“And…..The Winner is”

Jp Enlarged

 

Blah, Blah, Blah.  More CVS criticism from a CVS grunt on the front line.  Apparently, you enjoy reading this stuff.  I’ll keep on passing it to you.  Tell me when you are sick of it.  This pharmacist makes a good point.  I wonder who was charged with picking the winner?  Jay Pee

Jim,

Attached is a weekly CVS newsletter to a certain region. Of the 6 stories, I would think saving a life with story 1 would be the most impactful. The “contest” is judged by which story is most impactful in regards to helping out a customer/patient. Apparently, saving a life is second fiddle to opening a store in a hurricane. It is just another example proving CVS just doesn’t care about anything but money. Feel free to use this on your website. I’d love to see what other people think of it.

Thank you,

CVS pharmacist

Walking the Talk

District 1 – Store 5013. On 9/19 at the beginning of our day, a customer called up and told me she was trying to overdose on her medication. She was slurring her words and having a hard time talking. I immediately put my technician “Sally” on the phone to talk to our patient while I called 911 and informed the EMS of the situation. Because our patient lives out in the country, it took a half hour before the ambulance reached her home. All the while, Sally tried to engage our patient in conversation to keep her from falling to sleep. Sally was so extremely kind, caring, and calm. She really kept a level head on her shoulders in a crazy situation!!! She was such a blessing to me that day, as well as a blessing to our patient. She was making small talk as well as discussing deeper issues with her. She is truly a shining star!!! Thank you, Sally, for keeping a level head when it counts!!!

District 2 – Store 0649 – The store manager was given an envelope with money in it for “Suzanne.” The manager leanred later that it was to repay Suzanne for her covering the amount the customer was short when checking out at her register the other day. The customer was very appreciative of her doing this and wanted to be sure she was repaid. Thank you to Suzanne for “walking the talk.”

District 3 – Store 5008 – Shift supervisor, “Joe” found a wallet with a large sum of money in it in the store. Ed looked into the wallet and was found a CVS extracare card and was able to call corporate and get the information for the customer to return the wallet to him. The customer was extremely appreciate of Joe’s care and concern in returning his wallet to him. Thank you Joe for “walking the talk.”

District 4 – Store 0502 – An elderly patient came into the pharmacy and was distraught over their insurance situation, “Bill” learned at that time that the customer was suck in what they refer to as the “Donut hole” of insurance. Bill looked into the patient’s medications and insurance plan and speaking to the doctors and working all together they were able to reduct the patient’s co pays for the month in half. Thank you to Bill for “walking the talk.”

District 5 – Store 1600 – A customer called the pharmacy stating that she had fallen at her home and was unable to get up and was extremely upset and confused and was able to call the pharmacy in hopes of getting someone to help. “Danielle” stayed on the line with the customer talking to her calmly and distracting her from being upset while the paramedics were called and were able to locate her at her home. Danielle stayed on the line the entire time with the customer making sure the paramedics were at her side before hanging up. Thank you Danielle for “walking the talk.”

***WINNER***

District 6 – Store 1594 – During the recent storm the power was out at the store and “Ron” had been at the store with just a flashlight and was there in case anyone came in for their prescriptions. A customer came into the store that was in town visiting and explained to Ron that she was stuck due to no travel and unable to get back home to get her medications. Ron was able to help her in getting her medications so that she did not have to go without while she was unable to get back home. Thank you to Ron for “walking the talk.”

Jim,

All typos, run-on sentences, and improper grammar were put in as on the letter. I did not want to ruin all the fun.

Thanks, CVS RPh

49 Comments

49 Comments

  1. Pharmaciststeve  •  Nov 15, 2012 @4:48 pm

    to me the choice is obvious … the person in the first.. is suicidal and may be less of a chance of being a long term customer/pt

    creating good will … with a person in No.6… that may become a long term customer/pt.. is a much better choice.

    this opinion was developed using no rational thought process :-)

  2. Peon  •  Nov 16, 2012 @8:14 am

    The unclear choice is Store 0502. The poor guy hit the “Donut hole”. You know how concerned CVS is about ‘helping’ patients. Never mind the suicidal person..just tell the person to ‘have a nice day’ and hang up the phone. Don’t have all that time to spend on the phone because that would lower the pharmacies ratings on having prescriptions filled on time, take the tech away from making harassing phone calls to customers to tell them they have meds they need to come pick up. You know CVS pharmacists and techs have to set their priorities! :)

  3. Studly CVS Stud  •  Nov 20, 2012 @1:59 pm

    As I read through these, I see two situations which can be truly life or death (suicide and woman falling). I’ve been with CVS since the late 90s. Back when it was solely CVS, life was grand. Now, since Caremark came into the picture, I cannot wait to leave. CVS/Caremark places the focus on money making for their shareholders. I heard a rumor they guarantee their shareholders a 20% return on their investment. It goes to show why “being open” is a priority. Heaven forbid “Ron” died on the way home, CVS would not miss a beat. Put in a low priced grad and save money.

