Green Valley Pharmacy Interview

Transcript Below

1.)  What was your journey like to get where you are today?

The journey was fun for the most part but challenging at times. We recently opened our second location in Rancho Cucamonga, with the first pharmacy in Yucaipa, so things are going very well now, but as I look back, I’m amazed by the twists and turns in my adventure. I graduated from Loma Linda University School of Pharmacy 2010. Thinking that I really wanted to go into residency to specialize in transplant, I interned at the university medical center throughout pharmacy school. During my internship, I realized that I actually enjoy working more in a social environment, which doesn’t necessary happen in a hospital setting. Up to that point, community practice had not crossed my mind, so I went on to select clinical rotations that I felt focused more on interactions with people. I selected the pharmaceutical Industry rotation with Allergan and Oncology Research at the NIH in particular, because I saw myself interacting with many other healthcare professionals on a regular basis. In the end, I did not go into either of those fields for various reasons. While I like to interact with people, it’s difficult for me to engage when I feel the interaction is tainted. I am not saying there is anything immoral or inappropriate, but if my purpose is to promote a certain product or to push a certain agenda I do not believe in, it’s very difficult for me.

There were two separate experiences that pointed me towards community practice and made me want to open an independent pharmacy eventually. The first one happened during my time as an In-patient intern at LLUMC. There was a period of time that the outpatient pharmacy needed coverage, so I was called to help at the outpatient side. Maybe it was a different vibe or just higher energy at the outpatient side, but I really felt at home. And as I mentioned earlier, that’s when I realized I enjoy working with people in a more social, interactive environment. The LLUMC out-patient pharmacy team was great with good personalities, good leadership and overall good energy, which motivated me to go to work. The second experience I had was when I was rotating through Waterman pharmacy, an independent. The owner, Dennis, was my supervisor, and he was an amazing pharmacist/business owner. He modeled how a pharmacist should appropriately interact with his patients and how pharmaceutical care should be provided. I was blown away. It was then that I saw the tremendous value of a good community pharmacist to his patients and providers. It was literally life-changing, and I thought, “Now that’s a career I can get behind and do for the rest of my life!”

2.)  In one word, describe yourself.

Motivated. I am motivated because I have plenty of good motivations and motivators. Let me explain. I believe happy people find meaning in what they do and then they do it with a passion. In a way, I have it easy as a healthcare provider to find meaning at work. For me, being a pharmacist really means making a positive impact on the lives of my staff, my patients, and my providers, and there’s plenty of meaning in that, right? As a business owner, being able to provide for my staff and my family, while growing the business to bring more positive interactions, to make more positive impact, now that’s just the cherry on top. I am also motivated to improve our practice and share our experience with the next generation of pharmacists. I am constantly thinking of ways to improve our service and people’s quality of life. If you have my job, you’ll be motivated too!

3.)  How do you see the industry changing in three years?

It’s hard to say. In community pharmacy practice, I do see more and more clinical applications and collaboration with local providers, so I think that trend is going to continue. Eventually pharmacies may become the preferred locations for follow-up visits for certain chronic disease states like diabetes and hypertension, but maybe not in three years time. I do believe we need to stay on top of our skills so we don’t get left behind, and for that exact reason, I recently got certified as one of the first 500 Advance Practice Pharmacist (APh) in California. For those who are interested, you can look up the details, but in a nut shell that means you are making a commitment to stay current on the new treatment approach for different diseases and be able to collaborate with other providers and clinics when necessary. For pharmacists to be recognized as a crucial member of the medical system, we need to learn to communicate using the same platform with the same medical/legal language. I think that’s an important step we can take in the next three years

4.)  What are your top 3 professional accomplishments?

One is opening our independent practice so that we can provide the quality and the kind of care we want without having to deal with corporations and bureaucracy. Having an independent pharmacy also means that we have a platform to start a movement to improve community pharmacy practice.  My second top achievement is getting certified as an APh, which I see as becoming a specialist besides having my general practice in the community pharmacy world.

The third is not really an accomplishment, but something of which I am very proud. I lectured on the topic of independent practice at both Loma Linda University and Western University schools of pharmacy.  I also have had pharmacy students at our pharmacy for different school activities in an attempt to inspire the next generation of community pharmacists. Perhaps it is just my own perception, but I feel that the modern pharmacy school curriculum focuses heavily on clinical practice (and I can understand why) but at the same time, discourages community pharmacy practice. Community practice seemed to be viewed as lesser or inferior to any other practice, with Clinical being on the top of the pyramid. I know that community practice is the most common and does not require additional training, but that does not mean mediocracy. Perhaps it’s the lack of passion or enthusiasm people see from many chain pharmacy staff members who are burnt out, or the lack of meaning community pharmacists find in their practice. I believe we can change the culture of pharmacy practice if we can show pharmacy students the true positive impact of a good community practice on patients and the community. Then, more great community pharmacists will graduate and push our profession to new heights.

5.)  Who do you look up to?

