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I thought it would be helpful (or entertaining) for anyone interested in
owning an independent pharmacy or looking to start a new one to follow along
with me as I work to re-open a store starting from scratch with no retail/
independent experience. The store is in Florida. I will try and highlight
things I learned that I had never been exposed to before. Please feel free
to offer advice or ask questions.
I will edit the OP so no one has to constantly scroll down to check for
updates.
My Opinion of What it takes/personality and planning
First I would not recommend anyone go about pharmacy ownership in the manor
I am attempting, it has been very stressful and hard, but I knew this before
hand and was willing to except the good with the bad. My best
recommendation is to spend 1-2 years researching and learning everything
about running/owning a pharmacy and coming up with a business plan. Anyone
that says independents can't compete with a chain doesn't know what they are
talking about; the key is to have a strong plan of what you are going to do
different than a chain to bring in customers. Research locations, niche
services, and demographic statistics and come up with capital, either save
money, get investors or partners.
And lastly, you have to be willing to take a risk and handle ups and downs
without getting discouraged or giving up also don't let anyone tell you what
you can or can't do in life, believe in yourself. I may fail in this
endeavor but at least I can say I gave it a shot and didn't sit on the
sidelines in the game of life.
Back Ground:
I worked my ass off at a hospital job and wanted more than anything to have
a career in hospital management/administration. Unfortunately I learned some
painful lessons in corporate politics. I wanted out and knew I had the work
ethic, organizational and communication skills and decision making process
to run a business and I was willing to take the risk. I believe in myself
and I believe in the American Dream. Main goal was to have increased job
satisfaction, not money.
March 7th, started looking for other jobs and ownership opportunities.
Previous Pharmacy Store Back Ground and Purchase of assets and leasing space
Found out an extended relatives pharmacy that had recently closed was for
sale (pharmacy not actually for sale, assets and a lease is what I bought).
Store closed abruptly due to owner health and internal family drama, long
story there. Technically I am opening a new pharmacy in the same location
the previous one was for more than 50 years.
At this point I knew absolutely nothing about running a retail pharmacy and
had been working in a hospital so there has been much to learn.
Basic Plan of Attack to be Successful
Location, location, location. The store is near a busy intersection and no
chain pharmacies within a 2-3 mile radius, tons of foot and bike traffic as
well. Update the store and offer new front end and Rx products and services.
Advertise and constantly seek new accounts/services and stay abreast of
latest trends. All things the previous store managers/owners never did.
Constantly go out of my way to offer a more personalized and friendly
service that patients can not receive at a chain pharmacy. Make everyone
have a positive experience at my store.
April 22
Closed on the assets purchase and signed a lease in the building.
Approximately 3000-3300 SQ Ft space.
Cost of assists/fixtures: 20K
Lease: 900/month for 2 years, with two 2 year renewal options as same price
so a total of 6 years at 900/month.
May 16
Last day of work at the hospital and jumping in full time to work to open
the pharmacy.
May 20
Went to the NCPA ownership workshop in Buffalo. I figured this was a good
starting point to try and build a knowledge base and figure out what the
heck I am doing. Good info, a bit overwhelming because I felt/feel a ton of
pressure to succeed so I was extremely focused on every lecture. I would
recommend attending if you are interested in pharmacy ownership. City of
Buffalo was kind of dirty looking, reminded me of what New York must have
been like in the 80s, saw NiagraFalls which was nice.
May 20-Present Day Overview of Activities
I have learned the basics of opening a pharmacy, get a board of pharmacy
permit, get DEA permit, contract with a wholesaler, buying groups and 3rd
parties, get NPI and NCPDP number(number assigned to store for insurance
billing purposes) My understanding of why there are 2 separate numbers
issued for billing is this: NCPDP was original organization that issued
billing numbers for pharmacies and monitored data, when HIPAA came about the
government decided that every healthcare entity, doctors, hospitals,
pharmacies needed a standardized number that is the NPI(national provider
number) so instead of getting rid of the old NCPDP# we know have both.
I spend a decent amount of time reading, and networking with other owners in
the area, meeting with wholesalers/vendors and working on remodel plans. In
my opinion meeting with people who have been or are still currently
successful is key. The pharmacy ownership world seems to be very tight and
many owners have been very willing to speak with me and offer advice and
information.
