Pharmacy of the Year Finalist Gateway Pharmacy

 Pharmacy of the Year Finalist Roden-Smith Pharmacy

Pharmacy of the Year Finalist Bushard’s Pharmacy and Apothecary

Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.

Ask a variety of people about what they think about when they hear the phrase “independent pharmacy” and many of them would describe an independent pharmacy straight out of the 1950’s: a soda counter, some basic health necessities, and a pharmacist who fills prescriptions and has all of the time in the world to answer questions. The reality is of course quite different, as discussed at this year’s ThoughtSpot Conference and Trade Show hosted by AmerisourceBergen and 

in Orlando, Florida. Rich Tremonte, Customer Operations, Animal Health, and Community & Specialty Pharmacy (CSP), and Guilio Burzacca, Managing Director of Alphega Pharmacy, which is the European counterpart of 

 with pharmacies in 8 countries within the European Union plus the United Kingdom and Turkey, discussed how COVID-19 impacted independent pharmacists, what customers expect when they walk into a pharmacy, and what the future holds for the pharmacy industry.

According to Tremonte, customers are looking for the “instant gratification” that they experience elsewhere in their lives, especially online, to also happen within their healthcare destinations, including their local pharmacy. But at the same time, they also want the personal touch that has long been the backbone of independent pharmacy. The pandemic pushed this desire into turbo charge, when many people were trying to do their part and reduce contact with others. In Europe, more customers have returned to the brick-and-mortar experience, especially in independent pharmacy. According to Burzacca, independent pharmacies have seen in-store sales increase by 6% to 8%, whereas chain pharmacies have seen them only increase from 3% to 4%, indicating that the personal touch remains important and can be reason enough for a pharmacy customer to shop in-store.

Innovation is important to remaining at the forefront of the industry. However, many of the biggest innovations coming from pharmaceutical companies have been in areas that aren’t as relevant for retail pharmacies – including specialty injectables and infused therapies for rare and complex conditions, which means independent pharmacies must evolve their businesses in other ways. To spur innovation and find the next step, AmerisourceBergen has begun to invite pharmacist customers to the company’s headquarters, Tremonte said, where they are asked about what they’re looking for and how AmerisourceBergen can help them meet patient demands.

Standing out is more important than ever in a crowded market. Tremonte noted that when he’s in the field, he’s watching how GNP pharmacies find their “something special” that makes them stand out in order to engage customers and patients. Some pharmacies have a front-end that knocks it out of the park. Others have developed connections with health systems and providers to create symbiotic relationships that help customers achieve better health outcomes for complex or chronic conditions, such as diabetes. For others, it’s hearkening back to simpler times, like a pharmacy in Alaska that’s known for its ice cream counter.

To help pharmacies determine what can make them stick out, AmerisourceBergen offers 

business coaching and analytics programs to

 help pharmacies analyze patient data, as well as prescriber data, to identify key growth and marketing opportunities for the pharmacy. The program helps pharmacists answer the important, but sometimes hard to answer question, ‘where can I win?’ It analyzes demographics and other factors, along with identifying potential relationships, that can bring in new patients, garner more revenue, and help improve overall health outcomes. This approach seems to be working for 

“Highest in Customer Satisfaction with Chain Drug Store Pharmacies”

 in the J.D. Power 2022 U.S. Pharmacy Study. This is the 11th time that 

 has earned this recognition in the last 13 years and the network’s sixth consecutive win. What’s more, 

 also achieved the highest score with the “My Level of Trust with Pharmacy” factor, indicating exceptional patient confidence.

In both the United States and Europe, the COVID-19 pandemic was the shining moment for pharmacies and their staff to show what they can do and how they create value for the health care ecosystem. In the United States, this led to expanding vaccinating capability, testing, and even prescribing powers, albeit with some restrictions. In Europe, only 2 of the countries that Alphega operates in, France and the United Kingdom, allowed for vaccination in the pharmacy prior to the pandemic, but now 3 more countries: Portugal, Romania, and Italy also allow it, with some German states also vaccinating.

This expansion of pharmacists’ authority is based on a couple of simple facts. In the early days of the pandemic, pharmacies were often the only available health care site that people could access, with hospitals and clinics all over the world swamped with COVID-19 cases. Additionally with the drive to use telehealth, pharmacies offered the only face-to-face health care that many were able to find. Pharmacies were also quick to act to protect patients and employees, with many in the United States offering curbside pickup or delivery. In Europe, Alphega pharmacies had screens up within days of the lockdown starting as well as a one-way system through the store, according to Burzacca.

Already one of the most trusted groups in health care, recent surveys have found that the public places even greater trust in pharmacists since the worst days of COVID-19. A recent survey in France found that pharmacists had a trust score of 97. In comparison, the next most trusted group had a score in the low 60s.

The next step is to look to the future. For Burzacca and Alphega, this means focusing on Diamond, a program that allows independent pharmacists to have access to preferential programs, launches, and initiatives from large manufacturers. The hope for the program is that it will allow independent pharmacy to compete on more even ground with chain pharmacy, but still maintain the personal touch that is one of the cornerstones independent pharmacy. Alphega is also working on a program to provide the best treatment and use data in ways that can help improve care and give pharmacists actionable information.

In the United States, Tremonte said, “taking a step back, we need to be easy to work with. I always compare it to our personal lives. We all want to know who we’re buying from and be able to return something easily, or quickly get them on the phone to resolve an issue.” This view is what’s helping guide AmerisourceBergen’s continued commitment to enhancing the experience of its pharmacy customers.

One of AmerisourceBergen’s major investments is making it easier to reach someone who can help. Instead of being siloed, all customer service teams are now fully connected in one group with access to all of the same data to streamline the customer experience. And when making a call, pharmacists will soon be able to use a callback feature, which will mean that they no longer must stay on the line waiting on hold, but can instead go about their business until an available person calls them back to help. For common questions, the Self Service portal can provide answers, meaning that phone calls won’t even be needed. The ordering systems are also continually being improved to make it easier for pharmacists to find exactly what they need.

Beyond the specific projects, Tremonte believes the future of pharmacy requires a 2-pronged approach: diversifying clinical services and capabilities and embracing all that digital has to offer from scheduling to advertising to letting pharmacy customers search inventory before they even reach the store. For Burzacca, it’s helping pharmacists prepare for what’s next, not only with projects like Diamond, but programs that address new concerns like cybersecurity and can help expand clinical services.

Articles

The future of independent pharmacy requires the combination of what makes independent pharmacy special and the digital landscape found elsewhere in retail.

Total Pharmacy

Business Strategies

News

Supporting the Next Era of Independent Pharmacies in the US & Abroad 

Lauren Biscaldi is the Managing Editor of Drug Topics. 

From business education programming and innovative CE sessions to jam-packed General Sessions, this year’s National Community Pharmacists Association (NCPA) Annual Convention and Expo is an event that independent pharmacists and pharmacy owners simply won’t want to miss. The conference kicks off on Saturday, October 1 in Kansas City, Missouri at the Kansas City Convention Center through Tuesday, October 4.

Are you ready to embrace this year’s theme and 

? Read on for some of our top highlights and notable events taking place at the 2022 NCPA Annual Convention and Expo.

This year’s Annual Convention features two General Session events: Sunday, October 2 and Monday, October 3, both at 9:30 AM. The first of these sessions features keynote speaker Mike Abrashoff, former commander of the USS Benfold, who will share a story from his time in the Navy to demonstrate why leadership matters and why culture is everything.