Professionally, three of my old bosses were incredible pharmacists and successful business owners. William, my previous district manager at Rite Aid is now the owner of multiple pharmacies. He’s one of the most intelligent persons I know and the best district manager to work for. Then there is Dennis, a resourceful visionary. From community practice to specialty pharmacy, he’s involved in a multitude of pharmacy practices. And I also look up to Brandon, a very nice guy who successfully owned and operated six pharmacies at the same time and developed his own pharmacy software, and still managed to have time for his family. Impressive!

6.)  Think back and share a story about a personal life experience that defines who you are today. What was the value/lesson?

I’m not sure about a single story but rather a series of life events that helped shape me. But the first crucial event I can remember was when I started to attend the only boarding school in Hong Kong when I was 11, by choice, surprisingly. That period of time made me understand early on that decisions you make along the way will lead you down a certain path and each with its own consequences, heaven or hell. I remembered that I was somewhat of a ringleader among a group of trouble-makers in the dormitories, the only group really. Long story short, police got involved due to some damaged property, and I was under a tremendous amount of stress from my school. Friends, who I thought were solid, all left and disappeared when the situation went south. It was clear to me that I would end up somewhere ruinous if I were to stay the current course. So I made the decision to aim high to do something positive and not to stay angry and cause more suffering (mostly to myself). I learned that by acting and conducting oneself properly in the world, it will lead to an overall positive outcome, and vice versa. And since that point, I’ve been looking for areas that are intuitive to me and finding ways to apply myself effectively to bring some good eventually.

7.)  Would you explain a little bit about Green Valley Pharmacy and your role there?

So what is Green Valley Pharmacy? The right question is why. GVP’s mission is straightforward: to improve quality of life for everyone we come into contact with. Being educated at Loma Linda University, our school motto was “To Make Man Whole;” our pharmacy mission echoes that message. We are a group of people who care about the well-being of others. Besides doing what pharmacies traditionally do (like processing prescriptions, filling medications, auto refills…), we care about our patients’ health as a whole and our goal is to help them stay healthy so they are able to do what’s meaningful to them. We believe that each of our patients has a purpose and we are here to help them fulfill theirs with treatments and pharmaceutical care. We listen to their life struggles, let them know they are part of by a community. And we often see people take better care of themselves when they know that someone else also cares about them, that’s a cool phenomenon. We also focus on finding ways to better the lives of our employees’ and our local providers’ throughout our practice.

Besides being a full time pharmacist, my primary objective is to improve the quality of the services we are providing. I often collaborate and discuss how to handle various situations with my staff and how to tackle certain problems that come up. It’s also my job to learn about new services we can implement and to build relationships with the local providers and community.

8.)  What’s the biggest challenge facing your profession today?

The three biggest challenges we face today is low insurance reimbursements, insurance processing fees, and their exclusive contracts with the big box stores and their mail order pharmacies. For instance, certain plans will charge their patients higher co-pays when they fill their prescriptions anywhere else but their preferred chain pharmacy. For patients who can afford the higher co-pay and prefer our pharmacy due to our friendly service, they stay with us knowing that they are paying more. But that’s not always feasible for those who don’t have the financial means. Some insurance plans even limit their members to only their own mail order pharmacy. Another challenge we face today is the increased insurance processing fees which vary depending on the insurance company and the drug dispensed. In certain situations, these processing fees are more than the actual insurance reimbursement amount.

9.)  What advice would you share with pharmacists looking to start their own pharmacy?

As a pharmacist, you’ve got to have heart! People will see right through you if your motivation is not genuine. Your patients and your staff won’t feel empowered if you don’t believe in why you do what you do. In terms of the business aspect, independent pharmacies tend to do better when they can find a niche and are able to fill a need. In other words, you will need to identify a service that is meaningful to the local community you are serving, either to perfect what is existing or to introduce and deliver a brand new service.

10.)                     How can our viewers/readers reach you?

All of our information is available on our website Additionally, guests can always visit us at our Yucaipa location at the city center across from Vons or our Rancho Cucamonga location near Victoria Gardens.


How Long Does Facebook Marketing Take To Work For My Pharmacy?

“It feels as if I’m wasting my money. I advertise and nothing happens”

As a pharmacy owner who has tried Facebook ads (or any advertising), you know you’ve said that before.

I feel your pain. I’ve said it before too.

When I first started using Facebook ads, I had read so many great things about it that I assumed I’d put an ad up and within minutes customers would be knocking at my door. Instead, a day would go by and nothing. Another day would pass, and more silence. By the 4th day, I’d pull the ad.

I would do this with all of my advertising, and month-by-month I’d be shocked that I wasn’t growing as much as I thought I would. Finally, after a few years of mediocre growth, I hired a business coach, and that’s when I was reminded of the fundamental truth in all advertising with 10 simple words.

The fundamental truth – people will only buy from you if they know, like, and trust you.
And guess what?

No one is going to get to know, like, and trust you after just ONE ad. In fact, research says it often takes 8+ ads to get someone who doesn’t know you to buy from you.

For example, last night I purchased this 3D printer for my daughter.

I had never dealt with the company before nor have I even heard of them. So, guess how many ads it took me to pull the trigger and make the purchase?

Easily over 12 ads.