  4. Pharmservative  •  Nov 22, 2012 @4:09 pm

    Seriously…CVS is evil for picking a winner among a bunch of outstanding situations? Sounds like ya’ll are just trying to nit pick anything that CVS puts out. I’m sure Walgreens would have picked the “right” one. You know if you don’t like the company leave it. I hear plenty of people say that’s not practical. If you really hate somewhere so much leave and find better if tere is nothing better then find a new profession. Maybe you should be grateful for a job. If everyone wasn’t leveraged so far in debt with your house, car, credit cards, etc. you wouldn’t have to be a slave. Proverbs 22:7 The rich rule over the poor and the borrower is slave to the lender. You can choose to not work for a company if you are in a position of financial stability. Sadly most of us make between 2-3 times the average salery in America and yet still live paycheck to paycheck. You want to change the pharmacy world…make it so you don’t have to be a slave and you can walk when you don’t agree with a company instead everyone takes it from corporate America becauase we have no other choice. We are slaves by choice. Stop grumbling and complaining and do something real to change the situation.

  5. pharmaciststeve  •  Nov 22, 2012 @5:27 pm

    @Pharmservative… what is pathetic is that for every one that makes a comment there is probably 300-500 who are reading.. and probably agreeing.. but.. can’t muster up the chutzpah to get their fingers to start typing and agree or disagree.. with what is being said…

    IMO.. that is a major reason.. that pharmacy/Pharmacists are not going to change anything in a positive direction.

    A handful of states still don’t recognize us as a health care provider. Only one state recognizes us as a practitioner.. so that we can bill a third party.. if we can find a procedure code that they recognize us using… and it has an allowable.

    Unless Obamacare and ACO’s creates a new “niche” for us.. cause we are not going to do anything to find a new niche..

    The writing is on the wall… many states are increasing the RPH/tech ratio… some are now unlimited… ERxing, robots, computer checking tech,numerous automation equipment, remote pharmacies operated by a tech and RPH’s approving orders remotely at a rate of 100+/hr

    throw in a labor pool that is growing 1%-2% more than demand… and we have nothing short of a “professional crisis”

  6. Pharmacist Bob  •  Nov 23, 2012 @7:17 am

    Steve-Amen!
    And pharmaservative-
    “Change Professions” after 6 years or more working for that degree, I don’t think so. I prefer to hope for an idealistic outcome where the pharmacists change all that is bad with retail corporate pharmacy. It is all about profits for these corporations, we understand that, but as they are renting our profession, we don’t have to swallow the whole bologna sandwich. They could be like Hostess Twinkies tomorrow if we made that decision! Look at this Black Friday creep happening on Thursday now, next it will be Black November, hell, make it black Friday all year long, black Friday your way, any day. Metrics are fine to a point in determining efficiency, but let’s get all the metrics-how much time is spent answering the phone metric, how much time is spent at the register metric when added together leaves no time to fill the prescription metric . Do they teach classes in how to write threatening emails about not using a customer’s name and you need to start looking for an exit? Really? How pathetic and low will they go? For me, it only points to the answer of unionizing and all of the other actions available to us; that is the change that I want, I do not have to change where I work, workers have rights my bible quoting friend.

  7. prickly pharmacist  •  Nov 23, 2012 @7:52 am

    I think pharmaservative might be my old DM, the one who talked about back stabbing females and how awesome CVS is. He was not a nice man and I get the same vibe from this person.

  8. Goose  •  Nov 23, 2012 @8:22 am

    I really enjoy these discussions and I think that everyone brings a very different perspective based on your age,current work situation and past work experience. I think one of the reasons we have such a hard time building a consensus is that we don’t have a national organization that represents us. Add to this the fact that people today are not ‘joiners’, as evidenced by every decreasing membership in service organizations.
    When we baby boomers are gone, the younger generation will have to find their own way. Most of the bloggers I read like pharmaciststeve and JP are around my age (pushing Medicare or already there)and they focus on big pharmacy issues. (lack of employment growth, cost of education, lack of professionalism). Most of the younger bloggers focus on mean customers and working conditions.
    The death of retail pharmacy has been predicted for years and it may happen. Having worked in all areas of pharmacy, I can tell you at hospital is starting to get it right. We are moving towards getting paid for imformation and outcomes, away from dispensing. This will be tough to transition to retail, especially with the current structure and management. You will start seeing people do it though. My advice is: counsel and educate your patients about what happens if they don’t have 24/7 access to a pharmacy/pharmacist. Our customer base, for all of the information they have access to, is the dumbest I have ever seen in my 35 years as a pharmacist. They folks need what we do and we need to figure out a way to make it work.

  9. pharmaciststeve  •  Nov 23, 2012 @11:02 am

    @Goose.. You are right about my age.. went on Medicare this past June.. If I was a “younger” RPH and working for one of these “assembly lines”.. I would be talking to the MD’s in my area.. about doing one day a week work in a practice.. helping to manage patient’s therapy.. there is a way to get paid…work on a revenue sharing basis.. get your ducks in a row on how you can get it accomplished… As the ACO’s and Obamacare evolves.. you will find yourself in a place of demand… and you can walk away from that “assembly line”.

    Some numb-nuts in APHA and other organizations believe that this will happen with the RPH in the store and the MD in the office… FAT CHANCE ! This may work in some small towns with especially indys where the RPHs on duty is always the same and have been there for years with the same MDs in the community.

    As MD’s sell their practices to hospitals… because hospitals can afford the back office expense and they get paid more for many services than the MD in his/her office.

    These MD’s are going to find themselves in the same boat that we are… “number crunchers” driving the practice.. and who believes that the third parties are going to continue to pay more.. those of us can remember when PBM started and we were paid as much or more than U&C… and we see what happened to those reimbursement once they got a majority of the business… the same is going to happen to hospitals & MD’s except there is a shortage of MD’s.. at least in the near term.

