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Dennis Song, RPh, describes the steps to take when starting a compounding services business.
When Dennis Song, RPh, CHC, launched Flower Mound Pharmacy and Herbal Alternatives 18 years ago, he wanted a patient-centered, full-service pharmacy. Compounding helped him build and expand the business in an increasingly competitive market.
Compounding fits the patient-centered model because it’s all about preparing custom medications that address individual needs, Song said. It also dovetails nicely with patient care and nutritional products he offers.
Song shared tips on building a successful compounding service in an independent community pharmacy at McKesson’s ideaShare 2016 in Chicago.
Find your niche
The first step is looking at your community and what it needs, and what your competitors are delivering, Song said. “There was a need for compounding in our community, so that’s what we did.”
At first his pharmacy was the only compounding shop in town, Song said. But the area around Flower Mound, Texas, just north of Dallas/Fort Worth International Airport, grew quickly and two others opened close by.
“They didn’t realize they were too close together, so one closed and the other merged,” Song recalled. It’s critical to identify and assess your competitors before you launch, and reassess your services as your market develops, he said. “You need to find a niche and continually grow it.”
Today, nonsterile compounding makes up 25% to 30% of Flower Mound’s revenues. Dispensing is a little less than 50%, and the rest include patient services, dietary supplements, and specialty foods, such as gluten-free items.
A big reason Flower Mound remains successful is its close relationships with prescribers, Song said. Family practice and OB/GYN physicians are among his best partners, but also pediatricians, dermatologists, and surgeons.
Educating prescribers and their staffs generates demand, Song noted. Once they know about the pharmacy’s compounding capabilities like converting suppositories and oral pain medications to topical creams to encourage patient adherence, lidocaine lollipops for mouth ulcers, and bioidentical hormone replacement therapy (bio-HRT), healthcare professionals will consider these options for their patients. He remembered one three-year-old who weighed only 22 lb and needed special preparations of flecanide/atenolol for congenital heart defects.
In addition to human treatments, don’t overlook the veterinary market, Song noted. For example, let veterinarians know about compounding services for cats who have difficulty swallowing pills. There’s a market for compounding medicines like methimazole for hyperthyroidism into creams for application to feline’s ears.
Get the word out
To educate prescribers about compounding services, Song offers prescribers with in-service lunches at their offices, and wine-and-cheese physician appreciation nights at his pharmacy, featuring tours and demonstrations. Eight doctors attended one recently, and two became regular prescribers, each sending two patients a week on average, he said.
Tools can make ordering compounded items easier for prescribers. These include preprinted prescriptions where allowed or cheat sheets reminding prescribers how to order common custom medications. Establishing “standing order” protocols using preprinted templates for bio-HRT and other therapies helps communicate clearly and consistently with prescribers about patient concerns, assessments, treatment plans, and progress.
Frequent contact with prescribers about other products and services you offer expands and solidifies referral relationships, Song added. For example, he often has referrals for nutritional supplements with medication orders, such as vitamin D, dehydroepiandrosterone (DHEA), and B vitamins with bio-HRT. Some prescribers ask for pads with a list of supplements they can check off and send with patients.
Flower Mound has two nutritionists, and Song encourages referrals for nutritional consultations. Other services include medication therapy management, medication synchronization, immunizations, clinical testing, and weight loss, diabetes education, and fall prevention classes.
Song packages these into health maintenance programs, collaborating with prescribers, physical therapists, and trainers, to document interventions. This not only helps patients’ health, it improves physicians’ CMS Meaningful Use scores.
Flower Mound charges for services; typically $85 for initial nutritional or pharmacy consults and $40 for follow-up weight loss or other maintenance visits. Patients accept such out-of-pocket expenses if they know before they reach the pharmacy, Song said.
“It really helps if a doctor refers them and tells them there is a cost, Song said.