The very first ad I saw was a video ad on Facebook. Intrigued by the 3D printer, I clicked the link and went through the website. Although I immediately thought my daughter and nephews would love it, I didn’t make the purchase. I guess I didn’t want to make a $350 impulse buy.

Then the very next day I get on Instagram, and I see another ad for it. Over the next 5 days, I was bombarded with ads for it on Facebook and Instagram (the beauty of the Facebook pixel and remarketing). I watched every video, read every comment under the ads, and learned as much as I could about it. I visited the website at least 5 different times and even had it in my cart 2 different times. Finally, I made the purchase.

Now, if the old me was running that company, I would have given up after the first ad and lost a $350 sale. Not now though. Now that I understand the value of building “top-of-mind-tip-of-tongue” awareness, I would have been relentless just like that company was. Is it any surprise that that company is going to be featured on Shark Tank? They have a great product and know how to market it.

Think about this for a second….
Do you ever purchase anything from a company you don’t have a relationship with after just one ad? Doesn’t it usually take 3, 4, or even 10 ads before you pull the trigger? You’ll read the comments, search for reviews, talk to friends about it, and possibly even email the company before you make the purchase. Right?

So, obviously, our marketing wasn’t the problem. Our patience was.

What’s the takeaway then?
It’s extremely important that if we want to grow, we need to invest in marketing that’s designed to build “top-of-mind-tip-of-tongue” awareness, or as some marketers call it omnipresence.


Because almost all of the people we’re targeting are probably already patients at another pharmacy. After one ad, they probably aren’t likely to switch over. However, if they keep seeing your face everywhere, read glowing testimonials, and appreciate the value you put out in your content marketing, as soon as they do think about switching pharmacies, you’ll be the first pharmacy they think about.

Right now there are thousands of unhappy patients at Walgreens and Walmart. Between the poor customer service, the long wait times, and the prices, they’re constantly triggered.

Why don’t they leave then?

Simple. They don’t know they have another option. That is unless there’s an astute independent pharmacy owner in their area that’s constantly building top-of-mind-tip-of-tongue awareness.

So how can a pharmacy build “top-of-mind-tip-of-tongue” awareness using Facebook ads?
A Simple 15-second video targeting your entire zip code
This doesn’t have to be Oscar-worthy. Some of the most successful videos are made with nothing more than an Iphone. A simple, “Hi, I’m John Smith, owner of John Smith’s pharmacy in Smithville, IL. If you’re not getting great service from your pharmacy, I’d love to have you as a patient.” A few bullets with things like free delivery, no long lines, etc. Bam. It’s done. Budget $5 per day and run it for a few weeks, alternating between a few different videos/ad copies. As soon as the mere thought of switching pharmacies pops in your market’s head, they’ll think of John Smith.

A geo-targeted Facebook ad around the local physicians’ offices
Smart marketers know that if they can get in front of potential customers at the right time, they’ll have a much higher likelihood of turning them into actual customers. When is a person most likely to need your services? You guessed it – after leaving the physician’s office.

With this ad, we’ll drop a pin at the address of the physician’s office, limit it to only mobile devices, and even geofence around the physician’s office so the ad is limited to just the physician office and not the 1-mile radius around it you’re limited to with a pin drop. Our hope is that as patients are browsing Facebook or Instagram on their phones in the waiting room, our ad will pop up with our services. Bam. “Top-of-mind-tip-of-tongue” awareness. Budget $5 per day. This ad can run for months since most people aren’t at the doctor every day.

A geo-targeted Facebook ad around your competitor’s pharmacy.
Not too long ago a pharmacist posted in one of the independent pharmacy Facebook groups I’m a part of about how opening his pharmacy across the street from Walgreens was the best decision he’s made. In his words, Walgreens essentially acts like a funnel for him, bringing in new patients almost daily.

Unfortunately, we all can’t pick up our pharmacy and move it next to a CVS or Walgreens. However, with Facebook ads, we can do it virtually. Drop a pin at the address of your competitor, select only mobile devices, and geo-fence around it so your ads will only be shown to people physically at the pharmacy, not the 1-mile radius dropping a pin is limited to. As Walgreens makes a patient wait 30 minutes for a prescription, he’ll be browsing Facebook, see our ad, and realize there’s a more convenient solution.

Pro tip: If you know your competitor’s weakness, include that in the ad. For example, the large majority of patients we get from Walmart come to us because of the 30+ minute wait at the Walmart pharmacy. If we were targeting this WalMart, the first line of our ad would say something, “Are you tired of waiting for your prescription? We know your time is limited so we can get you in and out of the pharmacy in 10 minutes.” A $5 per day budget is ideal. This ad can run for months since patients will see it infrequently.

What were those 10 simple words that completely changed how I advertise?
If they don’t know you, they won’t buy from you.

Top-of-Mind-Tip-of-Tongue Awareness.

Author: TJ Allan


How Physician and Pharmacist Integration Generates Innovation















The common reasons shared for selling their practice:

  •  Low reimbursements
  •  High overhead cost
  •  Burnout
  •  Increased competition by bigger players
  •  Lack of innovation




How can a Physician be of aid to a Pharmacist:









How many times has a patient presented to you a prescription for a “specialty medication” that you are unable to fill?  It could be that you are not able to order the medication from your wholesaler. Or worse, the patient’s insurance is mandating a specific pharmacy different than yours.  It can be frustrating when a current or prospective customer is coming to you, the pharmacist, for a solution to their chronic and sometimes rare, condition.