On October 3, the second General Session kicks off with Lina M. Kahn, chair of the Federal Trade Commission (FTC). Kahn will join NCPA CEO B. Douglas Hoey, RPh, MBA for a fireside chat and Q&A session. “As FTC Chair, Khan has been receptive to hearing the concerns of independent pharmacists, and this is a great opportunity to get her thoughts about issues in our industry and talk about the important work her agency does on behalf of consumers,” said Hoey in a press release.

Finally, ophthalmologist Will Flanary, MD will take the stage as the day’s second keynote speaker. Perhaps better known by his social media handle of Dr Glaucomflecken, Flanary has more than 2.5 million followers across social platforms. With a keen eye for observational humor and biting satire, Flanary provides commentary on everything from “the perils of Visine to the horrors of health insurance”

 for audiences across the health care industry with the help of his 

"As a pharmacist, the most important thing is taking time to provide the best care possible for your patients, but pharmacists don't always lean on technology for the solution," Paige Clark, RPh, vice president of pharmacy programs and policy at Prescryptive Health, told 

 from Prescryptive Health, independent pharmacists said they spend an average of 2 to 6 hours a week reviewing drug pricing. That is up to roughly 312 hours a year spent reviewing pricing that could be focused back on patient care." 

"Intelligent pricing solutions driven by artificial intelligence can put this precious time back into pharmacy practitioners' hands, so they can do more of what they love: helping patients," Clark added. 

Led by Clark, Prescryptive Health will be presenting 2 sessions in the Exhibit Hall. The first—focusing on the ways in which pharmacies can use technology to remain competitive and boost their bottom line—will take place on Sunday, October 2 from 12:30 to 1:00 PM. During the session, Clark will present a case study detailing how one multi-location pharmacy was able to sustainably grow profits while keeping consumer prices affordable.

Between 3 and 3:30 PM on Monday, October 3, Clark will be joined by Brad Gallagher, partner at Barclay Damon in Albany, New York, for a CE session combining legal and pharmacy education to raise awareness of cybercrime in pharmacy. With personal health information selling for $250 per record on the black market—compared with 50 cents for a credit card number—this session is can’t-miss.

This 4-day event will also feature numerous business education sessions, many of which provide the opportunity to earn CE credits. On Saturday, October 1, learn more about the 

 and how pharmacists can use point-of-care testing services to grow their bottom line. On Sunday, October 2, a session hosted by NCPA senior director of professional affairs Lisa Schwartz will educate attendees on 

—to comply with the Drug Supply Chain Security Act, which goes into effect in November 23. And on Monday, October 3, Blueberry Pharmacy owner Kyle McCormick will answer pharmacists’ 

For attendees who are too excited to wait to start their NCPA Annual Convention experience, 3 days of 

—running September 29 through Noon on October 1—will be covering a wide range of topics, including a pharmacy ownership workshop, a guide to creating a pharmacist-led lifestyle and weight management program, and the ever-popular NCPA 

Pharmacy-Based Point-of-Care Test and Treat National Certificate Program

The Exhibit Hall will be open from Sunday, October 2 at 12 PM through 5 PM on Monday, October 3. Don’t forget to visit 

 at booth 931: Grab a copy of our latest issue, sign up for our eNewsletters, and chat with our team to learn more about how you can stay up to date on everything independent pharmacy.

Drug Topics’ coverage of the 2022 NCPA Annual Convention and Expo is sponsored Prescryptive Health.

FTC Chair speaking at NCPA Annual Convention in October. News release. National Community Pharmacists Association. September 12, 2022. Accessed September 19, 2022. 

https://ncpa.org/newsroom/news-releases/2022/09/12/ftc-chair-speaking-ncpa-annual-convention-october

Keynote speakers. National Community Pharmacists Association. Accessed September 19, 2022. 

Rewriting the script: Independent pharmacy trends. 2022 research report. Prescryptive Health. Accessed September 19, 2022. 

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

The meeting will take place in Kansas City, Missouri, from October 1 through October 4.

Conferences

Conference Preview: NCPA Annual Convention and Expo 

At best, the regulation of cannabidiol (CBD) in the United States can be described as patchwork. On a federal level, any part or constituent of 

 plants, more commonly known as cannabis or marijuana, is a Schedule I controlled substance. Hemp—defined as 

 containing less than 0.3% Δ-9-tetrahydrocannabinol (THC) and the basis for CBD product—was exempted from this scheduling by the Agriculture Improvement Act of 2018 (Farm Bill).

Enactment of the Farm Bill removed hemp from Schedule I of the Controlled Substances Act and launched a surge in hemp growing and a boom in the production of CBD products derived from now-legal hemp—and created confusion for regulators and pharmacists.

“I checked the landscape legally before I got involved,” said Tim Kotschwar, PharmD, owner of Alliance Community Pharmacy in Alliance, Nebraska. “I talked with the local police chief, the state patrol, our prosecuting attorney, even a local judge. I was basically told it’s not officially legal in Nebraska, but you can buy CBD in Bed, Bath & Beyond or just about any gas station.

“I was still nervous, so I talked with the state board of pharmacy and the Nebraska Pharmacists Association. They all said it’s not officially legal yet, but it belongs in the pharmacy. That guy in the gas station isn’t going to be able to talk about the long list of CBD-drug interactions or [adverse] effect profiles,” Kotschwar continued. “The FDA says we can’t call OTC CBD a drug, but pharmacists are the people trained to...counsel buyers about the drug-like qualities of CBD.”

The text of the Farm Bill set the upper allowable limit of THC in hemp as less than 0.3% by dry weight of plant material but said nothing about THC or other constituents in products derived from hemp products, including CBD. The bill also underlined the authority of the FDA to regulate hemp, said Al Carter, PharmD, MS, RPh, executive director and secretary of the National Association of Boards of Pharmacy. The problem, he explained, is that the FDA is largely avoiding CBD regulation outside the 2018 approval of cannabidiol (Epidiolex) for certain seizures.

The agency bans CBD claims for the diagnosis, cure, mitigation, treatment, or prevention of any disease, as well as adding CBD to human or animal food products—although use in cosmetics is specifically allowed.

“CBD was approved as an active pharmaceutical ingredient in a drug product; therefore, CBD is excluded from the definition of a dietary supplement,” Carter explained. “The law similarly does not allow sildenafil or gabapentin to be added to foods or supplements after being marketed as prescription-only drugs. A product can make the regulatory jump from being a food [or] supplement to also becoming a drug, like [omega-3-acid ethyl esters (Lovaza)], but there is no clear path to go the other way from drug to food [or] supplement.”

However, Carter added, the FDA is not entirely silent on CBD. Since 2018, the agency has issued more than 60 warning letters to companies selling CBD in violation of existing prohibitions against medical claims or additions to food or beverage products. But the agency has not acted on requests to reconsider regulations of nonprescription CBD.

“States got tired of waiting [for the FDA] and acted on their own,” said Tim Gregorius, RPh, vice president of operations for PRS Pharmacy Services in Latrobe, Pennsylvania. “Two years ago, there were maybe 20 states where CBD was still a bad word and 3 states where it was flat-out illegal. That is no longer the case.”

But individual states have taken different paths toward CBD regulation. Idaho appears to be the most restrictive, Carter said. There, CBD remans a banned, controlled substance unless it contains 0.0% THC and is derived from mature stalks, oil, or cake made from seeds or achene, or sterilized seed.

 Nebraska, like many states, allows up to 0.3% total THC as measured by dry weight of hemp, but it does not address products derived from hemp.

