Pharmacist Recruitment Firm

pharmacy jobsPharmacy owners and managers are all faced with the same dilemma – “How do we hire the right Pharmacist for the job?”. As everyone already knows, it is more than simply finding a “warm body” to fill the position. It requires that the candidate posses the right skill sets, qualifications, licensing requirements and experience to fill the pharmacist position and job description perfectly. The firs time around!

From the pharmacist’s perspective, one has to include salary, benefits, geography, shift hours and company culture into their decision making process. Most employers find the process tedious and painful, even those with full time HR departments. For most pharmacy owners and managers the hiring of a pharmacist to fill an opening is a reactive process that must take precedence over their daily job tasks. This leads to hiring mistakes that costs their business both time and money. So how is this to be avoided and the process of recruiting the right pharmacist made efficient and Painless?

What’s the Problem in Recruiting the Right Pharmacist?

The problem in recruiting and then hiring pharmacists is actually twofold. The first centers on skill and timing. The majority of pharmacy owners, directors and managers admit that hiring is not their strong point. Their success is in running and managing the pharmacy as a business operation. Maximizing the businesses efficiency, profitability and cash flow are their primary concern & should be. Finding, interviewing and hiring a new pharmacist is a time consuming endeavor that requires the skill and time that most employers simply don’t have.

The second challenge is the competitive nature of the pharmacist job market. Currently there are simply more jobs than pharmacists. A search on the largest job site Indeed shows 5,817 positions available today throughout the country. Although this will perhaps change by 2020 due to the projected increase in the number of pharmacy graduates (according to an article in Medscape), currently the reality is that open positions far outdistance the number of potential candidates that are realistically available. As we recently just discussed in our last post, perhaps the pharmacy school accreditation issues being seen recently will only lead to a future problem of a shortage of qualified pharmacists that can fit your individual pharmacy’s needs and skill set requirements for the position that you need filled.

What’s the Solution to Recruiting the Right Pharmacist?

Let an experienced Pharmacy recruitment and placement expert find the right pharmacist to fill your job opening. HealthCare Consultants Pharmacy Staffing has been a national leader in regards to Pharmacy placement services and direct hire and is known throughout the USA in all fifty states as a “full service” Pharmacy staffing company since 1989. Pharmacist recruitment, permanent placement and direct hire have been our specialty for over 31+ years now. HealthCare Consultants Pharmacy Staffing deals with all aspects of matching the correct pharmacist to the job description requirements and to the employer’s needs in every type of situation and setting. Our in-house staffing experts have experience nationally in all 50 states with all pharmacy job types: retail, hospital, clinical and specialty pharmacies. We also offer a six month pro-rated satisfaction guarantee!

Who Can I Talk To At HCC?

The Pharmacy Recruitment Division here at HealthCare Consultants Pharmacy Staffing is managed by Linton Creel, our Vice President of Professional Recruitment and Placement. Linton has extensive knowledge in the area of pharmacy recruitment and his duties include overseeing all aspects of permanent placement, direct hire and recruitment.  As a professional pharmacist recruiter, Linton serves as the liaison between the client and the qualified professionals to fill a pharmacy position resulting in the best possible candidate match possible for our clients. As a pharmacist recruiting expert, Linton takes the time necessary to build a solid relationship with you and learn about your business and your individual preferences and needs. This makes him uniquely qualified to help you locate the best possible candidates for your operation and company – now and in the future – and gives you immediate access to a broader, more talented pool of candidates than you would be able to reach on your own.
Click here to “meet” Linton and learn more about him.

In addition to staffing, recruitment, placement and direct hire of pharmacists, HCC additionally offers the finest pharmacy consulting services available throughout the USA. Customized Policy and Procedure Manuals (including 503A&B), audit and inspection preparation, pharmacy business efficiency reviews, and business management services are just a few of the consulting services that we have specialized in over 31+ years of serving our clients and their specific individual needs.

Call us today at 800.642.1652, or contact us online to discuss your needs. We are so confident you will be satisfied that we offer a six month pro-rated satisfaction guarantee!


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Pharmacy Drug Shortages in 2020

drug shortagesDrug shortages are always a frustrating situation for everyone involved in patient medical healthcare: the physicians, the nurses, the pharmacists and obviously the patient. The pharmacist certainly cannot fill the prescription for a medication that is unavailable, the nurse in clinical settings cannot administer to their patients what the pharmacy can’t supply to them, the patients cannot get the medicine that they need for their specific individual medical condition, and the doctor or physician can’t utilize the chosen and preferred method for helping to treat his or her patient in receiving the highest possible level of acceptable and preferred medication to ensure that the his/her patient receives the very best treatment that there is. Many times the pharmacist, doctor and, worst of all, the patient is forced to settle for the “next best” treatment that’s available. Then add into the “equation” the lost and wasted time that both the patient and druggist will usually spend on trying to locate the medication elsewhere. Additionally, the stress and anxiety this causes to everyone is something that you cannot even associate a monetary price to. Lastly, keeping in mind that the patient is already ill and suffering from a treatable condition that now cannot be therapeutically alleviated with the best possible medication (if at all without it!), and one can clearly see the dramatic and almost “domino like” negative effects that a drug shortage may potentially result in.

In attempt to put this in its proper perspective, according to one recent survey by Vizient, Inc. , hospitals alone in the U.S. lose over $350 million a year due to drug shortages, plus that more than an additional 8.5 million hours of people’s time are wasted annually.

What Statistics are there on Drug Shortages?

Drug shortages in the USA are documented and monitored by the ASHP (The American Society of Health-System Pharmacists), a professional organization of over forty-five thousand members that’s primarily comprised of pharmacists, pharmacy interns and students. Their most recent update on drug shortages in the United States was released just a week ago on January 24th of 2020. Note that this annually updated statistical report even includes the data from last year or 2019.

The January 24, 2020 report released by the ASHP included numerous statistics and data to analyze for those experts that enjoy doing that, but there were five key statistics and takeaways from the recent drug shortage report.

  1. There were 166 new drug shortages in 2019. This is actually lower than the number of shortages that the were documented by the ASHP in 2018 when there was a grand total of 186 for the year. Below are the yearly drug shortage counts that were document by the ASHP in the United States annually over the past two decades (from 2001 to 2019):
    2019: 166
    2018: 186
    2017: 146
    2016: 154
    2015: 142
    2014: 185
    2013: 140
    2012: 204
    2011: 267
    2010: 211
    2009: 166
    2008: 149
    2007: 129
    2006: 70
    2005: 74
    2004: 58
    2003: 73
    2002: 88
    2001: 120
    Although down from last year, and well short of the drug shortage record of 267 that were seen in 2011, there were 166 situations last year where a shortage did occur and resulted in the negative consequences caused by drug shortages that we discussed previously.
  2. Keeping in mind that the drug shortages we are discussing are NEW shortages, perhaps a better number to put this in its proper perspective is the total number of ACTIVE shortages. These include, quite obviously, the new ones each year added to the existing ones that are still in play. When we look closely at the total active drug shortages by year, perhaps we can all get a better appreciation of how drastic the drug shortage situation currently is. Plus it is actually growing each year!
    In 2018 the total number of active shortages was 915. At the end of 2019 the total number of active shortages was 1,087. Perhaps there was a drop in new ones, but the real point is that the total active and ongoing number has steadily been increasing every year! In fact, even though the number of new shortages decreased in 2019 when compared to 2018, the number of active shortages increased by almost 20%. Perhaps that helps explain why the NCBI (The US National Institutes of Health) has called the drug shortages a Crisis in the United States!
  3. Greater than half of the drug shortages (approximately 60%) were for non-injectable medications.
  4. Central nervous system drugs (included are drug treatments in patients with anxiety, insomnia, stress, etc.) comprised the therapeutic class of drugs that accounted for the most drug shortages in 2019. These were followed by:
    – Antibiotics
    – Electrolyte replacements (including IV electrolyte replacement treatments)
    – Cardiovascular medications (including blood pressure and heart disease drugs)
    – Chemotherapy medications
    – Gastro-intestinal, Hormonal, and EENT medications were all relatively about even and comprised the rest of the therapeutic classes of the 2019 drug shortages list.
  5. For the 2019 list regarding the causes of the new drug shortages, the majority were classified as “unknown cause” (over 80%). However, this inflated number was repudiated by by FDA Drug Shortage Task Force report that documented that greater than 60% of all the new shortages in 2019 were attributed to quality and/or manufacturing issues by the manufacturers, suppliers, and/or distributors. The FDA’s report also stated that the ASHP report’s number was askew and incorrect due to the fact that a “significant number of manufacturers, distributors and suppliers of the drugs” simply refused to provide a reason for the shortage on the ASHP report.