There is no finite definition for what qualifies as a “specialty medication“.  In general, specialty medications are used to treat chronic or complex conditions and usually require special handling or administration and close monitoring of the patient.  Sometimes, these prescription medications are indicated for rare diseases, which means that the disease affects less than 10,000 people. And they are therefore given “orphan drug status” under the Orphan Drug Act of 1983.  This Act allows for fast-track FDA approval for drugs intended to treat these rare diseases due to limited therapies available on the market.  Obtaining fast-track approval allows the medicine to be available as quickly as possible to the patients that need it the most.  This also means that the medication does not have to go through as many lengthy clinical studies as the “more” traditional therapies.  Often, as a stipulation of being given fast-track approval status, the FDA may require additional aftermarket studies to be completed, meaning that the drug is available to be prescribed but the patients taking the medicine are monitored for safety and efficacy of the therapy.  This is referred to as a Phase IV clinical trial.  Any pharmacy that dispenses one of these drugs must understand this process and accommodate the patient and drug manufacturer for any required documentation or data.


Some specialty drug manufacturers may limit the number of pharmacies who have access to order their medication.  These are deemed “Limited Distribution Drugs,” or LDDs for short.  When attempting to order one of these medications from your wholesaler, you may notice that the drug’s name is not listed in the system. Or it may take you straight to a screen that reads, “due to manufacturer limitations, this product is only available through a limited distribution network” and to contact the manufacturer directly.  This can be very disheartening for a pharmacist or pharmacy owner.


Upon calling the manufacturer, you may find out that in order to gain access to this drug, there are many rigorous requirements to meet first.  It is also worth mentioning that all manufacturers are different and have different specifications that must be met.  Many require weekly data reports so it would be prudent to know if your pharmacy’s dispensing software can accommodate customized and automatic reports.  The manufacturer may also request proof that you, as the pharmacy, have a way to monitor the patient for adherence and therapy response.  A common theme among these manufacturers is some sort of “specialty accreditation”.  This is often the first step to becoming a Specialty Pharmacy.


Achieving accreditation proves a commitment to quality and standards that are becoming the norm in the specialty space.  Accrediting bodies such as the Accreditation Commission for Health Care (ACHC) and the Utilization Review Accreditation Commission (URAC) are arguably the most reputable in the field.  Both sets of standards set the stage for core activities such as:

o   Patient Care

o   Coordination of Care and/or Delegation

o   Information Management

o   Compliance Program

o Quality Management and Continuous Quality Improvement, etc.

Accreditation is strongly recommended but could become mandatory by payers in the near future in order to ascertain preferred contracts for reimbursement purposes.  This means extra revenue for your pharmacy by adding a specialty line of business.  The entire process can take up to six months to a year for full accreditation and can be very arduous and labor intensive.


If all of this is intimidating to you, just know that you are not alone.  The key is to connect with a professional who has been through the process. Ideally, they should have been able to achieve and has maintained accreditation for some time.  Embarking on a project like this size could be overwhelming and a competent expert can guide you through the process.


There are many resources available though, if you choose to take on a project independently.  However, there is a lot of competition out there in specialty pharmacy but accreditation can set you apart from others.  Visit or to learn more about the various programs in accreditation.



We recommend using CSI Specialty Group for all of your specialty pharmacy consulting needs. Click Here 



10 Pharmacy Startups and Innovators

For a long time, the pharmacy space was dominated by big and long-established pharmacies. There was a major lack of startups and innovators were also lacking.

It was only recently when there was a rapid growth in pharmacy startups that areas in the pharmacy space, that have remained untouched for a long time, were disrupted. These include medication dispensing, delivery, cost-savings, prescribing, information, storage, vitamins and supplements, and specialty pharmacy services.

Below is a list of startups that have excelled in one or more areas of the pharmacy industry that are in need of improvement.

  1. DeliverCareRx

DeliverCareRx takes medication delivery to another level. Not only does the pharmacy offer free home delivery for more than three prescriptions per month but also synchronizes your prescription needs. This means your prescriptions are delivered to your door at the exact time that you need to replenish your supply.

This makes prescription acquisition convenient and timely. You never have to miss a refill for any reason. This also saves you money from fare or gasoline.

DeliverCareRx also offers free prescription management. No need to go to the doctor’s office and visit your insurance provider because they will handle the scripts/paperwork for you.

  1. ZappRx

ZappRx offers patients a quick and easy way to process the specialty drug orders through the ZappRx digital platform. You can order specialty medications online quickly and easily.

Considering that specialty prescribing takes time, the shortcut that the pharmacy offers makes a huge difference. Apart from streamlining the process of specialty med ordering, ZappRx also helps with the communication between providers.

  1. NowRx

NowRx hand delivers your prescription medication the same day you place your order. Since you only need to use an app to place an order, you can skip the long queues and have your prescription filled without leaving home.

