Want to start improving revenue, making your pharmacy safer, provide the latest services, or improve operations but don't know where to start?
Here are 100+ ideas to get your brain going:
1. Get a temperature monitoring device that is CDC-compliant
The temperature monitoring devices for your freezer or refrigerator that are CDC-compliant have a probe suspended in glycol, can track and record temperatures every 15-30 minutes (with reports that can be downloaded), are calibrated/traceable, and have alarms for out-of-range temperatures, among other features.
2. Check refrigerator and freezer temperatures twice-daily, including checking the min-max. Take action if it is out of range!
One of the most common misses I see in pharmacies is in tracking temperatures. Temperatures should be recorded twice-daily and include a min/max. Also, you should have an action plan in place for handling out of range temperatures. You can find out how to handle that in the CDC Vaccine Storage and Handling Toolkit.
Get your free temperature logs with immunize.org here.
Free Product: Excursion Labels
3. Get a pharmacy reconciliation service and be sure you are paid for all the claims you submit
Pharmacy reconciliation services will set you up on EFT for all payments, compile your 835 (remittance) statements, and line up virtually every prescription with the payment to be sure you were paid and were paid accurately. They will also resubmit claims when there is an AWP change that resulted in underpayment. This is a service every pharmacy needs and if you don't have one you should get one.
4. Start a medication synchronization program
In addition to improving adherence, MedSync can improve revenue by reducing Return to Stocks and improving efficiency. By proactively calling your patients and refilling all their medications at one time you can reduce phone calls, reduce time at the register, and boost patient satisfaction.
Check out this article by Mckesson on the benefits of MedSync.
5. Get procedures in place for handling of hazardous substances and be sure the pharmacy is ready for USP <800>
USP 800 was written to protect healthcare workers from hazardous substances and applies to all healthcare facilities, including community pharmacies. It is a long chapter and much of the information might be related to only certain types of facilities (ex. compounding or administering HD’s, which is not most community pharmacies), so be sure to check out the post on it for tips specific to the types of HD commonly encountered in the community pharmacy as well as other helpful resources to get you up to speed.
6. Get a water purifying system for reconstituting antibiotics.
Tap water, as most of us know, is not generally acceptable for reconstituting antibiotics. If you're still using the system of buying the jugs of water and using graduated cylinders, consider upgrading to a water purification system that meets USP standards. You won't have to worry about running out and being stuck without water and you can be sure you are getting high-quality water every time (after all, are you sure those jugs don't get dirty after a month or two on the shelf opened?)
Here’s an example of a system purpose-built for pharmacies.
In the meantime, if you're still using graduated cylinders, consider setting up a reconstitution system like this one that will at least be more efficient for staff.
7. Ensure you are checking both Federal and state databases for exclusions
Hiring someone (or filling a prescription written by a provider) who is excluded from billing services to Federal programs (Medicare, Medicaid, etc.) can be a costly mistake. Check your staff when they are hired and monthly afterwards.
Post: Exclusion list screening
Free Product: Monthly exclusions screening worksheet
8. Get prepared for an accurate inventory count
Getting an accurate inventory count is really important to be sure the Cost of Goods Sold (COGS) reported on your income statement is accurate. Be sure to mark all opened bottles, segregate and label items not to inventory (mark it as "DNI" - Do Not Inventory).
9. Start a home delivery service
It seems like even the big chains are investing in home delivery and/or mail order big time these days, and if you really want to stay on top of the competition home delivery is a great way to do it. Medspeed and Lyft are two that are in the business; there is also a startup named ScriptDrop that allows you to send automatic notifications to them, where they will coordinate with couriers to pick up the medications.
10. Start a Medication Therapy Management (MTM) program.
MTM can be a great way to earn some extra revenue during downtime as well as boost your Stars ratings, which affects reimbursement for many insurance plans.
For MTM through insurance, OutcomesMTM is really nice because they will give you short interventions, they call TIPs, that can be completed relatively easily. Mirixa is also commonly used; you can sign up for both to maximize your MTM opportunities.
Another option is to advertise it as a cash-paying service for a reasonable price to patients and to doctors' offices (to refer their high-risk patients).
11. Start a smoking cessation program
Most insurance companies will pay for some sort of smoking cessation product, including even Chantix, for no copay to the patient. Why not proactively identify patients, counsel them, and then either refer them to the state tobacco quitline and/or get a prescription from the doctor's office?
If you call the doctor's office, get a prescription for a product, and run it through insurance you can boost revenue and improve the public health. I was at Safeway when they were the first national chain to implement Ask-Advise-Refer with every patient encounter and as a company we had an enormous impact.
Another benefit to the patient and to revenue is that you can then recommend necessary vaccines, like Pneumovax.
12. Start a travel vaccine clinic
If your state allows you to give travel vaccines (which most do) then you should consider starting a travel clinic. While it can be expensive to bring in a provider, some pharmacies have partnered with contract travel companies like this one; they charge a flat rate to the patient and then send vaccine recommendations and travel medicine prescriptions over to you.
13. Launch corporate wellness services, including on-site MTM, chronic care management, and medication delivery
This could really be big business for a pharmacy willing to go after it. Instead of having to go through insurance for MTM, why not just go straight to the employer? Offering a flat fee or a la carte service levels would allow employers to just pay you directly (at a better rate for both of you and with less hassle) for you to reduce their healthcare costs.
