How Independent Pharmacists Build Their Brand In A Crowded Market

Drug Topics®: Hi TW, thank you so much for joining us today.

TW: It's my pleasure.

Drug Topics®: I wanted to just turn things over to you and have you introduce yourself to our audience and talk a little bit about who you are and what you do.

TW: Well, I'm a pharmacist on Williamsburg Drug in Williamsburg, Virginia. We have two stores here. And we practice very differently than most independent regular pharmacies.

Drug Topics®: Great. And that, kind of the different style of practice, is what I would love to talk to you about today. So can you talk a little bit about the diversified business model that you implemented and what that includes, and what gaps in the marketplace really prompted you to make that change?

TW: Great question. So to begin, when you look at the landscape, the normal way medicine is practiced today is "One disease, one drug," they'll wait until your blood sugar is 125, and give you Metformin, they'll notice that your cholesterol is too high, and it'll give you a statin. So, when you look at the model, and the way it's set up, it's just treating sickness, and it's basically keeping everybody sick. And so, what can us pharmacists do that's different than that? And that's how we ended up where we're at, we decided to do something different. And that is: let's fix the metabolic pathways, the things that are not working in our systems today, rather than just giving
you another drug. Some of these things are really interrelated. Let's say you have metabolic disease, so you have blood pressure, cholesterol and sugar issues. Well, those are all related to deficiencies. And so these deficiencies can be taken care of, so that you don't need the drugs. To give you a good example, we have a friend that's a physician, and a few years ago, he confided in me that he was just doomed, everything was getting worse. And so when we tested him, it showed that he was borderline deficient or deficient in 11 of the 15 nutritional molecules you need to process glucose. So we repleted him with all 11. In six days, his blood sugar was normal, according to his Dexcom six, and the next day his 1C was 4.9. So not only did we fix the problem, but we reversed the disease. Those are the kind of things that are available to us. It can be as simple as Vitamin D. A large part of the population is just depleted. You can't get the repletion because it's not available in the foods today. If you ate an apple in 1914, to get the same amount of nutritional value in 1993, you'd need 26. It's a whole lifestyle that you have to do differently than we used to.

Drug Topics®: Can you talk a little bit about what marketplace gaps really prompted you to make the shift into this business model? You know, if it was just issues with the insurance side of prescriptions, or if you just realized this was kind of the way for your pharmacy to go?

TW: Yeah, that's a good question. We do compounding, and I had a lady years ago, and we did a ZRT test with her, we knew exactly what a hormone should be. And we made the hormones for her, I checked back with her a couple of weeks later, and she was worse. She wasn't better, she was worse. And how could that be? "I knew what your labs were, we made the perfect recipe for you," I mean, you shouldn't be worse. And when we got to looking at it, women that are postmenopausal are usually going to have adrenal fatigue, or they're going to have a deficiency in vitamin B vitamins, or both. So, when I started figuring out that deficiencies was the problem, then we started really diving in to figure out what those were. And here it is, some years later that we have figured out that you have drug induced deficiencies, diet-induced deficiencies, and you can be MTHFR which means you cannot methylate so you need methylated vitamins. And so, with these deficiencies, once we started fixing those, we're starting to actually fix disease. So you're reversing disease. So let's say you have somebody that has scurvy, and you gave them vitamin C. Well, it will replete the scurvy, so it is gone. And that's what we're doing with patients across the board that have all these metabolic diseases and things.

Drug Topics®: That's incredible. It's very, very interesting, the way that's kind of changed, and just that model of treating patients. So it seems like based on that example, that patients have been receptive to these services and these products that you're able to offer. So how have nutraceuticals in particular really helped you optimize your revenue at your pharmacy?

TW: Again, great question, Lauren. The key to it, is that when you have somebody that needs magnesium, if they need zinc, or vitamin A, or whatever it is they're deficient in, we got to make sure that they actually get it so it works. That means it has to be absorbable, and it has to reach blood levels intracellularly. And so, we only use professional pharmaceutical grade supplements, because it's third-party tested, and we want to make sure that our patients are going to get a result. The last thing I want to do is give somebody a supplement and it not work. I mean, then we'd look like we don't know what we're doing. And the reason we do it the way we do it is that we believe in test, therapy, test: where we test you, we treat you, then we retest you. Then, I can show you the time, money and effort you spend is worth it. You are now healthier and the numbers show it. And, you have to feel better. It's just part of it. So it doesn't matter whether your hormones are out of balance, or you're deficient in one of these nutritional molecules that is affecting a process in your body that's no longer working correctly. Your body will do workarounds until it can't and then you end up with disease. So we want to fix all of that.