    From what I have seen/heard… the Feds are making moves to “back door” a single payer system in a piece meal manner.. I think that the PBM’s may have their business plan and profits shoved up their ass… the Medicare A/B carriers (DMERC’s) work on a 5% +/- gross margin… who believes that the PBM’s will be granted a much higher operating margin?

    IMO.. everyone in healthcare needs to think about living on a lower salary.

  10. Goose  •  Nov 23, 2012 @12:00 pm

    pharmaciststeve,
    You are right about the last part concerning salary. NPs make around 80 thou a year and I think that’s where we will end up as I envision we will be doing the same kind of work. Evaluating patients and drug therapy will only be worth so much.
    However, that is still a good living. I have 2 sons-in-law and two daughters with a total of 9 degrees between them including a PhD and none of them make near that. I think I make way too much money for what I do and I have a very clinical job, have management responsibilities and work all shifts, weekends and holidays. I figure I am worth about 75-80 thou a year because when I plug myself into business programs that measure pharmacy profit (at a retail store), you have to rachet the pharmacist’s salary down to that amount to show an overall store profit.
    I’m making about 125 thou a year and that is too much. When I talk to other pharmacists about this (and I don’t do that very often) you can see the look in their faces that they know you are right.
    You will start to see downward salary pressure soon, but I think the first step will be reduction of base hours in stores from 40 to 32 or 30. Excess pharmacists-less hours=more pharmacists per store. Raises will go away and erosion of the standard of living will start.
    If you are a cheater or a pill head, you’ll be the first to go. Older pharmacists will be next, followed by people who do not meet metrics or fit the company mold.
    Remember, Charles Darwin said it was not the smartest or strongest of the species that survive, it is the species that best adapts to change.
    That will be us.

  11. Goose  •  Nov 23, 2012 @12:10 pm

    One other thing I forgot to include, I would bet (and I know I’ll be some arguments here) that if we were getting paid around 80 thou a year as pharmacists, a lot of the other problems would go away.
    We may be victims of our own greed.
    Let the floggings of my post begin!

  12. pharmaciststeve  •  Nov 23, 2012 @12:56 pm

    @Goose… A few months ago.. I went and looked up the CPI from when I first got licensed (1970) and what I was paid (235/42.5hr wk).. and applied the CPI… our equivalent salary comes out in the 70K -80K range. Presuming that the government has not “played with” the CPI calculations. Back then, the RPH was the store manager/assistance manager besides and if lucky… you had clerk at the register.. if you were busy you could drag into counting for you and writing receipts/forms. Of course, doing a 100/day was a busy store.

    While most RPH’s are no longer responsible for the front end of the store.. our responsibilities and liabilities have grown exponentially. But these have little bearing on the MBA’s number crunching of what we are worth.

    IMO.. the whole healthcare system is moving toward less trained staffer to perform certain functions. I am not sure that is good or bad.. in pharmacy’s in particular.. if we are moving in this direction .. we need better trained techs.. not just dragging someone off the street and give them 15 minutes instruction and expect the Rx dept staff to do the rest of the training.

    we “senior RPh’s” are not going to cause this change to happen.. we are already considered – by many – as “dead wood”. The best we can do .. is to watch the back of the younger RPh’s and give them a “heads-up” as to what is sneaking up on them.. or what is the most appropriate way to deal with a work environment situation.

  13. Goose  •  Nov 23, 2012 @1:50 pm

    @pharmaciststeve,
    I agree with all points, somebody has got to mentor the youngsters, I graduated in 1977, had some of the same experiences as you and JP.
    I try to be realistic but positive and control my own destiny AMAP, which sounds like you.
    I read your blog and JP’s daily and am in agreement with you guys 90% of the time.
    Enjoy your posts.

  14. pharmacyslave2000  •  Nov 23, 2012 @7:28 pm

    I’ve often thought that we may be overpaid at the retail level for what we do. However, the product that we are in charge of, the product that we HAVE to be present for to be dispensed is worth MUCH more than we get paid. The product itself, the drugs we dispense, are very valuable and the companies we work for are MULTI-BILLION dollar entities because of us. Our salaries are simply in line for what we enable the companies we work for to make. But all it takes is for one company to find a way around the antiquated law that supports our existence and that is the end.
    ***
    My question is, should our salaries decrease and our work environment remain unchanged, would pharmacists stay on or would they leave the job? I know what my answer is.

  15. the truth  •  Nov 23, 2012 @7:37 pm

    Salaries won’t decrease but hours will. I have seen it happen. I am fortunate that wherever I work my hours have not been cut but district wide they have and big time. Also at Target and Walgreens they have been cut. Now we have pharmacy students working with us and I jokingly asked them if they were going to practice in retail. They quickly answered “no”. I don’t blame them. Every week a new threat from corporate about not acheiving a certain goal. We are worth our salaries. We do so much and get so little besides money in return. I really don’t care about the bonus, I’d like some respect and automony to do my job.

  16. pharmacyslave2000  •  Nov 23, 2012 @7:55 pm

    @the truth, I don’t necessarily agree. My store’s hours have been increased by 5 hours weekly which has lead to an increase of 2 hrs. weekly to my base salary. Unless there is an industry wide decrease in store hours, as there was after the economic crash of 2008, I don’t think decreasing hours will be a huge issue as the chains want to remain competitive with each other. However, I have seen many “part-time” pharmacists be given extremely limited hours recently. The company seems to be trying to thin the herd of part-timers and use floaters and younger pharmacists to work MORE hours in their place.

