doctor’s office, it might be worth calling their local pharmacy to see if they administer the vaccine needed and if they can see a patient sooner,” Pinto-Garcia said. “Many pediatricians were unable to keep COVID-19 vaccines in their office due to cost and storage requirements. This created a huge barrier to access for many children. Pharmacists were able to fill in these gaps because chain pharmacies have the resources to store and deliver vaccines in large quantities.”

Plus, many pharmacies are open 7 days a week and have much longer hours because of their larger staff size. This makes it easier for parents to get an appointment time that works for their families’ schedule.

“During the COVID-19 pandemic, pharmacists played a huge role in making sure that vaccines got to people who needed them,” Pinto-Garcia stated. “It’s clear the system works and hopefully in the future, new legislation will allow pharmacists to play a larger role in childhood vaccination.”

However, it’s not just COVID-19 vaccinations of course. Children should be receiving a number of vaccinations to protect against diseases such as pneumonia, meningitis, chickenpox, measles, mumps, polio and tetanus. The CDC recommends that children receive vaccinations against 16 diseases.

“Although we are all susceptible to infectious diseases, there are a handful of diseases that children are particularly vulnerable to such as chickenpox or measles, which is why staying up to date on vaccinations is important,” Pinto-Garcia said. “These diseases may seem less commonplace today because many children are vaccinated against them. But outbreaks do happen and are happening more frequently as vaccine rates go down.”

Right now, pharmacists are limited by state and federal laws in terms of which vaccines they can give to children. However, health care providers and pharmacists can work together to make the most of the current situation.

“Health care providers can offer parents a list of nearby pharmacies that are able to vaccinate children and which vaccines they offer,” Pinto-Garcia said. “Parents can also help get this information out to friends and neighbors. Getting a child vaccinated at a local chain pharmacy is new for many parents. Some are apprehensive about the experience. Hearing that another family has a smooth and child-friendly experience can alleviate anxiety.”

Diamond agreed that pharmacist working with local pediatric providers to see how to improve access is a great idea.

“Pharmacists can also ask questions about different vaccines seek resources in learning how to provide accurate information and counsel parents,” she said. “Pharmacists often give vaccines, especially flu and COVID-19, to kids. It’s important for pharmacists to have a full knowledge of the benefits of the vaccine, and be prepared to answer nuanced questions such as how many vaccines to give at once, timing and intervals, explaining safety and efficacy accurately.”

Childhood vaccinations took a downturn during the pandemic. Now is the time to get them done and pharmacists can help.

Urgent Need to Increase Vaccinations in Children

On New Year’s Eve, individuals worldwide declare this is the year that they’ll finally do it: They’ll eat right and exercise, they’ll quit smoking, and they’ll make changes in their lives to follow a healthier lifestyle. More often than not, however, these resolutions quickly fall by the wayside.

But for those who make wellness-related resolutions, pharmacists can play a key role in ensuring these individuals stick to their New Year’s wellness pledges by being accountability partners, providing lifestyle advice, selling OTC products that promote diet and exercise, and even recommending first aid products if injuries occur, helping patients resume their wellness journeys more quickly.

Jennifer Bourgeois, PharmD, a pharmacist at Market Street Pharmacy in McKinney, Texas, notes that pharmacists are the most accessible health care professionals; 89% of Americans live within 5 miles of a pharmacy. “In addition to proximity to a pharmacy, patients can typically speak with pharmacists without an appointment and thereby see them more often than [other care providers]—who they may only see for annual visits— which gives pharmacists an incredible opportunity to [support] patients’ wellness,” she says. “By using the skills and knowledge learned in pharmacy school training, pharmacists can provide point-of-care testing at the pharmacy. This includes blood sugar and HbA1c testing, cholesterol screenings, vaccinations, and COVID-19 testing.”