You can send your prescription to them or have your doctor send it directly to the pharmacy. So after your checkup, you can go straight home instead of going to the pharmacy to purchase your prescription because your doctor can send the prescription on your behalf.

Upon fulfillment, you will receive a notification. Your card will be charged automatically.

You also have an option to video chat with your pharmacist for consultation and for whatever queries you might have.

  1. Blink Health

Blink Health lets you buy your prescription meds at a more affordable price. They guarantee the lowest drug prices on all generic medications.


You can also pick up your prescription medication at local pharmacies near you. Just pay online and your order will be ready for pick up. Enjoy an average of 70% cost saving per prescription filled.

  1. GoGoMeds

Run by Specialty Medical Drugstore, a full-service pharmaceutical provider based in Greater Cincinnati, GoGoMeds offers low-cost prescription medications and other specialty pharmacy services.

You can have your prescription filled without the need to leave your home. Just send your prescription via mail or have your doctor fax it directly to specialty medical drugstore.

If you want to transfer from one pharmacy to GoGoMeds, just provide the name and phone number of the pharmacy when you process your order. Upon fulfillment, your medicine can be shipped to you directly or delivered according to your instructions.

  1. Alto Pharmacy

Alto Pharmacy fills your prescription and delivers your meds for free. The pharmacy stocks all common medication and specialty treatments and sells them to you at the best price. With the same copay and free delivery, you’re sure to achieve medicine cost savings.

With the acquisition of Round Health, Alto Pharmacy helps ensure people actually take their medicine. The reminder app not only takes note of your schedule for taking your medication but also the patterns and rhythms of your life. This allows the app to remind you of your medication more effectively.

You also have the option to have your prescription refilled at a specific schedule and right on time.

  1. NimbleRx

Fast and reliable medication dispensing is what NimbleRx is all about. They offer fast delivered pharmacy services that ensure patients get their prescription on time.


If you need to manage your refills, just use the Nimble Pharmacy app. It’s easy to manage and will speed up purchase and delivery services.

  1. MedAvail




  1. GoodRx

With the outrageous costs of drug prices, pharmacy start-ups that offer medication cost savings will save patients from financial worries. GoodRx is one of the drug coupon companies that provides patients with information as to where they can buy the prescription medication for the lowest price.

Using coupons, clients can save so much more.

Through GoodRx, you can compare drug prices from over 60,000 pharmacies in the US, print free coupons, and save up to 80% on your medication. You can also save a copy of the coupon on your phone and show it to partner pharmacies.

  1. Capsule

With Capsule, your prescription can be filled right from the doctor’s office. Just tell your doctor that your pharmacy is Capsule and wait for a text with a checkout link. Here, you can place your order and schedule same-day delivery.

You can go home right after your checkup and then wait for your prescription to be delivered right at your doorstep.

But their pharmaceutical services don’t stop there. You have the option to transfer a refill from your old pharmacy, have capsule take care of your refills, and ask questions related to your prescription.





Where are the Top 5 Medical Tourism Destinations?

Where are the Top 5 Medical Tourism Destinations?

More and more people are traveling abroad to seek medical care. They do so not for a less expensive healthcare but because some countries offer better medical services than what they would find in their own country.

According to the Medical Tourism Association, approximately 14 million people in the world go on a medical tourism annually.

A report by McKinsey and Company outlined what patients seek when traveling abroad to receive medical treatment.

  • 40% look for advanced technology procedures that are performed by a country’s highly-trained personnel.
  • 32% seek better and more human medical attention, care, and treatment.
  • 15% search for immediate medical service with shorter waiting periods.
  • 13% seek lower economic medical costs.

Top 5 Medical Tourism Destinations

  1. Mexico

When it comes to advanced care and cosmetic surgery and dentistry, Mexico takes the top spot. Tijuana, in particular, is a hotspot for cosmetic procedures.

The country has 98 hospitals accredited by the Federal Health Ministry and 7 hospitals accredited by the Joint Commission International (JCI).

With low-cost medical treatments that save patients up to 60% the prices in the US and Europe, it’s not a surprise that many people travel to Mexico for medical tourism.

  1. Costa Rica

In the last few years, Costa Rica has consistently ranked high in dentistry and cosmetic surgery above Canada and the US. It is also making vast improvements in the fields of bariatric surgery, cancer therapy, and eye surgery.

Compared to the US, healthcare services in Costa Rica is 45% to 65% lower.

The CheTica Ranch in San Jose offers medical tourists a unique ranch-style recovery retreat where patients enjoy amenities that rival a hotel and the care of well-trained nurses.

  1. Canada

According to the Medical Tourism Global Market and Figures 2018, Canada highly excels in stem cell treatment at a cost that is more affordable than in the US. In 2016, it was considered a world leader in health tourism according to an index developed by Fetscherin & Stephano.

With medical tourism considered one way for the country to create another source of revenue, expect more medical treatments to be added into Canada’s medical tourism.

  1. India

Healthcare costs in India will save patients 65% to 90% of similar services in the US. The country also uses cutting edge-technology in healthcare delivery. This is why it is one of the key players in the medical tourism industry.