  17. WrongAid  •  Nov 23, 2012 @8:33 pm

    What is it worth to keep pharmacists from opening up independents on every corner? That’s a huge part of these corpos overall strategy. Pay me 80k for an embarrassing position that will be the death of me? Nah, I’ll work for myself for 60 a year.

  18. pharmaciststeve  •  Nov 23, 2012 @9:02 pm

    @wrongaid.. IMO.. we are going thru a phase..but much more aggressive one.. that we went thru in the late 70′s & 80′s..

    One where restrictive networks and decreased reimbursements are the name of the game.

    back then it was the smaller PBM’s ( Metlife & Humana) that was doing the restrictive networks…this time.. IMO .. is going to be Medicaid and Medicare..

    It took the PBM’s nearly 30 years to gain 50% of the Rx market place.. the government is already there.. with Obamacare & ACO’s ready to gain traction is 2014… payment for healthcare services will most likely try capitation again.. and the per-cent of the Rx market place could ramp up to 80% in a very few years.

    These entities can contract with a couple of dozen chains and indys may be left out in the cold.. except those that don’t have a chain store within 10 miles of them.. and then they will only get what drugs that can’t be furnished by their mail order arm

  19. Goose  •  Nov 24, 2012 @9:37 am

    Good responses everone, but I would just like to give you an example of how quickly you can price yourselves out of a job.
    When I graduated in 1977, I worked retail for a regonial chain in Central Indiana, (Anderson, Indiana to be exact, Hook Drugs was the company) At that time in the Central Indiana cities of Anderson, Marion, Kokomo,Muncie, New Castle and Indianapolis there were probably around 150,000 Untied Auto Workers. Some of these union members had a 6th grade education (I’m not kidding) and all of them from janitors to line workers were paid more than I was and had better perks and benefits than I did. College grads and professionals were literally second-class citizens.
    The UAW workers kept wanting more and more and they usually got it. Things started to unravel in the late 80′s and early 90′s. Today, only a few thousand of those jobs are left, and some of those cities are in just awful shape.
    Whenever I here somebody say that unions are the answer, I tell them this story.
    We all have one thing that is very valuable and that is knowledge. Use yours and figure out a way to change things and make our profession better.

  20. pharmacyslave2000  •  Nov 24, 2012 @12:01 pm

    Agreed Goose. Unions served a purpose at one time, many years ago, but have done a lot of damage recently. The UAW single-handedly destroyed the domestic automotive industry and Hostess is now closing up shop because of unreasonable union contracts. People seem to forget that businesses exist to make money and if they can not do that they will simply cease to exist and all their employees are left with nothing. That being said, the pharmacy industry is much different. The companies we work for continue to be immensely profitable and we are an absolute necessary part of that profitability. Retail pharmacy does not exist without pharmacists. There aren’t many industries that require one employee or they simply don’t exist.

  21. Broncofan7  •  Nov 24, 2012 @1:06 pm

    I always enjoy coming here and reading the well formed opinions of pharmacists entering their twilight years. However as a 35 year old pharmacy owner I will tell all of you that seem to concede that Pharmacists are somehow paid too much ($120k) you are more than likely not owners any longer yourselves and not truly privy to current economics of Pharmacy. It takes ~ 6 Rxs on average per hour to pay that $60 Rph wage…. In today’s marketplace with ever increasing daily fill numbers especially with the boomers aging the $60/hr is still easily met by today’s Pharmacy budgets…. I truly hope to bein a position in a decade to provide start up capital for independent pharmacy owners…. It only takes 90-100 Rxs per day to “break even” in today’s pharmacy economic climate and that includes paying yourself in the neighborhood of $60/hr. mix in 5-10 compounds a day at $25 margins and you are well on your way to being secure financially and satisfied professionally. I’m a Healthmart pharmacy and the help that they offer for $130/ mo in terms of advertising , branding ( that price includes your own website with online refill access for patients) and cohesion of your services it’s a no brainier. There certainly are challenges but there are avenues upon which we can still achieve professionally and financially rewarding outcomes.

  22. Broncofan7  •  Nov 24, 2012 @1:07 pm

    As s side note, I average around $18 profit per RX at my store…

  23. Broncofan7  •  Nov 24, 2012 @2:58 pm

    And by profit that’s dollars ABOVE AQ cost of medicines….

  24. Broncofan7  •  Nov 24, 2012 @3:24 pm

    @ pharmaciststeve re: restrictive networks . Some states such as the one I practice in ( TX) have an any willing provider statute which can essentially make these restricted network contracts that these insurance companies put forth illegal. Obviously all of them do it anyhow ( mandatory mail order for example) but eventually once the chains start feeling pressure because of limited networks you’ll see a joint venture by the ncpa and nacds ( just as we see now regarding FULs) challenging mandatory mail order and closed network pharmacy contracts…. It’s a matter of when not if.

  25. bcmigal  •  Nov 24, 2012 @4:19 pm

    Pharmservative….since you like to quote the Bible….judge not, lest ye be judged (Matthew 7:1) And to Broncofan, there are plenty of references in both Old and New about self aggrandizing. That’s is all I have to say about it.

