My Pharm Start Up Blog. No Retail Experience, No Partners, Quit current job.

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Atlrph

Most independents are members of buying groups. You should go to some of their meetings and talk to some owners. They're a great source of information and many of them will come right out and say if they are interested in selling their store or not. Some may even be interested in opening another location if the right partner came along.

amerisource bergen is a sick wholesaler....i live in new orleans....when hurricane isaac came...they missed one day which was when isaac landed and they were there the next day but we were closed because we didnt have any power..they have great customer service

has anyone used pioneer rx...its pretty sick as well..they have an ipad for signature capture and email/text notifications far superior than the pharmacy software we use...generates prior authorizations automatically without manually typing all the fields....any future owners should definitely check it out

Never seen pioneer Rx. What would the cost of entry be and what would their support look like? I also wonder how much they would charge for each claim.

Def. like that they scan each prescription in and that they reconcile claims and rebill (in recent times we're getting hammered on hydrocodone prescriptions. It would be nice to be able to rebill these.)

We use Rx30. Seems like most indy's I know use Rx30 or Qs1.

man lousiana medicaid is killing us now....they used to awp minus some percentage...now it is cost plus 10 dollars on everything no matter the quantity....we are losing money on some claims like pediatex td and suprax through la medicaid

yeah pioneer rx does pre and post edit claims as well...we use a software company called carepoint and 3rd party switch called rx linc...we are getting ****ted on with the lortab and lorcet scripts....i try to get the doctor to write them for norco's 10/325....its becoming a payer driven world and bull**** price gouging on the wholesalers and manufacturers

Originally Posted by 504poboy

man lousiana medicaid is killing us now....they used to awp minus some percentage...now it is cost plus 10 dollars on everything no matter the quantity....we are losing money on some claims like pediatex td and suprax through la medicaid

yeah pioneer rx does pre and post edit claims as well...we use a software company called carepoint and 3rd party switch called rx linc...we are getting ****ted on with the lortab and lorcet scripts....i try to get the doctor to write them for norco's 10/325....its becoming a payer driven world and bull**** price gouging on the wholesalers and manufacturers

Yeah, that seems to be the case with medicaid usually. With more and more people needing care, and with Obama possible reelection coming, you may see those numbers get worse.

I recently sold my two stores and have 2 RX30 systems with pos included for sale.
I am located just outside of Philadelphia, pa. Please email if interested. Fallsrx@hotmail.com

Originally Posted by southpharmindy

Never seen pioneer Rx. What would the cost of entry be and what would their support look like? I also wonder how much they would charge for each claim.

Def. like that they scan each prescription in and that they reconcile claims and rebill (in recent times we're getting hammered on hydrocodone prescriptions. It would be nice to be able to rebill these.)

We use Rx30. Seems like most indy's I know use Rx30 or Qs1.

i have been talking to the guys because im thinking about opening my own pharmacy soon....check this out....15,000 for a point of sale, server, and a computer workstation, you can add unlimited computer work stations later down the road for no add on fee...the rep told me you can buy a computer and monitor from best buy and add it on later for no additional fee cheaper that way...they have an app built in for smart phones for refills and email/text notifications for when the rx's are ready for 100 a month...340 monthly fee for support....24 hour customer service....currently we use this software called guardian rx made by carepoint which sucks ass...their customer support after hours is only for if your computer crashes....thats the most bull**** i have ever heard in my life...5 cent transactions....i asked them to send me brochure...their reply "We can't cause we update our software so much we would waste money on wasted brochures"...that kinda turned me on because the pharmacy software has to adapt to ever changing pharmacy environment....in louisiana we have to submit all our narcotics filled every 7 days to the state prescription monitoring program...its a pain the ass right now for me cause i have to manually do it every 7 days which takes me 15 minutes do...pioneer rx does it automatically at whatever time you want it to schedule it to....the rep was telling me some states have to send it in real time....man this company is exactly what i been looking for ever since pharmacy school...i used to rotate at other independents and their software was in the dinosaur age...one guy was using DOS based software....thats what made not want to open up a pharmacy because of software that was not adaptable to changing environment of pharmacy....they do online demos to people who are interested....i have one coming up soon after i get off work...i had one but it was right when work started...they do demos online in groups and then they give you a quote when you are done...