If you can prove to them the cost reductions you’re bringing to the table are much higher than what you’re charing you’ve got a winning business model.
14. Get into pharmacogenomics
Genomics is at the forefront of pharmacy and, quite frankly, will probably become one of the biggest job markets for pharmacists when robotics and technicians take over dispensing. You don’t need to buy one of those big expensive machines yourself; instead, contract out with a company that does the testing and then interpret the results and make recommendations to the patient and physician based on them.
Here’s an article on genomics that lists some lab companies in the business. Also, you will need some extra education and training to get up to speed; University of Florida has training programs and even an annual conference in genomics.
15. Clean up all of your records and throw out unnecessary ones.
As soon as a record ‘expires’ (i.e. you don’t have to keep it anymore), it goes from being a requirement to a liability. Not only are you either paying to store it or it is junking up your pharmacy, but also if any of it was requested for a court case and you then destroyed it could be considered spoliation of evidence and you could be held liable. In other words - as soon as you legally can (and while no one is asking for it), throw it out!
16. Enroll in CSOS
The Controlled Substances Ordering System allows you to order Schedule II medications electronically and if you are not on it you should be. In addition to it being much easier you can get C2's in the next day. It is possibly one of the easiest things on this list you can do to help keep a competitive advantage.
After you are approved and get 1) your email and 2) your letter from the DEA call your distributor and they'll set you up in their ordering system.
17. Start a medication take back program
A medication take back program is a low-cost way to help the community while driving traffic to your pharmacy. It helps you stand out as a pharmacy that provides comprehensive services and can help resolve those sticky situations.
18. Start a sharps collection program
I worked with the local health department to start a sharps takeback program in my pharmacy and it was pretty easy to set up, came with not many additional costs, benefits the community, and theoretically could help foot traffic in the store. I take back approved sharps containers and our vendor picks them up on a regular run; granted because we are in a hospital we have the advantage of having a regular vendor, but maybe one of your vendors for RCRA waste or some other service also offers sharps services?
If you decide to look into this, I recommend checking in with your local health department. They can get you setup with licensing, etc. Florida requires a license that costs nothing and is only one page (basically they just want a list of who is offering it).
I also highly recommend you get a pair of puncture-resistant ‘turtle gloves’ for the initial setup to protect staff.
19. Partner with a pharmacy school to launch a community pharmacy residency (ACPE school directory and accreditation standards)
Like to to teach? Could you use an extra hand at the pharmacy to drive your new service lines? Consider working with one of the local pharmacy schools to start a community residency program. There are always many more students that residency spots available so there is definitely a need. Residents can help with year-long projects (like the ones on this list) that have lasting impacts on your pharmacy.
Check out all the cutting-edge services Moose Pharmacy, a popular residency program established with UNC-Chapel Hill, has implemented.
20. Get an effective and efficient error-reporting system
For both patient safety and liability purposes you need a good system for reporting errors. It doesn't have to be fancy but you should have a standardized format that provides comprehensive information on the event. All staff should be educated and pharmacists should be required to report the error within 24 hours of the event.
You can either create paper forms that you keep in a binder (that is probably easiest and most cost-effective for one or two pharmacy locations) or you can get a vendor that will set you up with an electronic system.
21. Be sure your formulation (and compounding) records are USP <795> compliant
USP <795> requires specific things to be on both formulation and compounding records. Also many states specifically use USP <795> when regulating non-sterile compounding in their state. Not sure how to get going with this? Take a look at the Helpful Links section (under Safety and Quality) for a link to download USP <795> for free.
Many pharmacy software systems also offer the ability to print compounding records when a compounded product is entered. If your system offers that it can save you a lot of time.
Store: Compounding Record Template
22. Use 5S to get your pharmacy in order
Ever heard of 5S? It is a system to help you get your pharmacy in order and stands for Sort, Set, Shine, Standardize, and Sustain.
Here's a great article on 5S from the American Society for Quality.
Free Product: Filing Cabinet Labels
23. Take a course in Lean Six Sigma to improve efficiency and reduce waste in the pharmacy
Lean Six Sigma (LSS) is a methodology aimed and reducing waste, improving efficiency, and reducing variation. It was popularized by Toyota to allow them to better compete on the global market. Today, LSS in healthcare is big business because it produces results. There are courses available through many colleges and online, and applying these principles to your pharmacy could help you save money and reduce wait times. One such company offering these services is MSI.
24. Standardize your system for checking your stock for outdated medications
Some state boards require that outdates are checked on a regular basis and regardless it is a best practice. In my pharmacies we check once-monthly and pull three months in advance. We also write the date in on all prescription labels to ensure we are not providing 90-day supplies of medications that might expire before they are completely used.
Download a free template to document your outdates in the Free Products section.
25. Improve the confidence of the vitamins and herbals sold in your pharmacy by including USP-verified products whenever possible
The Dietary Supplement and Health Education Act (DSHEA) basically tied the FDA's hands in dealing with nutraceutical manufacturers. Not only do they not have to obtain FDA approval but they do not have to undergo any kind of quality testing. As a result herbals frequently do not have what is stated on the label and can even contain dangerous ingredients. New York's investigation really highlights the issue.
USP verification gives you confidence that the vitamins and herbals you are recommending to your patients are high-quality while still allowing you to boost pharmacy revenue and provide your patients with access to these products.