Most states require retailers to obtain a license or registration to sell CBD products, Gregorius said, but these requirements vary widely. Some states focus on product content, certificates of analysis, and allowing/disallowing products from specific vendors. Other states focus on labeling with batch/lot identification, expiration dates, and QR codes linked to certificates of analysis. Ultimately, selecting and carrying products that meet these requirements are the pharmacist’s responsibility.

When—or if—federal regulation of CBD will happen is still unknown. The secretary of the US Department of Health & Human Services has the authority to bypass the usual exclusion of prescription-first products from OTC or dietary supplement regulation and initiate CBD rulemaking, explained Jane M. Wilson, director of program development for the American Herbal Products Association, but no secretary has acted.

“We see hemp as another botanical with robust regulatory frameworks at the federal level as dietary supplements and foods that can be used as the basis for regulating CBD products,” she said. “We and other industry groups have been advocating with the FDA to consider these CBD products as distinct from the pharmaceutical that has been approved.”

The absence of FDA regulation has helped spur the introduction of at least 5 bills to regulate CBD products in the US House of Representatives and Senate this year, Wilson said. One bill, HR 3617, the Marijuana Opportunity Reinvestment and Expungement Act, passed on a largely party-line vote in April 2022. Wilson and Gregorius agreed that stand-alone federal CBD legislation is unlikely to pass this year.

“We would encourage pharmacists to only stock products that comply with applicable law and recommend products based on their professional judgment,” Carter said. “This analysis should include weighing the risk vs benefits of the therapy, which is somewhat unusual for pharmacists, and needs to factor in the quality of the product and the possibility of undeclared THC or inaccurate labeling.”

There is no single information source for cannabidiol (CBD) regulation. The Agriculture Improvement Act of 2018

 regulates hemp but not finished CBD products, and the FDA has steered clear of nonprescription CBD,

 leaving regulation to the 50 states and resulting in 50 different approaches. Neither the American Pharmacists Association nor the National Association of Boards of Pharmacy track CBD regulation by state.

The National Community Pharmacists Association has information on CBD science, pharmacy-focused education, and marketing at ncpacbdsource.com, but it provides no regulatory guidance.

State pharmacy associations are the most reliable starting points for local regulation and requirements. Some state boards of pharmacy play active roles in CBD regulation while other boards are silent on CBD, leaving regulations to other agencies. Ultimately, there may be inconsistencies between state statutes, board of pharmacy rulings, federal laws or regulations, and local law enforcement priorities.

“The standing joke for years was that you could walk down the street in a certain major state smoking a joint and nobody would blink an eye, but you couldn’t buy CBD in a pharmacy, just in gas stations and grocery stores,” said Tim Gregorius, RPh, vice president of operations for PRS Pharmacy Services in Latrobe, Pennsylvania.

Some states may require—or prohibit—specific language such as “Δ-9-tetrahydrocannabinol (THC)-free” or “low THC.” These requirements, however, may not match the diverse terminology used in the description, marketing, and labeling of CBD products as understood by consumers, retail channels, or pharmacy.

Potency, for example, is a measure of biological activity in pharmacy and federal drug regulation but is often used in CBD labeling describe the amount of CBD or some other constituent(s), an attribute pharmacists know as strength. The American Herbal Products Association’s Hemp Lexicon

 is a useful guide to current industry terminology.

1. Agriculture Improvement Act of 2018, PubL115-335 (Farm Bill). Accessed August 18, 2022. 

https://www.congress.gov/115/plaws/publ334/PLAW-115publ334.pdf

2. FDA approves first drug comprised of an active ingredient derived from marijuana to treat rare, severe forms of epilepsy. News release. FDA. June 25, 2018. Accessed August 15, 2022. 

https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-comprised-active-ingredient-derived-marijuana-treat-rare-severe-forms

3. FDA regulation of cannabis and cannabis-derived products, including cannabidiol (CBD). Updated January 22, 2021. Accessed August 15, 2022. 

https://www.fda.gov/newsevents/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-productsincluding-cannabidiol-cbd#dietarysupplements

4. Cannabidiol(CBD). Idaho Office of Drug Policy. Accessed August 15, 2022. 

5. Nebraska Hemp Farming Act, Laws 2019, LB657, §1. Accessed August 15, 2022. 

https://nebraskalegislature.gov/laws/display_html.php?begin_section=2-501&end_section=2-519

6. American Herbal Products Association. Hemplexicon. Updated May 2021. Accessed August 15, 2022. 

https://www.ahpa.org/Files/Document%20Library/AHPA%20Guidance%20Documents/HempLexicon/AHPA_HempLexicon_Final.pdf

No federal agency has taken charge of regulating cannabidiol products, leaving decisions up to the individual states.

Law and Regulations

Pharmacy Law and Regulations 

The Evolution of the CBD Regulatory Landscape

 in partnership with American Associated Pharmacies sits down with Don Arthur, RPh, a pharmacist and owner of Black Rock Pharmacy in Buffalo and Brighton Eggert Pharmacy in Tonawanda, New York, to discuss what clinical care may look like, the biggest challenges that lay ahead for independent pharmacies, and successes that he's seen in pharmacy.

. We're joined today by Don Arthur, to discuss the challenges that lay ahead for creating the next generation of independent pharmacies, how ground advocacy is shaping clinical care delivery, and what he's implementing to create the improved pharmacy of the future. As we transition into this next phase of the pandemic, what do you think clinical care delivery will look like at independent pharmacies?

Well, I think it's going to take on many different appearances. But I think point-of-care testing is the big theme, you know, that I'd like to talk about today. Some of the other clinical services that independent pharmacies have been providing: medication therapy management, some of the newer programs with diabetes, I think those will continue to have opportunities. I think what's happened to community pharmacies in the last two and a half years now, is how they were able to quickly adapt and become familiar with the various point-of-care testing that's out in our community. So I would say as we transition away from the pandemic, I think antibody testing, still talking about COVID is some opportunities, and I'd like to talk a little bit about that. But I think some of the lab partners that we had not even known of prior to COVID have approached us now to do finger pricks for vitamin deficiency. So lots of clinical opportunities in the near future.

So do you think that this future will require state or federal legislative changes? Or will it be on the ground advocacy work that makes this care a reality?

 Well, I wish it were the latter. I wish it was simply advocating for it, and it would become a thing, but unfortunately, it doesn't work that way and our pharmacy space. We have the federal government involved, obviously, the FDA and others, but we also have states involved: State Board of Pharmacy, state health department's. In community pharmacy, we have to deal with all of those regulatory bodies. But specific to where we are today, emergency orders really created our opportunities. We began COVID testing in November of 2020, 9 months after the pandemic began. It took us that long for our state governor to recognize that independent pharmacies could play a role. And then it took us several months to go through the licensing requirements to become an LSL and receive a CLIA waiver. So I think I'm really hoping, we showed here in Western New York, that we have been able to test our community quickly, efficiently, professionally. We've tested over 92,000 people to date. We continue to test much smaller daily numbers. But our vaccinations, we have vaccinated over 15,000 people since the pandemic began. And I think that that volume, hopefully has shown the regulators or politicians that we are absolutely the best place to receive certain types of point-of-care testing, but it will take permanent legislative action, both at the state and federal levels, for us to be able to do that.

 So what do you foresee as the biggest challenge in creating the next generation of independent pharmacies?

