Sandra Levy is Managing Editor-Projects. She covers self care, chains and business, home care, over-the-counter medicines and Rx-to-OTC switches. She joined <i>Drug Topics</i> in 1998.

Sandra Levy

This article is contributed by the Hamacher Resource Group (

. Based in Milwaukee and with offices in the United Kingdom, HRG's comprehensive services combine the art of communicating with the science of data analysis to improve the profitability of every link in the retail healthcare supply chain. Manufacturers, retailers, wholesalers, and others count on HRG for strategic solutions to their business goals. 

Most drugstores do not merchandise as a separate category the product classes that fall under the umbrella of "medicated skin care." Rather, they are usually scattered about in categories as diverse as foot care, skin care, and cold and allergy. When considered together, however, the products typically included in this virtual category of medicated skin care are sales powerhouses, from efficient add-on sellers such as lip balms to premium big-ticket items such as anti-itch remedies for psoriasis and eczema. 

Virtually anyone could have a reason to buy a medicated skin care product, though some subcategories are more customer-specific than others. While essentially everyone can use a lip balm, a smaller segment of the population will have need for an anti-itch cream or an athlete's foot spray. All the same, it's important for drugstore staff not to stereotype the athlete's foot shopper as a young, athletic-looking male, or the psoriasis sufferer as an elderly gentleman. Women in their 40s can pick up a case of athlete's foot at a yoga class just as easily as men's feet can find it in the locker room after a game of basketball. Likewise, psoriasis affects a host of different people of all ages, though they may not all be aware their chronic dry skin actually is psoriasis. Acne-fighting products also are considered a part of medicated skin care, and that subcategory's shoppers range in age from pre-teen to middle age.  

It's important first for pharmacy staff to know about common conditions of the skin, then to be aware of the OTCs that can effectively treat them. For example, dry lips appear to be a self-evident problem. But there are two main paths to treatment: to burn off the dry layer of skin with an ingredient such as salicylic acid, or to soften that dry layer with a skin protectant. Different products take different approaches to the same problem; reading ingredients and learning the differences can arm every staff member with the knowledge needed to make expert recommendations. Psoriasis and eczema are examples of conditions that aren't always well understood, though a mild case of either is easy enough to recognize with just a little education. Often, consumers assume a prescription remedy is necessary to treat ordinary psoriasis or eczema, but several effective OTCs are available.  

Since products in medicated skin care range across different categories, clever cross-merchandising is crucial to generating extra sales. Ordinary lip balms are a classic point-of-sale item. But consider including a row of a premium cold sore medicine at the register as well. Or, if its premium price makes it too great a risk to keep near the door, include signage with the POS lip balms pointing customers to the cold and allergy department for serious cold sore medicine.  

Articles

Medicated skin care products are highlighted in this stockchecker article by the Hamacher Group.

Earn add-on winter sales with medicated skin care

The survey tags include tag F329, covering unnecessary medications; tag F425, covering pharmaceutical services; tag F428, covering medication regimen review; and tag F431, addressing storage, labeling, and controlled medications. (See 

How have the new requirements changed the practice of consultant pharmacists? 

Losben praised the medication regimen review guidelines, stating, "Before [the new guide], the physician would always have to answer Yes or No to a consultant pharmacist's recommendation. Now, if the physician disagrees with the consultant pharmacist's recommendation, the burden is on the physician to comment on why he/she is disagreeing. Now there is true dialogue between the physician and the pharmacist-a more interactive role that makes them both part of the pharmaceutical care process."  

Commenting on the tag covering unnecessary medications, Losben said, "The emphasis is on preventing adverse drug reactions and being able to recognize these reactions as soon as possible-to create not only a good atmosphere for pharmaceutical care but a safe one."

Gene Memoli, R.Ph., president-elect of the Connecticut chapter of the American Society of Consultant Pharmacists (ASCP), echoed Losben's sentiments. "The guide has increased consultant pharmacists' involvement in providing care to patients. If patients have a change in condition when they are in a nursing home for less than 30 days or have a change of condition that may be affected by the medication they are on, an interim medication regimen review (IMRR) has to be done within 72 hours of the event. You don't want the condition to continue to deteriorate and not have a pharmacist look at their drug regimen. You want them to act on it quickly so that the prescribers can make a change. This gets the consultant pharmacist more involved as part of the clinical team with the prescribers. This enhances the consultant pharmacist's value and role." 