Poboy

Seriously 14,000 sounds like a great price and it looks like it has a lot of features for a program for that price. I've heard some of the other systems like Qs1 run like 24,000. I think we pay 0.05 cents for each transaction but this new buying group has told us they will give us free transactions and 0.17 cent escripts.

Also agree with you about using amerisource as a wholesaler. In 12 years they have never missed a shipment to our store and that is even with 2 feet of snow on the ground.

How far are you along in opening your own store?

Southpharmindy,
What buying group do you use now, and which new one are you looking at switching to?

Kellison,

Which group are you in?

Southpharmindy,
I'm not currently in one, seriously looking at putting my shingle out, so I'm trying to one the numbers, explore all my options and put a plan together.

DHH Announces Adjustments to Pharmacy Reimbursement Change

State will issue new emergency rule based on feedback from Louisiana pharmacists

Friday, Oct. 19, 2012 | Contact: DHH Media & Communications; (225) 342-1532 Baton Rouge, LA - Today, Louisiana Department of Health and Hospitals (DHH) Secretary Bruce D. Greenstein announced adjustments to the Louisiana Medicaid program's pharmacy reimbursement methodology.
DHH promulgated an emergency rule in August that revised its reimbursement methodology for pharmacy services from an Average Wholesale Price (AWP) model to an Average Acquisition Cost (AAC) model. This change is consistent with federal policy direction and is similar to policies other states have successfully implemented for their Medicaid pharmacy programs. Effective Sept. 5, Medicaid began reimbursing pharmacists for their prescription services to Medicaid enrollees at the Average Acquisition Cost (AAC) plus a $10.13 dispensing fee.
In recent years, several national organizations have noted AWP-based reimbursement for Medicaid pharmacy is unreliable, subject to manipulation, and not representative of the actual purchase price for pharmaceutical products. A review of claims data showed when using the previous AWP reimbursement model Medicaid was consistently a top payer for pharmacy providers, paying more generously than commercial Pharmacy Benefit Management programs that serve patients with private insurance. As a result, a 2009 national Medicaid workgroup recommended state Medicaid programs shift their reimbursement methodology toward AAC to bring costs more in line with the actual cost of acquiring and dispensing prescription drugs to Medicaid recipients.
"We've talked about this change in reimbursement for more than two years. Since its implementation, we've worked extensively with community pharmacists to examine the impact," Greenstein said. "Louisiana pharmacists raised specific concerns about how the new rates were being applied to our attention, and we've made changes to adjust reimbursement upward and address their concerns."
In order to incorporate feedback from pharmacists, DHH convened a workgroup of both independent and chain pharmacists to discuss the new reimbursement structure. After careful analysis, including a detailed review of cost and reimbursement data through information submitted by community pharmacists, DHH has made several enhancements to the reimbursement methodology that will increase reimbursement for pharmacy services. The new items are:

1. Provide a markup of 10 percent above the AAC rate for generic drugs, and 1 percent for brand name generics.
2. Increase the dispensing fee paid to pharmacy providers as part of their reimbursement from $10.13 to $10.51, based on a factor of consumer price index inflation.
3. Reimburse certain classes of specialty drugs, which cost more and are more complex to stock and dispense than mass-market prescription drugs, at their Wholesale Average Cost (a more generous price index) plus 5 percent.
4. Closely monitor drug-pricing updates that manufacturers make on product and pass along to pharmacists, to ensure Medicaid can adjust to the updated pricing quickly and accurately, which will limit instances where pharmacy reimbursement is below the cost of acquisition.

