 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.

 Throughout the COVID-19 pandemic, how has being a part of the Good Neighbor Pharmacy network advanced your pharmacy and help set you apart from competitors? What areas of support proved most useful to your business and staff members?

 Good Neighbor Pharmacy and AmerisourceBergen have been so supportive to us throughout this whole thing. Obviously, we all had no idea what was going on and what was coming next. I was able to reach out to our business coach Kelly De La Fuente at AmerisourceBergen, and they were able to at least try and provide me an answer or advice on what was happening next. We were one of the first pharmacies to receive that first Pfizer[BioNTech vaccine] allocation, which I was a little nervous about taking on because, you know, the storage of it has to be at the super low temperature, and it was a large quantity of vaccines. I was a little bit hesitant, but we decided that being able to offer all of the vaccines was most important to our patients. Having the business coach… I can't even explain how helpful [it was] because I would call her or text her almost every day with a question about something. Even just processing these prescriptions and these vaccines, this is all new to us. Having AmerisourceBergen and Good Neighbor Pharmacy as a resource was really helpful for us throughout this.

As mentioned earlier, Bushard’s has been recognized as a Pharmacy of the Year finalist by Good Neighbor Pharmacy. What does this recognition mean to you, and what about Bushard’s are you most proud of?

Obviously, it is a huge honor to be nominated. We're very proud and feel very honored to be nominated.

Something that I'm really proud of about Bushards is the longevity. We are 75 years old, and like I said, hopefully going to continue on for as long as possible. I think in this day and age, having a family-owned business that's been around for that long… it's something to be really proud of. And, you know, we're on our third generation of family members running the store and I think that's something special that you don't see all the time and that's something that I would like to continue. I'm hoping that once all the voting is open and public that our community will come out and vote and support us like they always have. We're very excited for this whole process.

 That's great to hear, and best of luck to you. To finish our conversation, what are you hoping to accomplish for the year ahead? Do you have any new initiatives in the works or key priorities that you can share?

The health and wellbeing of our patients is always the priority. Things are always changing, and we're willing to adapt to what they need. Something that we've thought about is offering more vaccines; a lot of our patients are now traveling again, and there are certain vaccines that they need for that. We'll always continue to offer medication consultations with our patients to keep them healthy. And, I'm trying to coordinate some more wellness events to help our patients have more health information. I think the biggest thing is just to keep supporting our community and that's something that is always a goal, and always something that we're working on.

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

 Front-line Leaders: Bushard's Pharmacy and Apothecary

Hello, and welcome to Over The Counter, a podcast from 

®. I’m your host, Lauren Biscaldi, managing editor of 

®. Today I’m joined by Lani Bertrand, RPh, senior director of clinical consulting at Omnicell to discuss pharmacist burnout during the COVID-19 pandemic and how technology can ease some of the burdens that pharmacists face.

Lani, thank you so much for joining us today. Could you please give viewers an introduction and tell me about your role at Omnicell?

 Sure, and thanks for your time today, as well. I appreciate it.

I am a pharmacist with a unique blend of both clinical pharmacy practice and healthcare industry experience. I have had the pleasure of working with various health systems across the country. Through my role, I have been able to assist them in addressing operational efficiency, medication utilization and inventory management, as well as pharmacy automation and technology adoption.

At Omnicell, I enjoy applying my experiences to my current role, where I am the senior director of clinical consulting. I lead a great team of both clinical and technical subject matter experts. They work with our sales team to help support our customers as they look to enhance their pharmacy operations and ultimately improve patient care.

Great, thank you so much for that. Since the COVID-19 pandemic has begun, we have heard a lot about heightened burnout in the health care community, particularly among pharmacists. Would you be able to discuss some of the ways that burnout has manifested within the pharmacy profession over the last year and a half?

 Absolutely. While it is important to highlight the fact that the pandemic has brought attention to the impact on pharmacy and healthcare staffing, I think it is equally notable to call out that burnout was rising prior to the pandemic.