Well, in terms of my family, my dad started our pharmacies back in 1958. And most independent community pharmacies at that time were single pharmacies, opened by graduates of local pharmacy schools. And the average prescription, I think back then was under $10 and there were no such thing as PBMs. We actually, if you look at this historically, when we put our typewriters, I began working in 1977 in our family's pharmacies and in the early 1980s, when pharmacy computers were introduced to independent pharmacy, we took those typewriters that I still remember and put them under the counter, and we began processing prescriptions with our computers. At that time, insurance plans had started to evolve and offer prescription benefits with co-payments for patients and once we went to computers, we needed a platform similar to MasterCard Visa, to just basically handle that transaction for a transactional fee of 25 cents, 30 cents, whatever it was at the time. And they did a phenomenal job at that. But look what they've become, you know, now they're called prescription benefit managers. And unfortunately, even though we were there in the beginning, and we helped create that industry, they're probably our biggest challenge for independent community pharmacies. They are a partner, one would think, but the relationships we have with them are very, very difficult. We all have contracts that we sign independently as community pharmacies. But as I talk to my attorney, friends who do contract law, they're always confused by the lack of negotiation in the contract. So they are contracts, but they don't really feel like contracts because we as independent community pharmacies don't really have any options. And they're unfortunately becoming more and more difficult. On a day-to-day basis, I have two community pharmacies in Western New York, one Black Rock pharmacy opened in 1958. It's a traditional pharmacy, our volume is based on dispensing of tablets and capsules and solutions and liquids. And it's been very challenging to be able to work within this PBM world that's been created. My second pharmacy, Brighton Eggert pharmacy is a little bit different. We are a compounding pharmacy. We do nonsterile compounding. And we've been very fortunate in that regard to get a large amount of support from our physician community and our patients. So we've grown that business, we have a large erectile dysfunction business that we created with neurologists and throughout our area within a 60-mile radius. So, Brighton Eggert has been able to adapt a little more quickly than our traditional Black Rock pharmacy, but we shouldn't have to, these clinical opportunities, these things that pharmacy does, they should supplement an already vibrant, successful pharmacy, if you've been in your community since 1958, you're filling a large volume of prescriptions, which we are because we've developed a relationship with the community, sometimes three generations of families, and they respect us, they trust us, and they want to be with us. But a pharmacy like that should be able to compete to thrive, to be successful in the community, on providing those services, those traditional pharmacy services, if they're able to adapt and add staff and great clinical opportunities, that's fine, but they shouldn't have to do that to keep the lights on. So our biggest challenge is PBMs. And, of course, government, working with government, most independent pharmacies tend to be somewhat moderate, because we're just trying to find somebody out there on the state level and the federal level to help us.

 Okay, and so conversely, what successes have you seen in the industry so far?

 If we can get away from our traditional filling of prescriptions with tablets and capsules and having to interact with PBMs, and I'm always optimistic, I'm hoping that they do recognize the value we have in our community. Certainly our patients recognize and respect that. I think the local politicians in our communities too, but we're just not getting that from the PBMs. I'm hoping we soon have some successes in that area, both at the state and federal legislative level, in our interactions with prescription benefit managers, but in our relationships with our PSAOs, our pharmacy service groups that help us represent us in interacting PBMs. I hope we can come to some kind of an understanding that independent pharmacies truly do have value. We can help outcomes. We can help reduce healthcare costs. We can help make people healthier. So I'm optimistic in that regard. We are involved with CPSEN and CPSEN has grown throughout the 50 states, which is great for independent community pharmacy. They get it. Some of their programs we are working with. In New York state, there are active programs for diabetes. You had a nice article in your last 

 that talked about HbA1c point-of-care testing. I'm very interested in doing that. I think that's a big opportunity for independent community pharmacy. Again we've clearly shown everyone that there are certain health care services that are extremely convenient at independent community pharmacies. We showed that again, I do have 2 pharmacies and we decided to create a drive thru testing facility at my Brighton Eggert pharmacy, to be able to test 92,000 Western New Yorkers and counting and to vaccinate 16,000 people. Well, we didn't do it with our current staff. We were fortunate, we hired at one point 12 RNs working for us on a full time basis, and we were vaccinating 150 people a day. And I'm not any different than other independent community pharmacies throughout the country. I think in the last 24 months, we've shown that vaccinations, point-of-care testing, programs through CPSEN, medication therapy management. The spotlight has clearly been on us, the last two years. I think we've performed exceptionally, and I think that's hopefully going to create opportunities for the next several years and into our future.

 Okay, so in your current pharmacy practice, what kind of programs and practices are you implementing, to help create the improved pharmacy of the future?

I had mentioned our compounding business, and we focus on opportunities in that particular space. We're frustrated. We're fairly new compounders. We aligned ourselves with PCCA, Prescription Compounding Centers of America. And they've been fantastic. My father, we had eight pharmacies, and my father was a former president of NCPA. And my brother Brad, my dad was president in the early 80s and my brother Brad went through the system, and he was president a few years ago. So I've been going NCPA conventions since 1980, when I was in pharmacy school down University of Florida. And compounding was there back in the beginning, and my father and I, we had eight pharmacies. We were big front-end pharmacies at the time. We had gift departments and grocery departments. We sold beer, and we were part of True Value Hardware. And we said, ‘you know what, that's not us. We're pharmacies, we care for our community back in the pharmacy department. But we're also retailers and compounding’s just not something that we have an expertise in, or we're interested in.’ Well, I kept walking by their booth, and five years ago, we decided to start a compounding, a nonsterile compounding business. So we are somewhat new to the industry. But it's really changed our relationship with physicians, we now are problem solvers for our physicians whether it's in pain management, orthopedics, podiatry, or dermatology, but physicians now call us and ask us to help them solve problems. That's pretty neat. I didn't really experience that prior to getting into compounding. So we'll continue to grow that business. But it's this point-of-care testing, which is really exciting to me. We learned so much over the past two and a half years. It's amazing how technology changed from in the beginning of the pandemic. You would have to go to a large lab like Quest labs in our area and you would have to pay $225, wait upwards of seven to 14 days to get results on a COVID test. And now we do rapid antigen testing with results in 15 minutes. We do rapid PCR testing with results within an hour. We have a lab partner where we do lab-based PCR with results the following morning. So it's amazing how technology has been so rapidly evolving in that particular space. With that we met in creative relationships with businesses that I never even knew existed in our community. And we've been partnering with a local lab that has a national and an international presence. And they just received FDA EUA approval for a COVID antibody test that’s simply a fingerprint that gives you an analytical, numerical value. You know, we've been antibody testing in our pharmacies for the last year and a half with we've been using the first step. And it's a great antibody test, but it's just yes or no. So it doesn't really help the person know what level of antibody protection they have at a given time. This test will give you a number and that number equates to what they call the COVID-19 immune index and the number that goes from one to 20. It will define if you're at low risk or at high risk. So we're pretty excited. We think we're within weeks of launching that, again the company received an FDA EUA for this, where our role will be point-of-care testing. We will take the finger prick, we will put the sample into a card, and a courier will pick up those sample later that day. The patient will have very, very specific numeric report of their antibody levels with a very user-friendly explanation. Why is this of value? Probably, we're vaccinating about 25 people a day. Most of those people are age 51 and older, receiving their second boost, their fourth shot. And I think the number one question they have those under age 50, who are not yet eligible unless they have an underlying condition. Their question is, ‘do I need it?’ As I talked to the lab specialists that we work with and really understand and know this much better than I do, they think it's an excellent question, because it's not beneficial to overvaccinate someone. So if we know that people have different levels of antibody, well, we don't know, is it a genetic component? Is it a health component? There are several factors, I'm sure. But they all go back to the point of, if we have an antibody level, that's accurate, we can answer that question. And if your levels are low, it would be appropriate to receive another booster, if your antibody levels are high, you have significant protections still, and it's not necessary at the time. So we think we're going to be doing that, within the next two weeks. We feel it's going to be a covered service under insurance due to the Cares Act back in 2020. We're pretty excited about that. Because unfortunately, fall is right around the corner and we don't know what that's going to bring in the world of COVID. But to have a tool like that, for people to be able to know their antibody levels, and then make a decision based on that as to whether or not to receive another vaccine, I think is exciting.