Remodeling
Part of the potential this store has is that fact it has not been updated
since the 1970s, no joke. There was still a large portion of the store
devoted to VHS tape rentals, the tapes didn't go past the 80s. No one rented
these; they were just taking up space. The store is relatively large,
approximately 3000-3300 square feet. They had barely any front of the store
merchandise, basically empty shelves. No one had kept up with the place and
sought new produces and services in 20 years.
So I am updating the look and layout, using a contactor that is a friend of
the family so I have to go with their schedule but I am getting a discount
so it is worth it. Getting help from family/friends for labor to try and
keep remodel costs down.
Estimated remodel cost 15k.
June 6, 7
did demo, removing all the old walls and counters and anything else that was
going to be redone, filled two 40" dumpsters, hard days work. As far as the
new design and layout, I basically went around to several other
independents and chains to get some ideas. The goal is to have the store
look newer and updated with that old/small town feel; I did not want to
spend a ton of time and money researching the best layout and design. I did
want a section of the pharmacy area to be used for compounding, so I
included a back room with lots of counter space. Compounding seems to be a
great niche that independents can get into that offers much better margins.
Vendor Meetings
So far I have met with McKesson and AmeriSource Bergen; I will probably try
and meet with Cardinal and one other before making a decision. Went over
what was required from me and the different options and how the process
works. Basically the wholesalers need a business plan, cash flow statement,
personal financial statement and probably the most important aspect proof
that you have working capital, aka cash in the bank and a lot of it around
100K.
The majority of wholesalers seem to offer some type of financing deal for
the initial drug purchase, for instance if you wanted to stock the shelves
with 40k worth of meds you could finance that over 6 months (just an example
).
Learned a ton of stuff that I had never been exposed to before when meeting
with wholesalers which makes the process fun for me. I enjoy learning new
things, sometimes I feel like I am getting a real life MBA.
June 16th
Had a personal online meeting and demo with Rx30 a pharmacy software vendor.
Looks really great and has a ton of features that I believe would be very
helpful. Cost could be an issue; I want to keep my costs as low as possible
at first. Still going to research a few other pharmacy software management
systems. I also will probably need to upgrade the Point of Sale equipment as
well, unsure on what I will use. Might try and get used POS equipment.
June 17th
Called a few beer distributors to get information. That is a new product I
want to offer, this is based on the location and demographics of the area. I
want to have pseudo-convenience store products. Unlike Pepsi or Coke, beer
distributors do not lease you a refrigerator to put their products in, this
was an unexpected expense. I spent the day driving to several restaurant
supply stores and used/refurbished equipment dealers gathering info. So far
it looks like a used single door commercial fridge is around 800-900 and a
double door is 1600. Still unsure how many refrigerators I will have but I
am thinking 2 single doors and 1 double door. Then probably 3 other
refrigerators with Coke or Pepsi products. The nice aspect about the beer
distributors is that there was no minimum contract about, you can purchase
as much or as little as you are selling.
June 18
Met with PPSC rep, a buying group. The world of retail pharmacy seems very
convoluted, manufacturers, wholesalers, retail pharmacies and PBMs. Most
drugs are bought on a cost minus bases, which sounds so strange, but my
understanding is that everything gets screwed up with the manufacturers
giving rebates to PBMs and wholesalers and this information is not published
so it is hard to determine the actual costs. But basically PPSC is a group
that allows you to have greater purchasing power in numbers. They also have
rebates depending on your % compliance each month with buying certain
generic brands, all very confusing at first but with time it should become
clearer.
Week of June 20th
Next Week I am looking at finding some used pharmacy shelving and gondolas
for the store. Like I said previously the store was not updated for 40 years
so if I can get newer shelving at a decent price I am going to try and do
that. I may have a lead to some used equipment.
I may also try and attend the Florida Pharmacist Association's annual
meeting. This may depend if the contractor's electrician and carpenter are
back in town and ready to start building.
July 5th
Spent last week and this week working on remodel. I try to be as involved as
I can with the construction to cut down on costs and learn as much as
possible. Luckily the floors in the place are terrazzo but really old and
need to be polished and cleaned, found out that can run any where from 2.25/
Sq Ft for a diamond grind and polish to 0.75/Sq Ft for a polish and wax.
I have looked at two different pharmacy management systems, BestRx and RX30,
several people recommended RX30 but it looks to be more expensive. Both
systems have tons of features and modules that can be added such as a
nursing home module, they have point of sale equipment also. They both
charge for processing of insurance claims, something like 0.07/claim or 0.16
/new claim and 0.07/refill. Each also had modules for monitoring
reimbursement amounts and flagging anything that was incorrect or low. One
interesting feature was for any Rx that needed a prior authorization; the
system would automatically grab the correct form and fax it to the MDs
office. I still need more education on these systems before making a
decision.