It is likely that COVID-19 exacerbated those challenges. If I look at a recent pharmacy workforce survey, almost 70% of pharmacists reported that their workload was heavy, if not excessively heavy, and their frustration levels were reported as high.

Also, more recently, researchers at the University of Michigan conducted a survey and published their findings on this topic. Those findings were from the beginning of the pandemic, but even then, pharmacists were reporting an average of 50% burnout rates.

Part two of that study is underway. I had more recently noticed this survey and it will be interesting as we move further into the pandemic what those findings will be.

Unfortunately, with recent shortages and labor challenges, I am wondering if those numbers of burnout might tick upward?

 Yeah, I was just reading something recently about how they're anticipating the Bureau of Labor Statistics is anticipating a 10-year shortage in the healthcare workforce, which was just incredible to me. I wonder how much of that was the pre-burnout, that the pandemic exacerbated.

We were already experiencing shortages, especially for primary care providers. This explains why some of this recent legislation aimed at provider status is getting more attention to help close that gap as well.

Yeah, it is nice to see that they're taking steps on a legislative level to address it. Great. Do you envision technology solutions as a way that pharmacists can alleviate burnout or do these solutions stand to add on to the current pharmacist’s workload?

 That is a great question because I think that at one point in time, technology was viewed as a burden. It was something that pharmacy had to add additional FTEs to help get it going so to speak and to shorten learning curves. I think that has since changed.

If we look at the technology that is even offered with additional services (such as assisting sites in ramping up quickly and allowing an expert to provide ongoing monitoring), technology can be the best thing that we can do to enhance workflow to bring about increased medication safety.

Certainly, job satisfaction is a component. For example, if I am a pharmacist and I am allowed to do more of what I love through being closer to my patient, that is beneficial. Therefore, if done correctly, technology can make a big difference.

To give a couple of examples, I can cite a health system in Ohio where they implemented robotic technology in their central pharmacy to address medication dispensing needs for a few hospitals.

They utilized technology to remove manual processes at other sites and instituted a barcode scan and scan out concept, which in turn reduced medication errors, and certainly again, put clinical workforce closer to the patient clinical duties.

I think another area to call out that is important, is the rising use of technology. For IV medications and sterile compounding, we want to do everything we can to ensure medication safety and accuracy of those preparations. Additionally, we also want to look at the individual. There are even studies demonstrating manual fatigue for doing some of those procedures repetitively, over again and again. There are lots of ways to improve pharmacy operations and to help with that job satisfaction by removing some of the workload from those individuals in the pharmacy.

Yeah, it sounds like it's a really great opportunity to streamline a lot of efficiencies for pharmacists, and take away the burden of those manuals. It sounds like it would allow them to care for their patients, which is what you signed up to do.Is there one area in particular that you can mention, in which pharmacists can really optimize their workflow through technology?

 Certainly, I think most of us pharmacists, whether we were practicing in retail community or in a hospital setting, we are very familiar with how technology can help us with repackaging through filling vials with large scale, mirror mail order operations, and so forth.

I think the new areas to look at (in terms of technology) would be along the lines of inventory management. This is because it is beneficial to have a broad system of visibility, in addition to utilizing real time insights, and the potential for benchmarking. With that said, nothing has highlighted that greater than the recent pandemic.

If you think about how we had an influx of patients who needed a higher acuity level of care, the medications that they were demanding or needing for that care are also sometimes difficult to come by. They're unfortunately at the top of a drug shortage list at time.

If I am the leader of a health system it is beneficial to know what I had, where it is, and how I could move that to that new area of acuity. Additionally, I would have the opportunity to take better care of patients, minimize my risk, or even my additional spend to accumulate additional drugs. That is really where we should focus in as far as finding efficiencies.

That's very interesting, particularly how it relates to the whole supply chain issue with medications. I don't know that there are easy solutions to that, but it's nice to see that there are options out there to help mitigate, where it can be mitigated.

 Exactly. I think, and that can apply to all aspects of pharmacy, because the supply chain impact is so great. Everyone needs to become a little bit more shrewd, and on top of their game, as far as knowing what they have and how to get it quickly.