What Do Drug Shortages Mean to a Pharmacy Manager or Owner?

In what is now known as “The Age of Documentation” in the pharmacy business, updating your Policy and Procedure manual is a must. This manual must contain the required policies and reflect the actual operational procedures of the pharmacy. So how your pharmacy handles these drug recalls requires a customized and detailed policy be a part of your P&P, plus additionally, the documented procedures or steps undertaken to make sure that the policy is properly implemented and carried out by your staff. In addition to what most pharmacy managers and owners would consider the “normal” policies and procedures that are expected, how you deal with these drug shortages must include both Drug Recalls and Drug Shortages now. Also, training for your staff on how to address drug shortages (and documenting that you do have such training and that every employee receives it) is also a must!

Healthcare Consultants is a leading national Pharmacy Consulting company offering expertise in all areas of pharmacy consulting. Known for being one of the nation’s leading pharmacy staffing agencies for over three decades, HCC has been in the business of Pharmacy Consulting for 31+ years now. Known nationally as one of the industry leaders in providing a full range of professional pharmacy consultation services to its vast array of clients, HCC is owned and operated by pharmacists. We can provide proven expertise and experience in all facets of pharmacy operations, including retail, hospital and all specialty pharmacy venues.

Don’t overlook the fact that the mishandling of drug recalls and shortages can result in serious problems and issues to your pharmacy business. As the old cliché goes – “An ounce of prevention is worth a pound of cure!” Contact us online now or call us today for a Free Consultation at 800-642-1652 to discuss how we can help you.


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Medication Errors

Medication errors occur in a pharmacy under the best of conditions. However, a previous Missouri court ruling regarding a pharmacy medication dispensing error clearly shows that a lack of proper supervision, documentation and up-to-date policies and procedures will not be tolerated when the public’s safety is placed in jeopardy as a result. In an excellent article released several months ago in the Australian Journal of Pharmacy, an extremely valid point is made: the owner of the pharmacy is always ultimately responsible! The point was well made that although many pharmacies are owned by pharmacists (or non-pharmacists) who do not actually work in them, in the end it is the owner’s responsibility to make certain that current and up to date Policies and Procedures are maintained and followed by all of the pharmacy’s staff. Being an “absentee” owner will not stop the legal ramifications of dispensing errors and other mistakes by employees that could (and should) have been prevented. And that the owner is now held both responsible and accountable for in 2020 and future years!

The Missouri Case and Ruling

The Missouri Court of Appeals (Western District) reversed a lower court’s decision in late October of 2017 that centered around a medication dispensing error by a pharmacist in Missouri. The dispensing error occurred when a pharmacy technician took several prescriptions over the phone from a Registered Nurse on behalf of the physician who was discharging his patient from the hospital. Although several mistakes were actually made by the technician, the most significant medication dispensing error was that the prescription phoned in by the RN for the patient’s metolazone was transcribed incorrectly to read methotrexate. The directions given to the patient for “once daily” administration of the drug inherently led to the patient’s death less than three weeks later (after she followed the directions on the prescription bottle and took a dose every day).

The family then sued after the patient’s death and were awarded $2,000,000 in damages by a jury after a trial. Even though gross negligence was proven and admitted by the defendants in the initial trial, the damages awarded were reduced by a lower Missouri appeals court to $125,000 (based on Missouri statutory caps and limits to damages awarded by a jury). The victim’s family further pursued the ruling, which eventually led to the recent reversal by the higher court. The court upheld the jurors’ decision to award the patient’s family the additional damages that they initially were awarded for the pain and suffering caused by “aggravating factors and circumstances” resulting from the medication dispensing errors by the pharmacy.

The Four (4) Medication Dispensing Errors as Noted By The Missouri Court

What makes this case so noteworthy is that the Missouri Court of Appeals actually broke down the case into four separate incidences of medication errors occurring in the pharmacy’s process of dispensing the prescription.
1. The first error cited by the court was that the technician took the prescription verbally over the telephone. Although currently Missouri is one of the seventeen (17) sates that allows pharmacy technicians to take prescriptions verbally by telephone, the court noted that the pharmacy’s own policies and procedures actually prohibited this practice and state that only RPh’s are allowed to accept prescriptions via verbal phone communication.

2. The second error was that the pharmacist did not question the methotrexate being administered once daily. In conjunction was the fact that the pharmacy’s computer system failed to “flag” the daily methotrexate dose. The court’s opinion stated that the pharmacist failed to properly review the medication and its administration, plus the court noted that there was a lack of a computerized “hard stop” for methotrexate prescriptions prescribed to be administered once a day.

3. The third error cited by the court was the failure by the pharmacy to provide the patient with the necessary education and the required patient counseling when dispensing a new Rx to a patient. Especially when the prescription is for a high risk medication (such as methotrexate).

4. The fourth, and perhaps the most significant error cited by the court, was the fact that the pharmacy “had made no meaningful changes to its procedures as a result of the patient’s death.” The court noted that in the time since the original verdict, the pharmacy had failed to update and document any changes to their policy and procedures manual. This included any documented updates to their procedures regarding a pharmacy technician’s role in the prescription dispensing process.

Minimizing Medication Errors and Pharmacy Dispensing Errors

The FDA defines a medication error as “any preventable event that may cause or lead to inappropriate medication use or harm to a patient”. A study released way back in 2006 by The Institute of Medicine (a part of the US National Academy of Sciences) showed that medication errors result in harm to at least 1.5 million patients annually. Another study showed that over 400,000 patient injuries take place in hospitals in the US alone annually due to medication errors. Medication errors occur for a variety of reasons. and everyone agrees that no one is perfect. Yet in today’s society of consumers having more access to drug information than ever before, medication dispensing errors by pharmacists are being reported much more frequently. As a pharmacy owner and/or practitioner, we all need to take a hard look at this and ensure that the best practices of pharmacy are always being followed to the best of our abilities. As the National Institute of Health (NIH) points out: “Errors will always occur in any system, but it is essential to identify their causes and attempt to minimize the risks”.

What Does This Ruling Mean to a Pharmacy Owner?