26. Set up your system to be able to block the sale of medications at the register if the pharmacist needs more clarification prior to releasing
Some chains, and I’m sure many independents, have a system to allow pharmacists to block the sale at the register and add notes that the pharmacist on-duty at the time of the sale has to respond to prior to releasing the medication. This is a great feature because it allows you to ensure a patient isn’t taking a medication anymore that could interact with the one you are selling, that you counsel on a high-risk med, or that you perform some other critical safety function before releasing the med. You might be surprised to find your system has that capability that just needs to be activated.
27. Launch the use of compliance packaging in the pharmacy
What Pillpack did was not necessarily new, but they certainly did a great job popularizing the packaging and marketing it to consumers who are tired of making multiple trips to the pharmacy and having bottles laying all over the house.
You can easily get in the business too - just check with your distributor to see what kinds of compliance packaging they offer or reach out to new suppliers if they don’t have what you are looking for. You will need to combine it with medication synchronization for it to work.
Check out this article on compliance packaging for more info.
28. Partner with a local hospital to provide meds-to-beds services for discharging patients
If you have a hospital nearby, why don’t you see if you can get a program started to delivery discharge meds to either the nursing station or patient room? While the staff aren’t allowed to require that patients use your pharmacy I bet many of them will, and a high-volume hospital can give you a big boost in business. Plus it’s a great way to get more involved in patient care and get back to doing what you went to school to do.
29. Ensure you are tracking all controlled medications 'from birth to death,' including expired and waste medications
One of the most frequent issues I see in community pharmacies surrounds waste medication; I’ve seen everything from a bin in the control cabinet where waste is just thrown in there to even an empty stock bottle to keep broken pills.
Unfortunately both create a risk of diversion because you now have unaccounted for controlled substances in the pharmacy; a best practice would be to have a controlled waste log and to match that log to the waste prior to giving possession over to the reverse distributor.
Even better is to match those records with the list from the reverse distributor to make sure they didn’t make a mistake or (worse) attempt to divert controlled substances.
30. Download your state's pharmacy inspection form and go through it, line by line, to create a document answering each portion of the inspection
My state of Florida, and I’m sure many other states, post the inspection forms on their websites so you know exactly what to expect and prepare for. In my opinion it is a great service not only to the pharmacy but also to public health because it allows pharmacies to audit themselves first.
Have you ever gone through it yourself before the inspector gets there? Better yet, copy and paste the questions in an Excel or Word document on the left-hand side, type responses (where the records are, how you comply, etc.) on the right-hand side and stick it in your Compliance Binder.
31. Use SIGIS' SFTP to streamline downloading the Eligible Products List instead of manually downloading it
SIGIS is one of those back-end things I had never heard of until I started working at my current pharmacy because the chains take care of it, so just in case this is your first time hearing of SIGIS they are responsible for certifying companies to accept FSA and HSA cards.
One requirement to maintain SIGIS certification is to keep up with the “Eligible Products List,” which lets the register know what items are FSA and HSA eligible. Because those items need to be updated regularly as UPC’s change and new items enter the market the list must be integrated with your register monthly. In the past, I would do this by logging into the SIGIS website, downloading the .CSV file, and then uploading it to the register. If I was late completing it (which happens a lot when you get busy putting out other fires in the pharmacy!)
I would get a little love letter in my inbox from SIGIS telling me to do it or they would cut me off.
I recently found out that our software system has the ability to use SIGIS’ SFTP feature to be able to integrate the newest list with the push of a button, saving me time every month. It’s a small thing but also easy to setup and doesn’t cost anything so is an easy win. It’s a great project for a pharmacy student or even a technician intern.
32. Use the EquiPP platform to monitor and maximize your pharmacy's star ratings
EquiPP is a cool platform that gives you a dashboard of all your adherence scores that would affect a plan’s Star Ratings. Improving the plan’s Star Ratings means a higher likelihood you will be included in their networks and have lower DIR fees.
33. Enroll in CoverMyMeds to electronically send prior authorization requests
CoverMyMeds is by far the most widely used system for sending and tracking electronic prior authorizations (ePA). If you are still doing paper PA's - stop! They are also integrated with most systems out there and this is a huge time saver.
If you haven’t heard of MedsOnCue you’re missing out. The program will print a QR code on the prescription vial and when the patient scans it then it will play a counseling video (and it is available in English and Spanish).
Many states have allowed patients to opt-in to receive MedsOnCue instead of the paper leaflets, so for high volume stores you might be able to enroll enough patients that the saved paper costs pays for the program.
35. Get your accounting in order
Do you know for sure whether or not you are making money, and how much? Worried you might be missing out on tax breaks or other opportunities to boost revenue?
Hiring a bookkeeper and getting Quickbooks (and learning how to use it!) should be high priorities for any business owner, but especially a pharmacy that often has $200-300K of inventory sitting on the shelf that often only nets 3-4% in profit.
36. Become an accredited provider for DMEPOS products
It is a pain to get DMEPOS accreditation so I’ll be upfront about that. However, even getting enrolled to bill Medicare for non-accredited products is a lot of revenue potential, and getting full accreditation for diabetes testing supplies makes enough money I don’t know any chain (or many pharmacies, for that matter) that are not in the business.
Be on the lookout for an upcoming post where I’ll walk you through the process step-by-step. Another option is to hire a consulting company to do it for you, which many pharmacies choose to do.