 Okay, so do you have any final thoughts or takeaways that you'd like to share? Before we wrap up?

The final thoughts are that March of 2020, COVID, it's changed my pharmacy. I don't talk very much about the hand sanitizer, but if you remember in the beginning Purell just wasn't available. And, again, the country came to independent community pharmacies, especially those that had some compounding and lab experience, provided us with a federal formula, and asked if we could compound basically hand sanitizer. We made 10s of 1000s of bottles of hand sanitizer. We were providing in five gallon bottles for companies. We did that. We were able to adapt to do that over several weeks. We were able to gear up and provide a drive thru point-of-care testing for COVID. And the nasal swab as other independents have throughout the country and in very large numbers, up to 1500 in one day, during one of the holiday outbreaks. We were able to adapt to do that. Vaccines we've talked about, we've been vaccinating in New York State for 10 plus years. Unfortunately, the rate of flu vaccines is not as high as we would like it to be. So we would do 10,15, 20 a day during the season. We vaccinate for shingles. We vaccinate for pneumonia. But we had never thought that our staff expanded with some registered nurses could vaccinate up to 150 people a day. We've clearly showed our government that we can do these things. If you remember independent pharmacies throughout the country, it took some of us three months to receive our first vaccine, the government felt it was best to handle in clinic settings, which I think they may or may not have been right. I think those clinics, there was such a demand in the beginning when the vaccination became available, but they could have done better, they could have absolutely opened up those vaccine clinics and communities. I was actually a big part of some of those in our area. At the same time, they should have gotten those vaccines out to independent pharmacies day one. Ee should have been the focal point and chain pharmacies, because we've been vaccinating the community for the past 12 years. The rollout was difficult, but we're still vaccinating 20, 25 people a day. And I don't think there are any vaccine clinics. They've been gone in western New York for over 10 months. So I think government quietly, I wish it was publicly said, ‘wow, independent community pharmacies, look what you've done’, but I think they absolutely know. Tvery time we order vaccines, which we do weekly, New York State calls us and says ‘where are you finding these people? We've got pharmacies that haven't ordered vaccines and months.’ Where are these people coming from? I would say 90% of them are not our current patients. They're people that have heard about what we've done in the community in relationship to COVID and they're driving to us and we're vaccinating them. I'm excited about our future. I've got two boys, third generation working in our two community pharmacies, so I'm excited for them. I don't ignore the challenges we have with prescription benefit managers, but look what's happening around the country, all 50 states seem to be taking a much closer look, the FTC decided to take a look. I bounced around quite a bit today, as I do, but I do think there's lots of opportunities in the future.

Thank you for listening, and we hope to see you next time at the counter.

Podcasts

Don Arthur, RPh, discusses what lays ahead in independent pharmacy, from clinical care to success stories.

Looking to the Future of Independent Pharmacy

 Hello and thank you for tuning in to today's episode of Over the Counter, in partnership with AmerisourceBergen and Good Neighbor Pharmacy. I'm Miranda Hester and I'm an editor with 

. I'm joined today by Mark Szilagyi, owner and pharmacist at Gateway Pharmacy, a member of the Good Neighbor Pharmacy Network. Thank you for being here.

Gateway Pharmacy was recently named a Pharmacy of the Year finalist as part of Good Neighbor Pharmacy’s annual ThoughtSpot Conference and Trade Show. The award recognizes pharmacies that have gone above and beyond for their communities and displayed excellence in patient care and innovative pharmacy practice. Mark, congratulations to you and your team members on this amazing recognition. I'm excited to hear about the vital role that your pharmacy plays in your community and how you've continued to build that local legacy. But to start, can you give us a bit of background on the history of yourself and your pharmacy?

Absolutely. Gateway has been here in Phoenixville, Pennsylvania since the 1950s. And then in 1982, my dad Mark Sr. and his partner, Henry Katra. They both purchased the store and have been running it since then. So, of the 2 families, it's my sister and I and Henry's kids, Nicholas and Kristen Katra. We basically started when we were about 6 years old, a good funny story. I know 6 sounds young to start in pharmacy, but my mom would get tired of dealing with me. She would send me into work with my dad. And that's when I started at Gateway: pricing, different things up in the warehouse and just kind of puttering around as like a 6-, 8-, 9-, 10-, 12-year-old would do in a pharmacy.

I've had many, many roles here. From stock boy to pharmacy register to pharmacy technician and then to pharmacist and then finally to pharmacy manager and part owner. That's kind of my personal role here. As far as the store goes, we've been here since 1950. We purchased the store in 1982; it's been a staple of the community since then. We've been trying to offer as many services to the community as we possibly could.

 Can you tell me more about the Phoenixville community? What is your patient population like and what are they looking for from their local pharmacy?

Absolutely. The town is pretty interesting. In the 1800s, Phoenix Steel started; [Phoenixville] was a huge steel town, and as a lot of Pennsylvania towns that had steel or coal did in the 1980s, they closed the plant, and so the demographics really changed from a booming, popular town. I don't know if you've ever seen the movie 

—it's an old movie, a horror movie—and that was the biggest thing about Phoenixville after the plant closed—that it was filmed in Phoenixville. The demographics really changed in the 80s. It became a town where money wasn't flowing. The plant was closed. We had a lot of older people who stayed, and then a lot of people who left and went to the city, or went to more prosperous areas.

Then, in the mid 2000s, [community leaders] decided that they were going to try to revitalize the town. They started opening up Bridge Street to have some new restaurants and different pubs and beer gardens and things like that. And it's just taken off in the last 10 to 15 years. We have a really diverse population. We have those people from the old school, blue collar, steel mill; we have new millennials who have moved into town, who really love the bars and all that. Our population is really—I don't want to say too unique—but really wonderful because we have everybody from older people who've been here for 56 years to people who just moved here maybe 2, 3, 4 or 5 years ago. It's a great community. People come together, and it's a small community too—so a lot of people know everybody, and there are a lot of names that…you'll see and [say] ”Oh, that's a Phoenixville name.” It's a really great diverse and vibrant community.

 Let’s talk about your approach to patient care and relationships at Gateway Pharmacy. What kind of experience do you strive to provide your patients, and how do you and your staff members make that a reality?

I always thought about a couple of things, actually. The one thing I always thought about was [that] going to the pharmacy or going to the doctor is not really always the most exciting or pleasurable experience. I mean, when you're sick or you don't feel well, [or] you have something wrong with you, your mentality changes. [It’s different] than if you were going to get a breakfast or going to go shopping for clothes or something that you would enjoy. I try to impart that sort of mentality of the patient, that not everybody may want to be here, coming to us. Our goal is to try to make it as easy and as pleasurable as possible.

Being that we are small community, it's nice to greet people and try to know who they are, and to remember them. I can say that some of our staff are just so amazing. I could point out Tricia, our general manager. She knows so many people by name, goes right to the basket when she sees them, doesn't have to ask the name. We don't always necessarily require that of everyone, but that type of mentality, that we're here for you, we know who you are, and we're ready to help you out in any way we can, I think is good—not only for us, but it's great for someone who doesn't want to be there. It sort of helps smooth everything over and you leave feeling good about trying to not necessarily fix, but sort of treat, what is wrong. We're making a bad thing a little bit better.

