Filling the Holes in Whole Patient Care: Front End Niches for Wellness, Anti Aging, and More

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1 Filling the Holes in Whole Patient Care: Front End Niches for Wellness, Anti Aging, and More Dawn Butterfield, RPh D.H. John Kim, Pharm.D., FAARFM Gabe Trahan, Senior Director NCPA 1

2 Disclosure Dawn Butterfield declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. John Kim declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. Gabe Trahan is the Senior Director of Store Operations and Marketing with NCPA. The conflict of interest was resolved by peer review of the slide content. Learning Objectives Discuss potential pharmacy front end niches that provide good options for health care related patient care Evaluate market attributes to assess niche potential based on patient population Discuss key counseling issues and areas of concern in front end patient care environment 2

3 Dawn Butterfield, RPh West Cocoa Pharmacy & Compounding 3

4 On Customers Minds Anti Aging Energy Stress Weight Control Sleep Hair & Nail No one wants feel or look old Anti Aging Feel as Good on the Inside As you ll look on the Outside 4

5 Never Be Without! Collagen Boosters or Combos Bitoin Keratin B 12 Retinol Never Be Without! Collagen Boosters or Combos Bitoin Keratin B 12 Retinol Probiotics 5

6 All Consults Lead to PROBIOTICS Invest in Your Crown! Biotin 10,000 Collagen Booster Invest in your hair, it s the crown you never take off. 6

7 Invest in Your Crown! Invest in your hair, it s the crown you never take off. Biotin 10,000 Collagen Booster Hair/Skin/Nails vitamin Keratin Essential Oils 7

8 Essential Oils 1ml Thyme 1.5ml Lavender 1.5ml Rosemary 1ml Cedarwood 210 cc Jojoba oil 240 cc of this it will cost about $8.50 for a 30cc dropper (put in amber vial with dropper) cost to pharmacy around $8.50. Retail $37.50 Patient buys all ingredients : Retail $57.96 = $24.30 profit Essential Oils 8

9 Invest in Your Crown! Invest in your hair, it s the crown you never take off. Biotin 10,000 Collagen Booster Hair/Skin/Nails vitamin Keratin Essential Oils B 12 Methylcobalamin TEAS! 9

10 Specialty Teas C Specialty Teas C 10

11 Additional Sales Homemade soaps (from local vendor) Exfoliating scrubs for nail care Bath bombs Exfoliating scrubs skin Additional Sales 11

D.H. John Kim, Pharm.D., FAARM Robinson Drug

Diabetic shoe fitting (Medicare) Compression

12 D.H. John Kim, Pharm.D., FAARM Robinson Drug & Compounding Center Mendham, NJ Traditional Front End Niches Durable medical equipment (DME) wheelchairs, canes, etc. Diabetic shoe fitting (Medicare) Compression stockings Surgical supplies Cosmetic / Anti Aging Skin Line 12

13 New Front End Niches INTEGRATIVE WELLNESS MODEL: Wellness custom vitamin program; anti aging; functional medicine programs; drug induced nutritional depletion Wellness Consultation Bio identical hormone replacement therapy; anti aging medicine; nutrition; functional medicine; medication therapy management; weight management Cannabidiol (CBD) supplement Wellness Global Market Place $4 trillion dollar global industry 10.6% growth from 2013 to 2015 Ten wellness markets analyzed Fastest growth 1. Preventative / Personalized Medicine & Public Health (+23.5%) 2. Fitness & Mind Body (+21.4%) 3. Wellness Lifestyle Real Estate (+18.6%) 4. Wellness Tourism (+14%) 5. Health Eating, Nutrition, & Weight loss (+12.8%) 13

14 Wellness Revenue Year 2013 ~ 2015 Pharmacists can join these markets: Beauty and Anti aging $1.02 trillion ~ $999 billion Healthy eating, nutrition, and weight loss: $574.2 billion ~ $647.8 billion Preventative and personalized medicine: $432.7 billion ~ $534.3 billion Complementary and alternative medicine: $186.7 billion ~ $199 billion Wellness Pharmacy Programs to be introduced Drug Induced Nutritional Depletion (DIND) EX) Statins; Birth control; Anti biotics; Diabetics Nutraceuticals to complement current medication therapy Functional Medicine Target disease states Diabetes High blood pressure Menopause Autoimmune Disorder 14

