To compete against the big drug store chains, Buford Road Pharmacy sells home health equipment and offers in-store fitting for custom order Dr. Comfort brand orthopedic shoes, among other services.
“Because there is not much (profit) margin in pharmacy retail sales of medications, that’s why we have the home health department,” said pharmacist Wendy Bare, store manager at Buford Road Pharmacy at 2608 Buford Road which last month marked its 60th anniversary.
“Your standard rollators, wheelchairs, lift chairs, hospital beds. … We don’t have the Medicare contract so we can’t bill Medicare for it. But a lot of people, they just might prefer to have a hospital bed,” and be willing to pay for it out of pocket, Bare said. The store rents and sells home health equipment.
Lafayette Pharmacy, a community pharmacy that turns 80 this November, also has adapted to the changing pharmacy landscape by adding services not always available at chain pharmacies, pharmacist Mel Fitzgerald said.
“If you are just going to pour and fill, you are not going to be around,” said Fitzgerald, who has owned the small neighborhood pharmacy on Lafayette Street in Richmond since 1986.
“So we have developed a niche here. It’s called adherence packaging, where we package (drugs) for people at home. It has just exploded,” Fitzgerald said.
Independent, community pharmacies realizing that they can’t compete on drug prices against the CVSs, Walgreens, and Rite Aids of the world or the mail order pharmacies are putting more emphasis on their ability to be more flexible and provide more personal service, including prescription delivery, custom compounding, convenience packaging of prescriptions, and related services such as immunizations, medication counseling and more.
“Over the years, we’ve reinvented ourselves multiple times, looking for the newest niche, something unique that you can’t find at other pharmacies,” said pharmacist Catherine Cary, president and chief executive officer of Bremo Pharmacy, which was founded in 1976 by her father, Dan Herbert.
“The consistent has been that relationship part, though. We’ve always prided ourselves on getting to know our patients and making sure that we are helping them stay healthy, making sure the medicines are working for them,” Cary said.
Even so, Bremo Pharmacy had to figure out new ways to build a client base and generate revenue, she said.
The pharmacy has a long-term care division that is focused on serving smaller, community adult homes and group homes.
It also has an arrangement with HCA Virginia’s Henrico Doctors’ Hospital to offer bedside delivery to patients being discharged. With Bremo Bedside, Bremo employees come by and pick up prescriptions, have them filled and bring them to the patient before the person is discharged from the hospital.
In another customer-friendly effort, Bremo Pharmacy offers the SyncRX program where customers with multiple prescriptions can arrange to have them refilled at the same time.
“You just have to distinguish yourself as different. It’s what we try to do,” Cary said.
“We don’t have a drive-thru, and we’re not open 24 hours. But what we do thrive on is building that patient connection and helping to make sure people are taking their medicines and getting well,” she said.
Nationally, about 22,000 independent community pharmacies operate in the U.S. — a number that has been stable for the past 10 to 15 years, according to the National Community Pharmacists Association.
“The real change happened from about 1980 to 2000,” said John Norton, spokesman for the association, which is based in Alexandria.
“That is where you saw the real growth in terms of chain pharmacies. … That is when you saw a lot of independents being purchased by these publicly traded companies,” he said.
The biggest chains are CVS, which has about 9,700 pharmacy stores, and Walgreens with about 8,175. Walmart and Rite Aid each have about 4,500 stores. Kroger has pharmacies in 2,255 of its stores.
Overall, independent pharmacies make up close to 40 percent of pharmacies, Norton said.
“Independent pharmacies serve a need. We offer a lot of different services that chains don’t have the flexibility to offer,” Norton said.
In Virginia, about 9 percent of licensed pharmacists in the state work in independent community pharmacies, according to a 2015 Virginia Department of Health Professions workforce report on pharmacists. The report is based on survey responses of 12,440 pharmacists.
Norton said the main competition for independent pharmacies is not so much the chain drug stores as it is mail order companies.
Insurance companies contract with pharmacy benefit managers, PBMs for short, to oversee prescription drug benefits for employee health plans, and those PBMs often encourage patients to use mail order pharmacies to get the cheapest price or lowest co-pay, he said.
“They hand us take-it-or-leave-it contracts. They are not open to negotiation. We don’t have an alternative,” Norton said.
In some cases, the PBMs own the mail order pharmacies.
“They are our business partners and business competitors,” Norton said.
For independent community pharmacies to be competitive, they’ve got to establish a loyal customer base and be flexible.
“If you’re relying solely on prescription drug sales it can be challenging,” Norton said.
The pharmacy profession is changing in other ways.
In Virginia and the U.S., more women than men are licensed pharmacists, a profession once dominated by men.
Leah Argie, a 2011 graduate of the Virginia Commonwealth University School of Pharmacy, is one of them.
When the independent pharmacy in Charlottesville that she worked for closed earlier this year, she opened her own.
“I was faced with a ‘what am I going to do next type’ of situation,” Argie said. “There were jobs out there for pharmacists along different career paths. I have always been interested in owning a pharmacy. I decided to go ahead and go for it.”
Top Notch Family Pharmacy opened July 17 at 943 Preston Ave. in Charlottesville.
“What we feel like sets us apart is our customers service. We really try to treat everybody who comes in like family,” Argie said.
Top Notch offers custom compounding, free prescription delivery in town, home health supplies and custom medication packaging.
“Most people come to us for customer service, compounding and medication packaging. We are able to get prescriptions out to people quickly, and delivery is a big portion of it. The total package of all these little extras are why people say they come to us,” Argie said.
At Bell Creek Pharmacy, which opened in February, pharmacist and owner Hemal Patel also offers compounding, delivery and patient counseling. The pharmacy is located at 8324 Bell Creek Road in Hanover County.
“There’s a need for compounding. A lot of chain pharmacies don’t compound, so that was one aspect of it,” Patel said.
“Second was being your neighborhood pharmacist. A lot of times old school pharmacists knew their patients by name versus at the chain pharmacies. A lot of times you are seeing so many patients it’s more like a number rather than knowing the person individually. As a retail pharmacist at a chain pharmacy you will know some of the patients, but you are not going to know each and every one. The personal care is missing,” Patel said.
VCU School of Pharmacy assistant professor Lauren M. Caldas has a sense of what incoming pharmacy students are thinking about the profession. She is faculty adviser for the National Community Pharmacists Association’s student chapter, which has about 16 members.
Out of an incoming first-year pharmacy class of about 130 students, Caldas said maybe three indicate they plan to open up their own pharmacy.
Students get experience at independent community pharmacies during their course work. And after students earn their doctor of pharmacy degree, they can opt to do residencies, including a yearlong stint at a community pharmacy. Argie did a yearlong community pharmacy residency at Bremo Pharmacy.
“Independent pharmacy is kind of the heart of our profession,” Caldas said. “We are fortunate to have a strong, independent pharmacy network in Virginia.”