We don't prescribe medicine. So we can't say, “Well, you know, this is the drug you take,” but we can communicate it to the patient, and that's really our job as a pharmacist. I tell people they don't pay me to count pills. They pay me to talk to you. They pay me to communicate and work you through the process of getting a prescription. I think that our staff really tries to impart that as best they can, and to just tries to make the experience a little bit better.

 Great, thank you. As those in the industry know, pharmacists’ role and value in the health care system has been increasing exponentially for many years, even prior to the COVID-19 pandemic. Mark, can you discuss how Gateway has grown and evolved its services and offerings over the years to meet the changing needs of your patients.

After COVID-19, we had a number of things in place that we really saw starting to take off. The biggest one was obviously the immunizations. We always did immunize people; we did flu shots yearly, and we do shingles shots, pneumonia, and Tdap. But obviously, with the COVID-19 vaccine… that was a huge thing. We really had a great response with our customers and the community at large, being able to provide it through a couple other different organizations that we worked with. We also do medication adherence—the SMM program is what we call it—which really tries to help people not only get their medication every month or every 3 months, but also to tries to keep them on track to take [those medications].

We are now starting a diabetes prevention program, which is headed up by Nick Katra, one of the partners. The goal is to try to capture people who are prediabetic, and to teach them a way to avoid getting diabetes through lifestyle changes.

We also have a compounding lab, which we do a lot of different stuff, some pet medication. We do some programs for patients who are unable to take certain dyes and fillers. And we have actually— it has really been a robust thing—is some long-term care homes, which has been a wonderful, wonderful experience for us. We found that in the community, there were a lot of smaller group homes that had maybe 5, 6, or 7 patients…and they had patients taking care of them. They were not getting the type of service from their previous groups that we were able to provide. It wasn't that we were doing anything really all that phenomenal or new. It was just that we work personally with them, to blister pack their medicine, do a monthly cycle for them, provide them with medication records, so that they're able to give the medicine to the patients. That's been a wonderful, wonderful windfall for us. We're really proud of that program.

One of my personal favorites is doing a lot of pet medication. It's been really a great experience, because we're finding that as an independent pharmacy, you're a lot of times priced out by the bigger guys, as far as prescriptions go. This was an opportunity, once AmerisourceBergen was able to get us a contract to do pet medications, that we could become relevant in that space, and that's been great. You're not dealing with insurance companies, so that's something that's been fantastic.

We had a mobile app before [the pandemic], which has been used a lot more. We instituted a text function, and everybody texts now. I mean it's just amazing how 90 year old people, they text—which is fabulous, because I think it definitely helps you communicate better.

And we do a lot of over-the-counter stuff. Our gifts section is just phenomenal. We have a great candy case that we just put in a couple months ago, and people have really responded to that. So, we do a lot of different things. And after COVID-19—or during COVID-19—we really didn't change anything other than that we made [the pharmacy] more accessible to people. If people wanted to do curbside, we did curbside. If people wanted delivery, we did delivery. The good thing about it was doing the vaccines and getting more exposure; I think people started to see all the things that we did, which was really great because we always did these things. It was just letting those people who didn't know about us already see all the great things that we did.

 Mark, can you tell me about the mobile vaccine clinic that Gateway had during the COVID-19 pandemic?

Yeah, we had a great partnership in town with the mayor, Valley Forge Fire Company, West End Fire Company, Phoenixville emergency management and Phoenixville hospital. We all got together in a very serendipitous way. It turned out that I could get the vaccine, [and] they couldn't, but I didn't really have the people to provide the right volume of shots. We got together and we did amazing things. I think we've vaccinated over 10,000 people at this point. It's been it's been a wonderful thing.

We would go to schools; we did Phoenixville Area Middle School, we did Phoenixville High School, we did Owen J. Roberts Middle School, and we did Owen J. Roberts High School. We also provided a number of different vaccine clinics together with them. It was just a wonderful experience. We got to really know the mayor, who is an amazing man. We got to know a lot of the community even better than we already do, so it was fun. I will say this: it was fun because it's amazing what you can get done when everybody is on the same page and has a common goal. I think we really did that. And we've created partnerships for the rest of our lives with that.

 It’s so inspiring to hear how you and your team have continued to go above and beyond for your community during such a critical time. Independent pharmacies are known for their ability to provide trusted and high-quality patient care, but there is so much more that goes into running your business behind the scenes. How has being a part of the Good Neighbort Pharmacy network helped advance and optimize your pharmacy’s operations so you can focus more on delivering the best care possible?

Being a part of AmerisourceBergen and Good Neighbor Pharmacy has been integral, particularly with the COVID-19 pandemic…We knew that this [the vaccination process] was going to be something that we wanted to be a part of; we just weren't sure what we were going to be able to do, whether it was just a couple people here, just a local population. And as I said before, it turned into a wonderful thing where we did the high schools in the area and a lot of the community. When I worked with Mark, our business coach, he really gave me the ideas like, “You can do more, you can do more than a couple hundred people.” He laid it out, that it's “Look, if you guys really want to do this, you can do this.” And so, with AmerisourceBergen having the Pfizer-BioNTech vaccine… I'll be honest, I was incredibly intimidated by having ultra-cold, frozen, 1200 shots of [the vaccine] sitting in a freezer in my pharmacy. I was nervous about that, [thinking], I don't want to screw this up. My sister and I sat down one day and we said, “Can we really do this?” We talked to Mark a little bit and then we talked to our group that we were working with and we said, “Let's do it, let's get this done.” And it took off from there. I said to Mark, “I can't thank you enough for inspiring us and for AmerisourceBergen being able to provide us the shot.”

What happened in our county was, the local health department sort of took over initially and they did these mass vaccination clinics and that was great. They did what they needed to do, but they cut a lot of the local smaller groups out, so we weren't able to get a lot of the vaccine to the state. When AmerisourceBergen stepped up and said, “We have this available,” it really gave us that opportunity. I said to Mark, “You know, it's really nice to be able to play in the game”—like that old 

 kind of thing—and see what we can do. I think when you see the numbers and what we were able to do, if you look at the vaccination rates in our county, we definitely had a hand in vaccinating a lot more people, because AmerisourceBergen put us in the game.

 As we mentioned earlier, Gateway Pharmacy has been named a Pharmacy of I Year finalist by Good Neighbor Pharmacy. Mark, what does this recognition mean to you? And what are you most proud of?

That this nomination is not just for the owners, or [for] me or my sister. It really is a testament to everyone that we work with—all the employees here—and a testament to the community because it's been difficult for independent pharmacy. In the last 10 years, it's been a difficult drive. There are a lot of competitors, a lot of big chains; they use tactics where you have to go to them for monetary reasons. It’s really a testament to our customers who stuck with us for years and years and years; [they] didn't have to come to us. This nomination really is… we wouldn't be here without them. It's a great honor. I think it's well deserved from all groups, our customers, the owners, and all our employees.

 That’s wonderful, and best of luck to you! To close out our conversation, what are some of your biggest priorities for the year ahead? What excites you most about the future of independent pharmacy?

I think we're excited to see what happens with the new vaccine. In the fall, we're going to plan on vaccinating as many people that want to get vaccinated. We're planning on doing flu shots, which I think is going to be another big thing. It's been really a good scene for us. What I am most excited about for independent pharmacy, I think, is being independent. I think that gives us a really good niche. Like we said, the competitors… they basically force you there. You're not happy to go there. You go there because you have to. Being independent allows us to stick and move and figure out different things: how can we help this smaller group, or [what happens] when you get enough small groups together? It starts to snowball and you start to pull people together and you start to have a little bit of a network. That’s what I'm interested in: Not necessarily getting the people who can't come to us, but getting the people who want to come to us. Getting those small groups and finding enough small groups together to make a big group to thrive and to grow and to do new and different things.