  26. Pharmaciststeve  •  Nov 24, 2012 @5:55 pm

    @Broncofan7.. you make it sound so easy.. in a indy.. labor is typically 1/3 of total overhead.. If you are opening a store from the ground floor.. typically the Rx volume for a new store doesn’t “pop”.. it builds slowly.. While it has been a number of years since I opened a new store.. I would suspect that – depending on the size of the store – you will need 250,000 – 500,000 to get open and to profitability.

    If you buy an existing store… you may need more than that… but should have a instant cash flow.. not necessarily instant net profit.

    If I remember correctly, you are in a small town in TX.. presuming little competition.

    what would happen to your cash flow/profit.. if the state brings on a Health Care Exchange Program under Obamacare in 2014 and it contracts with the same entity that is now handling TX Medicaid and over 50% of your existing pts are now covered under the reimbursement for that program?

    IMO.. how health care is provided and how healthcare is paid for.. is about to be turned upside down.. In regards to quality and availability of services.. by the end of this decade.. we may not be able to recognize it.. from what we have been used to.

    Being a former indy… I hate to see/hear/read where a indy has to close…for any reason..

    But we are operating under the premise “… too large to fail and too small to matter…”

  27. Broncofan7  •  Nov 24, 2012 @7:49 pm

    @ bcmigal …. Your post added nothing of substance to the matters being discussed here. So why did you post it? The irony isn’t lost on me….

  28. Broncofan7  •  Nov 24, 2012 @8:10 pm

    @ pharmacist Steve. Your estimate to start up a pharmacy is off exponentially. I know of two gentlemen who recently opened a pharmacy for $65k plus credit for inventory… They opened in August and are currently doing 70 Rxs a day in a town with a Cvs and another Indy. Your completely out of touch with the current economic realities and your hypotheses about the future of our healthcare system are just that; hypotheses. The problem is you don’t have a good understanding of the CURRENT market so that takes away some of the relevance given to your hypotheses. IMHO. Single payor could be advantageous to our profession as it would allow us to compete strictly on service levels ( truly a free market) instead of competing with mandatory mail order and closed networks. Even with reimbursement potentially decreasing further with FULs these wholesales are not going to want to lose 20,000 + customers ( independent pharmacies) so a relative decrease in AQ costs will also take place. I am about 12-14 months away from starting another pharmacy in a highly competitive highly commercialized north Dallas suburb. I’d be the only full service ( free delivery , compounding and DME) pharmacy in that town and it’s a town with plenty of stay at home mothers and expendable income. Free children’s vitamins ( cost 0.31 cents) and free flavoring of medication will develop traffic as will doctor detailing . Our future is not as bleak as some may think; as someone else had noted, we are well paid professionals who banks love to provide capital too ( as opposed to a restauranteer, etc) ; with a little creativity and perhaps a partner to help with the economic stresses that starting a new pharmacy would bring our future can still include professional and economic satisfaction. NCPA. Showed me the way and if some if the “Debbie downers” haven’t yet taken the ownership workshop or gotten with a broker to explore buying an existing pharmacy then all of the effort you make posting here could be better served turning your professional experience into a marketable and more gratifying time.

  29. broncofan7  •  Nov 24, 2012 @8:39 pm

    @ mR. Pharmaciststeve; as currently constructed, I am actully being paid BETTER by the TX managed care medicaid program than when the STATE ran it (for BAND NAME MEDICATIONS AND AWP based generics (not those being MAC’d out))However that is because I am rural. HERE’S A QUICK AND DIRTY SUMMARY OF STARTING AN INDY: PHARMACY M-F 9AM-7PM SAT= 9-3 RPH= $60 X56 HOURS X52 WEEKS= $175k TECHS 80 HOURS AVG $13/HR X52= $54K CLERK $10X40X52= $21K =~$250k IN SALARY MONTHLY EXPENSES: RENT ~ $2500 FOR 2300 SQFT 3RD PARTY SWITHCING FEES= $160/MO PHARMACY SYSTEM $400/MO ELECTRICITY $400/MO DSL/PHONE $250/MO WATER= $100/MO VIALS $400/MO PAPER $120/MO = $4330 X12= $52k ……………SO $52k + $250k IN SALARIES = ~$300k PER YEAR IN OVERHEAD. (NOT INCLUDING DRUG INVENTORY WHICH YOU ARE GIVEN CREDIT FOR BY ANY WHOELSALER) 300k/12 MONTHS = $25K A MONTH / ~24 DAYS OPEN PER MONTH = $1100 PER DAY TO BREAK EVEN. OBVIOUSLY, THIS IS A SIMPLIFIED OVERVIEW. The average dollar margin on Rx’s in ~$13 per rx…90-100 rx’s per day (like I have said repeatedly is break even slight profit territory). Do some flu shots that cost $4 per shot but you charge $25 on and you can see why the chains have strongly pushed for RPh’s to immunize. There is a model for success out there.

  30. broncofan7  •  Nov 24, 2012 @8:42 pm

    I apologize for the typographical errors above….BF7

  31. broncofan7  •  Nov 24, 2012 @8:47 pm

    1)Average computer system cost (purchase vs lease) ~$15,000 2)shelving etc= ~$20,000 3) store signage ~$5-10,000 4)phone system $4000 5) security system $2000 6) delivery vehicle ~ $10- $12,000

  32. Pharmaciststeve  •  Nov 24, 2012 @9:32 pm

    @Broncofan7… you ignore the cost of inventory as part of start up costs.. and the cost of funding A/R.. and the interest on carrying all those dollars..

