Lisa Faast, PharmD, DiversifyRx CEO

Getting new pharmacy patients doesn't have to be expensive.

Patients are the lifeblood of pharmacies. Whether you focus on dispensing prescriptions, selling supplements, or fixing hormones, you need patients.

I am a huge fan of guerilla-style marketing. Over the years, I have perfected many tactics that work well for independent pharmacies, as we want our patients to come to us, IRL (in real life!). There are tons of marketing strategies out there, but not all work for brick-and-mortar businesses. Let's dive into some of my favorite low-cost strategies guaranteed to bring you new patients.

My first tactic is inspired by one of the best marketing books, 

Purple Cow: Transform Your Business by Being Remarkable,

 by entrepreneur Seth Godin. If you want people to change their habits (which is hard) and do something different (like come to your pharmacy), you have to offer them something exciting, unique, and—dare I say—a little sexy. A great way to do this as a pharmacy is to provide and promote niche supplements. Here are my current favorite options, with a brief explanation for what makes them special.

 - A full-spectrum CBD product with a higher concentration of CBN to promote relaxation and sleep. What Makes It Special: It works the first night guarantee. 100% Money-Back guarantee. You can offer this risk-free to your patients as Ananda Professional offers it risk-free to you.

 - A natural supplement that helps increase the body's nitric oxide level. What Makes It Special: They have a 15-second saliva test that patients can see if they are low in nitric oxide and to make sure the supplement is working.

 - With a simple 60-second scan of your patients' palms, you can give them their antioxidant score. What Makes It Special: A one-of-a-kind line of vitamins guaranteed to raise the score, and you can retest as often as you like to show that the supplements or lifestyle changes are working.

You can simply promote these products and talk about what makes them notable on social media, in bag stuffers, or on your website. They pique people's interests because they are different than the typical supplement. A test to see if you actually need the supplement? Pretty cool. A 100% money-back guarantee? That's super rare. Remember: rarity grabs attention, just like a purple cow does.

Dispensing prescriptions for hospice patients is gratifying work. Some of my fondest professional memories are of hospice patients I helped care for. Now I can hear your exasperated breathing as you think, "Aren't hospice prescriptions really low in profit?" They can be, especially if a pharmacy benefit manager is involved. There are ways to boost hospice prescription profitability by billing directly with the help of companies like 

Even with low profits, I say hospice prescriptions are still worth going after if you have a goal of growing your pharmacy. Here's why:

You get new patients almost daily. This means you are exposed to new families in your community that have probably never heard of you.

You become known in the medical community. Nurses that work in hospice often work for local doctors and hospitals too. You can easily impress them on the hospice side, and then they sing your praises during their day jobs.

New prescribers will become aware of you. Almost every non-specialist doctor will have a patient that goes on hospice. As these doctors call in the hospice scripts to you, you get introduced to new prescribers you now have some relationship with.

I see hospice as a way to get paid to market your pharmacy. While you may not make a killing, you often make a small profit, 

 you get a massive amount of exposure in your community. That's a win-win.

Plastic surgeons stay busy with a constant stream of patients. Work closely with a plastic surgeon, and you can be busy with a constant stream of new pharmacy patients. Every plastic surgery patient will require both prescription and OTC medications to get the best outcome from their surgery, but frequently, surgeons are very particular about what their patients take. You can fill that need by always keeping their preferred products in stock and ready for patients.

These prescriptions are often cash revenue to the pharmacy. Many surgeons include the cost of medications in their surgery price to promote an all-in-one price. Some prescriptions might be billed to a patient’s insurance as well. Surgeons want their patients to experience the highest level of service, and independent pharmacies are the best place for them to receive that. Many times, these patients will convert to recurring patients as your awesomeness wows them from their surgery. For more information on partnering with plastic surgeons, 

 is a coupon that is only good in-store and generally refers to being valid on the patient's next visit. I use them for both repeat business and to pass out to prescribers or other local businesses to drive people to the pharmacy for the first time. One great aspect of these types of coupons is that you only pay for them when they are effective. I like to offer at least $10 off, and you can easily vary this number based on how you use them.

Bounce-back coupons don't always have to be monetary, either: We give all local pediatricians and urgent care centers bounce-back coupons for free prescription or OTC medications flavoring. The flavoring offer brings a lot of new patients into the pharmacy.

The most important rule for getting new patients? Be consistent. These tactics or many others will be successful if you execute them consistently.

For additional support on increasing your pharmacy's profits, feel free to reach out to Dr. Lisa Faast at info@diversifyrx.com.

