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10/10/2017
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www.ncpanet.org/niceawards
Filling the Holes in Whole‐Patient Care: Front‐End Niches for Wellness, Anti‐
Aging, and More
Dawn Butterfield , RPhD.H. John Kim, Pharm.D., FAARFMGabe Trahan, Senior Director NCPA
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Disclosure
• Dawn Butterfield declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.
• John Kim declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.
• Gabe Trahan is the Senior Director of Store Operations and Marketing with NCPA. The conflict of interest was resolved by peer review of the slide content.
Learning Objectives
• Discuss potential pharmacy front‐end niches that provide good options for health care related patient care
• Evaluate market attributes to assess niche potential based on patient population
• Discuss key counseling issues and areas of concern in front end patient care environment
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Dawn Butterfield, RPh West Cocoa Pharmacy& Compounding
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Anti AgingAnti Aging
Weight Control Weight Control
EnergyEnergy
StressStress
Sleep Sleep
Hair & NailHair & Nail
On Customers’ Minds
Anti AgingAnti Aging
No one wants feel or look old
Feel as Good on the Inside … As you’ll look on the Outside
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Never Be Without!
Collagen Boosters or Combos Bitoin Keratin B 12 Retinol
Never Be Without!
Collagen Boosters or Combos Bitoin Keratin B 12 Retinol Probiotics
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All Consults Lead to … PROBIOTICS
Invest in Your Crown!
Invest in your hair, it’s the crown you
never take off.
Biotin 10,000 Collagen Booster
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Invest in Your Crown!
Invest in your hair, it’s the crown you
never take off.
Biotin 10,000 Collagen Booster Hair/Skin/Nails vitamin Keratin Essential Oils
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Essential Oils
1ml Thyme1.5ml Lavender1.5ml Rosemary1ml Cedarwood210 cc Jojoba oil
240 cc of this it will cost about $8.50 for a 30cc dropper (put in amber vial with dropper) ‐ cost to pharmacy around $8.50. Retail $37.50
Patient buys all ingredients : Retail $57.96 = $24.30 profit
Essential Oils
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Invest in Your Crown!
Invest in your hair, it’s the crown you
never take off.
Biotin 10,000 Collagen Booster Hair/Skin/Nails vitamin Keratin Essential Oils B 12 Methylcobalamin
TEAS!
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C
Specialty Teas
C
Specialty Teas
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Additional Sales
Homemade soaps (from local vendor)
Exfoliating scrubs for nail care Bath bombs Exfoliating scrubs skin
Additional Sales
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D.H. John Kim , Pharm.D., FAARM Robinson Drug & Compounding Center
Mendham, NJ
Traditional Front End Niches
• Durable medical equipment (DME) – wheelchairs, canes, etc.
• Diabetic shoe fitting (Medicare)
• Compression stockings
• Surgical supplies
• Cosmetic / Anti‐Aging Skin Line
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New Front End Niches
INTEGRATIVE WELLNESS MODEL:
• Wellness – custom vitamin program; anti‐aging; functional medicine programs; drug induced nutritional depletion
• Wellness Consultation – Bio‐identical hormone replacement therapy; anti‐aging medicine; nutrition; functional medicine; medication therapy management; weight management
• Cannabidiol (CBD) supplement
Wellness – Global Market Place
• $4 trillion dollar global industry • 10.6% growth from 2013 to 2015
• Ten wellness markets analyzed – Fastest growth1. Preventative / Personalized Medicine & Public Health (+23.5%)
2. Fitness & Mind Body (+21.4%)
3. Wellness Lifestyle Real Estate (+18.6%)
4. Wellness Tourism (+14%)
5. Health Eating, Nutrition, & Weight loss (+12.8%)
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Wellness – Revenue Year 2013 ~ 2015
