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By PCCA
The COVID-19 pandemic has forced pharmacies to balance the safety of their staff and customers with the need to serve their communities, all while weathering reduced revenue and supply shortages. They needed personal protective equipment (PPE) that was hard if not impossible to find, and they had to adopt new modes of business or revamp existing ones, from portable point-of-sale (POS) systems for curbside service to plexiglass shields at checkout registers.
The pandemic will likely have lasting effects on pharmacy practices just as it will on societies around the world. To help pharmacies who have struggled and continue to struggle with the challenges brought on by this unprecedented time, we asked six compounding pharmacy owners about how they have successfully steered their practices through the pandemic and what they have learned from the experience:
What are the biggest challenges your pharmacy has had to face because of the pandemic?
Steve Branch : Safety is the first challenge. I have to protect my staff for obvious reasons. Finding ways to protect them from patients as well as from each other was difficult. I do not want them taking COVID-19 home to their families or bringing it from home to the pharmacy.
The second challenge has been financial. Initially, we closed our lobby for six months for the safety reasons mentioned above. We lost a lot of revenue due to loss of foot traffic — people weren’t there buying supplements and other wellness products. The cost of PPE has skyrocketed, too. It can cost $20, $30, even $40 to outfit each employee on a daily basis. It has been very difficult to add that back into the cost of making a compound.
Dawn Ipsen : Initial decreased revenue that required us to change how we help our community. The hardest months were when we went closed door and didn’t allow customers to enter the store. During that time we used social media, bag stuffers and phone conversations to provide clear information to patients about our services and options available to receive their prescriptions and supplement orders. We also initiated a wellness/refill-reminder calling system. Patients were identified within PK Software when they were due for refills. We used that information as an opportunity to telephone our patients and check in on their health, mental well-being and prescription refill needs. We reminded patients that taking care of their health was the one thing that they could control in this challenging time. Our pharmacist team researched and put together flyers that would guide patients on what supplements would be most helpful for immune support, sleep and anxiety/depression. We did this because we were listening to our patients and hearing loud and clear what their concerns were and how the pandemic was negatively affecting their daily lives and health. Luckily, our efforts paid off, and we were able to turn that trend around within two months.
PCCA was tremendously helpful during this time in providing weekly networking opportunities for us to share best practices from across the nation. Together, we are better and we can do more! I love my community of friends and colleagues. Also, the business webinar by PCCA’s Bryan Prescott was so vital in our hardest of days. The messaging I still remember is to control the portion of revenue that you can control. At that time, it was refills! New prescriptions weren’t happening because almost all providers had closed their doors and they were trying to figure out telemedicine. It took a few months before we started seeing offices reopening and people seeking out treatment for things that had been put on the back burner.
Processes and communication changes I implemented to keep my team healthy, supported and safe presented some additional challenges. Fortunately, we were 100% successful in preventing any COVID-19 cases within our team or our immediate families. This was an amazing feat since the first confirmed hospitalized case and the first nursing home outbreak were literally just down the road from our pharmacies. At the height of the pandemic, we hit over 400 cases per 100,000 people! My team has mentioned many times how grateful they have been to have clear planning, guidance and safety measures. We closed our doors for about six weeks at one point and used drive-thru, curbside and shipping. Even today, we still require masking and hand sanitizer use by all employees and patrons, as well as plexiglass shields at our registers and social-distance markings on the floors. Our staff continues to be vigilant in their time off, and we all work together to make smart choices in our personal lives for the betterment of our team and community.
In-person consultations for hormone replacement completely became a back-shelf item as well. I wasn’t comfortable conducting them in person while in a small room for an extended amount of time with an unknown patient. I have transitioned all of those types of appointments to an online model. It is more efficient for both me and the patient, too. I find I get the same amount of value via a camera as I do in a room. The patient has the convenience of doing these types of appointments from anywhere. I’ve had patients do them in their car while on lunch break or from their vacation home in the mountains and even from another state! This has actually opened the door and normalized a new way for patients to receive information that can be helpful to their health.
David Miller : We have been unable to obtain supplies necessary to help our patients. PPE has been difficult if not impossible to obtain. We are also having increasing challenges obtaining the pure pharmaceutical ingredients and excipients necessary to compound certain dosage forms.