Articles

From Purple Cows to bounce-back coupons, there are numerous marketing strategies available to entice new patients into your business.

Four Tactics to Bring New Customers Into Your Independent Pharmacy

Transparency is a buzzword these days. We hear about it on the nightly news in reports about our government, schools, restaurants, and even social media. Transparency in the pharmacy industry is undoubtedly an active discussion topic, and pharmacy owners have been fighting for it for years with little success. Let’s discuss some key areas where a lack of transparency hurts pharmacy owners and, ultimately, patients. 

Because of past situations involving the over-prescribing and over-dispensing of controlled medication, both the Drug Enforcement Agency (DEA) and wholesalers closely monitor pharmacies’ ordering habits. On the surface, this is a good thing: No one is a proponent of pill mills. However, the lack of transparency in this process hurts pharmacy owners and patients.

Pharmacists will regularly turn away legitimate prescriptions from legitimate patients who present with a new controlled prescription. Why? Likely, these pharmacists are worried about going over ambiguous thresholds and ratio limits. The pharmacist is concerned that if they increase their purchases of these controlled substances, they will trigger a controlled medication audit and perhaps prevent the pharmacy from ordering what they need to fill prescriptions. This confusion comes from a lack of transparency from wholesalers and enforcement agencies. 

Many pharmacy owners have heard horror stories of pharmacies forced to close or their ability to order controlled medications taken away. For West Virginia pharmacist Martin Njoku, these horror stories became real life when the DEA raided Oak Hill Hometown Pharmacy and revoked Njoku’s right to dispense controlled substances. The raid, according to previous reporting,

came a few years after Njoku began dispensing buprenorphine to customers, both local to Fayette County, West Virginia, and those displaced by flooding in nearby counties.

Although Martin was cleared of all wrongdoing, the damage was done. He was forced to close his pharmacy and his community lost critical access to the care it needed. 

There is a shroud of secrecy surrounding everyone from the wholesalers to state and federal agencies about what triggers these drastic actions. No one will talk about it and no one will help pharmacy owners and pharmacists on the front line maneuver legally within the system to best help patients. Pharmacists want to help combat the opioid epidemic; we need transparency and collaboration with the key players to do our part while still providing care for our patients. Instead, we feel like we have no choice but to turn patients away.

Another area that lacks transparency is drug pricing. From the patient’s point of view, there has been some significant, positive headway where drug pricing transparency is concerned. However, many pharmacies must still deal with smoke-and-mirrors pricing in the drug acquisition process.

In the traditional wholesaler model, the pharmacy places orders for medication and pays an “invoice cost,” which is an inflated price for its inventory. The pharmacy can earn rebates over the next several months to lower its acquisition cost, but because rebates come in long after the medication is dispensed, pharmacies don’t know the actual cost of a product at the point of sale. They are left to make educated guesses.

Some pharmacies will not bet on getting the total rebate—as it is not guaranteed—so they keep the invoice cost in their pharmacy management system. In contrast, others will accept the theoretical rebate as a given. The ambiguity of each product’s price leads to decisions at the point of care. If the pharmacy assumes it will lose a significant amount of money, it may choose not to dispense the prescription. Conversely, a pharmacist may think they are making a profit on medication—but in reality, their cost is higher than anticipated and they are now losing money. 

These “leaked” dollars add up to significant unrealized revenue for pharmacy owners. For a typical independent retail pharmacy, between 15% and 20% of the prescriptions it dispenses are a negative reimbursement at the point of sale. This loss not only puts a strain on a pharmacy’s ability to stay in business, but it also impacts both clinical decisions and the service offerings provided to their community. The purchasing process needs to be infused with transparency so pharmacy owners can focus on patient care instead of playing purchasing games. 

A lack of transparency around pharmacy payments has the same deleterious effects as pharmacies not knowing drug costs. Frequently, pharmacists are either left guessing how much money they are losing or assuming they are making money only to never see those revenues realized. 

Confusion on the reimbursement side comes in many forms, but the 2 most egregious culprits are effective rate contracts and direct and indirect remuneration (DIR) fees. 

Under an effective rate contract, the pharmacy has a maximum profit percentage cap across an insurance's entire book of business. This cap causes a reimbursement amount at adjudication to become, essentially, a made-up number, with the payment processor guessing at what the rate should be. A “true-up” will happen later, typically resulting in the pharmacy paying back large sums of money to the pharmacy benefit managers. Pharmacy owners are left in limbo for months, wondering what their actual revenues will be. Any business owner can easily empathize with the trouble this unknowing causes.