• Pharmacists can join these markets:• Beauty and Anti‐aging ‐ $1.02 trillion ~ $999 billion
• Healthy eating, nutrition, and weight loss: $574.2 billion ~ $647.8 billion
• Preventative and personalized medicine: $432.7 billion ~ $534.3 billion
• Complementary and alternative medicine: $186.7 billion ~ $199 billion
Wellness Pharmacy
• Programs to be introduced• Drug Induced Nutritional Depletion (DIND)
• EX) Statins; Birth control; Anti‐biotics; Diabetics
• Nutraceuticals to complement current medication therapy
• Functional Medicine – Target disease states• Diabetes
• High blood pressure
• Menopause
• Autoimmune Disorder
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Drug Induced Nutritional Depletion
• Statin – Coenzyme Q 10
• Ace Inhibitors – Zinc; B‐complex; Coenzyme Q 10
• Beta Blockers – Coenzyme Q 10; B‐complex
• Digoxin – Magnesium; potassium; Coenzyme Q 10
• Potassium Chloride (Klor‐Con) – B12
• Metformin – Folate; B12; Zinc; Coenzyme Q 10
• Sulfonylureas (Glipizide; Glimiperide) – Probiotic; Coenzyme Q10
Drug Induced Nutritional Depletion
• H2 Blockers – Folate; B12; Vitamin D; Calcium; Iron, Zinc
• Proton pump inhibitors – beta‐carotene; B12; folate, calcium; zinc; iron
• Antacides (aluminum hydroxide) – Folate; vitamin D; zinc; calcium; magnesium; chromium; iron
• Anti‐depressants – Coenzyme Q 10; B‐vitamins
• Birth control (hormones) – B‐vitamins; 5‐HTP
• Bisphosphonates – Calcium; magnesium
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Functional Vitamin Program
Targeting disease states:
• Diabetes – chromium; omega‐3‐fatty acids; bitter melon; cinnamon; berberine; alpha‐lipoic acid
• Cholesterol – omega‐3‐fatty acids; berberine; bergamot orange extract; niacin; folate; nattokinase; L‐carnitine; mixed tocophenols (vitamin E); B‐Complex
• GERD or Acid reflux – digestive enzymes; probiotic (covering both lactobacillus and bifidobactum); deglycyrrhized licorice (DGL); Avoid Gluten and Casein
Functional Vitamin Program
• Pain Management (Fibromyalgia)– Compounded low dose naltrexone; B‐complex; alpha‐lipoic acid; D‐Ribose; Magnesium malate; apple cider vinegar; proteolytic enzyme; cannabidiol (CBD)
• Autoimmune disorder – Detoxification support packs; Gut support vitamins (DGL; probiotics; saccromyces boulardii; L‐Glutamine; L‐Acetyl‐Cysteine; Lactoferrin; N‐Acetyl‐D‐Glucosamine); avoid gluten and casein and other offending food; Organic Diet
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Functional Vitamin Program
• Chronic fatigue (aka burn out syndrome)
• Attention deficit disorder (ADD)
• Irritable Bowel Syndrome
• Dry eyes
• ETC.
Wellness Consultation
• Due to the complexity of medicine and time, many patients look for private consultation
• Consultations are 30 minutes to 1 hour
• Fee based Consultation• Never start the consultation program without charging
• Pharmacists are undermining their value• Many other professional (i.e. lawyers, doctors) charge hourly fee for their knowledge and time.
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Wellness Consultation
How to start:
• Education and additional credentials: Certified Clinical Nutrition (CCN); Institute of Functional Medicine; Professional Compounding Center of America (PCCA); Academy of Anti‐Aging Medicine (A4M); Fellowship of Anti‐Aging and Function /Regenerative Medicine (FAARFM); Self study
• Strategize and target on the disease state clinician can manage
• Ex: hormone therapy consultation; functional medicine
Wellness Consultation ‐Marketing
• Where to market:• Directly to current patient population in your pharmacy
• Monthly or Weekly In‐Store Seminars
• Partner with your prescribers – Patient referrals
• Local Disease Support Group
• Local Community Forums
• Town events – Set up marketing table (usually free or small fee)
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Wellness Consultation – Barrier to Entry
‐ Education, time , and Cost – Time factor
‐ Marketing service to patients and practitioners
‐ Relationship building to have constant referral
‐ Cost to patients – Patient willing to pay cash
‐ Push back from doctors and local practitioners
‐ Lack of passion and drive to provide service.