I met with a coke distributor; he kind of pissed me off. Came of some what
condescending and made me feel like a little kid who didn't know what I was
doing. Looks like it is Pepsi's lucky day, not to mention Pepsi has Gatorade
, GO GATORS.
Week of July 10
Still working on the remodel, decided to redo the ceiling. This is not only
aesthetic but energy saving as well, the lights in the store are very old
and the heat they give off probably contributes to the monthly utility bill
of 650(YIKES). Not to mention there are 9 ceiling fans that I want taken
down, they make the store look cluttered and I like a smooth and seamless
look. I need to get a POD and get all the merchandise and office equipment
out of the store to redo the ceiling and to polish/grind the floors. The
store front windows also have paint/decals/stickers on them; I need to try
and removal all this clutter. I want a clear simple window where people can
see into the store, hopefully attracting customers with the newer updated
look. I want to put castor wheels on all the gondolas also, this will allow
me to rearrange the store easily or I can push them out of the way to host
large groups like say a diabetes education class or if a club wants to use
the space after hours (had my buddy ask if his Linux group could meet there)
.
I want to advertise on buses and bus stops since the population surrounding
the store uses public transit and the bus stops are positioned at busy
intersections. I was quoted 200/month for an ad on a bus stop, they didn't
have the stop I wanted available so I am going to wait till the store is
closer to opening and see what bus stops are open for ads. I have not
received a quote yet to advertise on a bus.
This past week I also came up with the idea to fix up or landscape a small
median that is in front of the store. I think it would add some curb appeal
to the plaza. I am not sure who currently mows the grass(weeds really), but
if it is the city maybe I could adopt the median and I am sure that would be
a tax write off. I am always looking for ways to make the store stand out
and create a positive experience for customers. I try to visit other
independent pharmacies as often as I can to learn and gather ideas and one
store had like aroma therapy, basically used smell to enhance the experience
in the store.
July 28th
On Craig’s list I found a CVS that had moved locations and was
liquidating many of their fixtures, so I got pharmacy shelving for around $
110 per 36" section I believe. I needed some shelving and had not seen many
used fixtures so I tried to jump on this one, I think it was a decent deal,
at least it was used which is definitely cheaper than new. I also purchased
3 double door refrigerators and 1 double door freezer, this is for selling
any drinks or frozen items such as beer, or buying soda from say a SAMS to
sell or ice cream or other frozen products. I am going to try and reuse the
gondolas/fixtures in the store front that were already there since I am
already behind schedule which will put me over budget.
Remodel, definitely taking longer than I originally had planned, the project
grew from cleaning floors and painting walls to basically redoing the
entire place. The biggest problem with this is the anxiety that it causes me
, I do not like being in a state of unknown. I think it is mostly because
there is a certain amount of anxiety that goes into starting a business and
the longer it takes to get open the longer the feeling of "will it work"
persists. I try to keep organized and prioritizing and plugging along.
I did meet with a bus advertising agent and found out it costs 400/month for
a side panel and it has a production cost of 150. I really want to target
the immediate surrounding area and I think the bus stop shelter, bus panel
and print magazine will be my initial advertising plans. I was quoted 900/
month with a 4 month commitment for a full page ad in a print magazine.
Advertising is pretty expensive, but I believe it is a must do, so I will
have to try and make room in the budget for this.
I also try and think of what will draw people into my store, a few examples
I have seen are being pet friendly and giving a doggie treat to anyone that
brings in their dog, giving a candy or surprise bag for new prescriptions to
anyone with children. Also having sales for certain products or partnering
with other local establishments for sales on certain days. I tried reading
through the city sign codes to find out how big, tall well lit of a sign I
can have, not easy reading and not much flexibility, but I think I will try
and clean up what is there and then have something new on the awning or
overhang of the building since nothing can go on the roof of the building
unless it is part of the building structure. I may explore putting some form
of display screen in the window to advertise sales or new services; it
would only be really functional at night when it could be seen easily from
the street.
Aug 3rd
Forgot to mention in the previous update, I got the double door refrig for
1k each and the freezer for 2k. I was quoted 1600k for a used double door
refrig in Orando Fl. So that seemed like a decent deal. I am currently
working on trying to update the front of the store gondolas. I believe I
found a solution, just change the brackets on the current ones and buy used
lozier shelves to fit in them, I believe this will save me around 1500 bucks
from buying new/used gondolas.