Losben credited the guidelines with forestalling many adverse drug events. "It's not just that a resident might become dizzy but that he or she may fall and break a leg, and that will affect the total well-being of that resident in a more permanent fashion. It has really put into place some mandate for the nursing facility to know about the medications-with the assistance of the pharmacist-and to continually monitor what seniors might be at risk for when they use multiple medications. It allows the consultant R.Ph. to be a leader in adverse drug reactions and in preventing adverse drug consequences." 

Losben said the tag for labeling, storage, and security of medications helps to establish a chain of custody in the nursing facility. "It makes sure the drugs that are delivered are appropriately distributed and accounted for and that there are periodic reconciliations done. It really minimizes drug diversion and allows the nursing facility to identify it as soon as they possibly can through this reconciliation process."  

Consultant pharmacists applaud CMS' guidelines on nursing home surveyors one year after State Operations Manual guidelines become effective.

Revised SOM guide for surveyors bolstering role of consultant R.Ph.s

Conducted by Advanstar Communications Research Services, the online survey was fielded in late November and closed in early December. It obtained a total of 249 usable replies.

2007 Over-the-Counter Cough, Cold, and Flu Survey said that patients are asking for more counseling as a result of manufacturers' substitution of PE for PSE; 78% reported that because of the recent voluntary withdrawal of cough and cold products for infants, they get plenty of questions from parents confused by the controversy.  

Who gets the dialogue going? Customers aren't shy about striking up a conversation with R.Ph.s. Some 87% of pharmacists mentioned that customers typically initiate the tête-à-tête. Pharmacists start the dialogue only 13% of the time.  

Pharmacists who live in the Southwest appear to counsel more patients per week during cough, cold, and flu season and those in the northeast counsel the least number of patients. 

When asked what prompts them to initiate discussions about OTCs, pharmacists gave the following reasons: to improve the patient's health (78%), protect the patient's safety (66%), or an ingredient in the patient's prescription medicine may require discussing an OTC that can be used with it. (63%).

Seeing patients deliberate about what OTCs to buy in the cough/cold section draws some pharmacists out from behind the counter to help. Another R.Ph. said "coupons" get them involved. 

Do patients heed R.Ph.s advice? Forty percent of respondents indicated that patients "almost always" follow their advice on OTC cough, cold, and flu products; 50% said patients "frequently" take their words to heart; and 8% reported that patients "sometimes" heed their words. Fewer than 1% said patients never follow their advice, and 1.6% said "don't know." 

When asked whether state and federal requirements for placing PSE products behind the pharmacy counter have affected sales of these products in their pharmacy, 77% said yes. Ninety-two percent of these respondents reported that sales have decreased as a result.  

Similarly, when asked whether state restrictions on products containing dextromethorphan have affected sales of these products in their pharmacy, a smaller group (26%) said yes. Eighty-nine percent of these respondents said sales have decreased. One R.Ph. noted that this regulation has created "more theft" of these products.  

What do pharmacists think about the FDA advisory committee's recent recommendation that cough and cold products not be used by children under six? Thirty eight percent of respondents said they strongly agree or agree with the recommendation; 33% somewhat agree; and 29% disagree or strongly disagree. 

Drug Topics conducted an exclusive OTC survey for cough, cold and flu products.

Featuring this month: Cough and cold medications

Here's a look at what some chains are doing to capture holiday sales: 

The iCraig's iPod Alarm Clock Radio, which plays and charges all dockable iPod models, is also expected to be a best-seller. For stocking stuffers, there's a 25-piece mini tool set, and a combination clock and pen holder. On Black Friday, CVS plans to offer the CVS Battery Box, containing a variety of batteries in a storage box, for $9.99. 

Immediately following Halloween the chain urged on-line shoppers, "Find great gifts in our holiday shop." CVS offered customers Triple Extra Buck rewards on all nonprescription orders placed on 

 from Nov. 3 through Dec. 7 with its ExtraCare loyalty card.  

Griffin anticipates  Nintendo Wii will be the rage. He also predicts that Nintendo DS, Guitar Hero electronic guitar, digital picture frames, Webkinz (interactive stuffed animals) Barbie MP3 doll, and High School Musical dolls will be snatched up. When it comes to decorations, he said, tube lights and inflatable holiday decorations will be popular. Other hot items include Shania, Celine, and David Beckham fragrance gift sets. 

Griffin plans to hold a Black Friday Extravaganza (after Thanksgiving) with stores open at 6:00 A.M. "Some items will be outrageously priced," he noted. 