As a pharmacy owner or manager, ask yourself the following questions:
– Do you ensure that if a mistake is made that you have documentation that will prove that you made changes to your written Policy and Procedures Manual to show that you take every step possible to avoid medication dispensing errors?
– Is your staff properly trained and able to document situations where a mistake is made? Do you have job descriptions for your technicians and support personnel?
– When was the last time that your pharmacy took a good look at how it dispenses prescriptions and medications, plus how you document patient counseling?
– Are you following “best practices” and limiting the chance for potential medication dispensing errors (and therefore reducing your risks of potential lawsuits and bad publicity)?
If your answers are “not lately”, then we strongly advise that you get a qualified pharmacy consultant to take an objective look at your policies and procedures. An objective third party review may mean the difference between a court ruling like the damaging case seen in Missouri and your pharmacy maintaining its good reputation.

Pharmacy consulting is an area that most pharmacy owners don’t take advantage of until it is too late. At HCC we stress that addressing and preventing issues before they occur is the key to avoiding future problems, lawsuits and bad publicity. The old cliché that “an ounce of prevention is worth a pound of cure” has never been more relevant than it is today.

About Healthcare Consultants

Healthcare Consultants has been in the business of Pharmacy Consulting for 31+ years now. Known as one of the nation’s leading full service pharmacy staffing companies, HCC is also one of the industry leaders in providing a full range of professional pharmacy consultation services to its vast array of clients. Owned and operated by pharmacists, Healthcare Consultants can provide proven expertise and experience in all facets of pharmacy operations, including retail, hospital and specialty pharmacy venues. With a full-time staff of in-house Pharmacy Consultant specialists, HCC can answer any questions that you may have in all areas of your business. Contact us online now or call us today at (800) 642-1652 for a free consultation to see how we can help you.

 

 

 


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New Pharmacies and Ownership

New Pharmacy ConsultationNew pharmacy startups and the opening of brand-new retail community pharmacies are occurring at a faster rate this year than ever before seen. Just reviewing the first three to four weeks of January this year reveals a staggering number of new retail community pharmacy businesses being opened and successfully established all across the entire fifty states in the US. Considering the 2019 “explosion” of new independent community retail drug stores, plus the recent national economic growth and positive forecasts for 2020, one can only conclude that the number of new pharmacy start-ups will continue and even, probably, accelerate at a rate that’s never been seen previously in all areas of our nation.

Examples of Recent Pharmacy Startups

Just as examples of this pharmacy startup trend, consider the following recently opened or scheduled to open retail community pharmacies that have been in the news in just the past several weeks.

  1. In East Haddam, Connecticut – Nutmeg Pharmacy announced just this week that it intends to hold a grand opening of a new Moodus village location on February 10th of 2020. Many residents of the rural areas of Connecticut have witnessed the closings of their independently owned and operated local community pharmacies and drugstores over the past several years. The town of East Haddam is located in Middlesex County, Connecticut, with a total population of less than 10,000 people (9,126 according to the 2017 US Census Report), and the community has been without without a pharmacy for more than three months now after the Nathan Hale Pharmacy shut down and closed its doors in October of 2019. The drugstore will obviously be focused on filling and dispensing of prescription medicines, but will also be offering their customers and patients specialized packaging, first-aid supplies and over-the-counter (OTC) drugs, plus free delivery.
  2. In Nederland, Texas, a new retail community pharmacy opened for business just this past week. The Mid County Pharmacy opened their doors to an enthusiastic community for their the first day of business with a celebratory local crowd gathered and officials from both the Nederland and Greater Port Arthur Chambers of Commerce in attendance. Located in Jefferson County, Texas, Nederland has a population of almost 18,000 people and was actually settled all the way back in the late 1800’s by Dutch immigrants on land that was sold to the immigrants by the Kansas City Southern railroad. It is a part of the area in Texas that many people refer to as “the Golden Triangle”, which comprises Beaumont, Port Arthur, and Orange. The owners of the new pharmacy also operate multiple independent pharmacies in New York and New Jersey, but this is their vary first location in Texas.
  3. In Williamstown, Massachusetts a brand new drugstore has announced that it is scheduled to open their doors this coming March, with local residents hoping that the pharmacy will fill the void left by the closing of a small independent pharmacy several years ago. Williamstown is located in Berkshire County, in the northwest corner of Massachusetts, and shares borders with Vermont to their north and New York to their west. Following the shutdown and closing of the only local retail pharmacy servicing the area’s residents several years ago, both the students attending the local Williams College and the neighborhood townsfolk have often experienced challenges and frustration in getting their prescriptions and medications in this small town that has a population of less than 8,000 residents.

    Buying an Established Pharmacy

    In addition to the rapid pace of new pharmacy practices being recently started and established, there is also an increasing frequency of established pharmacies being sold, bought and reorganized under new ownership and management. Once again, simply scanning the past several weeks reveals numerous examples to consider.

    One such example is a drugstore located in Grand Rapids, Michigan. After several months of careful planning and getting the store ready, the Essentia Health-Deer River Pharmacy has opened their doors and serving the needs of their community and Grand Rapids’ local residents. The newly reopened independent community pharmacy was formerly known as Ott Drug, and it remains in the same physical location as its predecessor. Grand Rapids is the largest city in Western Michigan and the second biggest city in the entire state.The drugstore will offer their customers numerous reasons to get their prescriptions filled at the new store. Some of these include:
    – Numerous “no appointment required” immunization services, including flu shots and shingle vaccines
    – Legend Rx prescriptions and medications
    – OTC (over-the-counter) medications
    – Safe medication disposal services
    – Medication management
    – Refill requests online via the Internet
    – Custom medication packaging

    Starting a Drugstore or Buying an Existing Pharmacy

    If you are considering a pharmacy startup or the purchase of an existing drugstore business in 2020, then consider asking yourself several basic questions. Your answers may make the difference between your pharmacy becoming a successful business venture versus it being a disappointing failure and a loss of money.
    1. How much money and funding will I need and where will it come from?
    Your answer should include all of the possible initial startup or acquirement costs, plus take into consideration such ongoing costs as staffing (if necessary) and marketing. If this is your first business venture, are there additional costs that you may not have thought of? How much debt or equity are realistic? How best to obtain funding should you need it?
    2. Do I need a written pharmacy business plan?
    The answer is YES! Whether starting up a pharmacy business or purchasing an existing drugstore, every successful entrepreneur knows that in order to become successful one must write a solid business plan. In addition to being a “road map to success”, a solid business plan can help you get the funding from lenders that may be required.
    2. What experts will I need?
    You may have already considered an accountant and an attorney, BUT the most important expert of all is a seasoned Pharmacy Consultant on your team. HCC is known for being a national leader in helping pharmacy owners plan, purchase, setup and staff their pharmacies nationwide. Having helped open hundreds of new pharmacies and pharmacy startups, HCC ensures that all aspects of the business are covered and done right.