I haven't said much about my business plan or some of my different marketing
/advertising ideas because I have become worried about corporate espionage,
maybe a bit paranoid but I have heard some stories so I want to error on the
side of caution. I will post these up when I have the store open and I am
implementing them.
Spent today painting the bathroom and patching holes in the concrete wall.
The electrician says I should decide where I want all the wiring in the
store this week, so I have to try and plan for now and the future, really I
want an outlet, internet, phone and coax every 5-6 feet. Also I would like
to try and just make my own security system, I believe there is enough
consumer electronic equipement out there to do this. Set up cameras, a
computer server, DVR, motion sensors and even an autocall to the police. I
really want to be able to check the cameras from my home computer or even
phone, I need to find out if there are regulations that dictate having a
security company monitor the place. But if this is another monthly cost I
can cut out that would be great.
The post office near by may shut down,if so I would love to get a contract
postal unit or CPU in my store. I have seen this at other independents and
think it would be great to generate traffic.
I will try and post up some pictures in a bit so everyone can get a visual.
Not much super new knowledge to give anyone at this time, remodel is going
slow. I might try and diamond grind the terrazzo floors myself, a bit risky
if I screw it up but will save probably 4k if I can do it myself.
End of August Quick Update
The board of pharmacy permit is in the mail so I keeping my fingers crossed
that everything was filled out correctly. I learned that not every law
enforcement agency carries the correct finger print cards and many of them
only do finger printing at certain times on certain days, make sure to
double check before wasting a trip or 2.
Spent about 30 hours trying to grind/clean/polish the terrazzo floors, they
look better than before but still some visable discoloration and lines where
counters or isle shelving used to be. At one point I used a diamond pad but
I still think I needed something harder to really grind off the top layer.
I looked into the contract postal unit. I learned the post office can be a
strange place. I figured it would be pseudo government run with lots of
policies and rules on how business is conducted. Nope, I get an email in
blue marker font with an attachment that doesn't have any official seal or
really explain much. I also learned that I would negotiate with the local
post master the % cut I would get from the sale of stamps, envelopes etc.
I think I came up with a solution to not have to buy new or used store
fixtures. I am going to make them with slatboard and either cut my own
shelves and formica or use the premade bull nose shelving for the slatboard.
October 12th
The board of pharmacy application was processed in less than a week much
faster than expect and told it would take. I spoke to the board inspector
several times on the phone before having the actual inspection. I tried to
make sure I would have everything he was looking for and what would happen
if I did not. I would recommend using a gut feeling here. Since I spoke to
the inspector (not a pharmacist) I knew what to expect and he knew that I
was trying to do everything right, when I went to schedule the inspection he
said he would be out of town for 2 weeks and his partner (a pharmacist)
could do it. I didnt want someone I had not spoken to do handle the
inspection so I said screw it and scheduled it for the next day even though
I wasn't sure I was ready. I had a feeling the guy I wanted was pretty chill
and I was right, inspection passed no problem. Basically ran down a list of
questions, made sure I had the correct signs and a running sink.
Next up is the DEA, I filled out the application online this week. It was
pretty simple and straight forward, much easier than the board application.
I have not heard back yet. I printed out their pharmacist manual to read and
have ready incase I get asked a question.
I also started filling out paperwork to get insurance, mostly straight
forward stuff. The confusing part is that many of the questions can vary
with time, for instance how many employees I will have or services offerd.
For example I may start with 1 employee but when things get busier I will
add more, no compounding to start but plan on adding that later. I would ask
around on who to call for insurance, I had a friend in the industry that
gave me the name of someone to contact who did healthcare liability.
I have also been working on getting paperwork to the wholesaler for an
opening order. The wholesalers will finance the intial order so you don't
have to pay 40-50k up front. The downside is they require lots of stuff, its
like applying for a loan. Financial statements, tax returns, banks
statements etc. And if you have a partner in the business they will need all
that information from as many as you have.
On the actual store build out front most recently I have installed 8
security cameras. I bought these online after doing some research, they have
night and day vision, inside and outside cameras. Working at the store
takes a ton of time. To me it is like doing a home improvement project for
the first time, you think it shouldn't take to long but since its your first
time it takes a really long time with lots of trial and error.