ThoughtSpot

Mark Szilagyi, co-owner and pharmacist at Gateway Pharmacy, a member of the Good Neighbor Pharmacy network, joins Drug Topics to discuss the role his pharmacy plays in his Phoenixville, Pennsylvania community.

Front-line Leaders: Gateway Pharmacy

 Hello and thank you for tuning in to today's episode of over the counter in partnership with AmerisourceBergen and Good Neighbor Pharmacy. I'm Miranda Hester and I'm an editor with 

®. I'm joined today by Micah Lansford, owner and pharmacist at Roden-Smith Pharmacy, a member of the Good Neighbor Pharmacy Network. Thank you so much for joining us.

Roden-Smith Pharmacy was recently named a Pharmacy of the Year finalist as part of the Good Neighbor Pharmacy’s annual ThoughtSpot conference and trade show. The award recognizes pharmacies who have gone above and beyond for their communities and displayed excellence in patient care and innovative pharmacy practice.

Dr. Lansford, congratulations on this incredible recognition. I'd love to hear more about how you've supported your patients and community over the last several years. But first, can you share a bit of your background in history of both yourself and your pharmacy?

 Thanks for having me on; I appreciate it. My name is Micah Lansford. I'm the owner and pharmacist in charge here at Roden-Smith Pharmacy. I went to Texas Tech University for my undergrad degree in biochemistry and then went to Creighton University in Omaha, Nebraska, for pharmacy school. My background thus far in my career has mainly been community pharmacy.

We're located in Clovis, New Mexico. It's all the way on the east side of the state, about 10 miles away from Texas. Roden-Smith pharmacy has been around for almost 75 years through various owners; I just happen to be the current one. My dad bought the pharmacy back in 1996 and I purchased it from him in 2019. My parents are still involved. My mom was a technician and a bookkeeper and my father is still a pharmacist, of course. He relieves our staff pharmacists whenever they are out, and he also holds a block in our morning rotation that's primarily checking patient medications. They're both really very helpful still, to this day, in my ownership of the pharmacy.

 Can you speak a bit about your specific community in Clovis, New Mexico? And what makes your patient population unique in terms of their needs and how they interact with your pharmacy?

 In Clovis, we have a relatively diverse community, for more of a rural community. We have an Air Force base here that's a special operations base that means a lot to us; we're awfully proud to have the Cannon Air Force base here. Those members of the Air Force community, their families live here, we go to school with them, and we’re involved with them in a lot of ways. It changes the dynamics having them here. We have a huge agricultural community, a railroad community, a dairy community… And so in our town of about 50,000 people, we have some pretty different occupations that all collide together and coexist here.

You mentioned the family-owned aspect of your pharmacy. Has that dynamic influenced your approach to patient care and relationships?

 It definitely has. I started working in the pharmacy when I was very young, probably at an illegal age. I got to observe not only my parents, but our entire staff engage with patients. I felt like I really had a front row seat to see how to really take care of people, especially whenever they really needed something above and beyond a normal patient interaction. Being able to observe that really has a lasting effect and you want to have that type of engagement with patients as often as possible. That's what's rewarding about being a pharmacist, especially on the front lines—being able to have those experiences with patients.

 As everyone in the industry knows, the pharmacist’s role in patient care has, and continues, to grow exponentially. Can you discuss how your pharmacy has expanded its services and offerings over the years to meet patient's evolving needs?

 At Roden-Smith, we are all about our [medication synchronization] program. We see it as the main foundation of every other service. It really allows us to not just spend time filling prescriptions, but to do it in a thoughtful way. Then we can spend time pursuing other things like our nonsterile compounding, both hazardous and nonhazardous. We do facility management and consulting; we actually go into facilities almost every week to review patient medications, in addition to consulting services to make sure that the facility staff and our staff are on the same page whenever it comes to those patients at facilities who are synchronized.

We do travel health; we do pretty much all vaccines, both in the pharmacy and in the form of remote clinics. We offer delivery services, we do multidose packaging, and to a lesser extent, we offer testing services. We want to continue to invest in services that produce outcomes for our patients that are helpful. We've had experiences in the past with services where we can say we offer it, but it's not necessarily helpful for patients, or doing the most good with our time and resources. In the future, we want to make sure that anything we're adding onto our plate does the most good that it can do.

 Thinking specifically about the impact of the COVID-19 pandemic, what were some of the evolutions you needed to make to your business to continue delivering the care your community needed? How did you navigate factors like testing, immunization, and treatment to ensure access for your patients?

 That was something that we were really proud of. When COVID-19 started, nobody really knew what the appropriate reaction was. It seemed that there was this idea that a vaccine was going to become available; I knew that in our area, and in eastern New Mexico, that it was going to be an expectation that we provided [the vaccine], and provided it in an efficient way for a lot of people to get it. With allocations, and how they originally came out in New Mexico, the National Guard was put in charge of it. There was paperwork required to do business with the state, so to speak. And so, I tell people all the time, I wouldn't have that time, if I hadn't had been so organized with [medication synchronization], where I could spend days just preparing for the vaccine.

We partnered with the state in that way. We were able to get a couple hundred doses and had already developed a list of first-line eligible patients for it, and went to them within the first couple of weeks. We went to primary care clinics, we went to our facilities, and we went to our providers and frontline workers to give them the vaccine where they were at, and then also offered it in the pharmacy. We were able to get rid of a couple hundred doses in the first week in a really meaningful way.

That expedience, in initially getting rid of it in the best way, allowed the state to trust us with a lot more vaccines. I called the general who was in charge of it at the time and said, “You know, I'm really the only one here doing it. I could give a lot more, if you could promise me more vaccine.” He asked me, “How much can you give?” And I said, “Well, if I had 2000 doses a week, I could figure out a way to give it.” I thought I was overshooting what he was going to be willing to give me, but he said okay. I knew I was going to be getting 2000 doses a week for at least a month. I thought “How the heck am I going to get rid of 2000 doses that I've said I could get rid of?” It really put a lot of pressure on me to reach out to local people in the community and pull together to make it happen.

We reached out to a local building owner who owned [a building where] a grocery store that went out of business [used to be]; he offered up his building for us to set up a remote clinic. We reached out to the telecom provider to provide free internet there for us to put in all of our equipment, and we reached out to emergency management with the city and they provided services on-site and coordination for patients, [in addition to] cones and chairs and partitions and all kinds of equipment. The schools provided some equipment; emergency management provided an EMT on-site every day to manage our post-vaccination room.

We went through several months of giving as many as 500 vaccines a day. I think that working through local connections and partnering with a local pharmacy—with the connections and relationships we have and [are able to capitalize on]—those really made it a really successful endeavor for us. We had people driving from all the way up in Farmington, New Mexico—6 or 7 hours away—to Clovis, New Mexico, to get their vaccine because they had heard that they could come and get it, and it would be efficient and quick. They didn't have to worry about jumping through a bunch of hoops to get their vaccination in the first few months of 2021. It was a very stressful process, but we're awfully proud that we made it happen. We were able to give just an incredible amount of vaccines in the first few months of 2021.

 How has being part of the Good Neighbor Pharmacy network benefited your pharmacy, particularly during the height of COVID-19, and what areas of support proved most valuable?