    Pharmacy Startup Experts

    There are many factors to consider in the planning, execution and the long-term success of starting up or purchasing an existing pharmacy business. Planning and execution are the keys to a drugstore being opened and becoming a successful business. Some of the considerations and tasks that Healthcare Consultants Pharmacy Staffing can provide include:

    – Creation and review of a business plan
    – Evaluation of proposed business location
    – Design recommendations
    – Obtaining financing
    – Assistance and guidance in the application process
    – Provide a Pharmacy Manger for both the application process and inspection
    – Provide a list of equipment and supplies (both for the Board of Pharmacy inspection and the actual Pharmacy operations)
    – Make arrangements for the final inspection of the facility (including a mock-inspection)
    – Suggestions for vendors
    – Provide legal support
    – Provide staffing

    If you are considering starting up or purchasing a pharmacy in 2020, we strongly urge you to get in touch with us today for a free consultation. We offer you the support of an experienced staff who have been through the process numerous times and know the business inside and out!  With over 31+ years of experience, Healthcare Consultants Pharmacy Staffing has helped hundreds of business owners (both pharmacists and non-pharmacists alike) establish successful businesses over the years.  Contact us now online or call us today at (800) 642-1652  to discuss how we can help you.


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Custom Pharmacy Policy and Procedures

Custom Pharmacy Policy and Procedure Manual

Custom Pharmacy Policy & Procedure ManualCustom P&P manuals are now a must! Every pharmacy must have written policies and procedures in a Policy and Procedure manual. According to the National Association of Boards of Pharmacy (NABP) every state and the majority of third party PBMs have specific policy requirements that the pharmacy is expected to incorporate into their manuals. More importantly, the pharmacy is expected to adhere to their own policies and procedures and document when necessary to be able to prove that they do so. This means that in certain instances the pharmacy must also be able to demonstrate adherence by additionally having accessible documentation to support that they actually do follow a specific policy and procedure. Merely possessing a generic P&P manual is not enough. The manual must be customized to the individual pharmacy operation and contain the required policies and reflect the actual procedures involved in the operation of that specific pharmacy.

The Reality of Pharmacy Policy and Procedure Manuals

Most of the pharmacy owners and pharmacists that we talk with are extremely busy dealing with the day-to-day business of making a living. Filling prescriptions, compounding IV’s, consulting with patients and all the other tasks that their jobs require them to deal with on a daily basis lead to items like developing and updating a P&P manual on the “back burner”. Additionally, the development and maintenance of  a written Policy and Procedure manual simply is not their area of expertise and in most cases is not even on their “Must Do List”. The fact of the matter is that the majority of pharmacy owners are satisfied with a generic P&P manual. But is the State Board of Pharmacy, the FDA, the DEA, the PBM’s and the remainder of the regulatory agencies satisfied? The answer is no! What’s required are customized policies and procedures that are up-to-date, plus are regularly updated, maintained and strictly adhered to.

The Real Bottom Line

The bottom line is that all pharmacies are required to have a written P&P manual AND the pharmacy is expected to adhere to their own policies and procedures. In almost every case of a pharmacy receiving disciplinary or punitive actions from a State Board of Pharmacy, Federal Agency or a third party (such as a PBM), the results were dramatically worsened by two factors:
1. A lack of Policies and Procedures in place
2. A lack of documented adherence to the existing Policies and Procedures

In what is now being called “The Age of Documentation” in the pharmacy business, merely possessing a generic Policy and Procedure manual is not enough. This manual must contain the required policies and reflect the actual operational procedures of the pharmacy. Plus, it now lies on the pharmacy to prove that the established  policies and procedures are being followed and adhered to by their employees! In addition to what most would consider the “normal” policies and procedures that are expected, many examples have been in the news for additional ones that most don’t even consider. Just a few examples include:
– Patient Consultations
– Pharmacy Security
– Pharmacy Emergencies
– Drug Recalls
Dispensing Errors and Medication Errors
– HIPAA Compliance and Patient Records
Drug Supply Chain Integrity Act Compliance (DSCSA)

The list is virtually endless.

Where Do You Start?

You start with HCC! Our regulatory and operations consultants can assist your staff in developing or customizing an existing Policy and Procedure manual that is sufficient and specific. We will also create a process that will allow your pharmacy manager to update and modify the policies as needed. HealthCare Consultants’ in-house experts have years of experience in  Policy and Procedure development and operational evaluation and can provide your pharmacy team with valuable insights and recommendations. Let HCC help you.

Healthcare Consultants is a leading national Pharmacy Consulting company offering expertise in all areas of pharmacy consulting. Known for being one of the nation’s leading pharmacy staffing companies for over two decades, Healthcare Consultants has been in the business of Pharmacy Consulting for over 30+ years now. HCC is in the business of helping pharmacists establish, run, improve and make their businesses profitable. Known nationally as one of the industry leaders in providing a full range of professional pharmacy consultation services to its vast array of clients, HCC is owned and operated by pharmacists. We can provide proven expertise and experience in all facets of pharmacy operations, including retail, hospital and all specialty pharmacy venues.

Don’t let “being to busy making a living” lead to potential issues and problems that can result in serious threats to your pharmacy! As the old cliché says: An ounce of prevention is worth a pound of cure! Contact us online or call us today for a Free Consultation at 800-642-1652 to discuss how we can help you.


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Opening New Pharmacy

The opening up and start-ups of new retail pharmacies are once again on the rise. With the explosion of specialty pharmacies leading the list over the past decade, the number of new pharmacies that have opened across the nation rose to the highest level ever in every state during 2019. Of interest to many is the fact that the independent retail pharmacies are making a comeback in many communities and their growth is indicative of the health of the independent community pharmacy as a great business venture to get into.

Recent Partnership Offers a Great Solution

A recent partnership that was made public just this past week was the alliance forged between two major business institutions in Williamstown, Massachusetts: Berkshire Health Systems and Williams College. Following the shutdown and closing of the only local retail pharmacy servicing the area’s residents several years ago, both the students attending Williams College and the local neighborhood townsfolk have often experienced challenges and frustration in getting their prescriptions and medications locally.

The solution: Williams College officials and the management team at Berkshire Health Systems decided to form a “Retail Pharmacy Partnership” and announced that they would jointly open a new retail community drugstore named Williamstown Apothecary in a space already owned by the college. The proposed new retail site is currently undergoing both permitting and renovation, and is expected to officially open their doors for business in early April of this year.

“In discussions with Williams College leadership, the desire to have a pharmacy in easy walking distance from the college campus was cited as a significant need for students, faculty and staff, and will also greatly benefit the overall community,” said Darlene Rodowicz, BHS chief financial officer. “Having something close to campus was just really important, and to have a partner in that with BHS made a lot of sense.” The fact that BHS is already operating two other pharmacies (one at Berkshire Medical Center in Pittsfield and the other at Berkshire Medical Center’s North Campus in North Adams) made it clear that they were the perfect partner for Williams College to align themselves with to insure both a smooth startup of the new retail drugstore, plus the ongoing management and expertise required for a successful and profitable pharmacy startup venture. The Williamstown Apothecary will be operated by Berkshire Health Systems through its Berkshire Community Pharmacy as a full retail pharmacy with patients having access to both legend prescription drugs plus OTC (over-the-counter) medications.

What Factors Need Consideration In a New Pharmacy Startup?

There are numerous factors to consider in the planning, execution and long-term success of the opening up of and maintaining a new pharmacy business. The planning and execution are really the keys to a smooth pharmacy operation being opened and becoming a successful business. For en entire list of all tasks, duties and requirements involved in the opening up a new pharmacy, please visit our Pharmacy Startup section.