Medicaid made these changes to better use taxpayer dollars by more effectively containing costs in the program, while providing a fair reimbursement for pharmacists. Given Congress' unexpected reduction in Louisiana's Medicaid reimbursement rate to the lowest point in 25 years, Greenstein emphasized the importance of balancing the budget, living within the state's means and more effectively using taxpayer dollars.
"Due to Congress' reduction in Medicaid funding to Louisiana, we must look at how we can operate in a more effective and less expensive manner," Greenstein said. "In making these changes, our top priority is ensuring Medicaid recipients have access to the prescription drug services they need, while also ensuring that we make optimal use of taxpayer dollars and that our pharmacists are paid a fair and transparent reimbursement."
"I want to recognize the members of the House, particularly the Health and Welfare Committee, for their strong advocacy on behalf of the pharmacists in Louisiana," said House of Representatives Speaker Chuck Kleckley. "I also want to thank the Department for their willingness to listen and respond to pharmacists' concerns. Secretary Greenstein has made a commitment to continue their dialogue, and House members will closely monitor their progress."
"I'm pleased with the progress we've made by bringing all parties to the table to determine the best path forward for the Medicaid pharmacy program," said Senator David Heitmeier, Chairman of the Senate Health and Welfare Committee. "DHH and the Legislature are committed to making necessary adjustments to these policies, and will continue to closely monitor the data to ensure that we are paying a fair rate for pharmacy services."
"The pharmacies in Louisiana continue to work to be accessible to the population of the state needing necessary prescription drugs, regardless of the payer," said Randal Johnson, President and CEO of the Louisiana Independent Pharmacy Association. "The move by DHH to address shortfalls in funding is something that our small business community pharmacies understand and respect as members of the tax-paying public and as health care providers. We appreciate the willingness of DHH to continue to review the information and work toward a fair and transparent reimbursement methodology."
"On behalf of our chain pharmacies operating more than half of the retail pharmacies throughout Louisiana, we are encouraged by the Department's willingness to continue these discussions and make adjustments where appropriate," said Mary Staples, Director of State Government Affairs with the National Association of Chain Drug Stores. "We've been working with DHH for over a year on this issue, and we look forward to continuing our positive relationship as we observe the impact of these reimbursement changes."
The Department is promulgating the new emergency rule, which will implement the updated reimbursement methodology changes for Medicaid fee-for-service pharmacy claims with dates of service Nov. 1, 2012 and beyond. Like all reimbursement changes, these adjustments in methodology will be subject to federal approval by the Center for Medicaid and Medicare Services (CMS).
The Louisiana Department of Health and Hospitals strives to protect and promote health statewide and to ensure access to medical, preventive and rehabilitative services for all state citizens. To learn more about DHH, visit http://www.dhh.louisiana.gov. For up-to-date health information, news and emergency updates, follow DHH's blog, Twitter account and

I'm waiting until december-january to see the reimbursements..Louisiana medicaid used to pay the pharmacy every 7 days now they moved it up to 14 days....I'm thinking about using ANDA pharmaceuticals and PARMED for drugs...Amerisource wants all these bull**** financial documents before you even apply....PARMED and ANDA i can use my personal credit card to pay off the initial ordering as I go by...then later go to Amerisource

Kellison

Check out Smartfill and American Associated Pharmacies depending on your area. What part of the country are you in?

Poboy

I really like ANDA and Parmed as a secondary but who will you get your brand drugs off of? Have you talked to a buying group>

I'm in North Central Florida area, Gainesville, FL

Originally Posted by southpharmindy

Never seen pioneer Rx. What would the cost of entry be and what would their support look like? I also wonder how much they would charge for each claim.

Def. like that they scan each prescription in and that they reconcile claims and rebill (in recent times we're getting hammered on hydrocodone prescriptions. It would be nice to be able to rebill these.)

We use Rx30. Seems like most indy's I know use Rx30 or Qs1.

You can scan Rx's in with Rx30 and reconcile and rebill.

Originally Posted by kellison

I'm in North Central Florida area, Gainesville, FL

I'm with AAP and really like them, great rebates. The only issue I have with them is their return policy kind of sucks.