15 Drug Induced Nutritional Depletion Statin Coenzyme Q 10 Ace Inhibitors Zinc; B complex; Coenzyme Q 10 Beta Blockers Coenzyme Q 10; B complex Digoxin Magnesium; potassium; Coenzyme Q 10 Potassium Chloride (Klor Con) B12 Metformin Folate; B12; Zinc; Coenzyme Q 10 Sulfonylureas (Glipizide; Glimiperide) Probiotic; Coenzyme Q10 Drug Induced Nutritional Depletion H2 Blockers Folate; B12; Vitamin D; Calcium; Iron, Zinc Proton pump inhibitors beta carotene; B12; folate, calcium; zinc; iron Antacides (aluminum hydroxide) Folate; vitamin D; zinc; calcium; magnesium; chromium; iron Anti depressants Coenzyme Q 10; B vitamins Birth control (hormones) B vitamins; 5 HTP Bisphosphonates Calcium; magnesium 15

16 Functional Vitamin Program Targeting disease states: Diabetes chromium; omega 3 fatty acids; bitter melon; cinnamon; berberine; alpha lipoic acid Cholesterol omega 3 fatty acids; berberine; bergamot orange extract; niacin; folate; nattokinase; L carnitine; mixed tocophenols (vitamin E); B Complex GERD or Acid reflux digestive enzymes; probiotic (covering both lactobacillus and bifidobactum); deglycyrrhized licorice (DGL); Avoid Gluten and Casein Functional Vitamin Program Pain Management (Fibromyalgia) Compounded low dose naltrexone; B complex; alpha lipoic acid; D Ribose; Magnesium malate; apple cider vinegar; proteolytic enzyme; cannabidiol (CBD) Autoimmune disorder Detoxification support packs; Gut support vitamins (DGL; probiotics; saccromyces boulardii; L Glutamine; L Acetyl Cysteine; Lactoferrin; N Acetyl D Glucosamine); avoid gluten and casein and other offending food; Organic Diet 16

17 Functional Vitamin Program Chronic fatigue (aka burn out syndrome) Attention deficit disorder (ADD) Irritable Bowel Syndrome Dry eyes ETC. Wellness Consultation Due to the complexity of medicine and time, many patients look for private consultation Consultations are 30 minutes to 1 hour Fee based Consultation Never start the consultation program without charging Pharmacists are undermining their value Many other professional (i.e. lawyers, doctors) charge hourly fee for their knowledge and time. 17

18 Wellness Consultation How to start: Education and additional credentials: Certified Clinical Nutrition (CCN); Institute of Functional Medicine; Professional Compounding Center of America (PCCA); Academy of Anti Aging Medicine (A4M); Fellowship of Anti Aging and Function /Regenerative Medicine (FAARFM); Self study Strategize and target on the disease state clinician can manage Ex: hormone therapy consultation; functional medicine Wellness Consultation Marketing Where to market: Directly to current patient population in your pharmacy Monthly or Weekly In Store Seminars Partner with your prescribers Patient referrals Local Disease Support Group Local Community Forums Town events Set up marketing table (usually free or small fee) 18

19 Wellness Consultation Barrier to Entry Education, time, and Cost Time factor Marketing service to patients and practitioners Relationship building to have constant referral Cost to patients Patient willing to pay cash Push back from doctors and local practitioners Lack of passion and drive to provide service. Wellness Consultation Prep Work Where to do the consultation Patient s house Private Consultation Room Must provide full attention to patient s needs Before meeting with patient: Patient intake forms; Treatment Consent Letter; HIPAA Agreement; Symptom List Form Contract set up with lab companies Saliva Test; Food sensitivity testing; Cardiovascular risk assessment; Genetic testing; etc 19