Some of the considerations and tasks that are required for a successful pharmacy business to be started begin well before the actual opening.  These may include:
– Creation and review of a business plan
– Deciding what type of corporation to form – basically of the five primary types to choose from (Limited Liability or LLC, C-Corporation, S-Corporation, Sole Proprietorship or a General partnership), most experts recommend an S-Corporation for an independent community pharmacy.
– Evaluation of proposed business location (of course most people will agree that this is perhaps the most important consideration of them all)
– Start up costs (these not only include prescription and OTC medication inventory costs, but a long list of items such as equipment, signage, advertising, insurance, security, etc. A very well done list is available at INNOVATIONS in pharmacy, although the pricing may not be as accurate and up to date as possible)
– Design recommendations
– Obtaining of the proper financing that you may require
– Assistance and guidance in the application process
– Hiring of a Pharmacy Manger and/or Pharmacist in Charge (PIC) for both the application process and inspection
– Purchasing the equipment and supplies (both for the Board of Pharmacy inspection and the actual dispensing and pharmacy operations)
– Choosing the right software and technology
– Making arrangements for the final inspection of the facility (including a mock-inspection)
– Choosing the best vendors
– Obtaining legal support
– Staffing (not only the pharmacist, but technicians and ancillary staff such as cashiers and other support personnel)

Getting Help With Opening a New Pharmacy 

HCC is the Pharmacy Consulting Company that is experienced and nationally known for starting (pharmacy start-up), moving and expanding pharmacies throughout the US for over 30+ years now. Healthcare Consultants Pharmacy Staffing has helped hundreds of satisfied Pharmacy owners through the process in almost every state. This includes the start-up and opening of independent retail community pharmacies, specialty pharmacies, mail-order pharmacies, compounding pharmacies and IV infusion pharmacies.

Once Your Pharmacy Is Open 

HCC is also always there to service your needs and available to provide you additional pharmacy services. A sampling of our pharmacy staffing and pharmacy consulting services include:
Pharmacy Staffing – This includes both temporary and permanent placement.
– Training and Compliance – HIPAA, CQI, JCAHO, OSHA, USP, Policy & Procedures; there are many state and federally required programs that must be implemented by all pharmacies. Our experts will assess your needs and help you achieve compliance through training.
Inspections and Audits – Is your pharmacy inspection coming up? We can take the anxiety out of this event by performing a pre-inspection audit. Our consultants are well-versed in each state’s Board of Pharmacy rules and regulations, plus we are able to objectively review your pharmacy opertation with a critical eye. Does your pharmacy compound medications? Our experts will assess your compliance to your state’s rules and USP guidance. We will then present our findings and recommendations to you, so that there will be no surprises during the actual inspection.
Business Performance and Efficiency – Our experts have been involved in all aspects of pharmacy practices, large and small. We can analyze and evaluate your current operation and offer insight and suggestions to improve efficiency and workflow.

If you are considering opening up a new pharmacy, we strongly urge you to get in touch with us today for a free consultation. With a history of more pharmacy startups than other pharmacy consulting companies, we offer you the support of an experienced staff who have been through the process many times and know the business inside and out! Whether you are a seasoned business professional with experience opening new pharmacies or simply considering a pharmacy venture as a new business investment, Healthcare Consultants Pharmacy Staffing can help you. With over 30+ years of experience, we have helped hundreds of business owners (pharmacists and non-pharmacists alike) open up and establish new successful pharmacy practices in almost every state. Contact us online or call us today at 800-642-1652 for a Free Consultation to discuss how we can help you.

 


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Pharmacy Challenges and Opportunities in 2020

pharmacy challenges solutions opportunitiesA new year is upon us and the pharmacy profession faces numerous issues, challenges and opportunities that are more abundant and at the same time more complex than perhaps they have ever been before in the history of the practice of our profession. New and fast paced pharmacy technological advancements and extremely rapid changes in disease treatments lead the way, but constantly changing laws and legislation, insurance issues, plus the explosion of specialty pharmacies have made change the norm in the past decade. One can only forecast that this trend of rapid change will continue and perhaps even accelerate over the next few years starting with 2020.

What Do these Changes in the Practice of Pharmacy Really Mean?

The explosion of “real time” media attention that now exists, plus a more educated and informed patient population have both certainly resulted in one major significant change: the roles that pharmacists play as part of the Healthcare Team are both expanding and becoming more demanding on our skills. The result is that pharmacists are being challenged now more than ever to be at the “center” regarding total patient care. Our traditional role and focus  is no longer centered only on our expertise regarding a patient’s medications and prescriptions, but perhaps has shifted to the pharmacist being the central player in ensuring a patient’s well being. This means both increased involvement with all other Healthcare professionals, as well as increased communication with physicians, nurses, ancillary healthcare staff, caretakers, insurance companies and of course, the patients themselves and their families.

The Pharmacist MUST Communicate and Educate

The vitally important role that we here at Healthcare Consultants can clearly see the pharmacist now filling (and the role ever growing and increasing in the future) is one of being both the “communicator” and the “educator”. One of the reasons this is taking place is that if you drew a diagram of all the healthcare roles and functions that are involved in ensuring the best possible patient care, the pharmacist is in most cases and scenarios at the very center. It is the pharmacist who must ensure that there is always an accurate flow of information taking place between all of then numerous healthcare team members to ensure the best outcomes and results for their patients. Keep in mind that the R. Ph. who often times is the one communicating directly with the patient and their family members. This not only relates to medications and making sure that factors such as accuracy of dosages, appropriate choice of medication for individual patients, correct administration instructions, checking for adverse drug interactions, adequate counseling and of course compliance all take place. The real focus has become education. After all, who is the real expert on drugs and medications? Once again the most recent Gallup poll shows that Pharmacists are at the top of the list for the most trusted professionals (see Gallup Poll). The public respects a Pharmacist’s knowledge, ethics, expertise and opinions. Add to this that studies have shown that patients are “more likely to be honest when talking to their pharmacist versus their doctor”. This was related to the fact that most patients interacted with their community druggist much more often than with their physicians or with any other healthcare providers on a “routine basis”. One example cited was a patient who had a total of 11 different physicians! Additionally, the point can be made that the specialization of physician care has led the public to view doctors as “only focusing on their piece of the overall picture” and leaves the pharmacist as the “overseer” who manages the entire patient care. This can be especially true when settings such as clinics and large multi-staff physician practices are involved.

What’s the “Bottom Line” Regarding the Change Taking Place?

The point is that a pharmacist’s role is no longer viewed as it previously was in the past as simply being a “pill counter, placing a label on the bottle and then being a cashier”. As a profession we are now responsible legally for counseling our patients, plus must initiate the increased communication with an expanding number of other healthcare team members to ensure our patients’ receive the best possible treatment available. This direction is a “must’ for each of us to understand and undertake in order to ensure increased patient medication compliance and provide the best healthcare available. This means expanding our own skills and education to perform tasks that perhaps many of us never did before (Pharmacogenetic testing is a great example as discussed in one of our posts several years ago – Pharmacogenetic Testing in Community Pharmacies. Physicians, related healthcare practitioners, insurance providers and especially our patients are demanding this of us. It is interesting to note that of the 10 “Top Read Health-System Articles” on Pharmacy Times , over half were about patient and/or physician counseling and communication regarding specific diseases and the pharmacists role as a “team member”.

The real “bottom line” is that 2020 is perhaps one of the most exciting times ever to be practicing pharmacy! The opportunities for us as both individuals and as professionals are almost limitless. Plus they are increasing at a rate never seen before. It is our choice to each participate and play a major role in this “revolution” in US healthcare, or to “sit on the sidelines” as an observer. I hope we all choose wisely.

