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Caring for Your Patients: The

Compounding Pharmacist

Presented by:

Bill Letendre – PCCA Mark Gonzalez, Pharm.D., INNOVRx Compounding Pharmacy Dana Reed-Kane, Pharm.D., Reed’s Compounding Pharmacy

John Voliva, R.Ph., Hook’s Apothecary

4:00 p.m. - 5:30 p.m., Saturday, October 7, 2006 Las Vegas, Nevada

Evaluation # 06-135

This program is approved by NCPA for 0.15 CEUs (1.5 contact hours) of continuing education credit. NCPA is approved by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Educational Objectives

Presentation Title: Caring for Your Patients: The Compounding Pharmacist Name of Presenter: Bill Letendre Objectives:

1. Describe the Professional and financial Satisfaction of Compounding Pharmacy.

2. Discuss How to Get Started in Compounding Pharmacy. 3. List the Reasons for a Specialty Pharmacy Business Model 4. Describe the Challenges to Overcome 5. Describe the Focus Areas in Compounding Pharmacy

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Caring for Your Patients: The Compounding Pharmacist

John Voliva, R.Ph.Dana Reed-Kane, Pharm.D.Mark Gonzalez, Pharm.D.

ModeratorBill Letendre, M.S., R.Ph., M.B.A.

Objectives

• Describe Professional and Financial Satisfaction of Compounding Pharmacy

• Discuss How to Get Started• List the Reasons for a Specialty Pharmacy• Describe Challenges to Overcome• Describe Focus Areas Served• Provide a Tour of the Specialty Pharmacy• Discuss Current Industry Opportunities

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Advantages

• Building relationships with prescribers and patients – loyalty to your pharmacy

• Problem-solving as a competitive edge• New source of business in a competitive

market• Ideally cobbled together with other niches• Modest financial investment • Several focus areas to choose from

Focus Areas

• Hospice• Pain Management• Wound Care• Bioidentical Hormone Replacement

Therapy (BHRT)• Pediatric & Geriatric Medicine• CSP; SVP & LVP – USP<797> Standards• Andropause• Veterinary

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Hook’s ApothecaryEvansville, IN

John Voliva, R.Ph.

Compounding Pharmacy

Reasons for choosing compounding pharmacy:

• Visit to Purdue by Dave & Kay Sparks• Always loved “lab” work• Wanted to interact more with patients• Didn’t want to deal with insurances

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What is our business makeup?(based on Rx volume)50% Hospice20% BHRT15% Veterinary7% Sterile4% Dermatology4% Pediatrics

Compounding Pharmacy

How did we get started?• Pharmacy opened in October 1999• Started in an “incubator”

– Approximately 500 sq. ft.• First year goal was to locate in more

permanent location• Startup costs approximately $175,000

Compounding Pharmacy

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Compounding Pharmacy

Startup Costs• PCCA Membership• Compounding Equipment• Computers & Phone system• Fixtures• Inventory

– Approximately $20,000

Compounding Pharmacy

Year One – Marketing, Marketing, Marketing!

• #1 Cold Calling Physicians– Started with Veterinarians

• Newsletters to Physicians• Newspaper and Radio ads• Marketing budget = $20,000

Compounding PharmacyCompounding Pharmacy

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Year One – Building Professional Relationships

• Attending Compounding Symposiums• Finding a Mentor• Working one-on-one with Doctors open to

compounding

Compounding PharmacyCompounding Pharmacy

Year Two – Moving to New Location• Build as Big as Possible• Don’t skimp on:

– Lab– Patient Interaction Area

• Invested in Advanced Compounding Equipment

• Attended Specialized Symposiums

Compounding PharmacyCompounding Pharmacy

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• Always keep your options open• Don’t get too specialized

– Begin as a generalist until you find a focus area that appeals to you

• Hospice

Compounding PharmacyCompounding Pharmacy

Hurdles and Roadblocks• Training• Finding Doctors Open to Compounding• Getting Patients to Our Store (initially)• FDA (IACP)• Staffing

Compounding PharmacyCompounding Pharmacy

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Hook’s Apothecary

Hook’s Apothecary

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Hook’s Apothecary

Hook’s Apothecary

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Hook’s Apothecary

Hook’s Apothecary

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Hook’s Apothecary

Hook’s Apothecary

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Reed’s Compounding PharmacyTucson, AZ

Dana Reed-Kane, Pharm.D.NFPPhC, FCP, FACA, FIACP

Do you ever feel like you are filling more and more prescriptions and getting paid less and less?