DIR fees for Medicare claims are the most significant source of concern for pharmacy owners. The lack of transparency comes from several questions: 

How can the pharmacy improve its performance?

While these seem like easy questions to answer, the lack of transparency makes answering nearly impossible. Each Medicare plan has published DIR fee ranges, but these ranges are wide and the difference to a pharmacy’s bottom line is critical if it is, for example, 11% vs 15%. There also never seems to be a straightforward answer for how each pharmacy earns its score and ensures the data are clean. A patient who passes away, for example, counts as missed fills, lowering the pharmacy’s adherence score for many months until the patient drops from its calculation. No one intended for deceased patients to cost pharmacies thousands of dollars. 

Many pharmacy industry organizations and individuals are fighting long, hard battles to improve transparency throughout the industry. It is critically important to talk to your elected representatives at all levels of government and to support organizations like 

Pharmacists United for Truth and Transparency

 in their quest for change. Most importantly, pharmacy owners must understand the impact that a lack of transparency has on their business. Knowing where there are information blind spots may help owners see the bigger picture and make better choices for patients and the pharmacy alike.

Pattani A. DEA takes aggressive stance toward pharmacies trying to dispense addiction medication. NPR. November 8, 2021. Accessed January 3, 2022. 

https://www.npr.org/sections/health-shots/2021/11/08/1053579556/dea-suboxone-subutex-pharmacies-addiction

Without transparency, pharmacy owners must clear numerous hurdles to run an effective business. 

Prescribing Transparency as the Solution to Pharmacy Owner Woes 

Ask any group of independent pharmacists their opinion on Mark Cuban Cost Plus Drug Company (MCCPDC), and their views may sway wildly from one end of the spectrum to the other, ranging from an appreciation for the light his adventure is shining on the unfair practices of traditional PBMs to the fear that this will further hurt the shrinking independent pharmacy industry. After speaking with many pharmacy owners and reading tons of comments on Facebook and LinkedIn, here is a roundup of the good, the bad, and the opportunities of billionaire Mark Cuban’s MCCPDC stepping into the online pharmacy space.

What is Mark Cuban Cost Plus Drug Company?

MCCPDC is a transparent, cash-based pricing model for hundreds of prescription products. The company's goal is to dramatically reduce the cost of drugs and, just as important, to introduce transparency to the pricing of medications. Hence, patients know they are getting a fair price.

It is important to note the MCCPDC is not a pharmacy. They have chosen to partner with TruePill, a mail-order pharmacy and digital health platform. Currently, MCCPDC buys its medication on the open market. In the future, the company plans to leverage a manufacturing plant being built in Dallas, Texas, to produce their own pharmaceuticals at the lowest possible cost.

Independent pharmacies have been screaming from the rooftops for years about the unfair practices of PBMs—and for a good reason. PBMs continue to represent the biggest threat to our livelihood that this industry faces. Many believe that Mark Cuban, the man, is the perfect mix of investor smarts, business acumen, and celebrity influence to bring a wide range of attention to unfair, unregulated PBM practices. Many independent pharmacy owners believe MCCPDC will bring about a refreshed push for stricter regulations on a national level. While many individual states have passed policy changes in recent years, not much difference in the day-to-day practices of PBMs has been realized.

Other positive aspects include increased patient awareness and personal responsibility for medication choices and costs. When patients truly understand the cost of their therapy, they can make more informed health care choices. Many commenters—especially those outside the industry—see Cuban’s activities as a positive disruptor, breaking out of the status quo. There is a sentiment that our healthcare system is broken, and he is the one taking active steps to try and change it. Even if they don't fully understand the market, they like the shake-up.

Although some indepdenent pharmacy owners are grateful for the publicity that MCCPDC is shining on unfair PBM practices, many still worry about the impact that this "shiny" new online pharmacy will have on their business, their patients, and their communities. The promise of steep discounts over "retail prices"—without regard for the services and prices that many independent pharmacies can provide—has many pharmacists hunkering down for another rocky season.

Many pharmacy owners were disappointed by MCCPDC's partnership with TruePill. It’s not a knock on TruePill itself; the disappointment comes from a nameless, impersonal mail order model. Many of the medications that MCCPDC sells are for chronic conditions. Typically, these patients are on multiple medications. Patients might fill some medicines through MCCPDC, and others through a traditional pharmacy, since MCCPDC won't bill insurance. Their prescriptions are now fragmented, and the dispensing pharmacists don't have the complete picture. MCCPDC could have achieved the best of both worlds if they had chosen to partner with independent pharmacies, providing low-cost, cash-based prescriptions and billing insurance for appropriate medications.