About HealthCare Consultants

As always, HCC is here to help you in any way that we can. Contact us online or call us today at 800-642-1652 to discuss how we can help you (or just if you’d like to talk about any idea that you may have regarding Pharmacy!). Healthcare Consultants is a nationally renowned full service Pharmacy staffing and consulting firm that has been in business for over 30+ years. Owned, managed and staffed by full-time in-house Pharmacists, HCC offers a full range of Pharmacy Staffing & Placement, plus is noted for our Pharmacy Consulting Services that other firms simply cannot offer.

From major hospitals and healthcare systems to individual community retail and specialty pharmacies, HCC has been the nationally renowned pharmacy consulting firm of choice for over 30+ years now. We work with businesses of every size – from the corner drug store to national corporations and organizations – with only one goal in mind: to improve your pharmacy’s business operations. We can assist with expert advice in any area of your pharmacy business or practice.

HealthCare Consultants is additionally the leader in pharmacy startups! No other firm has opened and started up as many pharmacies throughout the nation as HCC. Plus, these new pharmacies run efficiently and profitably. Our in-house consulting experts can make sure that you do it right… every step of the way!

We urge you to contact us today to see how our Pharmacy Consulting services can help you improve your business now, plus be ready for the future. With a full-time staff of in-house Pharmacy Consultant specialists, HCC can answer any questions that you may have in all pharmacy settings. Contact us online or call us today at 800-642-1652 for a free consultation.

 


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Managing A Pharmacy

Managing A PharmacyManaging a pharmacy is an important part of almost every pharmacy owner’s responsibilities. The day-to-day management of just the pharmacy’s personnel, inventory, customers, vendors and store maintenance issues always seem to take up a majority of an owner’s day… and the list sometimes seems endless. Then add in such critical functions as ensuring that your pharmacy’s policy and procedure manual is kept up to date, that your drugstore is ready for any compliance or regulatory audits or inspections, that your employees are properly trained, and it sometimes seems that an owner never has the time to spend on what is perhaps the most important thing he or she needs to do: how to make sure that your drugstore is profitable. Plus spending the time on making your business even more profitable!

With the diminishing number of independent local community pharmacies operating throughout the United States, it’s sad to see over a ten percent reduction in the total over the past two decades. According to data supplied by NCPA (National Community Pharmacists Association), nearly 22,000 independent pharmacies are currently in business in the US. This represents a 12% decline since 2001, when the association reported that there were over 25,000 independent pharmacy businesses in operation nationally. Perhaps better management of those pharmacies that have been closed or shut down over the past seventeen years could have resulted in more profitable businesses and less pharmacies closing across the nation.

The Challenge of Managing a Pharmacy

Most independent pharmacy owners that were surveyed recently about the challenges they faced in managing their businesses cited two major areas of concern that they found challenging:
– Lack of time and resources
– Lack of business and management training

As discussed in the opening paragraph, most pharmacy owners simply don’t have the time to spend on what’s perhaps the really most important issues that face any business owner in any type of industry: increasing both efficiency and profitability. Delegating was often times mentioned as one possible solution, but this also had its drawbacks. Delegating was seen as “hiring additional staff” and this additional drain on the pharmacy’s limited resources often times offset any capital gains that resulted. Additionally, many pointed out that there simply was no objectivity from their internal staff. There was a “fear” that no one internally could look at the pharmacy’s operation and evaluate the business with the impartiality and detachment required to properly make unbiased recommendations and adjustments.

The second major area of concern that drugstore owners saw as challenging was the lack of both business and management training that they actually had. Very few had actually taken any courses in business or management since graduating from college. And how many pharmacy students have actually received this type of training while in school? Although many colleges and universities have now added business training into their curriculum, the fact remains that earning your diploma to graduate and pass the Board exam is the primary focus for most students. Most owners agreed that they had to learn the business side of owning and operating a pharmacy “on the fly” and made business mistakes that could have been avoided with more training.

How To Get Business and Management Help

Most large corporations and companies actually have entire departments dedicated to managing, monitoring and evaluating their business operations. Most small and medium sized pharmacy businesses simply cannot afford hiring full-time employees to perform these critical tasks, nor can they afford to train their existing staff to objectively carry out these essential business roles. Many owners are finding that outsourcing to an experienced and qualified pharmacy consulting company best suits their needs for strategic planning and management. They find that outsourcing can be the most practical and economically feasible way to achieve large company effectiveness without the large company price tag.

Suggestions to Make a Pharmacy Profitable

Here are just a few examples of areas that most pharmacy owners tend to overlook, yet can result in increased operating efficiency, cost reductions and enhanced profitability.

Quarterly Business Reviews

Pharmacies should conduct quarterly business reviews to accurately assess their strategic position, direction and practices, and to ensure they continue to align with market shifts, competition, profitability and regulatory compliance. To be objective, perhaps the pharmacy owner should consider including a qualified third party who is able to provide an in-depth analyses and report on the actual state of the business. One who is able to evaluate the operation objectively in regards to the efficiency and opportunities that exist to gain a larger market share. This information can be invaluable in helping managers make the right decisions at exactly the right times to ensure your business always runs as efficiently and effectively as possible.

Cost Containment Strategies

Pharmacy owners can also benefit from an expert consultant on cost containment strategies. When cash flow is an issue, an owner really only has two choices: increase sales and volume, or reduce costs. Increasing sales is obviously an objective that every owner wants, but for immediate results cost containment is the fastest way to increase profits. Yet many managers simply don’t see some of the “hidden” costs that can be addressed immediately. An in-depth analysis of where the money goes can also sometimes reveal “hidden” costs that can be either reduced or eliminated.

Industry Niche Identification

Industry niche identification is also a great way to generate more revenue and be more profitable. Are there certain areas and services that the pharmacy can quickly ramp up and take advantage of? A great example is the sudden explosion of IV infusion therapy pharmacies that we discussed in detail in one of our previous blog posts just last week. The projected increase to approximately $28 billion dollars by 2021, plus the estimate that the market would expand by a compound annual growth rate (CAGR) of over ten percent by 2022, makes IV infusion and compounding a lucrative idea to consider.

Technology Evaluation

Technology evaluation has also become a critical area of pharmacy operations that many need outside help on. After all, keeping up with all the new medications coming onto the market and the ever changing regulatory and compliance requirements keeps every pharmacist pretty busy. Although pharmacists have always been considered “early adapters” when it comes to embracing new technologies, everyone can agree that the pace at which technology changes makes keeping up with the latest software, hardware and systems an almost impossible task. Why not rely on a technology expert to evaluate what you currently have and advise you regarding what’s coming or available? Perhaps new technology exists that offers a cost reduction, increases efficiency and leads to greater profits.

About HCC

Healthcare Consultants has been the nationally renowned pharmacy consulting firm of choice for over 30+ years now. Contact us today to see how our Pharmacy Consulting services can help you improve your business right now, plus be ready for the future. With a full-time staff of in-house Pharmacy Consultants and specialists, HCC can answer any questions that you may have in all areas of your business. Just a few of the services that we offer include:
– Business planning
– Business problem resolution and turnaround
– Cost containment & financial projection analysis
– Management consultation & operations evaluation
– Policy & Procedure review & Custom P & P Manuals
*Including Policies and Procedures customized for 503A and 503B operations
– Process design and evaluation
– Quality control and improvement
– Regulatory compliance and Gap analysis
– Workflow management

Contact us online now or call us today at 800-642-1652 for a free consultation.