Drug Topics®: Great. Can you talk a little bit kind of about the financial side of that, and how that has impacted, you know, the revenue that you're now getting from these patients and bringing into your pharmacy?

TW: Oh, yeah. So we're actually above 40% sales and cash. And so 42%, 43%, 44% - somewhere in that range - of all of our sales is cash. And so it's a relief that we don't have to, like - when we were kicked out of TRICARE recently - I didn't have to lose any sleep, because we still have plenty of revenue. Now, fortunately, our PASO has got us back in it looks like, and we're getting some of our patients back. But it's one of those things that you don't have to worry about as much because all your revenue is not in one stream, which is prescriptions. And, you know, we're kind of dumb about how we've done this. We've tied our income to a product that's going down in value. And then we complain about it. And so we need to practice very differently. And one of those differences is how we practice on a daily basis with our patients so that we're helping them become healthy. Now, I can't help everybody because everybody doesn't want to be helped. And that's what Hippocrates said 2000 years ago, you know; You can't help someone if they don't want to be helped." But the people that do want to be helped, and are interested in living a long, anti-aging life, then those are the people we want to help. And it doesn't have to be 100% of your people, it can can be a small percentage. I mean, if I ask 100 people, and only 10 said "Yes," I still got 10 "yes's", and we need to go with that. Not practice out of somebody's pocketbook. It's not your pocketbook. It's not your decision how to spend their money, it's their decision how to spend their money. And I've got patients that are like, taking our Ananda professional CBD that you wouldn't think could afford it. But it works so well, they afford it every month. And so it makes a difference.

Drug Topics®: Yeah, I think that's a good point that you brought up. Even if only 10 people say yes, you're still impacting 10 people, you're still bringing revenue from 10 people into your pharmacy through this model. So I think specifically in terms of the financial side of things, what has been your biggest challenge in setting up and executing on this business model that you're using?

TW: Well, it's like everything else. Your your time has taken up, right? 100% of your time is already taken up doing whatever you're doing. So what are you going to give up to get something greater? And I think that's what all our pharmacists need to ask ourselves. Are you willing to give up a Sunday afternoon to study something new? Are you willing to give up half a day, being off, doing something that's going to bring in new revenue streams to your pharmacy. And so the first thing is, what are you going to give up to get something greater? And if you're not willing to do anything different, then your income won't be any different. I think that's the very first thing.

The next thing is: What is it that's going to make the biggest effect the fastest? I went about it very differently. We we have a full fellow in functional medicine on staff - All she does is see patients. Dr. Reid, she's a pharmacist and we charge $225 an hour, she's booked some time until the end of February, I think. So, we really have gone after it. I think a lot of people probably aren't willing to go that far. And you don't have to be; you can start out with just one supplement or two supplements. We started with vitamin D, I mean, everybody is just about vitamin D deficient. And they need a level of about 75 or 80 to be optimized. And so just optimizing vitamin D right away will give you a good start. If you want to do that, you can do 45 international units per pound. That's a good place to start.

Drug Topics®: So what are some of the pitfalls of this diversified revenue model that pharmacy owners should be aware of, you know, if they're looking to implement something in their own stores?

TW: Well, one of the battles that we've had is do you private label, or you don't private label? Private labeling usually means a lot of inventory, because you got about 12 or 24 or 48, or something. And so we've private labeled a lot, but we do sell a lot. So, it's a win for us. So we private label a number of the things that we do. You can't private label everything, some companies will let you private label some of their items, then others do. So we primarily use biotics research designs for health orthomolecular, some of those quality companies. And in some of that stuff, we do use Wellness Works from PCCA. And that's a nice one because you can buy one bottle if you need to. And so that's a little separate. But that's some of the issues is how do you keep your inventory stocked. You don't need a ton of stuff. But you do need enough to make sure that people are coming back. To give you an example, the average GNC sells $508,000 a year. The average pharmacist sales none or very little. And we should own that market. Why do we let a three week wonder outsell us? We shouldn't look at ourselves as selling to our patients, we're providing them opportunities to become healthier by fixing these metabolic pathways. And so if you've got a GNC or Vitamin Shoppe in your area, you should be killing it and not letting those people take advantage of us.