Nana Entsuah, PharmD, explained that because of their extensive education and subsequent medication and health expertise, pharmacists can provide evidence-based health and wellness recommendations to promote the well-being of patients. Entsuah is a health sciences assistant clinical professor at the University of California, Irvine School of Pharmacy & Pharmaceutical Sciences.

“Pharmacists can assist their patients in setting SMART goals. SMART is an acronym used to describe goals that are specific, measurable, achievable/attainable, relevant, and timely,” she said. “Goals should be specific and clear. The goal should be measurable, meaning that it is quantifiable and trackable. Achievable/attainable goals are those [that] are realistic and safe.”

Joseph Poling, PharmD, explained that because pharmacists have such good relationships with their patients, they are better equipped to help them figure out their health care goals and lead them to success. Poling is president and owner of Good Day Pharmacy, which has 9 retail pharmacies in Colorado. “Because pharmacists know most, if not all, medications a patient is taking, they can identify nutrient deficiencies and identify and recommend supplementation,” he said. Programs that educate patients on nutrition, water intake, exercise, and strategies to help prevent diabetes can also be helpful. “Most pharmacists will say the best part about the job is interacting with patients, and patients love this because they feel healthier. Pharmacists are happy they are making an impact,” Poling said.

Bill Drilling, PharmD, co-owner of Drilling Pharmacy in Sioux City, Iowa, has more than 50 years of experience in the field. Over his long career, he has found more and more individuals interested in talking about establishing a healthier way of life.

“We do wellness screenings at the pharmacy, and we do different lab tests—a complete lipid profile, HbA1c testing, glucose testing, [and more]—to try to screen [patients] who may not normally go to the doctor or can’t afford to go to the doctor,” he said. “There’s a huge segment of [patients] who are underinsured, so this is a big way we are trying to help keep [them] healthy.” Often, that means recommending different vitamins and supplements or talking about the importance of healthy diets.

Pharmacists can also offer education and support when a patient expresses interest in healthy eating as a New Year’s resolution. “One way that pharmacists can easily help is to point out dietary supplements on or near the pharmacy counter,” Bourgeois said. “These items may include protein powders, collagen powders, low-calorie snack bars, and other popular weight loss supplements that may help the patient achieve their New Year’s goal.”

Pharmacists can also provide handouts at the counter for patients to take home and discuss healthy lifestyle habits for the new year. Health.gov has a free tool kit for health care professionals, with dozens of handouts on topics such as building healthy eating routines, cutting down on sugar, and making healthy drink choices. These small but important lifestyle changes can positively affect the overall health of a patient.

Additionally, Bourgeois noted that because pharmacists are responsible for completing medication therapy management (MTM) services for select patients, it’s a great opportunity for pharmacists to counsel the patient on more than medications. “When I complete an MTM case, I take this opportunity to speak with the patient about diet and other lifestyle factors,” she said. “I ask open-ended questions such as ‘On a scale from 1 to 10, how well do you feel today?’ Then I ask more questions from there to learn more about the patient’s current health challenges and identify areas where I can provide both education and support.”

Kathy M. Campbell, PharmD, a 30-year veteran pharmacist in Tulsa, Oklahoma, thinks pharmacists are uniquely suited to look at a patient’s life and medication and instantly start helping them optimize metabolic function. “Starting to talk to patients about a plant-focused eating strategy is a critical first step,” she said. “If you can eat more plants, you can prevent a lot of chronic health conditions that most [patients] want to prevent. Community pharmacy is uniquely positioned to help [them] understand the importance of such a transition.”

Simona Dorf, PharmD, BCMAS, clinical pharmacist at First Databank in South San Francisco, California, noted that pharmacists can help reinforce exercise, a healthy diet, and adherence to therapies. “Patients often come in looking for a quick solution to weight management, such as a water pill to help them lose 5 pounds quickly, a detoxification treatment, or any [FDA-approved OTC] weight loss medication,” she said. “Some are looking for supplements. Pharmacists can help steer patients toward evidence-based medicine and help promote a healthy lifestyle. They can encourage patients to start an exercise program [such as] walking and record[ing] progress with a wearable device.” Pharmacists can also help dispel fads and provide references to reputable weight loss websites and advice.