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IV Infusion Pharmacies

IV PharmacyIV and infusion pharmacy startups are always at the top of the list when you may be considering opening up a new pharmacy business or an expansion of your existing pharmacy operation. The IV and infusion pharmacies were the primary catalyst to the emergence of both the compounding and specialty pharmacy booms that have been dominating the pharmacy start up marketplace for the past several decades. IV and infusion pharmacies compound medications that are typically administered intravenously, but also provide for drugs to be administered as intramuscular injections and for epidural use.

What Needs Consideration for an Infusion Specialty Pharmacy Startup

The major consideration in opening up an IV and infusion pharmacy is that sterile compounding is a highly regulated area of the specialty pharmacy business and industry. Ever since the terrible meningitis outbreak in 2012 that was linked to the New England Compounding Center (NECC) and resulted in the deaths of 64 patients, IV and infusion pharmacies are under strict guidelines and the scrutiny of numerous federal and state agencies. Formalized IV and infusion preparation training (based on USP 797) is required now for all pharmacists and pharmacy technicians who are involved in the preparation and compounding of all sterile medications such as those produced in an IV infusion specialty pharmacy practice.

The IV and infusion pharmacy primarily compounds sterile medications for patient use in their homes or in a long-term care facility (LCF). Most frequently the patient has a fenestrated catheter inserted and the infusion via the catheter is delivered by one of three methods:
1. Electronic Pumps – typically the medications are pre-mixed from vials and delivered via IV infusion bags using an electronic pump.
2. Elastomeric Pump – these devices deliver the medications stored in a “balloon like reservoir” that is unclamped for delivery of the patient’s IV dosage.
3. Pre-Filled Infusion Therapy – one of latest technologies that delivers a preset (metered) unit dose from a pre-filled IV container.

Additional Statutes and Guidelines Required for Preparing Infusion Meds

Along with all the usual considerations involved in the planning and execution of a pharmacy startup operation to become a successful business venture, an IV and infusion pharmacy must also adhere to numerous additional statutes and guidelines. These include:
503B FDA facility requirements established in the Quality Compounding Act of 2013
USP 797 compliance guidelines
ASHP Guidelines on Home Infusion Pharmacy Services
– The Medicare Home Infusion Therapy Coverage Act (S. 1203 and H.R. 2195)
Additional equipment, supplies, logs and records are necessary. Sterile compounding equipment is a must (such as Laminar Flow Hoods), plus storage and handling requirements pertaining to both the ingredients and the IV drugs prepared must be strictly adhered to. IV and infusion pharmacies additionally must be in compliance with all of these federal and state agencies:
– United States Pharmacopeia (USP)
– HIPAA (The Health Insurance Portability and Accountability Act)
– Federal Food and Drug Administration (FDA)
– Occupational Safety and Health Administration (OSHA)
– Drug Enforcement Administration (DEA)
– The Centers for Medicare and Medicaid Services (CMS)
– National Institute for Occupational Safety and Health (NIOSH)
– Environmental Protection Agency (EPA)

Add into the mix the fact that an IV and infusion specialty pharmacy must also be in compliance with all local, state and federal laws, rules and regulations and the task of starting up a new pharmacy becomes exponentially more complicated, regulated and difficult. It is important to note that there are frequent changes, modifications and additions to both the laws and regulations by these various agencies, yet strict compliance and adherence is a must.

A customized Policy & Procedures manual is a necessity for every IV and infusion compounding pharmacy! As everyone is aware, each pharmacy business is required to have a policy and procedure manual. Every state and most PBMs have specific policy requirements that the pharmacy is expected to incorporate into their manuals. More importantly, the infusion pharmacy is expected to adhere to their own policies and procedures. These must be kept up-to-date and must clearly document that the operation is strictly adhering to all requirements. Merely possessing a generic P & P manual is not enough. This manual must contain the required policies and reflect the actual procedures established to properly and safely operate the specialty pharmacy.

Additional Professional and Accreditation Organizations for Infusion Compounding

Additionally, there are various ancillary professional organizations and accreditation bodies that set the guidelines and best practice standards to ensure the delivery of high quality patient care in regards to IV medication preparation and delivery.
These include:
– JCAHO (the Joint Commission)
– ASPEN (American Society for Parenteral and Enteral Nutrition)
– Medicare
– ACHC (Accreditation Commission for Healthcare)
– PCAB (Pharmacy Compounding Accreditation Board)
– HQAA (Healthcare Quality Association on Accreditation)
– IDSA (Infectious Diseases Society of America)
– CHAP (Community Health Accreditation Program)

Is Additional Training Required?

An additional point that must be taken into consideration is that IV training is now a requirement for all pharmacists and pharmacy technicians who are involved in preparing sterile IV and infusion medications. In fact, according to the directives based on USP 797, formalized training is required for all pharmacists and pharmacy technicians involved in any type of sterile compounding. Many states also now require special licensure for a pharmacist for preparing sterile preparations (and many see this special licensure requirement being the next change on a national level).
Lastly, special permits are also required for the operation of this type of specialty pharmacy practice. One specific application for a permit requires a detailed written response to a list of 21 clinical and operational questions which are based on your Policies and Procedures manual.

How and Where Do You Start?

As with any pharmacy operation, there are numerous factors to consider in the planning, execution and long term success of opening and maintaining a new IV and infusion pharmacy pharmacy business. Planning and proper execution are really the keys to a smooth pharmacy operation being opened and then becoming a successful and profitable business venture. Just a few of the considerations and tasks that are required for any successful pharmacy start-up operation include:
– The creation and review of a business plan
– Guidance regarding type of corporation to form – Limited Liability or LLC, C-Corporation, S-Corporation, Sole Proprietorship or a General partnership
– Startup cost estimates
– Obtaining financing
– Work flow design
– Assistance and guidance with the DEA & State Board of Pharmacy application process
– Creating Policy and Procedure manuals and Continuance Quality Improvement (CQI) manual
– Purchasing the equipment and supplies
– Obtaining legal support
– Staffing (not only the pharmacist, but technicians and ancillary support staff personnel)

As always, please contact us here at Healthcare Consultants if you have any questions regarding establishing or running an IV and infusion specialty pharmacy. With over 30+ years in the pharmacy consulting business, HCC can assist with expert advice in any area of your pharmacy operation or practice. We urge you to contact us today to see how our Pharmacy Consulting services can help YOU. With a full-time staff of in-house pharmacy consulting specialists, HCC can answer any questions that you may have in all areas of your business. Contact us online now or call us at 800-642-1652.


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Cancer Specialty Pharmacy Startups

cancer pharmacyCancer and oncology pharmacies have become a major factor in the rise of specialty pharmacy startups nationwide. Because cancer and chemotherapy medications are typically extremely expensive and complex to both manufacture and compound, it is easy to see why oncology pharmacies have become a cornerstone in the specialty pharmacy industry. Oncology drugs necessitate special storage, handling and administration procedures that must be taken into consideration when starting up a specialty pharmacy or expanding an existing pharmacy operation. Additionally, out of all the specialty pharmacy models, oncology start-ups must consider that this type of specialty pharmacy requires the most clinical communication and interaction with other healthcare professionals, patients and insurance providers. However, the opportunities to create a successful startup pharmacy operation in this specialty pharmacy area are in place and there are numerous success stories. A survey by Zitter Health Insights showed that around 31% of oncology and cancer IV therapies were fulfilled in 2013 by cancer specialty pharmacies. Additionally it was reported that almost 28% of oncology medications were distributed to physicians’ offices or directly to patients to bring to their clinic by oncology specialty pharmacies in 2015.