Originally Posted by 504poboy

DHH Announces Adjustments to Pharmacy Reimbursement Change

State will issue new emergency rule based on feedback from Louisiana pharmacists

Friday, Oct. 19, 2012 | Contact: DHH Media & Communications; (225) 342-1532 Baton Rouge, LA - Today, Louisiana Department of Health and Hospitals (DHH) Secretary Bruce D. Greenstein announced adjustments to the Louisiana Medicaid program's pharmacy reimbursement methodology.
DHH promulgated an emergency rule in August that revised its reimbursement methodology for pharmacy services from an Average Wholesale Price (AWP) model to an Average Acquisition Cost (AAC) model. This change is consistent with federal policy direction and is similar to policies other states have successfully implemented for their Medicaid pharmacy programs. Effective Sept. 5, Medicaid began reimbursing pharmacists for their prescription services to Medicaid enrollees at the Average Acquisition Cost (AAC) plus a $10.13 dispensing fee.
In recent years, several national organizations have noted AWP-based reimbursement for Medicaid pharmacy is unreliable, subject to manipulation, and not representative of the actual purchase price for pharmaceutical products. A review of claims data showed when using the previous AWP reimbursement model Medicaid was consistently a top payer for pharmacy providers, paying more generously than commercial Pharmacy Benefit Management programs that serve patients with private insurance. As a result, a 2009 national Medicaid workgroup recommended state Medicaid programs shift their reimbursement methodology toward AAC to bring costs more in line with the actual cost of acquiring and dispensing prescription drugs to Medicaid recipients.
"We've talked about this change in reimbursement for more than two years. Since its implementation, we've worked extensively with community pharmacists to examine the impact," Greenstein said. "Louisiana pharmacists raised specific concerns about how the new rates were being applied to our attention, and we've made changes to adjust reimbursement upward and address their concerns."
In order to incorporate feedback from pharmacists, DHH convened a workgroup of both independent and chain pharmacists to discuss the new reimbursement structure. After careful analysis, including a detailed review of cost and reimbursement data through information submitted by community pharmacists, DHH has made several enhancements to the reimbursement methodology that will increase reimbursement for pharmacy services. The new items are:

1. Provide a markup of 10 percent above the AAC rate for generic drugs, and 1 percent for brand name generics.
2. Increase the dispensing fee paid to pharmacy providers as part of their reimbursement from $10.13 to $10.51, based on a factor of consumer price index inflation.
3. Reimburse certain classes of specialty drugs, which cost more and are more complex to stock and dispense than mass-market prescription drugs, at their Wholesale Average Cost (a more generous price index) plus 5 percent.
4. Closely monitor drug-pricing updates that manufacturers make on product and pass along to pharmacists, to ensure Medicaid can adjust to the updated pricing quickly and accurately, which will limit instances where pharmacy reimbursement is below the cost of acquisition.

Medicaid made these changes to better use taxpayer dollars by more effectively containing costs in the program, while providing a fair reimbursement for pharmacists. Given Congress' unexpected reduction in Louisiana's Medicaid reimbursement rate to the lowest point in 25 years, Greenstein emphasized the importance of balancing the budget, living within the state's means and more effectively using taxpayer dollars.
"Due to Congress' reduction in Medicaid funding to Louisiana, we must look at how we can operate in a more effective and less expensive manner," Greenstein said. "In making these changes, our top priority is ensuring Medicaid recipients have access to the prescription drug services they need, while also ensuring that we make optimal use of taxpayer dollars and that our pharmacists are paid a fair and transparent reimbursement."
"I want to recognize the members of the House, particularly the Health and Welfare Committee, for their strong advocacy on behalf of the pharmacists in Louisiana," said House of Representatives Speaker Chuck Kleckley. "I also want to thank the Department for their willingness to listen and respond to pharmacists' concerns. Secretary Greenstein has made a commitment to continue their dialogue, and House members will closely monitor their progress."
"I'm pleased with the progress we've made by bringing all parties to the table to determine the best path forward for the Medicaid pharmacy program," said Senator David Heitmeier, Chairman of the Senate Health and Welfare Committee. "DHH and the Legislature are committed to making necessary adjustments to these policies, and will continue to closely monitor the data to ensure that we are paying a fair rate for pharmacy services."
"The pharmacies in Louisiana continue to work to be accessible to the population of the state needing necessary prescription drugs, regardless of the payer," said Randal Johnson, President and CEO of the Louisiana Independent Pharmacy Association. "The move by DHH to address shortfalls in funding is something that our small business community pharmacies understand and respect as members of the tax-paying public and as health care providers. We appreciate the willingness of DHH to continue to review the information and work toward a fair and transparent reimbursement methodology."
"On behalf of our chain pharmacies operating more than half of the retail pharmacies throughout Louisiana, we are encouraged by the Department's willingness to continue these discussions and make adjustments where appropriate," said Mary Staples, Director of State Government Affairs with the National Association of Chain Drug Stores. "We've been working with DHH for over a year on this issue, and we look forward to continuing our positive relationship as we observe the impact of these reimbursement changes."
The Department is promulgating the new emergency rule, which will implement the updated reimbursement methodology changes for Medicaid fee-for-service pharmacy claims with dates of service Nov. 1, 2012 and beyond. Like all reimbursement changes, these adjustments in methodology will be subject to federal approval by the Center for Medicaid and Medicare Services (CMS).
The Louisiana Department of Health and Hospitals strives to protect and promote health statewide and to ensure access to medical, preventive and rehabilitative services for all state citizens. To learn more about DHH, visit http://www.dhh.louisiana.gov. For up-to-date health information, news and emergency updates, follow DHH's blog, Twitter account and

