Q&A: How a Community Pharmacist is Helping Other Pharmacies Through Consulting

Pharmacy has been a constant in the life of Benjamin Jolley, PharmD, an independent pharmacist at Jolley’s Compounding Pharmacy in Salt Lake City, Utah. From his grandfather and father introducing him as a store clerk to branching off to do his own pharmacy consulting, Jolley has made the most of his career opportunities to grow in the profession and help more and more patients throughout his journey.

“I am now a licensed health care agent for an insurance agency. I can help my customers to choose Medicare plans, to choose Affordable Care Act plans. I think that the potential role of a pharmacist agent is a really interesting one,” he said.

Aside from discussing his overall career path in pharmacy, Jolley addressed some of the overarching issues that impact his profession. Keeping his finger on the pulse of community and retail pharmacy, he’s been tracking the trend of closing storefronts in the past year and the declining reimbursements that have caused these shutdowns.

Benjamin Jolley, PharmD, an independent pharmacist at Jolley’s Compounding Pharmacy in Salt Lake City, Utah | image credit: Benjamin Jolley

Drug Topics: What initially drew you to the pharmacy profession, and how has your career path unfolded?

Benjamin Jolley: My grandpa was a pharmacist. He started my family's pharmacy here in Salt Lake City. So, I mean, I grew up in pharmacy. So it was, in some measure, just the most obvious thing. My grandpa was a pharmacist. My dad is a pharmacist; he owns the pharmacy where I work. I started working there as a clerk in the pharmacy, when I was 14 years old. I came to find that I actually enjoyed the job and enjoyed helping people get their medicines, enjoyed figuring out problems of insurance coverage, problems of just systems and making sure they work. That was what drew me in. I went to pharmacy school 10 years later.

Since I graduated pharmacy school, my career path has been rather different than I think most folks. I work in the pharmacy. I started working in pharmacy actually like 60 hours a week because I had no idea what I was doing, and I was basically the only person running the place because dad went on vacation the first week I was back. But since then, I've developed also a consultancy for other pharmacy owner-operators to help them understand how to use their software more effectively, how to run their operations because there are a lot of a lot of problems that pharmacies basically all have to solve for themselves. When [an] owner-operator starts their own business, they figure out, how am I going to do this thing? How am I going to do that thing? And through trial and error, I've learned that there are some right ways to do things and some wrong ways to do things. So, that has been a significant development in my career path has actually been consulting with other folks; particularly that was primarily around what that direct indirect remuneration is in Medicare. I helped a lot of pharmacy operators understand DIR fees.

That's a short version of how my career path has unfolded. Basically, I spent a lot of time in the pharmacy, figured out some solutions to problems that were translatable to other people, and then started helping people in social media sites, and then that grew into a consulting business that is where I spend most of my time. I still do practice in the pharmacy 1 or 2 days a week.

Drug Topics: Can you touch on some of the rewards and challenges within your practice setting?

Benjamin Jolley: Rewards-wise, it is very personally satisfying. It's a compounding pharmacy; it's a retail and compounding shop. Some of the rewards, though, are certainly the gratitude of people when you solve a medication problem, using compounding in particular. [It’s] immensely gratifying from a professional standpoint. To be able to say, “Oh my goodness, my kid couldn't take their medicine and you guys prepared it into a suspension,” that feels really good. Being able to change the, basically, operating system of the pharmacy, the background kinds of things that most people can't change, to me is really rewarding. One of the things that I have done that I think is really useful and has been really nice for me and for my customers has been: I changed the way that our prescription label is laid out to include deductible information. PBMs send us deductible information on every prescription, and I was able to put that information onto our label so that when someone says, “Oh, my copay is so high,” my staff, even the lowest clerk who just barely came on the job 2 weeks ago, can explain to the person that the reason their copay’s so high is because they have a deductible, not just because their insurance company sucks or something to that effect, but that this is a short-term thing. Once they hit that deductible, their copay will go down.

READ MORE: Chain Pharmacist Shares Keys to Success in Retail Settings

Challenges-wise, community pharmacy practice in general is really, really tough from a financial standpoint, [from] a business-owner perspective. But also, that translates into, for anyone who works in a chain retail site, the margins on prescriptions are not what they were 10 years ago, even for the largest pharmacies. And so that translates to a need to have lower staffing, because there's just not the money to pay people. So, it's really tough to ensure that the pharmacy stays cashflow positive, stays profitable, and that we don't lose money. There's only so much money that a pharmacy can lose before the owner has to say, “You know what, I can't mortgage my house. I can't, I can't liquidate my retirement. I need to, I need to get out.” And I mean, just this year alone, over 1100 pharmacy owner-operators have closed their doors, and 1100 chain pharmacies have closed this year.