Do you feel like all you do is fight with insurance companies and patients about their insurance coverage or co-pays?

Do you ever feel like you are not using the education you received in school?

Do you ever feel like giving up, giving in or selling out?

Then consider compounding as an option!!!

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Compounding allows you to:

• Get paid for your time, expertise and services• Fill less prescriptions and make more money

thus improving your profit margins• Discontinue business with third parties• Practice clinical pharmacy in the community

setting• Enjoy your job, your profession and learn

something new everyday• Go from Prison to Paradise!

The 5 P’s of Paradise

• Perseverance• Person• Process• Place• Promotion

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Perseverance: Why we did it!

• compounding business was at 25 scripts per day, traditional retail was at 300 scripts per day

• 25% of compounded rx’s were third party, 75% of traditional retail rx’s were third party

• Cash flow was limited• Margins were low • Reimbursements were dropping• No time to practice clinical pharmacy• Job satisfaction was poor

Person

• It is critical to find a partner in this process. – Current employee– New graduate– Pharmacist– Pharmacy Intern– Son/Daughter– Junior partnership

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Process: The Move

• Gradually transferred over prescriptions• Discontinued third parties one by one• All compounds were transferred over a 3 month

period• First month average 15 scripts/day

– One year: 57– Two year: 73– Three year: 88– Current: 125

Place

• New location: one mile away, strip mall, lease (WE SHOULD HAVE BOUGHT!!!)– Location, Location, Location– Size– Lease vs. Buy– Equipment, supplies & chemicals– Start up fees: memberships, education, accreditation– Building costs: construction, fixtures, permits

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Promotion: Build It & They Will Come!!!• Marketing• Advertising• Consultation• Screening Services• Internships/Residencies• Supplements• Specialty areas of practice: vet, pain, women’s &

men’s health, pediatrics, dermatology, ophthalmology, sterile

Timeline

• Opened Compounding Only location July 1998

• Expanded location 1999, 2002• Sold Files to Chain (Prison Release Date):

8/2001• Selling process took 9-12 months• Non-compete for 5 years• New Building vs. Remodel??????

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A Dream Come True!

Reed’s Compounding Pharmacy 1998

700 sq. feet.Tucson, Arizona

Reed’s Compounding Pharmacy

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Reed’s Compounding Pharmacy

Reed’s Compounding Pharmacy

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Reed’s Compounding Pharmacy

Designing Your Pharmacy

Reed’s Compounding Pharmacy 19991500 sq. feet.

Tucson, Arizona

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Reed’s Compounding Pharmacy

Reed’s Compounding Pharmacy

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Reed’s Compounding Pharmacy

Reed’s Compounding Pharmacy

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Reed’s Compounding Pharmacy

Reed’s Compounding Pharmacy

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Reed’s Compounding Pharmacy

Reed’s Compounding Pharmacy

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Designing Your Pharmacy

Reed’s Compounding Pharmacy 20022800 sq. feet.

Tucson, Arizona

Reed’s Compounding Pharmacy

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Reed’s Compounding Pharmacy

Reed’s Compounding Pharmacy

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Reed’s Compounding Pharmacy

Reed’s Compounding Pharmacy

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Reed’s Compounding Pharmacy

Reed’s Compounding Pharmacy

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Reed’s Compounding Pharmacy

Thank You!

Dana Reed-Kane & Tom ReedContact Information:

(520) 318-4421dana@reedsrx.comtom@reedsrx.com

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INNOVRx Compounding PharmacyYorba Linda, CA

Mark Gonzalez, Pharm.D.

Profile Of A Practice

• Opened Med Specialties Compounding Pharmacy In May of 1999– First Compounding-Only Pharmacy In Orange

County, California– Cash Only – No Third Party Contracts– Focus was to provide patients with unique

and personalized pharmacy services by enhancing patient care and managing therapeutic outcomes

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Starting Out• Joined PCCA in February of 1999• Starting location was in a hidden local business

park – No walk in traffic– 1500 sq.ft. facility

• We filled 11 prescriptions our first month “Growth Requires Hard Work”

• Spent most of my time during the first few months marketing to local professionals & patient groups