Yeah, for sure. If you could leave our listeners with one piece of parting advice for addressing burnout, through technology or through other means, what would that piece of advice be?

 Well again, I am very glad that we're talking about this important topic as it impacts not only pharmacists, but all health care workers. It is unfortunate that the rate of burnout in this industry is probably greater than in other industries.

So, it is important that we look for ways to lessen that and technology is the answer. I think the key takeaway here is to embrace the use of technology, to not see it as a burden, to look for ways where technology with services added to help you implement and ramp up quickly is truly the way to go. Further, to look at technology across all aspects like we covered.

It is not just a matter of serving as a packaging alternative, but it's your true hub of the pharmacy ecosystem so that we can use those important clinical players in the areas where we need the closest to patient care. This allows them to achieve better job satisfaction because they are doing what they signed up for. We did not go into this to manage manual reports and spend hours tracking things down. We wanted to do this to provide the best clinical service for the best patient care.

Thank you to Lani for taking the time out of your busy schedule to have this fascinating discussion on burnout technology, and the pharmacy profession.

If you enjoyed this episode, check out our other podcasts, available on drugtopics.com or wherever you listen to podcasts. As always, thank you for listening and I hope to see you next time at the counter.

Lani Bertrand, RPh, joins the latest episode of Over The Counter to discuss the role of technology in easing burnout during the COVID-19 pandemic. 

Easing The Burden of Burnout With Technology

: Hello and welcome to Over The Counter, a podcast from 

We have a very special episode for you today: It's the final episode in our ThoughtSpot 2021 series. Our guest hosts is Jenni Zilka, President of Good Neighbor Pharmacy, who will be leading a conversation with Brian Nightingale, President of Community and Specialty Pharmacy and Long-Term care at AmerisourceBergen, and Giulio Burzacca, Managing Director of Alphega Pharmacy. They'll be comparing independent pharmacy industry trends in the US and across Europe, including global legislation, drug shortages, top priorities for the future, and more.

 Hello, everyone, and thank you for tuning in to today's discussion in partnership with drug topics. I'm Jenni Zilka, President of Good Neighbor Pharmacy, a network of locally owned and locally loved independent pharmacies across the US. I'm so excited today to be joined by my colleagues, Brian Nightingale, President of Community and Specialty Pharmacy and Long -Term care at AmerisourceBergen, and Giulio Burzacca, Managing Director of Alphega Pharmacy, the leading network of independent pharmacists in Europe. Thank you both for being here.

I'm excited to have the opportunity to speak with these 2 industry leaders as we reflect on the evolution of independent pharmacy across the globe, how we've responded to the new challenges over the past year and a half, and where we go from here. So, before we dive into this global conversation, Giulio, would you take a moment to share an overview of what Alphega is, and how you support independent pharmacies in Europe.

 Thank you, Jenni, I’m really pleased to be here with you and going through and explaining a little bit more about the European market.

But let's start with what Alphega is. Alphega Pharmacy Europe is a comprehensive membership service to independent pharmacists, and the provider of added-value services to pharmaceutical and healthcare manufacturers. Our aim is to improve the health and well-being of communities by delivering a future vision for independent community pharmacy and supporting our pharmacists in their role as recognized health care professionals—and not just retailers of medicines. Alphega and its associated networks now count close to 10,000 independent pharmacy members, making it to the largest European network of independent pharmacies. It is present in 10 countries: the Czech Republic, France, Spain, the Netherlands, Germany, the UK, Italy, Turkey, Romania, and Portugal.

In brief, what does Alphega Pharmacy do for the member pharmacies? Well by joining Alphega Pharmacy, a pharmacy business retains its independent status, but gets a access to a wide range of support services, such as branding, business management training, professional services, digital solutions, and IT support—all of which provide competitive advantages to its members to support an increase [in] revenue and profits through improved customer footfall, increased basket size, and improved operational efficiencies. Additionally, every pharmacy member benefits also from all the personal and online coaching offered by the network.