    Showing a profit on an accrued basis is not the same as showing a positive cash flow..

    The last time I had access to a store’s P&L was 4 yrs ago.. I opened a apothecary… in house pharmacy in a out pt mental health facility… in 10 months I went from $0.00 sales to 500,000/month working on a 38 hr week.. Average Rx was $150 (mental health drugs are expensive) and gross profit was in 15% range. Yes average gross profit was $22/Rx.

    I was told that I was to do 24 turns a year…but.. the CFO kept on my back why my 40K opening inventory was around 100K… my turns were in the mid 30′s and now they wanted them into the 40′s..

    Unless your friend doing 70/day… has just a handful of MD’s writing the same 24 drugs… I would bet that his inventory dollars have close to doubled since he opened.

    When we started in HME in the early 80′s we went to a training program put on by Mc Kesson.. taught by a husband and wife who had been in the HME business in FL.. He claimed that it would take $150K to “get into the business”.. I thought that he was nuts… $500K later .. cash starting flowing.. But then, I ended up being the largest HME dealer in a two county area.

    I hope that you are right and I am wrong.. but.. I have watch/dealt with bureaucrats for nearly 40+ years.. They are very predictable in what they do.. how they do it..

    They just reinventing the same program and calling it something else.. Medicare Advantage .. is a good example.. this is the third version of this program first Medicare HMO… then Medicare C… and IMO.. Medicare Advantage has a few more years before it also implodes.

    IMO.. this Obamacare is a whole different animal.. now it is guaranteed to be in place in 2014..
    Healthcare is going to see a more centralization of services… we will see capitalization of payments.. we will see pts locked into a specific network for entire calendar year.. like Part D works now..

    Things are going to change and most likely neither the providers nor the pts will be happy with the changes.. but.. that is what the majority voted for…

  33. broncofan7  •  Nov 24, 2012 @10:39 pm

    Steve, of course a new Pharmacy(LIKE ANY NEW business)won’t cash flow positively until they reach that threshold of 90-110 rx’s a day for 120 days..after that they will be capable of easily paying their obligations both present and interest charging accounts payable ….RE: intial inventory, many of the smaller wholesalers give better repayment terms (up to 16 weeks of inventory at no intial charge I’ve heard) than does Mckesson…Mckesson gave me the typical 4 weeks worth of initial inventory of which the dollar amount is then divided up into equal payments over a 6-9 month period (those were my terms). With 2012 having been a bellcow year for generics (diovan HCT,Actos, Lipitor, avapro, singulair, etc) the secondary wholesalers like ANDA will be heavy players is restocking after the initial inventory. #1 ANDA has better prices on generics than MCK and give 30 days to pay..#2) they give the buyer a 5% credit of total purchases that are given toward FREE generics like lisinopril, losartan, furosemide, potassium and some others. Pharmacies literally can get these drugs for FREE now from ANDA. A Pharmacy needs to have ~ $40K cash in the bank to effectively weather the intial bumps of starting the Pharmacy..and that is from personal experience. MCK Healthmart will give large credtis off for start ups on equipment and signage…LiveOak bank and 1stMED financial(broker) are experienced lenders to Pharmacist’s and other Healthcare professionals and can easily fund buyers with good credit willing to sign a personal guarantee Is it risk free? Of course not, I never said it was….. but the payoff is that every negative thing that some seem to write about on this site is something that they won’t likely have to experience…something else for some to ponder…if the “stuff does hit the fan” due to othe ACA, wouldn’t you rather be in a position of ownership than simply as an employee completely at the mercy of a penny pinching publicly traded corporation?? Employee Pharmacists who think that they have no leverage now, just wait if Pharmacist Steve’s doomsday scenario comes to fruition, you will really not have a leg to stand on.

  34. Pharmaciststeve  •  Nov 25, 2012 @6:07 am

    @broncofan.. Someone starting a new business today… with the unknowns of the ACA on the horizon and all their personal assets on the line… might find that a penny pinching chain is a better option… until all the dust settles.

    Once the government evolves the ACA into a single payor system – IMO – by the end of the decade… the Feds’ only concern is that everyone has some access to healthcare services and constricting the gross expenditures of the system.

    The government could care less if any business shows a profit. There is no reason to believe that once the Feds becomes the sole payor.. that they won’t follow the same system that they have with HME and put “the business” up for bids… just like they do on most major purchases.. this is where the ACO’s will come to play in the new system.

    Personally, being at the front end of the “baby boomers” and now on Medicare… it scares the hell out of me that when I am approaching the period in my life where I will probably need much more from our healthcare system… me and the other baby boomers will end up on the short end of the healthcare system.

    During my career, I bet “the farm” several times and at least one time.. nearly lost it all.. I was not smart enough to know what I didn’t know or understand..

    when I was your age, I too had acute hyper-0ptimism .. and I hope that every young RPH that wishes to have their own store is successful in doing so.

    Let’s hope that you are as successful as I was to be able to retire at 49.