 I would say that through my rep and through our business coach, and through our boots on the ground people [at Good Neighbor Pharmacy], that's one of the most helpful things. If I have an issue with something, I can reach out to Todd, my rep, or Justin, my business coach. I can walk through with them, and they can connect me to the right people—whether that's products or services or paperwork, they're there to aid me in those endeavors and make sure that if they can't help me, they're going to get me connected with somebody who can help me. I really appreciate those two guys, especially for really being there for us throughout the whole process.

 What does it mean to you that Roden-Smith Pharmacy has been named a Pharmacy of the Year finalist?

 It is a special recognition to even be nominated. It’s something that we've often thought that would be cool to go after, then had second thoughts and thought, “We probably don't deserve it, there are way better pharmacies out there than us.”

But this year, we thought, “We've really just put ourselves out there.” Our staff has just been incredible throughout the last couple of years, just putting in all kinds of overtime and doing whatever it took to get the job done every day. It's not just special to me and my family, but it's really something that we're proud of and can say for the whole staff that it's not 

 Pharmacy of the Year award; it’s our entire staff that deserves the recognition for even being nominated for an award like this. We're enjoying the process of going through it and hope that we're the winner—but if we're not, we're just proud to be among the top 3 that got nominated.

 Best of luck to you! To close out our conversation, what are some of your main goals for the year ahead? What keeps you up at night and what are you most excited about?

 I think that as far as goals, in a lot of ways it's still surviving COVID-19; it's getting out boosters, and we're still spending a lot of time doing that. I think the last couple of years have taught us a lot as far as which goals should be prioritized, and how do you want to spend your time on those? We're wanting to make sure that our patients are taking care of in the most meaningful ways, and any goal we have in the future is going to align with that.

As far as what keeps me up at night, regulation and insurance practices—both in my career and before that—has been the most troubling thing. The complexity of just being a pharmacy and adhering to not only state and federal regulations, but then these provider manuals from [pharmacy benefit managers] and still having time to engage with patients [in ways that are] actually helpful to them... That's what I spend the most time talking about with my wife at night, and what would keep me up.

I hope that the industry, within community pharmacy and how it relates and interfaces with regulatory bodies and PBMs and insurers, can find a way where everyone can win. And we can evolve our relationship at the pharmacy back to being less about explaining insurance benefits and deductibles and copays and prior authorizations, and more back to medication therapy for patients and really being able to prioritize that and everything we do, and worry less about the financial side of it. That would be my hope for the future. I'm hoping to be a part of that change in whatever way I can.

Micah Lansford, owner and pharmacist at Roden-Smith Pharmacy, a member of the Good Neighbor Pharmacy network, joins Drug Topics to discuss the role his pharmacy plays in his Clovis, New Mexico community. 

 Front-line Leaders: Roden-Smith Pharmacy

 Hello and thank you for tuning in to today's episode of 

 in partnership with AmerisourceBergen and Good Neighbor Pharmacy. I'm Miranda Hester, editor for 

 and I'm joined today by Marisa Fader, Vice President at Bushard’s Pharmacy and Apothecary, a member of the Good Neighbor Pharmacy network. Happy to have you join us.

Bushard’s Pharmacy was recently named a Pharmacy of The Year finalist as part of Good Neighbor Pharmacy’s annual ThoughtSpot Conference and Trade Show. Each year, the award recognizes pharmacies that have gone above and beyond for their communities and displayed excellence in patient care and innovative pharmacy practice. Marisa, congratulations on this wonderful recognition. I'm looking forward to hearing about the role your pharmacy serves in your community and your approach to patient care, but first I want to give you an opportunity to share a bit more background in history on yourself and your pharmacy.

Hi, my name is Marisa. I am the Vice President of Bushard’s Pharmacy. My mom is the president. I graduated Loyola Marymount University with a business degree; when I came out of college, we were in quite a bit of a recession, so I couldn't find a job anywhere. I decided, why not, I'll work with my mom and see what happens. And over 10 years later, here I am.

Our pharmacy is located in Laguna Beach, California. My mom is the owner now, [and] my grandfather started the business in 1946. He was a pharmacist and went to [the University of Southern California]. We're on our third generation. I'm hoping that we continue that for as long as possible. We serve our little beach community, and our biggest priority is our customers and our patients. We try to do the most that we can to provide a healthy place for them.

 Can you touch on this specific community you serve in Laguna Beach, California? What is your community like, and what are they looking for from their pharmacy?

For the most part, we have a pretty healthy population. There's a lot of older, retired people, but there's also a lot of new, young families who have moved to this beach community so that they can enjoy it. We also have a lot of people that travel here on vacation, so we do serve a lot of traveling people when they run out of their medication or need something transferred, or forgot [a medication], or need help because they're not home. We also provide that service to that community.

You mentioned the family-owned aspect of your pharmacy; what does being a family-owned pharmacy mean to you, and what influence has it had on how you run your business and serve your patients?

Well, I think when your name is on the front door, there's definitely much more of a pride of ownership in the business. There's a personal responsibility to our customers and our patients. And for us, it's very important to know their name, know their kid's name, know their dog's name, know that they just went on vacation, and know what's going on in their lives. We treat our patients like our family because we are still family-owned, and to me, that's the most important part.

It's been made clear that pharmacists play a massive role in patient care, drive value for broader for the broader healthcare system and will continue to expand their roles in the years to come. Can you discuss how your pharmacy has evolved and expanded its services and offerings over the years to meet patient's evolving needs and expectations?

 We have tried to make the process of refilling and transferring your prescriptions as easy as possible. Obviously, we still accept phone calls all of the time, but we've implemented an app and we've put something on our website to refill your prescriptions. We try to offer as many immunizations and vaccinations as we can, because everybody doesn't always want to make an appointment [with their physician]. And if they're here already, it's easy to just get what they need.

We try to synchronize as many medications for our patients as possible. We do that through consultations with the pharmacist so that they're adherent to their medication and taking it when they're supposed to and know what [it is] and why they're taking it. We've offered delivery for a long time so we're going to continue to do that. We do have a little back Dutch door that has become kind of a curbside pickup, which is fun because people just drive by, and we hand their prescription out the window to them. Then as far as the front end of the store, the products that we provide to our patients are always adapting and changing, and we take their interests and their recommendations into consideration and try and always keep an updated front end.

 Thinking about the onset and impact of the COVID-19 pandemic, what changes were made to your pharmacy to continue delivering critical patient care during this time? I see that Bushard’s opened a COVID-19 vaccination site during April 2021. Can you talk me through that service and how it allows you to step up as a community health care destination?

Once the quarantine was sanctioned in California, we decided to offer free delivery because everybody was at home and didn't want to venture outside. Most of the time, we delivered toothpaste with somebody's prescription as well, so we're offering whatever type of medication [the patient needed] or over the counter items needed to feel safe and stay at home; we wanted to provide that free delivery.

And then, as the pandemic continued, we realized that we needed to be able to provide the COVID-19 vaccine for our customers and our patients. Like I said, we do have an elderly, retired population here who is somewhat homebound, and they can't travel hours to go get their vaccine. I worked with the city of Laguna Beach to be able to utilize a large empty building that's actually right across from our retail location. We were able to open up a big, safe space for people to come and get their vaccine. With the city's help, it was very easy to set up this clinic. And we were able to provide that service for our patients so that they didn't have to travel too far outside of their homes.

Marisa Fader, Vice President of Bushard's Pharmacy and Apothecary, a member of the Good Neighbor Pharmacy network, joins Drug Topics.