I'm waiting until december-january to see the reimbursements..Louisiana medicaid used to pay the pharmacy every 7 days now they moved it up to 14 days....I'm thinking about using ANDA pharmaceuticals and PARMED for drugs...Amerisource wants all these bull**** financial documents before you even apply....PARMED and ANDA i can use my personal credit card to pay off the initial ordering as I go by...then later go to Amerisource

I wished FL Medicaid paid a $10.15 dispensing fee + AAC

Originally Posted by Fallsrx

I recently sold my two stores and have 2 RX30 systems with pos included for sale.
I am located just outside of Philadelphia, pa. Please email if interested. Fallsrx@hotmail.com

Email sent

Originally Posted by southpharmindy

95 is pretty awesome for somebody thats been in business for less than a year. We do the compounds too; low cost of entry for pain relieving gels/suspensions/capsules and good margins. Did you take any classes like Medisca/PCCA/ACCA? I think I might try to take one in November.

We're trying to get into the DME more. We can bill medicaid and medicare (talk about a booger to get accredited) but we're having trouble getting in with a large third party in the area.

Tell ya what. If you're in a high cash area Id try to push high end vitamins/organics. That stuff is where its at. Women's Bio identical hormones too would go well. Unfortunately for me I'm in a cash poor area.

Oh yeah. I don't know who your buying group is but I met with a group a few days ago that gives everybody cost-5% on brand and great generic prices with rebates. They said its not volume driven either.

We averaged over 50-60/day last month and hit 60k in ordering volume.

Looking at that cms certification for DME as a goal for next year. Working on getting immunization certified still, the area is not very conducive to high end compounding.


For some of the veteran owners, anyone have any.advice on how to get a.doctors practice in the building your are in. Assuming you own the plaza or.building. I have briefly heard of going to MD conferences or job fairs, any other ideas?

You should have called me and it would have been a turnkey business for you. Let me know if you are ready for your next pharmacy because I have 2 golden opportunities in Fort Lauderdale, Florida.

Originally Posted by Hpower12

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.

"

It looks like your headed in the right direction. Good luck, if you need help with anything we are experts in independent pharmacies and start ups. Also check out www.mediportsupply.com , they can help you generate foot traffic to your store.

Originally Posted by Hpower12

I have also been working on getting paperwork to the wholesaler for an opening order. The wholesalers will finance the initial 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."
I ended up getting the exact opposite of financing for the opening order. I had to pay upfront and then draw from that account. I was really upset about this, especially since the business development manager never mentioned it as a possibility. The process reminded me of buying a house (only in recent times when lending has been tight) their is an underwriter that of course no one can talk to and seems to have no idea what matters to them or how they came to their decision. I am told after 3-4 months of good standing I can get regular terms and financing if I want it. I didn't spend very much on the opening order, around 5-6k for front end otc items and another 5k for Rx drugs. I have been ordering more every day as new patients come in and I get some cash flow.

Everything has been going really well so far. I have not done any advertising or had a grand opening, more of a soft opening. I wanted to work out all the problems before telling everyone to come by. I am planning on starting some advertising next week and I am going to do a decent amount (what I consider a lot). I am still waiting on several things, my beer/wine/tobacco permit, Lotto and being able to accept SNAP (food stamps) All things considered I think I am doing well. We are probably averaging around 10 a day I think but we usually transfer several others meds in with the one that actually gets filled. Between filled and transfered in rx's I have 265 in less than 3 weeks. Front end merchandise is doing much better than I thought, i rather not give away exactly what I am selling but just use your brain and get what will sell in your area. I have gone above and beyond what a chain would do for 4 people, I basically searched and searched to find a specific product and get it in for those patients, one product even ordered from Europe.