37. Start a long-term care pharmacy business
OK so the long-term care business can be one of the biggest projects on this list, but also one of the biggest boosts to your pharmacy. Get even one large nursing home and it can easily be enough business to need an extra 2-3 pharmacists. You will need separate inventory and on-call coverage but for many independents this is their bread and butter.
In future posts, we'll talk about long-term care laws and how they differ from both retail and inpatient laws.
38. Setup your system to automatically print Medication Guides
I know most pharmacies are probably already doing this but I wanted to bring it up because I’ve been in pharmacies that hadn’t gotten there yet. Most pharmacy systems have a way to automatically print FDA-required Med Guides so you don’t have to keep files and remember which drugs have them.
39. Enroll in automatic PDMP updating
When I first came on as manager of the pharmacy I’m currently working for, the pharmacist there was having to manually upload all the PDMP submissions once weekly (at that time Florida required them to be uploaded within 7 days) every Friday morning.
It took a while and if it was a busy Friday morning it could really mess his morning up. Thankfully, for $20 a month, our software vendor would do it automatically on the back-end and we would never touch them again. Talk about a sweet deal.
40. Get eligibility checking for your pharmacy system
If you don’t have the ability to perform eligibility checking yet (also called an ‘E1 transaction’) you need it. While not 100% accurate, it’s a huge time saver and prevents you from having to turn customers away because they don’t have their insurance card. Most software vendors offer it so check with them to get signed up.
41. Make sure you are getting the best deal on your switching fees
Do you know how much you pay for switching fees? Fees vary quite a bit on this; I’ve seen as low as $0.04 per transaction and as high as $0.07. While that might not sound like much, if you are processing thousands of prescriptions a month and many of those require multiple submissions to get a paid claim (each one, by the way, costs a transaction fee from the switch) then it can really eat into your bottom line.
42. Make sure you are getting the best deal with your credit card processor
Credit card processing fees can take a big chunk out of your bottom line. Do you know what your rate is, or if you’re even getting the best rate? There is some paperwork involved and you will need to get your pin-pads switched over to be encrypted with the new vendor (as well as update SIGIS) but in the end this could easily be done in a few weeks and save you a bunch of money in the long run.
43. Work with your POS vendor to get up to date with PCI Compliance standards
All POS vendors should be very familiar with and helping their customers attain PCI Compliance by now, which is a set of standards to improve credit card security. Of note, though, you might need to switch out your credit card machines in order to become compliant.
44. Enroll in an automated system to comply with the Combat Methamphetamine Epidemic Act (CMEA)
There’s nothing that will hold up the line at the register faster than a Sudafed transaction when the staff have to go into a separate system and manually enter all the information from the customer’s driver’s license into the database. With so many systems setup to scan the driver’s license and automatically submit that to the appropriate database there’s a good chance you have the ability to get that done.
When I enrolled us in this program it took less than a week to get setup and has saved tons of time.
45. Enroll in the Surescripts Medication History and share dispensing history with prescribers
I learned about this one the hard way when one of our hospitalists got upset because he told me he can’t see the prescription history for anything we fill in Cerner. My response - what prescription history? I looked in Cerner and did some digging and eventually found what he was talking about: if you share your data with SureScripts they will upload everything you fill to inpatient EMRs. When I enrolled with our software vendor it cost nothing. What an easy win to keep prescribers happy and patients safe.
46. Get your pharmacy a mobile app
Many pharmacy systems offer the ability for you to get your own mobile pharmacy app, where patients can request refills, check the status of their prescriptions, and sometimes even see their profiles. For us, it cost $20-30 a month, which is a no-brainer.
47. Join a Group Purchasing Organization (GPO)
GPO’s are collaborations of numerous independent pharmacies that collectively negotiate drug pricing. By sticking together, they can leverage their purchasing power to get better prices than they would on their own. GPO’s are sometimes actually run by distributors, but either way if you aren’t part of one you might not be getting the best possible pricing.
48. If you have multiple locations, use SupplyLogix
SupplyLogix is a cool program for pharmacies with multiple locations that will monitor the computer on-hands as well as dispensing history to suggest drug transfers between stores that maximize exiting inventory, lowering Cost of Goods Sold. When I’ve used this program in the past it was great because we could have an $800 bottle with just some crumbs in it that I get sent out to a store using the drug regularly and get it off my hands.
49. Get automated price updates from your software vendor
If you aren’t getting daily AWP updates from your wholesaler you could be losing money. Most systems use AWP to calculate not only cash prices but also the U & C price sent to the insurance company. Price it too low (due to a rapid change in AWP) and you could be losing out on money because the insurance company will pay you the lowest of 1) Maximum Allowable Cost, 2) Contracted Rate, or 3) U & C.
Be sure your pharmacy is set up so #3 is never the lowest.
50. Enroll in pre and post edits (PPE) with your switch vendor
Most pharmacies probably have PPE by now, but it is good to appreciate all they do. From safety checks to preventing unnecessary chargebacks, PPEs protect you and your pharmacy in so many ways. Check out this article for some ways they help you out, and if for some reason you don’t have PPE yet this should be a high priority.
51. Get rebates by sharing de-identified prescription data with databases
Drug companies purchase access to large databases of de-identified dispensing information to use for their business purposes. A good example, and one of the largest, is the database put together by IQVIA. Most systems provide the option of you voluntarily enrolling to send your data and then giving you a cut of the money in the form of a rebate on your software maintenance invoice. You don’t have to submit anything because all data is pulled from the switch.