Many of its hospitals are accredited by the Joint Commission International and the National Accreditation Board for Hospitals and Healthcare Providers. Some private hospitals offer health care packages for foreign patients that include airport-to-hospital pickups, private chefs, and free in-room Wi-Fi.

Some of the more popular procedures include eye surgery, orthopedic surgery, bone transplants, and heart bypass surgery.

Chennai currently ranks number one as the ultimate health care tourism destination in India.

  1. Brazil

In Latin America, Brazil is the best in healthcare delivery as noted by the World Health Organization. It is home to some of the world-renowned surgeons and has 43 JCI-accredited hospitals.

Brazil offers high-quality cosmetic and plastic surgery services that cost about 30% to 50% lower than in the US. This shouldn’t come as a surprise as cosmetic treatments are considered the norm in the country.

The Ivo Pitanguy Clinic in Rio de Janeiro is well-known for performing more cosmetic surgeries than other places in the world.

These are the just the top 5 medical tourism destinations in the world. This means you have more options when seeking medical treatments abroad if you look long and hard. What is even better is that you’re not just paying for lower costs but excellent medical care as well.




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Categoriesnews,  PBM

How Pharmacy Benefit Managers Impact Drug Pricing, Hospital and Patient Care, Payers, and More


In the United States, the cost of diabetes-related drugs, such as insulin or Victoza, cost 10 times as much than if you were to buy them outside the US. Price inflation of prescription drugs are not new but it is a unique problem for the United States.

Who’s to blame for the skyrocketing costs of prescription drugs?

Pharmacy benefit managers (PBMs)

They may not be the only culprit, but they contribute largely to the problem. Competing drug companies buy access to PBM formularies so their products will be chosen as the recommended choice.

By paying rebates and other fees to a PBM, a drug manufacturer can take a bigger piece of the sales pie. To recoup the large rebates and other fees paid to the PBMs, drug manufacturers have to increase the list price of drugs.

The result is skyrocketing drug prices.

But the cost of prescription drugs is not the only thing that PBMs can impact in both negative and positive ways.

How Pharmacy Benefit Managers Work

Historically, PBMs act as middlemen entities that process prescription medication claims and plan sponsors for a small fee. They provide services and educational programs to aid patient. They also serve as an intermediary between insurers and other healthcare members. This allows them to negotiate large customer contracts and for pharmaceutical companies and pharmacies to get the best rate.

What PBMs do

  • Negotiate rebates to get the most affordable option
  • Operate mail order pharmacy to deliver medications directly to patients
  • Ensure patient compliance in taking prescribed medications
  • Manage formularies and process claims from patients and pharmacies
  • Manage distribution among pharmacies, connect pharmacies to orphan drug supplier, and provide other specialty services.

The role was clear-cut and clean until they leveraged their position as middlemen to impact nearly every aspect of the prescription drug marketplace. Even an independent pharmacy is not spared from the impact that PBMs make.

Impact of PBMs on hospitals and patient care

PBMs are exploiting a Medicare provision that allows them to charge remuneration fees directly and indirectly to pharmacies within their network. To price out the competition, particularly a local independent pharmacy where patients have a personal relationship with pharmacists, they increase the fees for using in-house and member pharmacies as part of Medicare reimbursement.

With the way the incentives are structured, PBMs retain more of the discounts and fees, driving up costs on Medicare. Since the pricing model used is fiercely guarded, pharmacy benefit managers continue to hide the costs paid by health insurance companies, patients, and the government.

Impact of PBMs on American Health Care

PBMs generate revenue in three ways—administrative fees, pharmacy spread, and rebates.

  • Administration fees are charged to plan sponsors and manufacturers. The additional fees and payments go straight to PBM
  • Pharmacy spread is a PBM practice where the plan sponsor is charged a higher price than what is reimbursed to the network pharmacy. The difference, also known as a clawback, is pocketed by the PBM.
  • Rebates are discounts on a mediation that drug manufacturers provide in exchange for PBMs covering a drug product from a paying manufacturer. Since the formularies that the plan sponsors cover are made by the PBMs, they can choose which drugs will be used even when there are less expensive drug alternatives.

All these resulted in high prescription drug prices, restricted patient access to pharmacies, and the negative impact of limited formularies.

Impact of PBMs on employers/payers

Payers can benefit from a PBM through management of prescription drug benefits for members. Because the contracts are often one-sided and complex, partnering with PBMs often results in limited savings.

Only 30% of employers understood the clauses of their PDM contracts, according to a study by the National Pharmaceutical Council.

Research from Cigna showed that employers sponsoring their own health plans can save annually with integrated medical and pharmacy benefits. They can also bolster member patient care and self-management.

Although tackling prescription spending without the help of a PBM is beneficial, employers/payers still need to weigh the pros and cons of partnering with PBMs.

Lack of Regulation and Transparency

Through all these scenarios, a commonality is the lack of federal regulation and transparency that allowed PBM practices to take advantage of their role in the healthcare marketplace and make money at the expense of patients, payers, and pharmacies.

Something needs to be done.

Lawmakers are pushing to fill in what’s lacking and make PBMs more accountable.