Another worry from independent pharmacy owners is misinformation. The blanket statement MCCPDC is touting—that 

 are the transparent pharmacy—implies that all other pharmacies are not. We all know that is not true. In fact, independent pharmacies cannot be transparent under some PBM contracts. Some contract language includes the requirement to bill all prescriptions to the PBM regardless of what is in the patient's best interest. At the same time, others prohibit pharmacies from discussing reimbursement rates with patients.

Pharmacy owners are also fearful of the impact on their performance scores due to patients filling through MCCPDC or other cost-plus model pharmacies. DIR fees are already at excruciating levels. Patients could be deemed non-compliant by their insurance company if they get their medications filled outside of their insurance network, and the independent pharmacy that fills their insurance-based prescriptions is punished with higher remuneration fees when this happens.

In this author's opinion, communities are better when they have a thriving independent pharmacy. While MCCPDC has been looked at as ground-breaking, those of us in the industry know that isn't the case. Independent pharmacies have been helping patients save on their prescriptions for decades. Many years ago, I had a program offering a 100-day supply for $18 in my pharmacy, and in my hometown, a friend started a cash-only, generic-only pharmacy in 2006! Newer startups such as Blueberry Pharmacy or ScriptCo have also garnered some media attention recently.

With all the attention on cash-based pricing, there is no better time to showcase your pharmacy's value to the community. Whether you offer low-cost prescriptions, amazing supplements, or unique services, your community is primed to take control of their health, and your pharmacy should be at the forefront of helping them succeed.

Take a quick inventory of all the uniquely special things your pharmacy provides that an online pharmacy can't:

What unique prescriptions do you dispense?

Who can help with consultations or medication questions?

How many children have you impacted by sponsoring local sports teams?

One-stop shop for all cash-based, insurance, or OTC health needs for your community.

There is a lesson to be learned from MCCPDC and other recent disruptions: You need to be seen and heard. One of the reasons MCCPDC is news is that Mark Cuban’s name is attached to it. He is a celebrity, and celebrity sells. You can be the local celebrity of your community. Do a radio show and morning news tour. Write opinion pieces for your local newspaper. Publish your cash prices compared against the 'other guys.' Make a list of all the products and services you offer that make you stand out and ensure everyone in your community knows about them.

Authors Dr. Lisa Faast and Heather Haro are from DiversifyRx a company committed to helping independent pharmacy owners improve profitability. For any questions or comments, you can reach the authors at 

The billionaire’s first venture into pharmacy launched earlier this year.

The Good, The Bad, and the Missed Opportunity of Mark Cuban Cost Plus Drug Company

Cannabidiol (CBD) sales are driving profits for many pharmacies, whereas others seem to be watching from the sidelines. Here are some tips to help increase your pharmacy’s CBD sales.

Many pharmacy owners treat CBD like the field of dreams: If they carry it, sales will come. You may get lucky with a few of these sales, but to create a profitable cash niche with CBD you need to focus on nurturing it. I speak every week with pharmacy owners who do not carry CBD because they lack confidence or simply have not seen sales. I have been able to help many pharmacies turn around their CBD sales with simple tips pharmacists can easily implement.

A limiting mindset shows up in several ways when I speak with pharmacy owners, including the following:
•	I am not a CBD expert.
•	Other pharmacies are already selling CBD.
•	My community does not want CBD.
•	I do not know which brand(s) to carry.

Yes, I think we can all agree you are not Dr Alex Capano, America’s first doctoral degree recipient in CBD studies and a leading industry researcher. However, you do not have to be Dr Capano to help your patients. Individuals get caught up on the word “expert.” Either everyone claims to be experts when they clearly are not, or even highly educated individuals are wary of the word for fear of being called imposters. Here is my definition: If you know more about a topic than the individual to whom you are speaking, you are the expert in that conversation.

You do not have to be an industry expert to sell CBD, but you should be educated. Many CBD companies offer education as part of their service. If you are interested in carrying CBD, I would recommend using a company with a robust educational platform to help you get started. You need to understand CBD as a clinician. Going through a course or continuing education of your choice will bolster your knowledge and confidence. Do not forget about your employees. They also should receive an education in CBD.

This phrase has now become the most common excuse I hear. Pharmacy owners will say, “I don’t carry X brand because the pharmacy down the street carries it already.” Or “I don’t carry CBD because another business next to me carries it.” In summary, many feel they missed out on the CBD opportunity because they are late to the game.