In addition to giving you some rebates, the data is also used on occasion for retrospective analyses (with the end goal of advancing patient care) so is not always solely for business purposes.
52. Get eVouchers to process manufacturer copay cards and vouchers
In addition to proactively running copay cards and free trial cards for patients, be sure to enroll in an eVoucher program like this one. It will automatically screen patients for eligibility and add a voucher when available; while none of the programs I have worked with are 100% effective in capturing eligible patients (and so you will always have some opportunity to help them save on top of this program), they are a great start.
53. Go on a 'doctor detailing' trip to promote your pharmacy
I’ve done this on occasion and especially if you bring some treats (cookies, snacks, etc) the doctors’ offices love it. It get things off to a great start, not only for them to remember your pharmacy (and let patients know they like you) but also to build your relationship if, for example, you need to call them for a drug interaction or dosing concern.
54. If you have the space, consider partnering with a provider or health-system interested in opening an urgent care in your pharmacy
The chain pharmacies have really taken off with this idea, and in fact there are urgent cares inside a lot of Walgreens here that are operated by a local health-system. Why not do the same? If you have the space for a clinic (or can make the space) you can rent it out to make money on rent and get more prescriptions from their patients just looking for convenience.
55. Get a professional website
I personally use Wix and love the platform for building out a professional website, but no matter what you choose, the bottom line is that it has never been cheaper or easier to have a good website.
Get a domain name, connect it to your account (Wix offers domain names as well), and at least get your contact info, bio, some pictures, and a few front-end specials put up so have you some sort of an online presence.
56. Work with your software vendor to embed a prescription refill request feature in your website
The software vendor we use at my pharmacy has the ability to embed a refill request section on your website with minimal cost. Once you get your basic site up save your staff some time and make it easy for your patients to request their refills.
57. Get into specialty pharmacy
Specialty pharmacy is one of the fastest growing and most profitable areas of community pharmacy. It is a wide field, with everything from fertility to oncology being potential market areas. While it initially takes some leg work to get into it (especially with limited distribution programs) you will gain a lot of patients in need and make money doing it. What can be better than that?
URAC is the most widely recognized specialty pharmacy accreditation.
58. Invest in a medical refrigerator
Medical refrigerators provide numerous benefits over consumer models, including more temperature uniformity inside the cabinet, door ajar alarms, self-closing doors, and defrost cycles designed to minimize temperature fluctuations. For what is probably the most expensive inventory in your pharmacy it is worth getting a quality refrigerator to protect from losses.
59. Start a compounding business
Like specialty pharmacy, the compounding business is not only growing but can be extremely profitable compared to traditional community pharmacy. Both human and animal patients sometimes need preparations not commercially available, and a high-quality compounding business is an excellent service for any community.
PCAB is the most widely recognized compounding pharmacy accreditation.
60. Develop a nuclear pharmacy business
Understandably this is an enormous undertaking with a lot of capital investment; however, like one of my friends said, it’s pretty good for job security when you make a product that goes bad in 12 hours. I’ve also heard of community pharmacies getting into nuclear pharmacy. Check out this pharmacy, for example, that has been in business almost 30 years by specializing in compounding and nuclear pharmacy.
Purdue offers a nuclear pharmacy certificate program that can get you started.
61. Optimize your front-end business
Don’t neglect the most profitable part of your business. On average, the front end has higher margins than the pharmacy business, so optimize that (and be sure you carry the products you and your staff pharmacists recommend!) for a better bottom line. One way you can distinguish yourself from the chains is by carrying a range of products that chains typically don’t; many independents get into medical supplies and compression stockings, for example.
Heck there’s a landmark pharmacy in Chapel Hill, where I went to school, that does burgers in the front and drugs in the back. If you can dream it, you can do it.
62. Help your patients select a Medicare Part D plan during open enrollment and keep a customer for life
The government actually has a really good website to help patients enroll in the best Medicare Part D plan for them, and the best part is that it is free. Why not use it to help either attract new customers or retain the ones you have? Training your pharmacy technicians on how to use the website and go over the options with patients to save yourself time while providing a much-needed service.
63. Make sure you have a Label at Pickup (LAPU) workflow for high-cost items
We use a lot of baggies to keep items from getting messed up but sometimes you just have to put a label on the package. Even one mistake from labeling a drug someone never gets can cost thousands. Putting some consistency in place around labeling high-cost items is an easy way to cut costs. Some pharmacies use baggies, some use a LAPU bin, some use both. Whatever works for you!
64. Be sure you are compliant with the Resource Conservation and Recovery Act
When I first graduated I had no idea the EPA even had any authority to regulate pharmacies. Later on, I was working for Safeway when the EPA went systematically through numerous retailers, including Safeway, fining them for violations of the Resource Conservation and Recovery Act (RCRA). They also fined Costco, Wal-Mart, and others, and while it was not only for pharmacy violations it included pharmacy violations.
The EPA not only has a right to inspect pharmacies (yes I've seen an EPA inspection before too) but also to fine them as hazardous waste distributors. Look up the EPA standards here.
65. Save time dealing with time cards by using the Quickbooks Time Card App
Quickbooks is a necessity for any small business, but did you know you can integrate time cards into the software? There’s no point in purchasing additional programs and time clocks when you can more cheaply and efficiently track time with their app.