The project has been pretty hard so far, I expected it to be but its been
different. Really not knowing anything about starting is hard, I had to
learn as I went. For instance insurance, I have the same car insurance for
12 years and my home owners was done for me at closing. I had no clue where
to start, do I just call up the local start farm agent and say I need
liability insurance? I am hoping going through the process of starting a
pharmacy from scratch will benefit me in the future, maybe consulting or
helping others open stores.
Anyone know anything about importing or exporting medications or medical
supplies? I was thinking about this today.
April 12th update
Sorry for going MIA for so long, got busy with several life events at once.
Short story is my pharmacy is open, opened end of March. Took much long than
I initially thought but I know realize it takes anywhere from 6-8 months to
get going. I will try and update where I left off if I can remember the
details.
Next up is the DEA, I filled out the application online this week. It was
pretty simple and straight forward, much easier than the board application.
I have not heard back yet. I printed out their pharmacist manual to read and
have ready incase I get asked a question.
The DEA actually took several months to get approved. The inspection wasn't
bad, I had heard they just basically want to know you are not going to be a
pill mill(since Florida has had so much trouble with this lately) and they
did. They asked about how I was going to get business and a few other things
to test and see if I had planned to run a legitamate pharmacy. If you do
all your homework and read the laws and all the requirements you will be
fine also. Security is big with them as well, so layout and design can come
into play. This didn't happen to me because I designed things with security
in mind but I knew someone who had the DEA tell them to put up security
glass by the pharmacy counter.
Now onto something really frustrating. To order control substances everyone
knows the 222 forms. Well it can be done online now much like you order all
your drugs from your wholesaler through CSOC(everyone calls is sea sauce).
But even though you have a DEA license you have to send out more paperwork
and jump through 3-4 more hoops to get it live. The computerized ordering
seemed harder than the DEA inspection to me. And of course somewhere along
the line something got screwed up and I did not know the security question
the DEA had and I had to start all over. The DEA swears this security
question is on the paperwork I filled out but I had no recollection of it
and it was not any of the normal ones I use. I think they mixed something up
.
Along the DEA CSOC lines in Fl we have the PDMP(prescription drug monitoring
program) and pharmacies are required to upload their controlled dispensing
records. This is to prevent patients from doctor shopping and going from
pharmacy to pharmacy. I can look their records up which has been a huge help
, I look up every patient that comes in with a CII (of course I get about 10
oxy 30mg patients a day that I turn away bc of this). You can see what
doctors they have been to, which pharmacies they got it filled at, which
drug, how many and days supply and the payment method. This is very helpful.
Signing up for this PDMP was a nightmare and I think it has something to do
with the DEA paperwork that got mixed but it took about an hour on the
phone trying to figure it out. Eventually I just said look I have a BOP
permit, I have a DEA permit, I am at my pharmacy and I am trying to do the
right thing and use this data base, somewhere along the lines something got
screwed up can you please just tell me the security question answer? And
they did.
****Very important lesson. Make copies of every single form, contract, if
its on paper and you are mailing it somewhere make a copy so you can
reference it when they call. You will have done endless paperwork and will
not remember what you wrote down.******
****Second very important lesson. Think very carefully about what address
you put down on all the paperwork. Since my pharmacy was not open I did not
go there every day. Well its logical to put down the pharmacies address for
many things but if you are not there when the mailman comes, it gets
returned and you waste time and go crazy wondering why whatever agency/
company/person/entity doesn't have your paperwork. For awhile between the
copies and this I figured I was actually one of the most unorganized people
around, until I met several other folks trying to start pharmacies who had
the exact same problem.********
I also started filling out paperwork to get insurance, mostly straight
forward stuff. The confusing part is that many of the questions can vary
with time, for instance how many employees I will have or services offered.
For example I may start with 1 employee but when things get busier I will
add more, no compounding to start but plan on adding that later. I would ask
around on who to call for insurance, I had a friend in the industry that
gave me the name of someone to contact who did healthcare liability.
I got liability insurance, it was around 1800-2000 for the year I believe.
You will need 1million occurrence and 3million aggregate, all the
wholesalers require this. I am still working on workers comp insurance. You
do not legally have to have workers comp insurance until you have 4 or more
employees. Yes you have to overestimate how many employees you will have at
the end of the year, if you have less at end you get money back, if you have
more you can pay a penalty. Also working on insurance for the contents of
the building for disaster and theft. Funny thing is terrorism is actually on
these and you can elect to be covered by it. I of course wanted to know who
determines if the act was terrorism or not? A crazy person who drivers
their car through the front window or the more commonly know plane crashing.
Read down, this got to long and couldn't finish it in this post.
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