An estimated 133 million Americans are living with at least 1 chronic illness such as hypertension, heart disease, or diabetes. With the obesity epidemic reaching an all-time high, health care professionals have an obligation to use whatever skills and tools are available to help patients.

That’s why many pharmacies are incorporating wellness initiatives and programs into their pharmacy models. In addition to the programs at the pharmacy counter, hundreds of pharmacists offer online services to provide patient education and support in areas such as stress reduction, weight loss, diabetes management, and more.

At Drilling Pharmacy, many customers talk about quitting smoking at the beginning of a new year. Pharmacists there initiated a smoking cessation program that has proven to be very successful.

“We’re also in partnership with the Iowa Department of Public Health and the Iowa Pharmacy Association, and we’re screening [patients] for diabetes. The local YMCA has a prevention program, so if we can catch [symptoms] early enough, we can keep [patients] from [developing] diabetes,” Drilling said. “We’re handing out literature and trying to get more [patients] signed up for the program.”

Campbell sells vegetables at her pharmacy in the summer and provides recipes at the counter for healthy meals her patients can create. She also gives a TED Talk about weight loss, hosts cooking classes aimed at healthier eating, and conducts a monthly seminar at her pharmacy to better educate her patients.

“One of the opportunities that pharmacy has is to create support groups and education initiatives,” she said. “Having a brick-and-mortar [pharmacy] is a real advantage right now, because people want to get together.” Pharmacists can also promote wellness with preventive care modalities such as administering immunizations and providing education on lifestyle adjustments, vitamins/supplements, and other holistic care modalities using evidence-based medicine.

“Additionally, pharmacists can screen patients [for] mental health [conditions] as well as the status of their chronic disease states [such as] HbA1c tests, lipid panels, and blood pressure measurements,” Entsuah noted. “Pharmacists are not diagnosticians; however, the pharmacist can play a very important role in establishing a treatment plan once a diagnosis is made.”

Despite the help that pharmacists can offer their patients, most patients don’t think of the pharmacy as a place to receive advice about diets and living a healthier lifestyle. It’s vital that pharmacists let their patients know what they can do to be a part of their patients’ wellness journeys.

“The role of community pharmacists is to provide care and compassion to their patients in everyday interactions, whether that’s a smile, listening, or explaining the patient’s medications,” Bourgeois said. “I believe one of the most important responsibilities of pharmacists is to be proactive in asking questions of their patients to offer better assistance and education about services available to help their patients get and stay healthy.”

Campbell believes marketing should be done on a large scale for the profession but on a small scale when pharmacists are counseling patients about medication at the point of sale. “They need to ask [patients] how they’re doing with their diet and then offer them solutions to possibly improve those outcomes,” she explained. “I ask everyone how they’re doing and [say] I would appreciate seeing their lab results so I can support their best outcome.”

Placing posters near the pharmacy, advertising on the pharmacy website, allowing patients to schedule appointments online, and listing the types of services available are other ways that retail pharmacies can help get the word out about the wellness services their pharmacists can provide. “One of the best ways pharmacists can let their patients know they are here to help is by offering patients their time, asking questions, and trying to understand the challenges their patients are facing,” Dorf said. “Taking the time to make each patient feel valued and heard and providing meaningful advice is how pharmacists can build trust and a large following. The rest is word of mouth and great reviews.”

Pharmacists can play an important role in patients’ wellness journeys.

Getting Well and Staying Well: Supporting Patient New Year’s Resolutions for 2023

Sustainability and the concept of going green have hit home with patients over the past decade as public attention has turned toward helping the environment and being responsible for one’s carbon footprint. That’s why many pharmacies have made a strong commitment to being environmentally conscious and showing their patients they are thinking sustainably.