20 Wellness Consultation Prep Work Day before the meeting: Call the patient to confirm appointment Ask patient to stop by the pharmacy 15 minutes before the meeting fill out intake forms (Online forms can be made available on the pharmacy website) Remind patient to bring their current list of vitamins, medication, lab results, and chart notes from the doctor (if possible) Make sure the consultation room is nice and clean Go over the test results and have list of questions ready Wellness Consultation Meeting All discussion and meeting must be set to meet the patient s needs First Question to ask: What is your goal for today s meeting? Private consultation is available to fill in the care the patient is not getting from their regular doctor. Must be able to empathize with your patient Many of these patients have wasted money and time for many years and looking for a solution 80% of clinician s time must be spent in LISTENING We have 2 ears and one mouth 20

Wellness Consultation After Meeting Supplements or Vitamin to

part of wellness consultation program Customized consultation

P. Note Compounding or Medication Order from the doctor

21 Wellness Consultation After Meeting Supplements or Vitamin to dispense to patient In Store sale Provide discount for being part of wellness consultation program Customized consultation notes to be provided for patient s doctor to review EX) S.O.A.P. Note Compounding or Medication Order from the doctor Follow up meeting done with patient 3 to 6 months CBD Products 21

22 Cannabinoids Hemp Based Supplement Cannabinoids Lipophilic, odorless compounds Exert multitude of effects depending on the endocannabinoid receptors they work Two endocannabinoid receptors CB1 and CB2 CB1 Mostly found in the brand CB2 Mostly found within the immune system CBD(Cannabidiol) VS THC (Tetrahydrocannabidiol) CBD Science Profound influence on the human body Endocannabinoid receptors found throughout the body: Brain, organs, connective tissues, glands, and immune cells Goal of endocannabinoid Create homeostasis and maintain a stable internal environment Example: Autophagy cell sequester to self digest cells and recycle Deadly effect on malignant tumor cells Stabilize the nerve cell to prevent excessive firing and calming nearby immune cells to prevent release of pro inflammatory substances. 22

23 CBD: Medical conditions Where clinical opinions, research, and data exist to support potential benefits: Acne ADD and ADHD Addiction AIDS ALS Anxiety/Bipolar/Depression / OCD / PTSD / Schizophrenia Pain / Fibromyalgia / Migraine Cannabidiol (CBD) Atherosclerosis Arthritis / Rheumatoid arthritis Diabetes Epilepsy and seizures Neurodegeneration / Multiple sclerosis Osteoporosis / Bone health ETC. 23

24 Cannabidiol (CBD) Dosage forms available: 1. Capsule 2. Tinctures / Sublingual drops (Dosage available for pets) 3. Melt away strips / Bucchal Tablets / Troches 4. Topical Cream / Lotions / Ointments 5. Inhalation / Vapors 6. Gummies / Candy Dosage Dosing can vary from CBD manufacturers Must obtain dosage guidelines from manufacturer Potency and quality of CBD can vary from manufacturer to manufacturer (Suggestion must inquire from manufacturer) Severe anxiety, ADHD, and mood disorders: 25 to 50mg daily Nicotine and other withdrawal symptoms: 50 to 100mg daily Epilepsy 25mg daily Rheumatoid arthritis 10mg daily 24

25 Side Effects 1. Inhibition of hepatic drug metabolism (CYP 450P) 2. Dry mouth 3. Increased tremor in parkinson s Disease at high CBD dose 4. Low blood pressure 5. Lightheadedness 6. Drowsiness 7. Vivid dreams Legal Disclaimer While industrial hemp products may be sold legally under the Agricultural Act of 2014 (2014 Farm Bill), the federal Drug Enforcement Administration (DEA) has stated that it considers CBD a Schedule 1 controlled substance. Many people within the industry as well as members of Congress disagree with the DEA s position and believe that the DEA would be violating federal law if they interfered with the Farm Bill program. Nevertheless, retailers that sell CBD products may face the risk of federal enforcement action which could also have ramifications for contracts with wholesalers and payers. 25

26 D.H. John Kim, Pharm.D., FAARM Robinson Drug & Compounding Center Thank You! Questions! 26

27 Join Us! Shoot the Breeze! 27

High Impact Front-End: Improving Your Pharmacy s Image and Profitability

High Impact Front-End: Improving Your Pharmacy s Image and Profitability Gabe Trahan NCPA Sr. Dir. Store Operations & Marketing Date: Friday June 29, 2018 Copyright 2018, Cardinal Health. All rights reserved.