  35. Pharmacist Bob  •  Nov 25, 2012 @7:43 am

    I like the idea of owning my own pharmacy and I appreciate the material brocofan has brought to this forum. What I don’t like is the fact that your business has to compete with these penny pinching companies that are now giants in terms of the amount of professional pharmacists they employ and how much of the market share they control. It would be difficult for the new startup to offer 60 inch TVs in the $600 range and $25 to $30 coupons for transferring a prescription. The coupon offers are so un-professional if you consider that continuity of care will be disrupted all for the mighty penny to be delivered to the offending company shareholders! Personally I would do whatever it takes to run them out of business just like Twinkies, they so deserve it. Unionizing is an option for pharmacists as we are not a dime a dozen yet and could not be replaced like a register person that does not require licensing. Any cut to current wages should cause an uprising from the pharmacist masses I would hope.

  36. Broncofan7  •  Nov 25, 2012 @10:00 am

    Thanks Bob. For business capital loans As a rule of thumb for every $100,000 borrowed from a lender you’ll owe ~ $1000 per month over 13-15 years ( which is the typical length of pharmacy loans ) … Plus the interest on those loans is deductible and a pharmacist can obviously get by while paying himself $1-2000 dollars less per month in salary if need be with thd ultimate goal being making additional income above ones RPh salary as the owner. And I agree with Steve that we as Pharmacists need to be very in tune with the political happenings on capital hill… We can do this by contacting our state pharmacy organizations and the NCPA who now even has a legal team available to brief members…

  37. Peon  •  Nov 25, 2012 @11:29 am

    “The government could care less if any business shows a profit. There is no reason to believe that once the Feds becomes the sole payor.. that they won’t follow the same system that they have with HME and put “the business” up for bids… just like they do on most major purchases.. this is where the ACO’s will come to play in the new system.”
    -
    Steve, I think you pretty well summed it up. I can remember when durable medical equipment was a lucrative business for pharmacies. That was until the government took the profit out of it for the pharmacies. As you say, the FED’s don’t care if a pharmacy makes a profit or not. And, I bet that in the coming years we are going to see pharmacies squeezed more and more, along with all other providers. I would hate to be in the position owning a pharmacy and depending on the government for my income.

  38. Broncofan7  •  Nov 25, 2012 @1:03 pm

    What were the typical margins 20 years ago on DME? and if DME is so unprofitable why do stand alone medical supply stores still exist? Here’s what I’ve come to understand about RPhs who have practiced since the 1970′s …. Most who were owners were used to making 40% margin on drugs just as we do on OTCs here today. SO when the PBMS came into an ever increasing role of squeezing margins , those Rph owners who were used to making 40% simply through their hands up and sold out to chain stores or closed down altogether. I may get paid $1 over AQ on bactrim ds but I get paid $30 over AQ on lotrel…. The business is still viable but those who practiced it during a time when 40% margins were expected didn’t truly realize how capably they could have competed. The same is true regarding DME.

  39. Pharmaciststeve  •  Nov 25, 2012 @1:52 pm

    @Peon.. IMO .. by the end of the decade all of us in healthcare will be employed by the government — because that is who is going to be paying for – and setting the allowables – for the entire industry.. EXCEPT.. we won’t have all the benefits of being an employee of the FEDS.. think dozens of three day weekend holidays…as a starter..

    right now… MD’s have a 20+ % reduction in Medicare allowables – and growing – hanging over their heads at the end of each year.. hoping that Congress will give them a reprieve for another year..

    I know the six prescriber group that we go to.. are no longer accepting new Medicare pts.. they will allow existing pts that go on Medicare to stay in the practice..

    The Medicare law even has in place that if a MD does not accept assignment on services they cannot charge the pt more than 15% above the stated allowable. Just imagine the FEDS paying all the bills under such restrictions and then starting to ratching down the allowables…. and or making the medical necessity for some expensive services so onerous… that it is nearly impossible to get them covered.

    You are correct about HME.. I got into the HME business back in the early 80′s when the DRG’s were just kicking in and the hospitals were discharging pts “quicker and sicker”.. but it cost me 500K back then before a positive cash flow started.. it is a very capital intensive business between buying equipment to rent and carrying the receivables.

    If you have never ran a business and had to pay the bills.. the FEDS require you to work on an accrued accounting basis.. meaning that you owe taxes on a sale when it is done vs a cash basis that you owe taxes when it is received.. When you have a very capital/AR intensive business .. inventory & AR increasing… a new growing business can show a profit – on an accrued basis – and have a serious negative cash flow.. when you have to pay the taxes.

    I can remember long periods in my early years.. when there was no money left for me at the end of the month.

  40. Peon  •  Nov 25, 2012 @7:59 pm

    Broncofan7, there are no pharmacies in my area carrying medical equipment. If there was money to be made, don’t you think some of them would be doing it? Where I work, we handle Medicare Part B diabetic supplies. It is such a hassle to get the claim paid! We can fill 10 prescriptions in the time it takes to do one of those. Then, we are starting to get letters from Medicare wanting copies of rx’s, a letter from the physician about the diagnosis, and etc. We are busy and we just don’t have time to fool with this crap. As far as I am concerned, the folks that specialise in this sort of thing can have all these patients! Since I work for a chain, I have no idea what they make. My guess is very little if anything. The chains concern is getting the patient in the door. They think they will make up any losses on something else. I think the day is fast coming when the idea of taking a loss on one thing to make money on another is going to a lost cause. As pharmacists, we have given away too much for far too long.