The Onset of the Cancer Specialty Pharmacy

Historically the oncology medication treatments were administered to cancer patients in a hospital, but this changed dramatically in the early 1990’s. Cancer treatments increasingly moved to the clinic or physician’s office settings, with an estimated 80 – 90% of patients receiving their oncology drugs intravenously outside of the traditional hospital setting. This resulted in thousands of cancer clinics being set up across the nation who were being supplied by several major drug suppliers. The primary oncology drug suppliers were divisions of major wholesalers who dominated the marketplace. The largest of these providers that eventually became known in the industry as Specialty Distributors (SD) included:
– McKesson Specialty Care Solutions
– Cardinal Specialty Pharmaceutical Distribution
– Oncology Supply (owned and operated by the Amerisource Bergen Corporation)
– CuraScript (a division of ExpressScripts)
Then arrived “the age” of oral oncology medications. With the dramatic explosion in the number of oral cancer medications available for oncology treatment during the first decade of the new millennia, oral drugs accounted for a little over 35% of the marketplace by 2011 as reported in Pharmacy Times.
Physicians were focused on their patients who received intravenous medications and oncolytics at their offices and clinics, thus sending patients to their local pharmacies who were really unprepared to dispense the oral cancer medicines. Not only did the retail chains and independent community pharmacies not wish to stock the expensive medications, but there was a definite lack of patient counseling and education regarding the dispensing of these prescriptions. Specialty cancer and oncology pharmacies quickly emerged in the marketplace as a viable solution.

Additional Challenges for Oncology and Cancer Specialty Pharmacy Startups

Along with all the usual considerations involved in the planning and execution of a pharmacy startup operation to become a successful business, an oncology or cancer pharmacy has two additional challenges that must be taken into consideration. The first is the counseling and education involved with the dispensing of these medications. In many instances the specialty pharmacist is at the communication center and the key to a patient’s treatment regimen being a success. In the instance of “brown bagging” (where the cancer specialty pharmacy ships the medications directly to the patient), many pharmacists admitted that they underestimated the amount of time required to counsel and educate patients. It definitely requires the right personality and a pharmacist who is patient and enjoys extensive patient interaction. For “white bagging” (where the cancer specialty pharmacy ships the medications directly to the physician or clinic for the patient’s treatment when they arrive), the same is true. The physician or clinic’s staff members depend on frequent communication with the specialty pharmacist and once again the time required for this essentially vital task being performed well is significantly underestimated in many situations. The cancer regimens presented a challenge to all the healthcare professionals involved in the patient’s oncology treatment by the necessity of the ongoing clinical support that the specialty pharmacist now fills the role of providing.

The second additional challenge faced by the specialty pharmacy business owner that must be considered is the reimbursement from third-party providers. Many third-party providers embraced the cancer specialty pharmacies as a means to controlling costs, while the drug companies saw them as a good way to manage the expensive inventories associated with their products. However, the issues surrounding reimbursement have become extremely complex. It is important to keep in mind that about half of all specialty drug spending falls under the patients’ medical benefit coverage. Add into the scenario the Federal 340B Drug Pricing Program which requires that the drug manufacturers provide the medications at significantly reduced prices and you can start to see the complicated landscape and the “cloudy” issues involved. The drug manufactures embrace the specialty pharmacies, as they have proven effective as an additional outlet to dispense and ship their products to patients and providers. The manufacturers realize that the traditional channel strategy of wholesale distribution of their products will lead to a diminished return on investment for them. The distributor channels obviously are opposed to the cancer specialty pharmacies. They see a significant decrease in their distribution volume, plus decreased profits. If they can get the specialty pharmacy to order through them, then they get to keep the volume, but earn far less profit.
Faced with the dilemma of extremely expensive drugs used for a small proportion of patients, payers have attempted various new strategies designed to control costs. To participate, the specialty cancer pharmacy is faced with the complexity of the reimbursement system. These attempts at controlling costs include such strategies as:
– Formulary specialty tiers.
– “Split-Fill” programs.
In this scenario only half of the first 30 days of a patient’s therapy is covered for payer reimbursement until the patient is proven to be tolerating the drug and positively responding to the drug before treatment can be continued.
– Prior authorization requirements.
– Mandated use of designated specialty pharmacy providers.
To become a designated specialty pharmacy provider in many instances requires certification by the manufacturer of the pharmacy, the pharmacists and the technicians involved in the drug’s storage, handling, compounding and shipping. It must also be noted that trying to become accepted by a manufacturer into their distribution network usually requires a “tremendous” amount of data generation, collection and storage.

The Upside to Opening a New Cancer/Oncology Pharmacy

The upside of these challenges is the fact that in 2018 approximately 85% of Managed Care Plans (MCP’s) had entered into contracting with specialty pharmacy providers in regards to the supply of their oncology drugs. Although as noted above it can be a difficult task, the manufacturers also are embracing the specialty pharmacy business to help increase their market share. The fact that 51.4% of the Managed Care Plans reported using a single, preferred specialty provider is a challenging fact, but many organizations are now taking a very close look at this. One such group known as The Community Oncology Alliance (COA) is a forerunner whose mission “is to ensure that cancer patients receive quality, affordable, and accessible cancer care in their own communities”. They have become a major voice in being “dedicated to advocating for community oncology practices and, most importantly, the patients they serve”.

Find an Experienced and Reputable Pharmacy Consulting Firm to Partner With 

The cancer specialty pharmacy startup is a business and needs to make a profit. Yet the complex challenges discussed present risks that can affect the bottom line (plus result in a cash flow problem that is known in the entrepreneurial world as “the killer of new business enterprises”). Since the oncology specialty pharmacy usually takes on the assignment of benefits from their patients, they bear the burden of obtaining reimbursement by billing the payer. Thus the specialty pharmacy is at risk for incurring the pharmacy costs, and when dealing with such expensive drugs cannot afford to make mistakes or miss opportunities. The point is that as with any pharmacy operation, there are numerous factors to consider in the planning, execution and long term success of starting up, opening and maintaining a new oncology or cancer specialty pharmacy business. The planning and execution are key to a smooth pharmacy operation being opened and becoming a successful business. Just a few of the considerations and tasks that are required for any successful pharmacy start-up operation include:
– The creation and review of a business plan
– Guidance regarding type of corporation to form – Limited Liability or LLC, C-Corporation, S-Corporation, Sole Proprietorship or a General partnership
– Startup cost estimates
– Obtaining financing
– Work flow design
– Assistance and guidance with the DEA & State Board of Pharmacy application process
– Creating Policy and Procedure manuals and Continuance Quality Improvement (CQI) manual
– Purchasing the equipment and supplies
– Obtaining legal support
Staffing (not only the pharmacist, but technicians and ancillary support staff personnel)
As always, please contact us here at HCC if you have questions regarding establishing or running an oncology or cancer specialty pharmacy. With over 30+ years in the Pharmacy Consulting business, HCC can assist your business with expert advice in any area of your pharmacy operation or practice. We urge you to contact us today to see how our Pharmacy Consulting services can help. With a full-time staff of in-house Pharmacy Consultant specialists, HCC can answer any questions that you may have in all areas of your business. Contact us online or call us at 800-642-1652.


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