Wellness Consultation – Prep Work
• Where to do the consultation• Patient’s house
• Private Consultation Room – Must provide full attention to patient’s needs
• Before meeting with patient: Patient intake forms; Treatment Consent Letter; HIPAA Agreement; Symptom List Form
• Contract set up with lab companies – Saliva Test; Food sensitivity testing; Cardiovascular risk assessment; Genetic testing; etc
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Wellness Consultation – Prep Work
• Day before the meeting:• Call the patient to confirm appointment
• Ask patient to stop by the pharmacy 15 minutes before the meeting fill out intake forms (Online forms can be made available on the pharmacy website)
• Remind patient to bring their current list of vitamins, medication, lab results, and chart notes from the doctor (if possible)
• Make sure the consultation room is nice and clean
• Go over the test results and have list of questions ready
Wellness Consultation ‐Meeting
• All discussion and meeting must be set to meet the patient’s needs
• First Question to ask: What is your goal for today’s meeting?
• Private consultation is available to fill in the care the patient is not getting from their regular doctor.
• Must be able to empathize with your patient • Many of these patients have wasted money and time for many years and looking for a solution
• 80% of clinician’s time must be spent in LISTENING – We have 2 ears and one mouth
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Wellness Consultation – After Meeting
• Supplements or Vitamin to dispense to patient• In Store sale – Provide discount for being part of wellness consultation program
• Customized consultation notes to be provided for patient’s doctor to review
• EX) S.O.A.P. Note
• Compounding or Medication Order from the doctor
• Follow up meeting done with patient 3 to 6 months
CBD Products
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Cannabinoids – Hemp Based Supplement
Cannabinoids ‐ Lipophilic, odorless compounds
‐ Exert multitude of effects depending on the endocannabinoid receptors they work
‐ Two endocannabinoid receptors – CB1 and CB2‐ CB1‐Mostly found in the brand
‐ CB2‐Mostly found within the immune system
CBD(Cannabidiol) VS THC (Tetrahydrocannabidiol)
CBD ‐ Science
Profound influence on the human body
‐ Endocannabinoid receptors found throughout the body: Brain, organs, connective tissues, glands, and immune cells
‐ Goal of endocannabinoid – Create homeostasis and maintain a stable internal environment‐ Example: Autophagy – cell sequester to self digest cells and recycle – Deadly effect on malignant tumor cells
‐ Stabilize the nerve cell to prevent excessive firing and calming nearby immune cells to prevent release of pro‐inflammatory substances.
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CBD: Medical conditions
Where clinical opinions, research, and data exist to support potential benefits: Acne ADD and ADHD Addiction AIDS ALS Anxiety/Bipolar/Depression / OCD / PTSD / Schizophrenia Pain / Fibromyalgia / Migraine
Cannabidiol (CBD)
‐Atherosclerosis
‐Arthritis / Rheumatoid arthritis
‐Diabetes
‐Epilepsy and seizures
‐ Neurodegeneration / Multiple sclerosis
‐Osteoporosis / Bone health
‐ ETC.
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Cannabidiol (CBD)
Dosage forms available:
1. Capsule
2. Tinctures / Sublingual drops (Dosage available for pets)
3. Melt‐away strips / Bucchal Tablets / Troches
4. Topical Cream / Lotions / Ointments
5. Inhalation / Vapors
6. Gummies / Candy
Dosage
Dosing can vary from CBD manufacturers
‐ Must obtain dosage guidelines from manufacturer
‐ Potency and quality of CBD can vary from manufacturer to manufacturer (Suggestion – must inquire from manufacturer)‐ Severe anxiety, ADHD, and mood disorders: 25 to 50mg daily
‐ Nicotine and other withdrawal symptoms: 50 to 100mg daily
‐ Epilepsy – 25mg daily
‐ Rheumatoid arthritis – 10mg daily
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Side Effects
1. Inhibition of hepatic drug metabolism (CYP 450P)
2. Dry mouth
3. Increased tremor in parkinson’s Disease at high CBD dose
4. Low blood pressure
5. Lightheadedness
6. Drowsiness
7. Vivid dreams
Legal Disclaimer
• While industrial hemp products may be sold legally under the Agricultural Act of 2014 (2014 Farm Bill), the federal Drug Enforcement Administration (DEA) has stated that it considers CBD a Schedule 1 controlled substance. Many people within the industry as well as members of Congress disagree with the DEA’s position and believe that the DEA would be violating federal law if they interfered with the Farm Bill program. Nevertheless, retailers that sell CBD products may face the risk of federal enforcement action which could also have ramifications for contracts with wholesalers and payers.
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Thank You!
D.H. John Kim , Pharm.D., FAARM Robinson Drug & Compounding Center
Questions!
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Join Us!
Shoot the Breeze!