 Thank you, Giulio, so interesting to hear you share the services that Alphega offers, as we in the US are always looking to improve upon and evolve the services that we provide with Good Neighbor Pharmacy.

To set the stage a bit more, Giulio, would you share a little overview into how your pharmacies operate in Europe? What makes them similar or different to the independent pharmacies in the US?

 Sure, Jenni. The European pharmacy retail market is very diverse. And, although of course we have the European community, we cannot really talk about the European market. As an example, out of the 10 countries in Europe in which we operate, 5 countries have regulations allowing retail chains, while the other 5 don't. So, as you can see, it's a very different situation.

Also, the penetration varies a lot. On average, a pharmacy serves, in Europe, just a little bit more than 3000 citizen in their community area, but the coverage is not equally spread across the different countries. And, for example, you have up to 46 pharmacies per 100,000 inhabitants in Spain, while in the Czech Republic and Holland, you have only—respectively—7 and 8 pharmacies for the same number of inhabitants. So, as you can see, [there is] very diverse coverage.

But the key point is that almost two-thirds of European citizens can reach their nearest community pharmacy within only 5 minutes distance, and 98%—the vast majority of the population—can reach a nearby pharmacy within 30 minutes. The level of services allowed by country regulations is also very different, with some countries—like the UK and France—at the very forefront of health care services provided.

Many European countries have introduced changes in legislation to expand the role of pharmacies and relieve pressure on the rest of the health care system. As a result, in 8 European countries, community pharmacists have been involved in the administration of COVID-19 vaccines. We are very proud to mention that the very first 4 pharmacists to vaccinate in the UK—and overall to vaccinate in Europe—were all Alphega pharmacies. And this was thanks to the fast approval process in which we supported our members to get the authorization to start vaccination.

In almost all countries, people can now access authorized COVID-19 self-sampling kits from pharmacies or get tested directly in pharmacies. In France, more than 12 million rapid antigen tests for COVID-19 have been carried out since October 2020. In Italy, we also had our Alphega testing mobile vans going around the country and offering testing capacity just in front of our member pharmacies. A study conducted across Europe has mapped 30 pharmacy interventions on COVID-19 by community pharmacy, from symptoms-based referral to home delivery of medicine [and] pharmacy telephone support to vulnerable patients.

And if we look at the issue of medicine shortages, in 6 countries, community pharmacists have been now granted the opportunity to provide alternative solutions for occurring medicine shortages during the pandemic.

 It's amazing, amazing work. I'm glad you brought up COVID-19 specifically, and all of the services and the care that your pharmacies provide to their patients. It's really astounding, especially when you are operating in multiple countries.

Brian, I'm going to shift over to the US. Here in the US, the pandemic has truly been at a time of immense change for independent pharmacies, not only in Europe, but also here in the US. What have you seen over the course of the past year and a half that's really demonstrated the resilience and the adaptability and the value of independent pharmacies in the US?

 Thanks, Jenni, and thanks for hosting today. If you don't mind, before I dive into that, I would just like to kind of respond to some of the commentary that Giulio just mentioned.

We've gotten to know each other over the past several months, quite a bit; our organizations have been learning from each other and it's just amazing to me how many similarities there are between those independent pharmacies across Europe and the independent pharmacies here in the United States, especially in terms of purpose, passion, care for the community, customized service, going above and beyond… A lot of those examples that you just provided, Giulio, are really amazing and, I think, resemble in a lot of ways similar stories that we have here.

It's just really exciting to see how these entrepreneurs and these community providers across the globe have arisen in big ways to address this global pandemic, and I think it's across both continents. It just shows what more independent pharmacies can do in their communities to serve in times of need and in times of normalcy—whatever that looks like these days.

It's just really enriching to hear, again, how Alphega pharmacies have responded. And it's also really exciting to see a lot of the innovations and different things that come out of the different countries in Europe and perhaps identifying ways that we can do things different over here in the United States. So, again, it's interesting and super exciting to learn about the similarities, and certainly the innovations and the best practices that we can share with each other.