66. For high-volume stores, consider investing in automation so you can focus on service-based income
Let’s face it, dispensing is going to eventually become completely automated. We might still have pharmacists to verify the prescription but pharmacists will never be as accurate as robots at just putting the right pill in the right bottle. Frankly, I think that for us to keep a job in the future we will need to focus more and more on service revenue and less on dispensing revenue.
Currently we still need to dispense to pay the bills, but if you are a high-volume store an automated dispensing machine can be a lifesaver. I’ve used a couple of brands and Yuyama works by far the best and requires the least maintenance.
67. Use an IVR system to automatically update patients on holidays and streamline calls to the correct area
A lot of independent pharmacies don’t really want to go to an IVR because it is kind of a selling point to patients and providers to be able to call the pharmacy and have someone directly answer. Still, that should be weighed against the fact that IVR systems can accept refills automatically, automatically flip the phones over to a closed message every day, automatically flip the phones over during a holiday, and route calls to an appropriate station.
Also, some software systems even have the physician and patient voicemails integrated into the system so they will pull up in a queue, where they can be played with Windows Media Player or a similar program.
I got us enrolled in an IVR system at my pharmacy and it is very helpful because you can playback specific parts of a message easily without having to replay everything (side note though - you should always be listening to the full message twice!)
68. Start a remote dispensing program with MedAvail
While it might take some time and money to get started, the MedAvail remote dispensing kiosk can help you capture a lot of prescriptions you would have otherwise lost and improve volumes. We are launching it at two sites within physician offices at the health-system I work for
69. Start a wound care business
Wound care is big business, and as pharmacists we have the background to really learn about the products and make good recommendations to the patient to provide excellent wound care. If there is a wound clinic nearby you could start by going to their office, finding out what their needs are, and then checking with your distributor to see if those products are in your distribution center.
Note for some products you will need DMEPOS accreditation to bill Medicare.
70. Get your pharmacy, and patients, ready for the next natural disaster
I moved to Florida in 2016, and since then we’ve been hit with a hurricane every year: Matthew, Irma, Michael, and Dorian. Most of you reading this probably live in an area that gets some kind of natural disaster, whether it is hurricanes, tornadoes, earthquakes, wildfires, or something else. Do you have a plan in place?
FEMA is the go-to place for anything related to disaster preparation.
71. Put together your compliance binder
The compliance binder should be designed to be a one-stop shop for all pharmacy staff during an inspection. It contains pharmacy records (and locations of records that are in a filing cabinet), licenses, inspections, controlled substance inventories, policies, etc.; in other words, even if you had a brand new pharmacist that knew nothing about the pharmacy they could get through an inspection as long as they had the compliance binder.
Free Product: Required records location template
72. Develop a standardized training checklist for your pharmacy technicians
It might take a little trial and error, some tweaking, and regular updating, but a training checklist for your technicians (and pharmacists actually) can ensure you have covered all necessary safety and operational topics. One big advantage of using a checklist (in addition to helping with training consistency) is the ability to keep a good training program going as you add service lines.
73. Develop a local wholesaling business for physician offices, if state law allows
There are probably a lot of clinics that just feel like it is a hassle to setup an account with a wholesaler for as little as they need in medication. Why not get in the business of selling them the occasional medicine if your state allows? Keep in mind Federal Law allows a pharmacy to wholesale 5% of its annual product before being considered a wholesaler.
74. Get in the cosmetic business
I’m always amazed just how much people will pay for a tiny tube of skin cream, wrinkle cream, foot scrub, or even soap. While you don’t have to be a pharmacy to get into the business it is certainly a natural extension of a pharmacy (especially a compounding business).
Be sure to check state laws on what you can and cannot do; in Florida, for example, you cannot manufacture cosmetics without a separate permit. Of note, under the Food Drug and Cosmetic Act, soap is not a ‘cosmetic’ and therefore (federally at least) is not regulated as a cosmetic.
Another option is to have a cosmetic manufacturer make it for you so you can sell it under your brand name. Here is an example of one to get you started.
75. Make sure you have a complete list of all your office site records (after old ones have been destroyed)
As soon as records do not need to be kept anymore they go from being a required asset to a liability. It is not difficult to keep up with on-site records, but once they are shipped off it is too easy for them to be out-of-sight, out-of-mind. Be sure to keep a list of all the records you do have (some vendors provide online accounts that will help you) and check it regularly to destroy records as soon as possible.
76. Standardize procedures, and consequences, for large amounts of Cash Over Short
How much does the cash register need to be short before you investigate? What if it is right under that amount but it happens multiple times per month? Having clear guidelines for when you will investigate and/or discuss with the responsible employee will help you secure the cash in your pharmacy. Some amount is to be expected (and actually budgeted for on the income statement) but having no procedures in place is risky from a loss-prevention standpoint.
Post: Managing Cash Over Short
77. Start a naloxone program and proactively recommend it to high-risk patients
Most states allow for pharmacists to dispense naloxone through a standing order or collaborative practice agreement now. Why not start a program to identify your high-risk patients, proactively recommend naloxone to them, and then offer to run it through their insurance to determine coverage? If it’s not covered you can still offer to sell it to them at a competitive cash price.
This is another one of those win-win situations: The patient receives a potentially life-saving medication and the pharmacy makes money while improving the health of the community and fighting the opioid crisis.