An exclusive on-line offering is a collectible die-cast 12-in.-long model of a Walgreens delivery truck.  

Pharmacy chains are expecting a bright holiday sales season for 2007.

Will holiday 2007 sales be lean or green?

Manufacturers are hurrying to introduce OTCs that have unique or enhanced formulations. Here's a roundup of the latest offerings: 

 has also been reformulated to provide more absorbable forms of key nutrients. Centrum Silver for adults 50 plus contains more vitamin C, vitamin E, and selenium to help support immune function. 

 (ecamsule) for UVA protection. The daily moisturizing cream with sunscreen has an SPF of 15. The firm claims the moisturizer's new sun filter provides exceptional protection against the UVA rays that cause skin damage year-round, even through windows and clouds. 

Manufacturers are putting a new spin on OTCs

Community pharmacists can expect problems on their hands over average manufacturer price (AMP) at the start of the year, followed by the need for tamper-resistant Rx pads in April. For hospital R.Ph.s, they have to guard against hospital-acquired infections, since Medicare won't be paying for the care associated with HAIs next year. Both community and hospital pharmacists can look forward to a knockdown, drag-out Presidential race in November that could determine how health care is provided in the future. 

Optimism reigns for community pharmacists

How optimistic are pharmacists? When asked what kind of business year they were expecting for 2008, 80% of the 460 respondents indicated that it was good, very good, or excellent. That figure represents a 15% jump over last year's figures, reversing a five-year downward trend. Not since 2002 have R.Ph.s expressed that level of optimism. Interestingly, while only 65% of pharmacists surveyed last year expected a good, very good, or excellent year for 2007, in the current survey, 74% reported that this year will actually be good or very good, and another 10% expect this to be an excellent year. 

Undoubtedly higher Rx volume plays an important role in the overall optimism and pharmacists are expecting a healthy growth in sales for next year. More than half of all respondents-59% in fact-predict that sales will increase in 2008 by an average of 10%. In addition, 67% of respondents predict that operating expenses will rise. 

The optimism and improved profits came despite a sense of increased competition. While last year Medicare Part D topped the list of worries, this year's focus turned to increased competition from big box and supermarket pharmacies offering discounted generics. When Kmart first introduced its discounted generic plan last year-followed shortly thereafter by Wal-Mart's own plan-it set in motion an increasingly competitive market, with chains and big box pharmacies offering steeply discounted and even free generic medications.  

Although cash customers make up only 10% of the business for most pharmacies, it is clear that the discounted generic movement is having an impact. Respondents pegged the discounted generics as their top concern, with 33% of respondents indicating that it was a negative factor impacting their company, followed by Medicare Part D (32%) and the move of some cough and cold medicines behind the counter (19%).  

Now that Medicare Part D has moved out of the initial shock-and-awe phase, pharmacies are beginning to get a better grip on its true impact. Nevertheless, Part D was the top news item for 2007, with 28% of respondents selecting it as the top story, followed by the release of the AMP rule (17%), the drug error TV exposé on "20/20" (10%), and the growth of in-store clinics (9%).  

While the Presidential election is less than a year away and will certainly be a top news story for 2008, many pharmacists are ambivalent about how important it will be for pharmacists. Forty-three percent of respondents indicated that they did not expect the new President to have an impact, while 25% said that they did. The remaining 31% were unsure of the impact. Still some respondents hoped that "the elections will focus on the healthcare issues and, thus, will impact the delivery of health care." 

Respondents were more comfortable commenting on the importance of specific government programs. When asked specifically about how Part D was impacting their business, 28% of respondents indicated it had a positive impact on their pharmacy, while 37% felt it had a negative impact. The remaining 35% did not know what impact the program has had on their pharmacy. In comparison, last year, 55% of respondents felt the impact was negative, while only 24% saw it as a positive. As one respondent this year noted, "Part D had a dual effect. First, it created severe problems with reduced cash flow and lower profit margins, but it increased the volume of business and helped many patients take medications that they previously were not taking because of cost. Many patients qualified for additional help with their prescriptions and had no help previously." 

One of the promising aspects of the Part D program has been the increased opportunity to deliver medication therapy management services to patients. 

' survey found that 34% of community pharmacists reported they are providing MTM services, although only 18% were actually reimbursed for it.

Among the questions asked were what is expected for sales, salaries, and staffing for 2008.