McKesson : Building a Foundation for Success at Your Independent Pharmacy

Keeping your independent pharmacy competitive amid the industry's never-ending changes should always be on your to-do list. But to be innovative and stand out from the pack, your pharmacy first has to cover the basics. Inventory. Staffing. Daily operations. Without these building blocks solidly in place, you can't take your pharmacy to the next level. And you can't provide quality care to your patients.

In this edition of Pharmacist to Pharmacist, Nicholas Turos shares his advice on how to build the foundation that will set your pharmacy up for success. Turos, a pharmacist, is the vice president of pharmacy retail operations for Health Mart. He travels to independent pharmacies across the country to help them troubleshoot any obstacles in their way-like decreasing margins or direct and indirect remuneration (DIR) fees-to create healthier businesses that in turn support the health of their patients.

What are you responsible for in your role at McKesson?

Turos: I see my role as two-fold; I essentially work with two sets of customers. The first set of customers includes the field sales teams for our independent pharmacies. I'm working with vice presidents, general managers and retail sales managers to help them understand pharmacy and industry trends and the Health Mart services that can help their business. My second set of customers are those who are already part of our Health Mart franchise. The goal is to help them use the tools and resources they already have access to by being a part of our franchise. It's a lot of travel. About 70 percent of my time is spent on the road, getting into the stores with the retail sales managers.

What common challenges do your independent pharmacy customers say are keeping them up at night?

Turos: The biggest challenges I hear about are decreasing margins and DIR fees. These are hot topics that are on everyone's mind. Not just independent pharmacies, but giant retail chains, too. The whole industry is facing those headwinds.

How do you determine the best ways to help those customers?

Turos: There are ways we can help from foundational, transformational or aspirational perspectives. First, you always have to look at the foundation of the pharmacy. One of the first things I ask is: What are your goals? What are your benchmarks? What are daily operations like? Next, we talk about transformational changes. How can your pharmacy keep up with the latest industry changes? If you serve Medicare patients, are you getting large DIR fees from them? Is there an opportunity for rebates or clinical bonuses based on performance metrics? We look at what they can do to achieve those benchmarks set by payers and pharmacy benefit managers to maximize profits. And the last part is about being aspirational. Where do you want to be in a few years? How can we help you grow?

What are some of the biggest areas for improvement when it comes to business strategies at these independent pharmacies?

Turos: Some pharmacies I visit aren't even measuring how often they're turning over inventory. Wasted inventory drains your cash flow. Next to inventory, payroll is another big issue that I commonly see room for improvement. It's important to know what your return on investment is for each employee. If you have an employee that you're paying $20 an hour, but you only sell $20,000 in front-of-store goods each year, are you maximizing what that employee is doing for you? Have you trained them to be a merchandiser? Or are they just running the cash register?

What tactics do you suggest to deal with those inventory and payroll costs?

Turos: Since many stores don't have those inventory management processes in place, the first thing you need to do is take a proper inventory of your store. You need to compare that to sales and see how often you're turning over the inventory every year. Do you look at your balance sheets? Are you reviewing your P&L line by line and seeing what your biggest expenses are? You need to have these processes in place on a regular basis. Many times, the owner may feel the responsibility for inventory management falls on them. But you should be training your technicians to help, too. And as far as payroll, it doesn't necessarily mean you need to fire somebody. It's more about understanding how you maximize each individual to their fullest potential. How can you help them be a better merchandiser? How can they drive more revenue to your store? These things are going to help you take care of that foundational aspect so you can move onto the more transformational and aspirational parts later on. All of this sets you up to offer more of those clinical services and other things that can help you have healthy patients and a healthy business model.

As independent pharmacies begin to offer more of those clinical services, what specific strategies should they consider to be successful?

Turos: If your pharmacy is not currently offering immunizations beyond the flu, that's a great place to start. Med sync is also a must. It's one of those foundational pieces that will set you up for success. Not just from a compliance perspective, but from a time-saving and inventory perspective, too. If you know when you need to have a prescription filled ahead of time, you can fill it on your timeframe. You won't be taken away from a separate task each time a refill comes in. Med sync also sets you up for success to do other clinical services like medication therapy management (MTM) and comprehensive medication reviews (CMRs). This is where you can provide the most value. You don't provide the most value by being at the cash register. You provide the most value through face-to-face interactions with your patients.

What trends should independent pharmacists stay on top of, and why?

Turos: I think we always have to be aware of new legislation. I make sure to watch what laws are passing not just in the states I work in, but for all the states that border those areas, too. If one state is proposing or changing a law, often the state next to it follows suit shortly thereafter. So it's a great way to stay informed and know what's going on. Laws are changing about what pharmacists and technicians can do, the shifting status of pharmacists to providers, and more.

What was one of your most memorable moments as a pharmacist?

Turos: A doctor had prescribed a patient two drugs that I noticed would have interacted with one another-and it would have been a serious interaction. I explained to the doctor and the patient why these drugs couldn't be taken together, and they were both thankful. This was before I had a family and kids, so I used to work every holiday because my partner had a family and children, and I didn't mind. And this patient caught wind of that. And because of the trust she had in me and the relationship we formed through our interactions and me collaborating with her physician, she ensured that no matter what holiday it was, she fixed me a plate and brought it to the pharmacy. She made sure I always had a holiday meal, every single holiday, when I was a pharmacist working at the store by her house.

Related: Learn more about McKesson's Health Mart pharmacy franchise program