78. Standardize and communicate an opening and closing checklist to staff and float pharmacists
If you want consistency in anything you need to create what is called Standard Work in the world of quality improvement. One of the simplest ways of doing that is creating a checklist, and opening and closing procedures are no different. If you want to be sure the temperature is checked twice daily, the controls are counted, the drugs are ordered, or anything else, you need a list of those tasks everyone can see and follow.
79. Be sure you are billing insurance companies for the correct days' supply on inhalers, topicals, eye drops, and other medications that are frequently entered incorrectly
Most pharmacies struggle with billing correct days’ supply to some extent, and it is always an ongoing process to maintain correct billing practices (especially because the rules seem to always change).
A good place to start might be to focus on your high-cost items, which are more likely to be audited. I’ve gotten calls from insurance companies within an hour to two of accidentally billing Restasis for the wrong days’ supply, for example, but have never been audited on a $4 tube of TAC cream (although I theoretically could be).
80. Actively offer your patients complementary products with their prescription
When I worked for Walgreens we had a campaign to offer people specific items at the drive-through as appropriate, and while many pharmacists didn’t like the idea of ‘up-selling’ I thought it was a nice service (in addition to some extra revenue).
We offered water to get antibiotics started or cough/cold products for patients who are coming through with sinus infections, etc. We created a small separate section of ‘drive-through items’ so we had them handy.
81. Set clear guidelines on who, and when, you will dispense controlled substances to
Patients and staff both are going to do better if there are clear policies on who opioids are dispensed to (based on risk for abuse, not because they ‘didn’t look right’) and how soon before the due date they are filled. A common policy is no earlier than 2-3 days before the due date but be sure to check state laws too (when I worked in South Carolina they had specific rules in place about this).
82. Use only syringes with safety features to prevent needlesticks when giving vaccines
If you’re giving vaccines at all in your pharmacy you should be using syringes with safety features.
I’ve had to use the ones where you pull a shield up from the barrel to cover up the needle, but I personally like the spring-loaded needle much better. I’ve given hundreds and hundreds of vaccines and with those by the time you even got done injecting the vaccine the needle had already retracted.
83. Be sure you are setup with a Workers Comp processor and reporting system for
Worker’s Comp could be expensive, especially if it isn’t handled properly. Since it is not a core
function of your business I recommend you learn the basics and then hire out a vendor like Sedgwick to take care of the rest. In addition to potential needlesticks from vaccines, staff could slip on the floor or even twist their back picking up boxes, so it is best to get prepared now, before anything happens.
84. Be sure your required posters on minimum wage and labor laws are visible and up to date
This one is self-explanatory and the law. Keep in mind they are updated annually. Find your state’s poster here:
85. Set clear lunch break schedules for staff
We always struggle with lunch breaks because staff go late, they take too long (even 5-10 minutes adds up when there are 3-4 techs) and then the last techs to go to lunch end up going at 2PM.
When we set lunch schedules based on who got in first and how many techs there were for the day it helped. I’m not saying it’s perfect, and it probably never will be, but it sure beats what we did in the past (relying on someone remember to start lunches on time and deciding who goes).
86. Standardize security settings in your computer system based on role type
This is a project I’m working on now at our pharmacy. None of our technicians have access to pharmacist-only functions, but we have a lot of variability in other aspects - running certain reports, adjusting prices (including AWP for drug records), accessing A/R accounts, etc. It isn’t on purpose, but it is just a product of not standardizing it in the past and having staff members’ access adjusted based on need (or perceived need) as we went.
Standardizing these settings and only allowing the manager to adjust them will prevent variability and help prevent surprises in the future.
87. Offer curbside service for older patients and those needing special assistance
Yeah I know delivery and curbside service has taken off recently, and it is true it might help you with the general population in getting their prescriptions transferred. With older patients especially though it can make-or-break using your pharmacy because they might not be able to go to a pharmacy not offering the service. And guess who (on average) has the most meds?
This is another one of those services that is a complete win-win: you provide an excellent service to the community by helping some of the most in-need people maintain their health and stay adherent and make money doing it. What could be better than that?
88. Set up a menu of 'up-sells' to go with the home delivery orders
You're already paying the courier, so why not offer specials to the patient on front-end itmes? Not only will it boost revenue but it also provides a nice service to distinguish you from the competition. You could setup a Monthly Delivery Deals newsletter with seasonal items and fast movers.
This idea is similar to the drive-through suggestive sells but targets home delivery, where you can offer a much wider variety of products (after all, nobody wants to be sold sunscreen and cat food in the drive through when they are just trying to get their lisinopril and go home).
89. Volunteer to go the local school and teach the kids about medication safety
OK, so this one is not exactly to make your pharmacy better but I think it's a good idea. According to the CDC, 374 children are poisoned every day; we can work to at least reduce the amount of poisonings due to medication.
Free Product: Staying Safe With Medicine (activity for kids)
90. Setup security cameras to prevent both robbery and theft by employees
Security cameras have become too cheap not to have them setup in your pharmacy. While it might help with your front-end as well, it is more critical back in the pharmacy. Even better, check out this company that will not only setup and install security cameras for you but also monitor them.
If you’re into doing it yourself, Lorex Technologies is a big manufacturer of security cameras.