Of course, in times of shortage and supply chain disruption, the best value products that tend to be affordable disappear first. This puts compounders and their patients in a bind: either raise prices — which negatively impacts patients, especially those unemployed or underemployed — or absorb the increased costs ourselves. It has been a very delicate juggling act.
The last big challenge we are having is over burdensome governmental oversight. During the pandemic, we were limited to a very strict formula for compounding hand sanitizer. This is just one example, but governmental oversight is making it increasingly difficult to provide customized care for our patients.
Michelle Moser : E-commerce has been a challenge! We bought a hand-held POS tablet to help with transactions curbside too. We pushed our seminars and international conference to a Zoom platform just like everyone else. The expense was covered by a grant.
Human resources needs have been a challenge as well. This has been so, so very stressful to keep up with documenting the little pieces associated with COVID-19, the changes allowed and not allowed.
Masoud Rashidi : One of the biggest challenges we had was obtaining PPE during the pandemic and staying up to date with all the new CDC guidance, which was changing every few days. We had to create new sets of SOPs, which was very time consuming. We would have to implement a new SOP, and a few days later, we had to do the same thing all over again.
Keeping the employees and customers safe was our top priority, so getting used to curbside service and shipping was a bit challenging at the beginning, but we got used to it after a while.
Letting patients and prescribers know we were open was also a challenge. Most people thought that with the shutdown, we had to close as well. This caused a lot of downtime in the pharmacy.
Terry Vasenden : A big challenge was the loss of income for the months last spring when doctor’s offices were closed, resulting in a drastic drop in new prescriptions. In-person marketing was not possible because their office lobbies were closed, too. Keeping our team and patients safe was the other big challenge.
How have you overcome those challenges?
Steve Branch : Once we reopened our lobby, we began to offer weekly promotions to increase supplement sales. For example, we started Wellness Wednesday, where we offer 10% off all supplements. Also, we began using social media posts and emails. This has helped. While our numbers are not what they were, we are seeing an upward trend in sales.
David Miller : We have had to become creative. We have had to change excipients where appropriate and work with doctors to achieve therapeutic interchanges where appropriate.
We had a program last year during the height of the pandemic that ensured no one would go without their compounded medication for financial reasons. If we called them because they were late ordering their refill and their response was, “I am out of work and cannot afford my medication,” we would send them up to two months at no charge if they did not have insurance covering the medications. We did not want any patient to have interrupted therapy because of this terrible virus.
Michelle Moser : I tried really hard to take each day as it came. My staff is very supportive and have stepped up to help with the changes in human resources and state guidelines.
Masoud Rashidi : One of the most rewarding parts of my job is being part of PCCA’s Advisory Council and Concierge Compounding program. This became especially important during the pandemic. Our groups were meeting via Zoom one to two times a week and exchanging ideas. This helped all of us to overcome some of the challenges. Networking and being able to call a colleague if we ran out of PPE or a chemical was crucial.
Bryan Prescott with PCCA’s Compounding Pharmacy Management Services helped a lot with some of the COVID-19-related policies and how to stay afloat. He was very informed about all the employee-related COVID-19 coverage and obtaining the grants via the Paycheck Protection Program to be able to keep our employees and stay in business.
Terry Vasenden : We established goals for growth, and once doctor’s offices were open, we found creative ways to market and pursue our goals for growth, even though it looked very different from prior years. For example, we used the PCCA Speakers Bureau to provide education to practitioners via Zoom, we offered women’s wellness classes via Zoom, and we sent marketing materials via mail (rather than dropping them off at the office in person) and followed up with a phone call.
What advice would you give to other pharmacies about how to deal with the continuing effects of the pandemic?
Steve Branch : Our philosophy has always been, “Central Drug is bigger than all of us who work here; without it, none of us have jobs,” so what are we willing to do to ensure that it stays open? We have asked employees to make sacrifices, and we as owners have made sacrifices knowing that this is short lived. At the same time, we have continued to do the things that got us here, the things we do well, and we have not compromised our integrity or the integrity of our compounds — the things that set us apart.