Just kind of diving into a little bit of the US perspective, again, I think what I've seen—what we've all seen here—is similar to what Giulio just said: a doubling down of what makes independent pharmacy so special, right? A doubling down on their personal service and the care they provided, even before the vaccines were available. Obviously, pharmacies response, and being part of the vaccination solution is front and center… But I think what a lot of people don't necessarily realize is that before the vaccines were even available, independent community pharmacies evolved; they transformed rapidly. Many of them in the United States had to shut their doors and go to only home delivery or only a curbside pickup, so they had to completely change their workflow patterns in order to continue to serve their patients, whether that was through COVID-19 testing, or just continuing to care and provide medications and counseling for their patients.

We saw very rapid changes in very unique ways, that in a lot of cases had nothing to do with medications. So, for example, many independent pharmacies in the US—and certainly most of the Good Neighbor Pharmacies—have offered same day home delivery for years and years and years. We saw examples of, those drivers, those technicians, delivering medications to a home, calling that person knowing that they were shut-in and saying, “Hey, can I stop off and pick up some groceries? Is there anything else that you need that I can stop off and pick up before I get there with your medication?” We saw pharmacies who rallied school kids to hand write and hand design thank you cards and thinking of you cards to be delivered with the medications to elderly shut ins who couldn't see their family anymore because of COVID-19. So again, those little micro touches that independent pharmacies do every day really kind of came to the forefront before the vaccines were even available.

And then, of course, the rapid response and participation of these pharmacies in providing vaccines when once they were available was key. I think we've seen statistics now that well over 80% of all vaccinations in the United States had been provided through a community pharmacy. That's important for several reasons. One is, many of our pharmacies are located in underserved and economically disadvantaged communities, and that's been a huge focus of the vaccine efforts here in the United States. I think the latest numbers that I saw within our network was that well over 50% of all vaccines that were provided by our member pharmacies were provided to individuals who resided in underserved and disadvantaged communities.

That access to care, that access to providers, is key in those communities. And then also, the pharmacist’s role in being a trusted adviser and an expert on these vaccines, and help[ing] people get more comfortable with receiving the vaccine, has been key as well. So, again, I think you're hearing a lot of what I'm saying in terms of similarity to what Giulio was saying: they just stepped up and really did what they did best, and continue to do what they do best, and that is care for their patients.

Quickly, the other thing that that I think has challenged our pharmacies—and again, they have adapted greatly—is how they engage with their patients and their communities during a pandemic where a lot of folks were not traveling, not driving, and staying at home. They've really embraced digital engagement. We launched our digital platform a couple years ago—about 3 years ago—and we saw a gradual adoption of that; there's a lot of these pharmacies that are more traditional, and kind of stuck with the traditional print, TV, and radio, which is fine. But over time, they started to embrace digital platforms and digital engagement. And then once COVID-19 hit, we saw a rapid uptake of that. And I think that's a positive that has come out of this: the innovation and the adoption of different ways to engage patients, whether through telepharmacy, social media, outbound call campaigns, all those types of things [that] I think are going to be mainstays moving forward. So again, could not be more proud of the response that community pharmacy has had over the last 2 years, and I think there's lots of opportunities to leverage that moving forward.

 That's great. Brian, thank you for highlighting all the amazing work that our pharmacies do. You [talked about] feeling proud, and I think that there really aren't words for how proud and honored I feel to be able to work with independent pharmacies day in and day out, especially as the value of independent pharmacies is on display like never before, because of COVID-19.

I would like to shift and focus kind of on the year—or years—ahead, I'm certainly seeing some common threads as I listen to Giulio and Brian share the state of independent pharmacy in the US and abroad. With the pandemic encouraging regulators and professional bodies to accelerate digital evolution, vaccine programs, and—in the US—the position of pharmacists. Brian, I'd love to hear from you on where kind of where you think independent pharmacy can go from here. What are some of the core priorities you have in your mind as we think about pharmacy customers in in the year ahead? And how [can we] take this moment this this unprecedented moment that we're in and carry that forward?