Sadly I have already had to send a compounded medication to another pharmacy in the area. I am planning on compounding but have not been able to set that up yet. Another surprise and disappointment is that I have had 3 people come in with Rx's for DME i had but they wanted to bill insurance. To bill insurance for DME you need a separate accreditation through medicare, I will do this eventually but it takes more money and time.

At this point I am not out of the woods but the trends are very positive. Another thing, you barely make any money from insurance paying customers, mine have averaged 10-11 dollars a script. you make all your money through your cash patients. I have beat CVS, WalGreens and Walmart on cash scripts for several people, I was very surprised at this. I thought with the chains buying power that it would be very hard to sell things cheaper than them but it is actually very easy. Also, apply business principals to some medications when it comes to supply and demand, thats how you can make up some ground. I think it is reasonable to expect 6-12 months before getting to a break even point. I believe I will beat that but I am not planning on it.

biggest surprise-already working on 2nd pharmacy, may or may not happen but would be really cool.

hello there,
This is a great thread. I have learned so much from reading about your experience. Best of luck!!
I have one question for everyone here-How long does it take to actually open a pharmacy for business after the application goes out?

Originally Posted by think

hello there,
This is a great thread. I have learned so much from reading about your experience. Best of luck!!
I have one question for everyone here-How long does it take to actually open a pharmacy for business after the application goes out?

Well I know in Florida right now the limiting factor is the DEA permit, I have heard they are taking. 8 months. There great way on ccontrolling the diversion, pharmacy and pharmacy wholesalers are the "choke point" in the supply chain. To hard for them to shut down all the doctors, its on us. I would say 6-8months is a reasonable time frame.

I would also say never stop asking questions, many times now I know more about the internal workings of my wholesaler than my reps do. Make connections and just keep asking questions, find out what motivated them and how decisions are made and who makes them and what actually matters.

I know the delivery driver well and have his cell #, if I need a favor I can call it in and throw a favor his way. I have wanted to say, "what would it take for you to lose or deliver extra late a walgreens or competitors delivery for the day" but, everyone out there can have info so get to know them all.

Originally Posted by think

hello there,
This is a great thread. I have learned so much from reading about your experience. Best of luck!!
I have one question for everyone here-How long does it take to actually open a pharmacy for business after the application goes out?

Average of 9 months right now. Gotta get your medicaid and medicare provider numbers, that can take a while. And you should not open until you can bill medicaid, otherwise....death sentence.

Originally Posted by Hpower12

I would also say never stop asking questions, many times now I know more about the internal workings of my wholesaler than my reps do. Make connections and just keep asking questions, find out what motivated them and how decisions are made and who makes them and what actually matters.

I know the delivery driver well and have his cell #, if I need a favor I can call it in and throw a favor his way. I have wanted to say, "what would it take for you to lose or deliver extra late a walgreens or competitors delivery for the day" but, everyone out there can have info so get to know them all.

It's funny you say that, cause we always have coffee waiting for our Cardinal driver and now he delivers to us first....

thank you all for the input. I was considering going this route but not even sure what to do any more I don't have a full time job my loans are not getting paid. I was thinking of maybe opening a pharmacy but I think that would be suicide for me right now.Now I am considering moving to somewhere like Alaska so I at least I can pay my loans off. I feel like all these years of hard work in school has not paid off at all

Anyways best of luck with your pharmacy it is great to know how well you are doing I am a strong believer in God and seems like he is definitely helping you out right now
I will keep on reading this for ore advice

Originally Posted by southpharmindy

Kellison

Check out Smartfill and American Associated Pharmacies depending on your area. What part of the country are you in?

