Innovations in Pharmacy Panel

1. Cheri Garvin, R.Ph., Leesburg Pharmacy Chris Simmons, R.Ph., PCCA Lea Wolsoncroft, R.Ph., KidsMeds Pharmacy NCPA Future Pharmacist Programming Innovations in Pharmacy Panel

2. Cheri Garvin, RPh Owner/CEO Leesburg Pharmacy Cheri@LeesburgPharmacy.com Innovations in compounding pharmacy

3. Opened in 1976 Located in Leesburg, Virginia which is 45 miles NW of Washington, DC Leesburg is the county seat of Loudoun County, the fastest growing county in the US Age categories: <19 = 13%, 20-44 = 44%, 45-64 = 19% and >65 = 6% Average household income is $115,000/yr Leesburg Pharmacy, Inc.

4. Tour of Leesburg Pharmacy

5. Mix of Business

6. Compounding is the method of preparing customized medications to help meet unique prescriber and patient needs. What is Compounding?

7. The Compounding Center

8. Potential for greater net profits than traditional prescriptions Sets you apart from your competition It is professionally rewarding (and fun!) Considering Compounding?

9. More labor intensive than traditional Rx Considering Compounding

10. Requires specialized equipment and training Liability concerns and insurance billing Considering Compounding

11. Fee and appointment based consultations are offered in our Wellness Center Consultations

12. Bio-Identical Hormone Replacement Therapy • Estriol, Estradiol, Progesterone, Testosterone, DHEA, Pregnenolone • Customized dosage forms and combinations Men’s and Women’s Health

13. Supplements for patients with Lyme Disease • Vitamin/mineral replacement • Herbal protocols and Probiotic support • Sugar free and Dye free preparations for Autistic patients • Intestinal support: • Probiotics, yeast protocols, chelation • Specialized vitamin/mineral formulations • Liquid, capsule, powder-mix Nutritionals

14. Supplements and lifestyle/dietary changes • Customized thyroid preparation • T4, T3, SR and IR and combinations Thyroid and Adrenal Fatigue

15. Your target audience might be the patient OR it might be the prescriber Direct marketing to consumers Direct marketing to physicians – offer to solve a problem Host seminars (HRT), attend local events (horse and dog shows) Word of mouth Marketing

16. Policies and Procedures Process validation and consistency Sterility and Potency Testing Protection for staff Quality and Safety

17. State Boards of Pharmacy regulate compounding pharmacies Compounding pharmacists should be compliant with the USP chapters 795 and 797 on non-sterile and sterile compounding (process validation, sterility and potency testing, P&P in place and followed) PCAB accreditation – the best thing we ever did! Regulations and Accreditation

18. Professional Compounding Center of America International Journal of Pharmaceutical Compounding International Academy of Compounding Pharmacists National Community Pharmacists Association Resources

19. Innovations in Veterinary Compounding Chris Simmons, RPh VP Creative Development PCCA

25. Flavoring News

38. Pediatric Pharmacy Practice Lea Wolsoncroft, R.Ph. KidsMeds Pharmacy

39. Why choose pediatrics? • Children 6 and under are the 2nd largest group that uses medications • Seniors use the most medications • 60 million (20%) of the US population are children under 14 • Nearly 80% of medicines marketed in the United States do not carry recommendations for use in children • Pharmacists that specialize in pediatrics are needed • Out of 250,000 pharmacists in US, about 1000 specialize in Pediatrics and 99% of those work in hospitals. .

40. Clinical Services • OTC Selection and Counseling • Pulmonary • Asthma, COPD, CF • Influenza, H1N1 • Immunization • Compounding • Nutrition Counseling • Diabetes • Obesity (weight management) • IV services • Specialty Meds (biotech & oncology • Flavoring

41. Critical need for pharmacists counseling to prevent harm • DDD (Drug, Dosage, Duration) - varies by age and weight of child • When to refer to physician? • Most common health issues in pediatric population • Cough, Cold, Fever • Pain • Itching, Rashes • Constipation, Diarrhea, GI issues • Allergies • Business Opportunity: High profit margins (35-50%) And NO third party billing OTCs

42. Disease states that can be managed • Asthma • COPD • Cystic Fibrosis • Help manage disease therapeutically and through lifestyle changes • Opportunity to mange patients with Collaborative Practice Agreements (CPA) • Business Opportunity: Service fee for education, disease management, and sale of supplies Pulmonary

43. Opportunity for educating patients regarding • Disease prevention • Distinguishing seasonal influenza from novel H1N1 • Treatment options • Administer Influenza AND H1N1 Vaccines • Business Opportunity: Administer vaccines (cash payment, can work with schools and day care centers), disease education (H1N1 FAQ), and sale of supplies (masks, hand sanitizers, and thermometers)1 1http://www.cnn.com/2009/HEALTH/07/25/uk.swine.flu.pharmacies/index.html Immunizations

44. Currently all 50 states allow pharmacists to provide immunizations • Pharmacist administer immunizations check your State Regs • Age limitations: can you vaccinate children of all ages? • Does state require RPh to finish certification course? (these often cover CDC guidelines and give CPR certification) • Are interns allowed to immunize while working under trained preceptor? • Do you need to work under protocol and obtain patient consent? • Pre-notify PCP if contraindication (good practice to notify/document) • Business Opportunity: Cash payment & third party billing. Can partner with local pediatricians, day care center, and schools Immunizations

45. One of the highest profit margin services • Huge opportunity in pediatrics as children • May not like taste of medication • May not like taking pills • Cannot take medication by mouth • Commercial products may have inappropriate doses • Rx needed that is alcohol, sugar, or dye free (allergies) • Require medication in an alternative formulation: rinse, gel, pastes, cream, suppository, etc Compounding

46. One of the newer services offered in pharmacies • Provide nutrition information to parents and children to address • Obesity • Diabetes • Poor growth • Hyperlipidemia • Eating Disorders • Food allergies • Chronic diseases (COPD, CF) • Provide various weight management programs • Offer parent and children fun cooking classes Nutrition

47. High demand for management of diabetes in children • 186,300 children OR 1 in every 400-600 have Type 1 diabetes • 2 million overweight adolescents have pre-diabetes • Type 2 diabetes is on the rise among age 20 and under population • Help manage disease therapeutically and through lifestyle changes • Business Opportunity: Sale of diabetic supplies, education, and disease management Diabetes

48. Number of obese children under 11 years have doubled since 1980 • Need for pharmacists to inform parents and children about long term effects of obesity • Increased prevalence of CV diseases in adolescence and adulthood • Business Opportunity: Obesity prevention/treatment education, weight management (could work with a nutritionist), offer fun physical fitness program utilizing Wii fitness gaming system Obesity

49. Pharmacists specializing in pediatrics are needed in community pharmacy setting • Many clinical services can be implemented • Opportunity exists for implementing profitable business services • Greater earning potential as pharmacy owner • Pediatric Specialty pharmacy presents a model of innovative clinical practice and a profitable independent pharmacy niche Conclusion

50. NCPA – National Community Pharmacy Association http://www.ncpanet.org • Lea Wolsoncroft, KidsMeds Pharmacy • http://www.kidsmedspharmacy.com/km_web/index.html • PPAG – Pediatrics Pharmacy Advocacy Group • http://www.ppag.org/ • Kids Meds • http://www.kidsmeds.info/ Resources