Pharmacists can do their part for the environment by reducing waste and excess packaging, using less energy, and ensuring their pharmacy has a proper stock of product so local customers can pick up their prescriptions without needing to travel far from home. Tatyana Franklin, PharmD, who practices in Baton Rouge, Louisiana, noted that for those who run their own pharmacies and wish to do their part to save the planet, several cost-effective measures can be implemented.

“E-prescriptions should be sent directly to the pharmacy’s computer system rather than [sent] via fax machine,” she said. “Even though e-prescriptions may cost more, they ultimately save time and money by eliminating the need for paper prescriptions and the associated labor involved in typing and scanning them. Reduced transcription time means fewer opportunities for human mistakes.”

In fact, she suggested pharmacists limit printing as much as possible. “Medication guidelines should only be printed during the first prescription fill,” Franklin said. “To save waste, we shouldn’t print much more unless the patient specifically demands it. We provide patients with written information, but studies indicate they don’t read them. If the patient doesn’t require a receipt, don’t print one.”

Another great tip is to provide bags only when requested; offering a plastic bag is only necessary in cases where customers require one to carry bulky purchases or make a special request. “When you bring up being environmentally conscious, most [patients] will be grateful for the reminder and the chance to make even the smallest change,” Franklin said. “Create a simple notice to hang next to the register to let customers know that your pharmacy is taking steps to reduce its environmental impact by not using plastic bags.”

Additionally, using the smallest available vial or container size while filling prescriptions may help the pharmacy save money and contribute to the bigger cause. Patients will also welcome the reduced bulk and weight of their medicines.

Along with his wife Pam, Jonathan Marquess, PharmD, CDE, FAPhA, owns 15 community pharmacies in Georgia, and the couple has always tried to operate with a sustainability mindset. “I think it’s important that everyone does what they can to help,” he said. “One of the things we’ve done is no longer print out our e-prescriptions; it’s all done online. At first, I thought this was just a helpful thing to do, but it wound up saving us about $30 a month in not having to get as many pickups for trash. Plus, we’re saving thousands of reams of paper, ink cartridges, and toner.”

Additionally, the Marquesses only use Centaur biodegradable bottles at their pharmacies to limit landfill. Small, everyday changes like this are encouraged and appreciated.

Some pharmacies are thinking even bigger. Boyd Ennis, PharmD, owns and operates 4 pharmacies in Alabama. He installed solar panels on the roof of his store in Fairfield, Alabama, resulting in an approximately 50% drop in energy usage.

“I had talked about it for years and finally gave it a try, and it’s been really successful,” he said. “There were tax incentives that made it even more attractive to do. Based on the rebates, we’ll have a 2.8-year payout period. It just made a lot of sense.” In fact, things have worked out so well, he’s getting ready to install solar panels at a second location which will have net-zero greenhouse gas emissions.

Another change Ennis has made is installing smart thermostats in his pharmacies, allowing him to set and program the store temperature automatically and eliminating reliance on personnel to change the settings during off-hours. “I’ve also added smart plugs. We have drink products in the store. As long as you keep the door closed in your refrigerator, everything is fine. So after the store closes, they are set on timers [which] automatically turn the drink box off, and [it] comes back on an hour before the store opens so they are as cold as possible,” Ennis explained.

Six years ago, he installed light-emitting diode lights inside and outside all his pharmacies. “You can either cut costs or cut [staff],” Ennis explained. These eco-friendly changes “are not only good for the environment; they are a way to cut expenses,” he said. “It’s also cleaner, and I think that’s important to many [individuals]. We have made a commitment to reducing our carbon footprint, and we’re hoping that will help us reach more [individuals] and bring them in as well.”

Pharmacists can make simple changes that add up to big environmental impacts.

Is It Easy Being Green?

Psoriasis is a chronic and inflammatory multifactorial disease but for some reason, people seem to suffer more in the wintertime when flare-ups are much more common.