  41. pharmacyslave2000  •  Nov 26, 2012 @1:10 pm

    This is an interesting conversation. Broncofan7, I am your age. I’ve been a retail pharmacist for 11 years and I’m pretty well burned out. I congratulate you on your successful business endeavors, however, I feel you may be over simplifying things. I know of very few indy’s that have started from scratch in my area. Most were purchased from long-term established business owners. There may be some money to be made but I have to agree with the older fellas on this one. This is not the economic climate in which to start up a new business, especially a healthcare business, as there are to many unknowns right now. I can’t see the future of healthcare being especially kind to pharmacy. We are an easy target. No strong leadership organization, no big-money lobbyists and companies with no plans on alternative revenue streams other than increased volume of rx’s. It’s easy to just decrease the price paid for a commodity, i.e. rx drugs, to “save” money. I believe we will see harsh decreases in reimbursements while having an increase in volume. Therefor, we will be doing MORE work for LESS money. The stress levels will increase exponentially.
    ***
    My goal is to be out of pharmacy by the end of 2013. I’m not willing to be part of what’s on the horizon. Good luck to you Boncofan7.

  42. Pharmaciststeve  •  Nov 27, 2012 @1:03 am

    @Slave… I prefer the term “Senior Pharmacist” as opposed to “older fellas” :-)

  43. Wrong Aid  •  Nov 27, 2012 @12:20 pm

    Pharmacyslave2000, I would be interested in hearing of your plans for a way out. I’m always looking for ideas to look in to.

  44. pharmacyslave2000  •  Nov 27, 2012 @10:02 pm

    Pharmaciststeve, you got it. How about “seasoned pharmacist”. Wrong Aid, I’m always looking for alternatives. Pharmacy was never my first choice as a career. It’s what was left after other things didn’t work out as expected. I know quite a few people in the medical field. I’d like to maybe try my luck in medical sales. I think I could leverage my knowledge and experience and be successful. I’m looking for something where I can dictate my success or failure and be paid accordingly. I’m tired of busting my ass doing 450 rx’s per day and getting paid the same as the guy doing 100. I think if you keep an open mind and look around, you’d be surprised by what you may find.

  45. Pharmaciststeve  •  Nov 27, 2012 @10:36 pm

    This post showed up on another website…

    I have had supervisors that stood up for us & fought to get the hours we needed. Now I’m working 50 hr/wk paid for 40 with pay cut in Dec!

    Let’s see.. we are “professionals”… so there is not a push to make us “salaried” and don’t need to pay us –
    overtime..per the law..

    Just remember, when your salary goes below $455/wk… you can no longer be considered “salaried”… you automatically becomes “hourly”… per the law…

    But then.. according to the Maya calendar.. the world is suppose to come to a end on Dec 21st… so it really may be a non-issue :-)

  46. broncofan7  •  Nov 28, 2012 @7:23 pm

    @pharmacyslave..thank you for the well wishes but I am not over-simplifying things. unfortunately as long as 95% of the Pharmacist’s who graduate continue to think inside of the box (like I did)instead of as individual practitioners then we will continue to suffer under poor working conditions as dictated by the chain drug store bean counters. I am writing not from hearsay but rather from my actual experiences today (not 5 years ago, not 20 years ago, not working for some trust fund baby who yells at me b/c of increased inventory dollars)..all it takes is differentiation of services (free home delivery for example, free flavoring of medicines) or a niche (compounding, taking the extra time to do DME billing) to drive the foot traffic necessary to have a sustainable if not succesful business (again 90-100 rx/s per day is break even territory)-too many of us take a “defeatist” attitude towards ownership and current faculty at Pharmacy schools stress clinical jobs and residencies rather than entrepreneurship…..

  47. broncofan7  •  Nov 28, 2012 @7:24 pm

    http://www.doughertys.com/locations.php

    These guys do it THE RIGHT WAY. I am patterning myself after them……

  48. broncofan7  •  Nov 28, 2012 @8:00 pm

    http://www.drugchannels.net/2010/09/surprise-independents-not-vanishing.html#.ULaydGf4JLw
    “Q: According to the new 2010-11 NACDS Chain Pharmacy Industry Profile, which of the following pharmacy formats had the biggest growth in number of locations in 2009?

    Chain Drug Stores
    Independent Drug Stores
    Supermarkets
    Mass Merchants

    Believe it or not, the answer is … Independent Drug Stores! In fact, independents added 474 locations (+2.3%) in 2009, almost three times as many as chains (+177 locations, +0.8%). Even more astounding, the newly-revised NACDS data now show the number of independents increasing by 1% over the past seven years instead of declining by 10%.”

    I am posting this information in the hopes that someone else who is currently in the position that I was in a few years ago is able to take interest in pursuing a successful ownership…opportunity is out there…it just takes a certain amount of chutzpah and some of what I deem common sense…As a whole,and many of us know this, my generation of Pharmacist’s seem to be great at being “book smart” but may lack the internal decision making ability that previous generations have had……be a Chief and not an Indian….

  49. broncofan7  •  Nov 28, 2012 @10:31 pm

    and to be clear, I respect every poster on this site. I truly appreciate the different perspectives that are formed and expressed from people who have practiced in different environments and/or in different times. My goal is to hopefully reach that 1 person who may lurk on this site to let them know that ownership is a real possibility if you have the right skill set. If one were to go and ask 100 people if they are capable of doing something, it’s easy to find 99 people to tell you why you can’t or won’t succeed (my old man is GREAT at that)but it’s rare to find someone to show you how you may be able to succeed…and it’s my goal to hopefully be able to share my positive experience in ownership to others..Further the NCPA ownership workshop is a great tool(google it)/resource as are other independent Pharmacists….

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