Drug Topics®: As you've gone further into this model, and you're really kind of shifting your business this way, do you find that patients are receptive to having to pay for these services? Or is this something that they're just like not interested in at all?

TW: Oh, we have tons of people, I mean, hundreds and hundreds and hundreds of people that deal with us, actually more than that, it's thousands, that deal with this all the time now. And they're pleased to do it. They're happy to do it. Because again, you're showing somebody that the time, money and effort they spent, now they're healthier. And the people that are interested in it are very happy that that they're getting the treatment that they're getting. I mean, we sell several hundreds of thousands of dollars in cash stuff a month. I mean, we do things like GI maps, we did 200 and some GI maps last year, which is a stool test. We're able to check and find out what's going on in your gut because everything stops and starts in your gut and makes a big difference.

The average American eats about three pounds of sugar a week. So they usually have candite in their gut that starts leaky gut which starts autoimmune diseases. So all these things are connected. You don't get to pick up a stick and pick up just one end, you have to pick up both.

Drug Topics®: Yeah, so it seems like as long as you're offering kind of that value for the patients, it seems like there willing to just kind of invest in this along with you, which is great to hear.

TW: You just said the magic word: value. And so, are you giving your patients the value that they want to receive? And we are. And that's why we're doing so well with it. Because it's all about the perceived value for your money.

Drug Topics®: So, you know, again, for those pharmacy owners who are watching this, who, you know, might want to start a similar business model, what are your top few tips for those pharmacy owners, so that they can deliver value to their own patients in their own communities?

TW: Just start with something. Start with vitamin D, that's a great one to start with, it's 45 international units per pound, if you use d3, it's 85% more absorbable than D2. Great place to start, you know. Everybody can benefit from CBD and fish oil, because they're anti inflammatory. Those are just easy ones to start with, you know, start with five or six, or even one. And once you get your patients using it, they'll see the difference. Like, for instance, nitric oxide is a foundational molecule for vein health. And as we get older, we don't make as much.

And on top of that, if your insulin levels go up, it decreases your nitric oxide level. And that's why diabetic patients have trouble with circulation. So, it's a win-win-win that you can do, just starting out with these few things: nitric oxide, fish oil, CBD, vitamin D, those are all great ones to start with.

Drug Topics®: Great. In terms of the money that you as a pharmacy owner would have to put out to get this started, what kind of advice can you give to pharmacy owners on that front?

TW: Well, I mean, it works. So first of all, it works. Second of all, if you start changing your model to more of a wellness model, it's not only better financially, but it's better personally. I mean, you'll feel better. Some of my fellow pharmacists, we all need to get in better shape and take care of ourselves. And so it's a win-win. And as far as what you're going to do to make it happen is that you've got to spend the time and money. I've got some friends in the business that are doing community stitches that are stitching their business to the community, they're hiring people that will, that will go out and do things for them like go to assisted living or a transitional living place. And they'll do some presentations and thing. We offer a speaker to anybody that wants a speaker. If it's a Kawanis Club, or Rotary Club, or whoever it is, just to be out in front of everybody. And it works.

Drug Topics®: So that's all that I had for you today. I think that at the end you made a really good point of kind of demonstrating how yes, this is financially beneficial for you and your your pharmacy, but also just really shows the value that community pharmacists can bring to the people that they take care of. So, thank you so much for for sharing all of that. I just appreciate you taking the time.

TW: Yeah, the most valuable thing that every independent pharmacy has, is its patients, and the trust that those patients have in you, the independent pharmacist. And so, if we can take advantage of that, we can become wellness centers where we're having healthier patients and healthier profits, which is what our goal should be.

Drug Topics®: Fantastic. Thank you so much TW, I really appreciate it.

TW: My pleasure, guys. Thank you!