In California, legislations are being proposed to boost transparency in PBM dealings. One of these legislations require pharmacy benefit managers to provide information about how much they paid for a drug, including administrative fees, acquisition costs, and rebates received.




Darshan Kulkarni Pharm.D, MS, Esq.

Amazon has made several recent moves including hiring new health IT experts, and physicians to make a big foray into health. Their recent disclosure that they want to enter the pharmacy world and their recent acquisition of PillPack makes pharmacists go – what does this mean for me? Will there be a reduced need for pharmacists?

As Global Positioning Satellites (GPS) became increasingly popular, the demand for cartographers dropped significantly. Digital maps created and updated in real time compared an individual’s current location to their desired location and told the individual how to get to the final location. Cartographers began to worry about their jobs and livelihood. Amazon’s overtures into pharmacy have similarly concerned pharmacists. However, since the concerns are similar, maybe the results will be too. There is a projection that between 2016 and 2026, the demand for cartographers will increase by 19%. This is attributed to an increased use of maps by government planning such organizations and the realization that there are some responsibilities that cannot be automated and delegated away. Similarly, pharmacists who hope to operate like they did 20 years ago are unlikely to survive. However, those who adapt, would likely be very much in demand.

What Amazon taketh away, Amazon may also giveth

Amazon has rarely been a manufacturer. Amazon typically connected businesses with potential clients and served as a marketplace. The marketplace originally started as being a place for them to sell their wares, but eventually expanded to become the Amazon Marketplace where anyone can use Amazon as a virtual store and sell their goods. As most know, goods sold by sellers on Amazon often compete against goods sold by Amazon itself, and the orders may often even be fulfilled by Amazon. Amazon has been happy to do this because they still make a profit with such an arrangement. So, one must wonder whether the pharmacy of the future will become a competitor to PillPack or will instead partner with them.

Accordingly, pharmacists may be able to compete or deal with a post-PillPack pharmacy in one of the four following ways:

  • 1) Amazon Marketplace

Competing against PillPack in the near future will likely require demonstrating specialization and knowledge. Cartography grew because of the creation of Hyper-Local Communities (HLCs), These HLCs looked at the location of the nearest Dairy Queen but also looked for shops surrounding the Dairy Queen? This was unable to be achieved by large mapping companies. In the case of pharmacy, pharmacists could develop a specialization by connecting with unique providers or providing unique services or simply products that cannot be easily mailed. This may include veterinary prescriptions, schedule II drugs, specialty drugs, emergency antibiotics, compounding or providing uniquely personalized care.

  • 2) Delivering Services

While Amazon has excelled at delivering goods, it has not demonstrated expertise in delivering services. As a result, CVS and Walgreens are looking to capitalize by partnering or hiring nurse practitioners or other mid level professionals and enabling them to engage with patients. Because these providers may be more likely to educate their patients at the pharmacy, diagnosed patients may find fulfilling their prescriptions on site to be more convenient.

  • 3) New Partners

Pharmacists traditionally think of Prescription Benefit Managers (PBMs) as their enemies. However, despite PBMs and Group Purchasing Organizations (GPOs) who are all supposed to theoretically help patients by keeping costs down, pharmacists feel squeezed and don’t have enough of a margin. With a new Amazon entrant, a pharmacy may now effectively assert that PBMs, GPOs and Pharmacies are likely to perish if they don’t survive together. Accordingly, this may enable better pricing opportunities and better opportunities for patients.

  • 4) Branded Prescriptions

Being a pharmacist in the Amazon Marketplace may enable prescription fulfillment across the state if not the country. Amazon Marketplace may enable a pharmacist sitting in New York City to sell a prescription to a patient in Albany. In some cases, the pharmacy itself may deliver to the new patient, or create a new category of “celebrity pharmacists” who simply are trusted to provide appropriate care, while a PillPack may do the actual fulfillment and delivery of the prescription.


While Amazon’s entry may provide interesting partnering opportunities, it is important that pharmacists consider relevant laws. The stark, anti-kickback, False Claims Act and civil monetary penalties law will each come into play. Accordingly, pharmacists hoping to partner with other providers, but should be careful with such endeavors since it may expose them to potential legal liability.


It seems likely that a push by Amazon into pharmacy may impact individual pharmacists who may see a decrease in patient volumes. This is likely to scare pharmacies and pharmacists. However, it seems like this may be a temporary situation and lead to more opportunities in the future.

If you are interested in hearing more about how Amazon affects pharmacists, the implications of an Amazon Pharmacy and patient centricity, or how Amazon’s Prime membership discounts might work with medications, search for the Pharmacy Podcast Network wherever you listen to your favorite podcasts or reach out to me directly on Twitter (@DarshanTalks).




Disease management aims to prevent or minimize the effects of a disease through integrated care. This involves disease management programs that are designed to improve the quality of life and health of persons with chronic conditions and to reduce healthcare costs associated with complications that are completely avoidable.

The idea is to treat chronic conditions more quickly and more effectively so disease progression can be slowed down.

Disease management uses a system of coordinated health-care interventions and one that empowers individuals to work with different health care providers to prevent complications and manage the disease. It operates on the basis that educated individuals are better able to manage their disorder because they know where to seek and receive better care.