 Thanks, Jenni. I think I'll kind of tie it into what I just left off with: if you think about the opportunity, that that the COVID-19 vaccine has provided in terms of consumer engagement.

I think all of our independent pharmacies have a great relationship with the patients who already know them, who have been coming there for years; there's that loyalty, there's that relationship… That's always been there. I think what I'm really excited about is the ability to participate so heavily in the vaccine response has opened up the awareness of many, many consumers out there that, quite frankly, didn't know that an independent community pharmacy was right down the street, or didn't know about the level of experience and personalized service that they provide. And now that they've been into that pharmacy, they've seen an experience that that relationship… I'm hoping that that these pharmacies will continue to engage those consumers and those patients and bring them back in and keep them. I think it's going to be critical, again, to tap into the digital platforms, to tap into the ability to engage with those consumers in a different way in order to say, “Hey, remember the great service and the great discussion we had when you came in to get your vaccine? Let us take care of your entire family, now and beyond.” I think that's number 1, to leverage those new consumers and to leverage the new technologies to attract and retain patients.

I think secondly—and this is a big priority for us as a service provider—is helping to promote diversified patient services beyond that traditional dispense, and to help our pharmacies offer and expand clinical offerings, again, beyond that dispense. They've got the time, they've got the relationships, [and] there's so much more that these pharmacies can provide[to] these patients and communities, and we just need to help them expand their businesses in that way, and to advocate and help for appropriate reimbursement and payment for those services.

Right now, our reimbursement model is pretty much focused 100% on the dispense of that drug; we've got to change that. We've got to advocate for fair and adequate reimbursement and payment for that drug and the dispensing services that go along with it, but also advocate for expanded scope of practice, and fair and appropriate reimbursement for clinical services beyond that dispense. Vaccination is a perfect example of that: pharmacies have stepped up and proven they can deliver, and now it's time to expand that to other avenues and areas as well.

That's the enablement part. And then on the advocacy piece, it's taking a strong approach within the industry to advocate for comprehensive reimbursement reform, expanded scope of practice through provider status, and increased awareness of the opportunity that lies within community pharmacies to really impact and increase access to care and reduce overall costs.

Pharmacies and pharmacists are part of the solution, they're not part of the cost problem. And advocating and educating legislators and regulators, at both the federal and the state level, is key, and it's a top priority for us as well. That has started to intensify very rapidly at the state level, because of the Supreme Court ruling in Rutledge vs PCMA in Arkansas.

So, again, those are really key priorities: it's helping our pharmacies engage in new ways with their new customers and their existing customers, it’s helping them diversify their business beyond the traditional dispense, and it's advocating very strongly for a comprehensive reimbursement reform and expanded scope of practice.

 That’s great, Brian, thank you so much, there’s so much to be excited about as we look to the future.

Giulio, I'm going to shift back over to you. How about Alphega? What are some of your top priorities for independent pharmacies moving forward?

 Thanks, Jenni. First of all, I would like to really echo what Brian just said, because it's so fundamentally true across our all our markets in Europe.

The first observation is—and I couldn't agree more with Brian—is the evolving positioning and image that the community pharmacy has taken during the pandemic and how, really, the normal person out there, the normal citizen, has really realized the relevance and importance of community pharmacies.

We really need to build on these evolving imagined positioning of the pharmacies and definitely advocate for recognizing the value of pharmaceutical services that have proven to improve the quality of people’s lives and also to help the health care systems that were really under, tremendous stress, by offering their services at the community level. It is huge work that we need to do all together.

The other big thing that came up is how to better manage the personalized care part. There is knowledge on a 1-to-1 basis by community pharmacists in the mastering of all the digital tools that are now available. And this is where, really, there is the right marriage between community pharmacies and the support that we can offer as a network and offering those tools that are more innovative [to help] reach the final patient.