Poboy

I really like ANDA and Parmed as a secondary but who will you get your brand drugs off of? Have you talked to a buying group>

we use smartfill for our buying group....so they give us 10 percent back on all generics on the backend in a form of rebate check at the beginning of the month...this causes an artificial higher acquisition cost on the front end so the PBM's do not see the true acquisition...which means higher reimbursements...

if anyone is reading this every wholesaler has an authorized secondary wholesaler...amerisource uses a company called bellcodrug....your ordering rep is not going to tell you this because they want you to do their one stop shop for all your generics with the primary wholesaler so they can rape you on their generic drugs...

another secondary wholesaler that is way cheaper than parmed and anda is gensource...i got quotes on all my generics they blew ANDA, parmed, and Amerisource out the water....they get majority of their drugs from aurobindo....still havent placed an initial order with gensource or bellco...will let you guys know in a couple of days

Poboy

We're going with Smartfill as well. Seems like a pretty good group from what I can tell. Anything you particularly like or dislike about them?

Im gonna check on Gensource. Thanks for the heads up.

With me I always order from my primary unless something is unavailable or the secondary is much cheaper. I got Lovenox for almost 300 dollars cheaper from Parmed than Amerisource. If I had order from Amerisource I wouldve lost my shirt.

Originally Posted by think

hello there,
This is a great thread. I have learned so much from reading about your experience. Best of luck!!
I have one question for everyone here-How long does it take to actually open a pharmacy for business after the application goes out?

Depends on how much you know what your doing and having the right connections. Everything goes in a step wise manor. For instance, you need a BOP permetlrmit before getting DEA. And signing with a wholesaler. Not to mention county and city biz licenses (we pulled a good ole boy game on one of those) and their computers can go down or you filled out some paper work wrong.

Just mentally prepare for delays at each step 8-9 months is realistic, not even factoring in the build out and code inspections.

Originally Posted by southpharmindy

Poboy

We're going with Smartfill as well. Seems like a pretty good group from what I can tell. Anything you particularly like or dislike about them?

Im gonna check on Gensource. Thanks for the heads up.

With me I always order from my primary unless something is unavailable or the secondary is much cheaper. I got Lovenox for almost 300 dollars cheaper from Parmed than Amerisource. If I had order from Amerisource I wouldve lost my shirt.

Does you buying group give you fatter rebates than your primary? They should. We use API and our entire order gets EDI to them, they fill what they can then send the rest to cardinal. Do all the work for me and my rebates are much better.

I would suggest having a primary Drug source and atleast 2 secondary ones. There have been many times where I saved 70% on specials the secondary vendors had on

Poboy

You were spot on about Gensource. Some stuff is the same or maybe a little more expensive. However the majority of their stuff is anywhere from 10-50% cheaper than what I pay with Amerisource. If you save anything over 10% I guess its safe to say the heck with the rebates.

KVL

Yeah we get all of our rebates through the buying group. They cut us a check every quarter.

nm. double post.

Originally Posted by kvl1027

Does you buying group give you fatter rebates than your primary? They should. We use API and our entire order gets EDI to them, they fill what they can then send the rest to cardinal. Do all the work for me and my rebates are much better.

being in Florida how do you like Cardinal? Given their control issues? I was also told by a rep that since Cardinal has the CVS contract they give priority or allocate drugs in shortage to CVS before any independents. Any truth to this?


Have any of you gone through the CMS DME certification? The new one where your store was not grandfathered in? I know their are several tiers and a few companies that can help with the compliance and preparing for the inspection.

Also, for tax purposes, what does everyone do for inventory? I have heard there are companies that will come and inventory everything in your store to give you the costs of your current inventory including non drug items such as beer,soda etc. Any advice on this?

i should have been more specific in regards what is cheaper.. gensource has all strengths of gabapentin that are half off price compared to anda and parmed......valtrex comes super cheap every once every 2 months.

Hpower how are things looking with your store?

looking forward for some new posts

Same here. Bump!

He is probably busy working them long ass hours that must be dome with a new store. Does he have a partner or is he doing this alone? Is he's doing this alone, i suspect he will be quite busy for some time.