91. Make sure all pharmacy keys are accounted for and logged out, by unique identifier
It is best if pharmacy keys are logged out (and back in - see #92) and accounted for by some sort of a serial number. It can be simple, like “Set A,” “Set B,” but at least there is proof (with signature) that you gave someone a set of keys. The key log can go in your compliance binder for easy reference.
For float keys, the chains do it best: a lockbox with both
1) the keys and
2) a key log for the float pharmacist to sign them in and out.
Only pharmacists know the combination to the box.
Product: Key Log: Staff and Float Pharmacist
92. Standardize your exit checklist to protect your pharmacy when staff leave
Eventually, even if you are an amazing boss, people will leave. They move, get offered more
money, go back to school, etc. Just like the opening and closing procedures (see #78), a checklist is the best way to make sure you are getting everything back and finishing up what you need to before they go.
93. Create a template for your perpetual inventory log to allow you to use a sticker instead of handwriting
When I first got to my current pharmacy we were handwriting all the information in the narcotic logs, which is a huge waste of time and a potential source of errors. To fix that, I just redid the label design so that one of the small stickers on our label was for the log and contained all the information we needed. Now we just put the sticker on it and sign.
Templates for the logs can be made pretty easily in either Word or Powerpoint to fit your specific labels.
94. Get into the pet medicine business
You are already for filling for lots of patients and their families in the community, why not fill for their furry/scaled/winged friends? In addition to offering compounded pet products you can offer standard heartworm, flea/tick, and even human medicine that pets take (I’m thinking tramadol, levothyroxine, or fluoxetine, for example). Combine that with medication synchronization to sync the dog’s meds to the owner’s and now you’re talking real customer service!
Here’s an article on how to get into that business.
95. Get pre-printed bags with ads to save money on supplies
Don’t pay for prescription bags when there are companies willing to give them to you for free if they can just print ads on them. They’ll reach out to local business, sell the ads, and then make sure you are OK with the company going on the bag before finalizing the design with you.
Here are a couple in the business:
96. Get a pharmacy advertisement on your personal car
If you own the pharmacy at least get one of those magnets on the door of your personal care with the pharmacy name, logo, and phone number. They run only between $11 and $30 with Vistaprint.
97. Start accepting technician interns
In addition to pharmacy students why not take technician interns? If you have a technician that would enjoy precepting it’s even better. The intern gets a good site to obtain their hours (in states that require technician training and registration) and the pharmacy gets some extra help.
Even better, you can set them up on special projects to help the pharmacy. Need project ideas? You’re looking at a list of them right now.
98. Analyze your store volumes by time and week of the day to optimize staffing
You probably can feel when you’re the busiest and need the most help but it never hurts to have some data for that. If you expand beyond just one store and need to have managers for multiple locations you will also probably find the need for more standardization of how much help each location gets or costs could easily get out of control. Your software system should have the ability to generate those reports so you can start working on when and how much help to have.
99. Start holding regular pharmacy huddles
Especially if you’re going through a lot of changes as you work on streamlining pharmacy operations, reducing cost, and starting new services, you’ll want to keep your staff in the loop. I held huddles every other week, or more often, when I first got to my pharmacy. You can also use this as a time to talk about errors and other safety issues; Florida even requires it at least every quarter and terms it the “Continuous Quality Improvement Program.”
Store: Florida CQI Template
100. Get a dashboard all staff can see that lists pharmacy goals and metrics
The health-system I work at, and many across the country, use a Daily Management Dashboard to be able to track goals around quality, satisfaction, safety, and anything else they might be tracking. Why not do the same?
For pharmacies, maybe you could track things like number of patients synced, dispensing errors (at least errors that are discovered), patient satisfaction scores (if you have a survey system), and number of MTM’s completed for the month. That way everyone can see how you’re doing and their role in it.
101. Work with your local hospital to get credentialed in their EMR
One of the hospital locations in the health-system I work for is not able to start an outpatient pharmacy due to some contractual barriers, but instead they partnered with a local independent. That independent is doing some Meds to Beds and is now credentialed in our EMR system so they can get all the patient info and help with medication reconciliation. I imagine they are doing a good business over there and you can too if you’re located near a hospital.
Even for patients not currently being discharged from the hospital having EMR access can really help when you’re trying to put together patient histories. After all, then you can access the Surescripts medication history (see #45).
102. Setup regular inventory clean up days and improve inventory turnover
Cost of Goods Sold makes up the majority of all expenses in a pharmacy, so it makes sense for it to be your highest priority for cost reduction. There are meds you have on the shelf that cost more than a month’s salary, and as the specialty market grows those items are only going to become more of your inventory.
Even if you’re careful about ordering stuff accumulates; if you schedule clean-up days even once a month I bet you’ll find thousands a year in savings. If you have multiple locations you can also have them transfer inventory between locations (see #48)
103. Train your staff on how to respond to a subpoena
Responding to a subpoena incorrectly or not responding at all can result in fines and legal trouble for the pharmacy. Do you have procedures in place for how to respond, and do your staff know about it? If you work in pharmacy long enough you will get a subpoena.
104. Set clear procedures for handling recalls
It is critical to prevent harm and liability that pharmacies have clear, effective procedures for handling recalls. The best option is a recall management platform, but no matter how you decide to do it patients need to be notified of consumer level recalls quickly and products need to be removed from the shelf.
Post: Recall Management
Free Product: Consumer-level Recall Action Form