• Well into the first year we introduced consultation & screening services

Our Practice In 2006

• Expanded to a new 2500 sq.ft. facility in 2004 in a busy part of town

• Fill an average of 65 compounds per day• Our health screening services have

continuously grown year by year• Constantly full consulting schedule

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Breakdown Of Our Compounding Services• Hormone Replacement (Female) – 50%• Veterinary – 15%• Dermatology – 10%• Sterile Compounding – 10%• Hormone Replacement (Male) – 5%• Pain – 5% • Other – 5%

– Ophthalmic, urology, pediatric, geriatric

Reasons Why I Chose Compounding• Enhance patient care• Autonomy• The ability to practice

as a clinician in a retail setting

• Continual use and growth of professional knowledge

• Variety of practice within one setting

• To build professional relationships

• The ability to receive adequate and fair compensation for providing cognitive & professional services which provide value and enhance outcomes

• More professional & personal freedom

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The Future Of Compounding In Our Practice• Taking advantage of new technologies

and research that will add to the services that we can provide our patients and practitioners

• New areas of interest– Ex. Cosmeceuticals, Nutraceuticals, Autism

• Continued improvements in quality assurance programs

Current Perceptions Of Pharmacy • “Perception Is Reality”

– Pharmacists are “Pill Counters”– The pharmacists knowledge is always

available free of charge– Pharmacists only take patient orders from

practitioners instead of participating in making patient orders

• Without changing perception it is difficult to change your reality

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What Will Compounding Provide You And Your Practice• Compounding Will:

– Change and improve the perception that your patients and practitioners have of your practice

– Provide your practice with financial stability– Allow you to work on your practice instead of

only working in your practice– Give you the ability to meet unique patient

needs on a daily basis.

Med Specialties Pharmacy

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Med Specialties Pharmacy

Med Specialties Pharmacy

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Med Specialties Pharmacy

Med Specialties Pharmacy

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Summary

Current Market Trends• Rx numbers are growing• BHRT patients demanding treatment• Companion & exotic animal population is

growing• Custom care is gaining notoriety in

mainstream medical care

Summary

Current Market Trends• PBMs are funneling compounded Rxs to

mail order in-house labs• Chain industry has launched regional

compounding centers• Media continues to spotlight industry in a

negative tone

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Summary

Current Market Trends• Many traditional pharmacies transitioning

to specialty pharmacy business model• Ideal exit strategy option• Specialty pharmacy generates <1/3

revenues of traditional pharmacy with owner earning ODP greater than traditional pharmacy

QUESTIONS???

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We Need Your Input!

The Pharmacy Compounding Network Invites NCPA Members to Participate in

the Development of a National Network of Compounding Pharmacies

We Need Your Input!

The Pharmacy Compounding Network Invites NCPA Members to Participate in the

Development of a National Network of Compounding Pharmacies

Learning Assessment Questions

Presentation Title: Caring for Your Patients: The Compounding Pharmacist

Name of Presenters: John Voliva, Dana Reed-Kane, Mark Gonzalez, Bill Letendre (Moderator)

1. Which of the following are good candidates for a junior partnership? a. New graduate pharmacist b. Current employee c. Pharmacy Intern d. Son/Daughter e. All of the above 2. Compounding allows you to? a. Increase your professional and financial satisfaction b. Spend more time with the patient and the prescriber c. Get paid for your time, expertise and services d. Practice clinical pharmacy in the community setting e. All of the above 3. When deciding to transition from traditional retail to compounding – only one should consider? a. Location b. Lease vs. Buy c. Expenses d. Finding a partner e. All of the above 4. What is the most popular focus area in compounding pharmacy? a. BHRT b. Pain management c. Veterinary d. Hospice e. Pediatrics

5. What is the most important thing to do in the first year of operation of a compounding pharmacy? a. Marketing b. Finding a good location c. Investing in a large building for your operation d. Developing a single niche as quickly as possible 6. To start a compounding pharmacy, it is necessary to go with the biggest space as you possibly can in the first year to ensure proper growth? a. True b. False 7. Which of the following is not a way to build professional relationships? a. Finding a mentor b. Attending compounding-related symposiums c. Working one-on-one with doctors d. Not sharing ideas and successes with other professionals e. Non of the above

Learning Assessment Answers

Presentation Title: Caring for Your Patients: The Compounding Pharmacist

Name of Presenters: John Voliva, Dana Reed-Kane, Mark Gonzalez, Bill Letendre (Moderator) Answers:

1. e 2. e 3. e 4. a 5. a 6. a 7. d