It's a very difficult position from a business-owner standpoint to make the business profitable. It's really tough. To some degree, the way that pharmacies get paid, from a global perspective—by insurers, PBMs, third parties generally—it kind of cheapens the pharmacist’s role to me. When I went to pharmacy school, I was trained to be a medication expert, to make sure that people are on the best therapies they can be on for their disease state, to make sure that they understand what their medicine does, how it works, how it helps them, what kind of side effects they can have, how we can mitigate those. In short, [we’re] making sure that the medicines they're getting are the most affordable, best drugs for them.

But the way that we pay pharmacies in this country is this really screwy system where, depending on the exact pills in the bottle, the pharmacy might make 10 cents, might lose 30 bucks, and might make $3,000, which makes, especially people in independent practice, of necessity, have to take on a second job as a commodities trader on Wall Street. Except [it’s] not really on Wall Street, just a commodities trader for prescription drug items. Make sure they know, okay, this product is going to be cheaper for me than this product. This one has a better reimbursement than that product. I get the reasoning for why it exists, but I still think it's dumb. Pharmacies are service providers first and foremost; they're not retailers first and foremost. And we should be paid like service providers. We should be paid just the cost of acquisition of drugs, plus a fee to cover the dispensing, the service that we provide, not a different price for every single drug.

Drug Topics: What do you think needs to be done to overcome the challenges that are facing pharmacy?

Benjamin Jolley: I think a big starting point would be if Congress would pass HR 9096, the Pharmacists Fight Back Act. That would do a big chunk, because that would make all federal programs pay pharmacies as service providers. It would pay the way I described, instead of the insane random-markups-on-drugs system that we currently have that makes running a pharmacy feel like pulling the slots in Vegas. Sometimes you get 2 cherries, and sometimes you get triple 7s, and sometimes you get whatever you get. It would change that system to be: Here's the cost of the drug, we're going to add a service fee to that, [and] that's what you get paid as a pharmacy. And I would do that to all federal programs.

Federal programs account for 60%-70% of all of the revenue that a typical pharmacy does. That would change the name of the game for how pharmacies get paid, and then the insane slot machine game would only be confined to the remaining 30%-40% of prescriptions. That's something I think can be done is the Pharmacists Fight Back Act. But it's really not something that can be changed without government action, because so much of the money that funds pharmacy operations is from federal government programs.

Drug Topics: What's going on at your pharmacy that highlights the role of pharmacists in patient care?

Benjamin Jolley: My coworker, the other pharmacist that works most of the time at the pharmacy, we've been dispensing a lot of Ozempic and similar kinds of products. He has been frustrated that people just expect to take a pill, take a shot, and suddenly lose weight magically. We've implemented a weight-loss training program for folks. We charge a small fee for them to sit down with the pharmacist for 30 minutes or so with him specifically. He's a Brazilian jiu-jitsu national champion. He knows what he's talking about with training, with muscle mass build, with fat loss, etc. He sits down with our customers that are getting these medicines and just walks them through. [He tells customers,] “Yes, this medicine will help with your weight-loss journey, with your desire to do all these things, but it's not the only thing and we need to also change your behaviors so that we can get that done.”

Since we started doing this, like 2 months ago, where he's sitting down with folks, I have had so many of our customers just rave about his ability to explain the chemistry, explain the training, and so forth, to them. It's that mixture of his athletic background with his pharmacist background that makes us able to provide that level of service.

Drug Topics: What are some other opportunities for pharmacists to expand their scope within patient care in today's health care landscape?

Benjamin Jolley: I actually just got myself licensed with another job. I am now a licensed health care agent for an insurance agency. I can help my customers to choose Medicare plans, to choose Affordable Care Act plans. I think that the potential role of a pharmacist agent is a really interesting one. Pharmacists already sort of work as uncompensated insurance agents. A lot of the time, they help people figure out what's on formulary. They help people navigate their benefits. They explain what a deductible is; all of these things. But we just get paid for the pills that go in the bottle at the end of the day, not for the work of doing that agent job.

Additionally, a lot of the differences between plans, particularly in Medicare, is which medicines are on formulary, how much of a deductible there is. This is stuff that folks working in community retail settings know intrinsically because we have to explain to our customers every day. A pharmacist becoming a health insurance agent, I think, is a pretty natural thing. Sort of felt weird at first, but after I thought about it for a while and after I actually took the agent exam and so forth, it's a very natural thing to do, and it allows us to get compensated for assisting folks in choosing plans.

I've done this for years in the pharmacy before I was an agent, where I would just sit down with people help them choose a Medicare plan because it's important to their financial health, it's important to their physical health, that they get the right medicines. But a pharmacist has the ability beyond that of an agent to say, “We could switch your medicine from this to this,” rather than just, “Let’s put in all your drugs, and we'll just choose whatever plan the computer spits out.” We can add a second layer of analysis there and say, “The medicine you're on, isn’t actually my favorite drug?” If we switch this to this, then actually this other plan that's actually cheaper for you comes up as the best option. I think that's one of the more interesting ways for pharmacists to expand their horizons.

To read more from this series, visit our American Pharmacists Month resource center.

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