My response is, “Are you trying to sell CBD to the entire community or to your patients?” Far too many pharmacy owners worry about what other pharmacies are doing instead of focusing on how to serve their patients best. My advice is to pick the brands and products that you think are best, provide stellar outcomes, and sell them to your patients. Most pharmacies are sitting on about $100,000 a year in profit with only their patients as CBD customers. Your patients trust you. Your opinion and action in helping them choose a good product could be the nudge they need.

Much of the stigma around CBD has been dispelled. If you find that your community still believes CBD is the same as marijuana, that is an excellent opportunity for your pharmacy. You can rise to the occasion and be the leader in teaching the truth about CBD. Become the local expert by explaining the differences and how quality CBD products will protect the community.

The negative impact of opioids has finally gone mainstream. Medical professionals and patients are looking for alternatives to opioids, controlled drugs, sleep medication, and the chronic use of anxiety medications. Because CBD marketing has become popular, many individuals already associate CBD with helping these types of conditions. Every community, no matter how conservative, is ripe for CBD sales.

I typically recommend that each pharmacy carry 3 to 4 brands of CBD. Many CBD companies have a specialty or a niche product that is special to them. Another strategy is to stock products at different price points. Here is my short list of requirements for choosing a brand to carry in your pharmacy:
•	The company offers education.
•	It accepts returns of unsold products.
•	There is a uniqueness to the products, such as price, combination dosage form, or selling model.
•	It provides stock marketing materials.
Once you pick a few companies that meet your criteria, have your employees receive education and practice discussing the companies and products. Then it is time to let your patients know and start selling to them.

Your patients trust you. They will listen to your recommendations. When you can use their prescription history to make a specific recommendation for a CBD product, the rate of conversion and getting the sale skyrockets. Here are 2 examples involving my 2 favorite products.

Combination of CBD and Melatonin
•	Run a pharmacy management software report for all sleep prescriptions.
•	Call the patients and ask whether they are 100% satisfied with their prescription.
•	Alternatively, you can consult in the pharmacy.
•	Create a bag stuffer for the product and attach it to every bag.
•	Work with your staff to create a comfortable talk track.
•	This product may be particularly good for patients on Medicare, where most sleep medications are not covered or are considered high risk.

Vaginal CBD to Help With Chronic Pain or Infections
•	Run a pharmacy management software report for recent yeast infection or antibiotic scripts.
•	Call the patients and ask whether their treatment was successful and whether they are interested in any prevention products.
•	Alternatively, you can consult in the pharmacy.
•	Create a bag stuffer or flyer and hand it out to every patient to create awareness.
•	Work with your staff to create leading questions to direct patients to talk with the pharmacist (because this can be a sensitive topic).

You can take these steps for patients with pain, anxiety, or any other therapeutic indication. For example, many CBD companies have incredible topical pain formulations. You could target patients taking nonsteroidal anti-inflammatory drugs or opioids. Having a system for identifying patients and then having a conversation will lead you to success.

There is no better awareness method than having a catchy bag stuffer on every prescription bag that leaves your store. Programs like Canva can easily create bag stuffers. You can print them in-house as a low-cost, effective marketing tool. Here is a quick checklist for bag stuffers.
•	Print on bright, neon-colored paper using black ink.
•	Every patient at every visit gets a bag stuffer (do not prescreen).
•	Use the same bag stuffer for an entire month.
•	Employees must also talk about it, not just secretly slide it in the bag.

These are my favorite inside the 4-walls marketing tactics. Cheap and effective—what more could you ask for?

If you want to foster a strong CBD niche, eventually you will have to go outside your current patient database. To increase your reach, it is important to use different tactics.

Marketing CBD on social media quickly became a no-go after Facebook shut off advertising accounts. However, time has passed and much more is known about what you can and cannot do. I am no longer concerned about posting about CBD on social channels if some simple rules are followed.
•	You have no paid ads for CBD, no boosting for CBD or where CBD is mentioned or goes to a page where CBD is mentioned.
•	Be creative. You can discuss the ailments and how your pharmacy has a solution without mentioning CBD. You can also use creative graphics that imply CBD.
•	Live videos are perfect for talking about CBD.

Your local news station, radio, or newspaper often can be great sources to help educate your community and position yourself as the local expert. Start contacting them and ask whether they would be interested in running educational CBD information for their followers. You could include a sample of what you have written or a link to a post you have done. Emphasize educational material, not selling products.

CBD can be a great product that helps your patients and boosts your profits. It is a win-win situation. If you have questions or want some additional support in getting started or in growing your CBD sales in your pharmacy, I am happy to help. You can contact me at info@diversifyrx.com.


Pharmacists interested in driving profit through CBD can start by changing their mindset. 