A comprehensive disease management program comes with more benefits.

  • Improve access to care
  • Improve patient self-management
  • Improve safety and quality of care
  • Save patients from high financial costs without sacrificing quality or patient satisfaction

Furthermore, it enhances the efforts of healthcare providers to improve the healthcare programs offered on a population basis. Care coordination is one of the primary concerns of these providers and an integrated multidisciplinary disease management program is the solution.

One of the members of the multidisciplinary team of providers are pharmacists who play a role in assisting individuals in managing their conditions.

What is their role in disease management programs exactly?

Pharmacists in Disease Management Programs

A pharmacist deals with both patients and health care providers, making them a link between the two even when the interaction is not linear.

Trained pharmacists, for example, can evaluate medication therapies and identify drug-related problems, enabling them to help patients manage these problems.

On the other end of the spectrum, a pharmacist can educate physicians about treatment guidelines based on outcomes research conducted.

This is why pharmacists have a significant impact on the development and implementation of disease management programs. Whenever improvements are needed, they can also provide expert information, especially on medications and pharmacotherapy.

In a published study entitled Pharmacist-Led Chronic Disease Management: A Systematic Review of Effectiveness and Harms Compared to Usual Care, increased involvement of clinical pharmacists are encouraged.

It is believed that their role in patient care will enable patients to have access to primary care services and improved health care.

This was backed by the H.R.592 – Pharmacy and Medically Underserved Areas Enhancement Act that was recently introduced in House. The bill aims to improve access to health care through the patient care services offered by pharmacists.

It will also help established two things:

  • Pharmacists as healthcare providers
  • Pharmacists’ services covered through Medicare part B, especially in medically underserved communities.

It is clear that pharmacists must be involved in disease management programs. Their involvement varies depending on each practice setting.

  • Assists in the identification of patients
  • Conduct monitoring for specific diseases
  • Provide patient education
  • Provide direct patient care
  • Help ensure medication adherence
  • Help reduce inappropriate medication use
  • Evaluate disease management program outcomes

Different Pharmacist Interaction with Patients with Different Diseases


According to the US Preventive Services Task Force’s (USPSTF), screening for depression can help reduce or eliminate depression symptoms, something that pharmacists can help with.

As a member of a collaborative care team, a pharmacist can:

  • Carry out depression screening services.
  • Monitor patients who are predisposed to depression symptoms because of their medication regimens.
  • Educate and communicate with patients in print or verbally.
  • Identify symptoms of depression in patients who avoid seeking medical help because of the social stigma of mental health issues and then extend support.
  • Make themselves accessible for advice on health care and depression medication and adherence.


Blood glucose testing and other routine and simple tests are offered in pharmacies. For diabetes patients who do not have an established relationship with a primary care physician, this option provides a more accessible and less-expensive alternative.

These tests are then used by pharmacists to identify those with potential diagnosis and to help them find appropriate medical attention. As the most accessible healthcare provider, pharmacists are key in the betterment of diabetes patients’ health.

  • Educate patients about the disease through educational programs often carried out in a less formal setting.
  • Educate patients on how to use blood glucose monitor equipment at home.
  • Regularly monitor glucose levels both self-tested and laboratory tested.
  • Monitor patient compliance with scheduled clinic and laboratory appointments and prescribed therapies.
  • Provide medication management and review.
  • Screen for interactions and infrastructure actions for drug/drug, drug/food, drug/lab and drug/disease.


Pharmacists not only provide asthma patients with the medication they need but also valuable resources to help them understand pharmacological agents for treating and managing their disease.

Their knowledge about the disease and recommended medication are valuable and beneficial to patients. Recent studies show that increased awareness about asthma reduced the numbers of asthma-related missed days at school and work, hospitalizations, emergency department visits, and deaths.

  • Educate patients about the proper use of inhalation devices, especially those that are overwhelmed with diagnosis and treatment plans.
  • Provide educational programs with an emphasis on warning signs of asthma attacks, triggers, and patient adherence.
  • Conduct a periodic review of the kind of inhaler technique patients’ use.
  • Regularly monitor peak-flow function tests.
  • Ensure compliance assistance and manage chronic medication use.

Hypertension and Cholesterol

When the American Heart Association released its new guidelines that specify 130/80 is the new high, many people found themselves with high blood pressure. This added 30 million people to the nearly half of Americans that have hypertension.

While the new guidelines spelled bad news for patients, it offers independent community pharmacies an opportunity to further serve them and boost business at the same time.

  • Offer patients blood pressure screenings.
  • Assist with medication adherence and prescription management.
  • Assist patients with smoking cessation program.
  • Educate patients about hypertension and cholesterol, their effect on life and health, and the common comorbidities and conditions.
  • Monitor compliance with diet and exercise regimens.
  • Perform periodic blood pressure and cholesterol level checks.


Disease management programs are an opportunity to improve patient outcomes. But it can only be achieved with complete commitment from the members of the multidisciplinary team. In terms of collaborative development and the implementation and improvement of disease management programs, the pharmacist has the leadership role.

Submitted by Prestige Pharmacy | Michigan 


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