In Alphega, what we really defined as our key priorities—to answer your question, Jenni—is really offering programs and campaigns to encourage preventive care and wellness, like we are already doing—for the cardio campaign, obesity, the diabetes—all those campaigns encourage preventive care.

The other big area—and Brian was also referring to it—is really to continue to expand on our vaccination and all our testing services, and expanding the scope of community pharmacy practice, to maximize their contribution to patient and health systems. Together with, and I was just mentioning before, defining the new models of care delivery. Really taking advantage of digital technology and offering several services like home delivery, consultation, et cetera, that really enhances the way that we can reach the final patient.

We are very active at Alphega in offering a digital platform to all our members, so that they can leverage it to know how [to be a] large provider while maintaining their personal independence and touch. Those data are for Europa, but I'm sure they could even be a probably as—if not more—relevant for the for the US. If we look at the latest IQVIA survey, when they asked industry executives what percentage of their sales they think will come from a pharmacy in the next 2 years, the answer was really between 15% to 30%—and even up to 50% in specific categories—will come from the pharmacy. So, it's really a way to offer community pharmacists the possibility to be present in different touchpoints to their final patients.

And last but not least, always continuing to reinforce the role of the pharmacist in his or her community, with all the support that we give, including all the social media support that we are offering.

 Thank you, Giulio, and thank you both for such a great discussion today. This was really fun. I have so enjoyed working with Giulio and his team and learning about independent pharmacy in Europe, and as I'm sure you're learning, there are so many similarities and so many opportunities to collaborate and learn from one another.

As we close, it's very clear that we are at a pivotal moment in the pharmacy industry globally. And the time is now for independents to use their increased visibility and trusted positions within their communities as a springboard for reaching new goals. It's been wonderful, wonderful to speak with you both. Are there any any closing comments from either of you as close the podcast?

 Sure, I just want to close by saying Giulio, I too have really enjoyed getting to know you and your team and could not be more excited about our path forward together, and sharing best practices and bringing many of the great things that you and your team are doing across Europe over here to the United States so that our member pharmacies here can take advantage of a lot of the things that you've built and execute them here. It's been a pleasure and I look forward to more collaboration.

 Well, Brian and Jenni, I can only really be extremely glad for all your word. It's absolutely a tremendous pleasure to work with you, and also to get all your learning and all your knowledge and be able to share all our best practices across different continents.

What is really relevant is also that we have a common culture, and—most importantly—that we have really the same passion, for the pharmacy and for the patient health, that is really at the heart of everything you do and that we do in in Europe. And that's really the strongest commonality that we have.

One point I wanted to mention, in addition to everything we said, is what else we can do for the other big player in the market, and that is the manufacturers. We can also provide manufacturers with instant access to all the different members of our networks across all those different markets—European countries as well as, of course, the very large market of the US. We are the perfect platform for new product development, placement, testing with consumers, clinical trials, in terms of acquisition of the patients… really, [there are] an infinite number of a solutions that we can really offer them. And on top [of that], we can get the real-time product performance and offer all of the results and the return on investment performance on all of the activities and programs that are run in all our pharmacies across the US and Europe.

 Thank you to Jenni for being a phenomenal guest host, and to Giulio and Brian for a really interesting discussion. We had a great time collaborating with AmerisourceBergen and Good Neighbor Pharmacy on another ThoughtSpot conference and trade show series, and look forward to partnering with them again for the latest and greatest pharmacy insights for independents.

If you liked this episode, check out the other episodes in this year's ThoughtSpot series. We have an uplifting and hilarious discussion with 3 independent pharmacy owners who shared their unique experiences navigating the COVID-19 pandemic, and an informative conversation with 3 inspiring experts who are dedicated to addressing health disparities and leading the conversation on racism in health care.

And as always, thank you for listening, and we hope to see you next time, at the counter.

As part of our ThoughtSpot 2021 podcast series, guest host Jenni Zilka, President of Good Neighbor Pharmacy, leads a conversation on global trends in independent pharmacy across the US and Europe. 

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