Jennifer Bourgeois, PharmD, a pharmacist at Market Street Pharmacy in McKinney, Texas, noted while there is no definitive answer as to why psoriasis flares up more in the winter, research speculates it’s due to drier skin that is caused by inside heat and spending less time outside in the sunshine.

Dry air can cause the skin to lose moisture, especially the upper layers, which is what results in dry, flaky skin. Studies have also found that fewer hours of sunlight in the winter seasons may trigger psoriasis flare-ups as well.

“Psoriasis is an inflammatory condition of the skin and the inflammatory cascade can be triggered by many different factors including stress, diet, and infections,” Bourgeois said. “We know that winter is often accompanied by higher stress of the holidays, increase in sugar intake, and peak season of flu—all of these may contribute to the psoriasis flares.”

Suzanne Friedler. MD, FAAD, a dermatologist at Advanced Dermatology PC in New York, noted one of the things that help psoriasis is UV light because sunlight decreases certain inflammatory mediators so it’s able to regulate the inflammatory cascade you see in psoriasis.

“Obviously in winter, there’s less UV exposure, so it causes psoriasis to be a little bit worse,” she said. “Also, people tend to take longer or hotter showers, which dries out the skin; there’s less humidly in the air in winter months; and those with dry, itchy skin can also add to winter flare-ups.”

Emily Fritchey, a holistic skin therapist at Sunshine Botanicals in Newnan, Georgia, notes as the skin gets drier, it is more likely to crack, bleed, and get infected.

“Low levels of exposure to sunlight’s ultraviolet rays likely cause psoriasis to worsen during fall and winter without proper care and precautions,” she said. “Lack of understanding when it comes to the proper skin care necessary is the biggest issue patients face.”

Psoriasis triggers vary from person to person, and some of the most common triggers include stress. Therefore, relaxation techniques, stress management and an anti-inflammatory die help tremendously to help minimize the impact stress has on this condition, Fritchey shared.

Friedler recommends moisturizing frequently to cut through the thick layer of scale and taking the correct medication helps, so communicating with your dermatologist is vital in proper care.

“There are better and better biologic therapies and lots in development,” she said. “It’s a hopeful time.”

Patients with psoriasis can keep a journal to track flares, Bourgeois said. This information can be used to help pinpoint the factors contributing to the flare, such as, is this only occurring in the winter months? Is the flare triggered by a recent illness or a change in diet?

“Awareness of the triggers can significantly help the patient and provider develop a lifestyle strategy specific for the patient,” she said. “This is often used in adjunct to a pharmaceutical medication.”

She recommends that patients use a thicker moisturizer, especially after they get their skin wet. Also covering the skin and not directly exposing it to the cold, dry air.

“This heated air in our homes and workplaces is typically drier and can steal from moisture levels in your skin,” she said. “Add a humidifier to support your skin health. Also, increase your water intake during the winter months.”

Considering lifestyle factors and natural ingredients that have science behind them is important to complement typical pharmaceutical treatments for winter flare ups. That’s why it’s important that dermatologists understand the environment their patients are in, especially for those living in cold climates.

Fred Pescatore, MD, noted that lifestyle adjustments that can help flare-ups, as well as the science behind some of the most beneficial natural ingredients for psoriasis, such as Pycnogenol French maritime pine bark extract, is an important way to best work with patients.

“Studies have found the natural antioxidant to significantly improve the painful and visible symptoms of psoriasis, including redness, flaking, thickness and total surface area of affected skin patches,” he said.

Most important, dermatologists should be providing patients with the information they need on what to do and not do daily during treatment.

“A simple handout that takes the guesswork out of the self-care they need to do at home will take the overwhelm out of what to do and not do at home and improve treatment outcome,” Friedler said.

This article originally appeared on Dermatology Times.

Patients with psoriasis seem to suffer more in the wintertime when flare-ups are much more common.