Originally Posted by kvl1027

I wished FL Medicaid paid a $10.15 dispensing fee + AAC

In this quote, you are insinuating that you would rather take AAC + $10 dispensing fee as opposed to AWP -16% plus 3.73 dispensing fee? I am trying to understand in the end, which way has the better margin? It seems as though 504poboy is complaining that with the new Medicaid rules, reimbursement rates will decrease, but almost get you a net $10 dispensing fee per RX. I am doing my research on the Medicaid reimbursement rates looking to either open in Florida or Alabama in which AL uses AAC +$10 and Florida is awp -16% plus 3.73. Thanks for any insight anyone can provide on this. Paul

Originally Posted by phampau

In this quote, you are insinuating that you would rather take AAC + $10 dispensing fee as opposed to AWP -16% plus 3.73 dispensing fee? I am trying to understand in the end, which way has the better margin? It seems as though 504poboy is complaining that with the new Medicaid rules, reimbursement rates will decrease, but almost get you a net $10 dispensing fee per RX. I am doing my research on the Medicaid reimbursement rates looking to either open in Florida or Alabama in which AL uses AAC +$10 and Florida is awp -16% plus 3.73. Thanks for any insight anyone can provide on this. Paul

http://www.managedcaremag.com/archiv...egulation.html

I'm not sure what to think about AAC.

Whose acquisition are we going to use to base this system on? If we factor in hospital and mail order acquisition cost then we're screwed because the average retail pharmacy and small chain couldn't match this. Now if we use my actual acquisition cost +$10 I'll be happy as can be. I'd love to average 10 per script. We also need a formula to determine this dispensing fee to keep up with inflation.

Originally Posted by southpharmindy

I'm not sure what to think about AAC.

Whose acquisition are we going to use to base this system on? If we factor in hospital and mail order acquisition cost then we're screwed because the average retail pharmacy and small chain couldn't match this. Now if we use my actual acquisition cost +$10 I'll be happy as can be. I'd love to average 10 per script. We also need a formula to determine this dispensing fee to keep up with inflation.

Fat chance we will avg $10 per rx with medicaid. If anything, they will factor all pharmacys acquisition price and we will barely make profit, if at all. The state wants to pay the least possible. they dont care if we close or not. Only that they pay the lowest price possible.

That is exactly what I'm afraid of. Right now it is a guessing game for the PBMs. Nobody knows our actual cost with our rebates and such. If they found it I can see them trying to reimburse us 3-4 dollars on average or cost.

Originally Posted by southpharmindy

That is exactly what I'm afraid of. Right now it is a guessing game for the PBMs. Nobody knows our actual cost with our rebates and such. If they found it I can see them trying to reimburse us 3-4 dollars on average or cost.

below cost

I am planning to open a pharmacy soon and remodeling is done but got stuck in the process. PLEASE help me...
Here are a couple of thigns I need to get info about

1.Any suggestion on the software? I contacted pioneer rx and it looks ok but they DO NOT sell the software, they LEASE it. You cannot sell the software to other pharmacy, for any reason you close your pharmacy (or maybe when you retire). I think it is unfair to charge for software and monthly fee even though a company does not sell it but lease it.
Anybody use RX30?? It looks kind of old and not much info showing on the main screen.
I kind of like window based software.
Any opinion on Best RX or Winrx (too expensive but looks good-I heard it is a lease too) or super scripts or any other software out there??? Which one is the best when factoring in the cost and funtionality??

2. Dose anybody know if a pharmacy balance has to be NTEP certified or not??

3. Do measuring devices (like graduated cylinders...) have to be class A too? (did not know it comes that way before)

4. On pharmacy permit application, do I have to check a box for compounding and delivery when I only occasionally mix oint. or cream or powder in them (just like any retail store) and deliver meds for my friends and church members MYSELF?

I have been trying to contact board of pharmacy with these questions but they are never there and never called back

Any input will be greatly appreciated. Thx in advance

I like Rx30. Lot of great features if you activate them and its really fast. Its also cheap, easy to understand, and has unmatched support. Have worked with Rite Aid, CVS, Kroger, and Walmart and Rx30 is my fav next to Walmart.

Your scales do have to be certified by the state. Don't worry about the measuring devices. Don't worry about checking compounding either; pretty sure they are just worried about sterile compounding.

Who is your wholesaler and what kind of deal are they offering?

I do not have wholesaler yet but if I go with Rx30 I think I have to go with API. They have a deal with Rx30.
It is hard to get a wholesaler now. They are almost nasty to deal with.
Any good advice?