Dawn Ipsen : Communicate, communicate, communicate. Be in front of your audience as much as you can. In these times, I think it is impossible to over-communicate. How are you doing your business transactions, what is expected of your staff from a safety and health standpoint, what services and products do you have that your community needs? Always remember to give your audience the “what’s in it for me” in your messaging.
If you don’t have one already, get a business coach. Make sure you start with your pharmacy’s vision, mission and values. When those are clear, it is easy to lead a team, make hard decisions, set clear expectation and cultivate a culture that you can be proud of. Also, a business coach is so important when setting contingency plans. Instead of constantly carrying the worry of the health of the business, we had what it needed to look like recorded on paper. I communicated this information to the team, and they knew what was needed in order to maintain the current staffing and spending level. They had less worry about their job security, and we then had a whole team working toward the same goals and objectives through our consistent vision and mission by living and working with our values.
David Miller : Be flexible and find creative ways to reward your staff. Everyone is on edge right now, and it is difficult to recruit and retain talent. They are torn between having to care for children that are home when they are not. They have little to look forward to because all they can do is go to work and go home. Don’t get me wrong, home and family are blessings. But not being able to travel, go out to eat, go to concerts or congregate with friends is really challenging for patients and team members alike. Find ways to connect. Give them something to look forward to like Hawaiian shirt Friday or Chic-fil-A Wednesdays. Let your team know they are appreciated. If you are a leader, study emotional intelligence and work the concepts.
Michelle Moser : Let’s talk, share information and keep in touch with one another. You are not alone. Together, we are stronger.
Masoud Rashidi : Always keep well stocked, keep informed and do not ever think you are alone. Rely on your colleagues, call them up and call PCCA member support. I had a lot of great information coming to me through the PCCA network. It is very hard to try to come up with the ideas yourself, so get help.
Terry Vasenden : Continue to think outside the box and be creative on how you can accomplish growth and serve your patients and practitioners even when conventional methods are not available.
After the pandemic is over, will you continue any of the practices and policies you’ve implemented in your pharmacy because of it? If so, what are they, and why will you continue them?
Steve Branch : We’ll continue social distancing where and when we can. We’ll have fewer chairs in the lobby as well. Plexiglass shields will become permanent at the checkout and patient-consultation areas. These changes are really common sense, and we should have done them a long time ago considering that nearly everyone coming to a pharmacy is sick, especially in the wintertime.
Dawn Ipsen : I really don’t think the pandemic will magically reverse our processes. I believe many, if not most, will be here to stay for many years. I see social distancing and plexiglass shields at registers staying forever. I see masking in some public venues staying for years. In Asia, masks have been considered quite normal at certain times of the year and in social settings. I think we now have more of a social acceptance of that look in the U.S., and it won’t be uncommon for many to have physical and mental health needs that are fulfilled by continuing to mask. I think touchless, no-contact purchasing will stay, as well as the uptick in online sales. Although my personality type doesn’t align with it, I wonder if we will become a society of less hugging and handshaking, too. I think if we look at history, we can maybe see some previous generations that have gone through that transition due to health issues that they faced in their generation.
There are many silver linings too! I think we’ve all had a significant amount of time to really think about and prioritize what is important — more time for family, prioritizing activities that truly bring value, finding improved efficiency in our commuting, meetings, etc.
David Miller : I think we are in a different society now. People have changed tremendously over the past year. They are looking for more work-life balance. We have to make their work experience rewarding and satisfying so they are willing to sacrifice time away from home and their families to entice them to keep serving our patients. As the evolution of the team culture continues to advance, we must continue to stay ahead of the evolution.
We are all incredibly flexible as compounders. That is what we do and who we are. We must continue to be nimble and innovate everywhere. We must continue to keep seeking creative solutions for our patients’ problems in order to be able to continue to serve them into the future.
Michelle Moser : Yes, the e-commerce has been amazing! We will keep our portable POS system, too. I am considering expanding our Zoom seminars as well.
Masoud Rashidi : Here are a few of the policies we implemented that we would like to keep:
Terry Vasenden : Patients really appreciate our curbside service, so that is a practice we will continue to offer. It was a great idea that came about because of the pandemic but turned into one more service we can offer that is valued by our patients.