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Universal Pharmacy Solutions

A really good business plan is the first step to success.

Angie Meeker has had a lifelong interest in pharmacy. She grew up in a small town in Wyoming where Steve Rogers, a friend of the family, was her pharmacist until she left home for college. She thought he was amazing: he was always making a special cough syrup or some type of medicine that seemed to magically make patients well. He was a great role model, and Meeker decided as a child that when she grew up, she wanted to work as a pharmacist. However, she first earned a BA in education from South Dakota State University before receiving a PharmD degree from Idaho State University. She then worked briefly as a nuclear compounding pharmacist for Central Pharmacy Services, Inc, in Eugene, Oregon. Nuclear pharmacy didn't appeal to her because she didn't have direct patient contact, so she decided to pursue other opportunities in medical-- pharmaceutical research. Although she was considering two residencies, she began to hesitate about her career choice. She reevaluated her reason for going into pharmacy, which was to help the individual on a day-to-day basis, and remembered a lecture during which Bill Letendre, a pharmacist from Professional Compounding Centers of America (PCCA), reviewed the ways in which compounding helps individuals. Meeker reconsidered her options. That night she changed her mind about her future and declined both residencies. The next morning, she called PCCA to ask how she could establish her own compounding-only pharmacy. "The staff there helped me through the entire process, and I have never regretted that decision," she said. "Compounding is absolutely the perfect profession for me."

Developing a Good Business Plan

Even before she called PCCA for advice, Meeker knew that a sound business plan was the basis for success. From PCCA, she obtained suggestions for establishing a compounding pharmacy and examples of effective business plans. That blueprint and advice from the staff at PCCA helped her to develop her own 3-year plan, which was so effective that when loan officers at a local bank reviewed her proposal, they tried to talk her into establishing a business writing business plans!

"That was one of the keys to my success: writing the plan in such detail forced me to have a vision of the pharmacy that I eventually wanted," she said. "I decided to follow that vision but to always be flexible enough to modify it as necessary. I knew that it was essential for me to keep track of where the business was in that overall plan. If you keep those goals in mind when you start, you'll go down the right path."

Meeker realized the importance of proving that a compounding-only pharmacy would be successful in the area she had chosen for her store site. She researched the local market thoroughly and compared the size of the population (about 70,000 people in Medford and another 170,000 treated at nearby medical centers) with the number of pharmacies compounding at that time. Although two other pharmacies in Medford were performing some compounding, they were retail stores as well. Meeker knew that the market could support a specialty compounding pharmacy. In her business plan she demonstrated that the overhead required for a compounding-only pharmacy was much lower than that for a retail pharmacy.

"Compounding is a niche market, and I proved to the satisfaction of my lenders that there was a need in my geographic area for that service," she said. "The presence of other local compounders (we're now about six blocks from each other) was not a deterrent to my securing a loan for the business. That's because when you open a compounding-only pharmacy, you don't steal other pharmacists' patients; you create your own business instead. My projections for the growth of the business were very convincing as well. As a result, it was just 4 months from the time that I decided to establish my pharmacy until the doors of Prescription Compounding Solutions opened for business in April 2000."

From its first day, Meeker's pharmacy was a nonstop success. When she first opened the store, she decided to offer all types of compounding. In her area, there was a great demand for compounded bioidentical hormone replacement therapy (BHRT), and today much of her business is still devoted to BHRT for women. However, she and her staff also compound many other formulations: topicals, intrathecals, preparations for veterinary patients and for pain management, injectable vitamins, and inhalation therapies. The pharmacy does no thirdparty billing; patients pay up front and then submit a universal claim form to their insurance companies. Sometimes pharmacy staff members help patients file claims for reimbursement.

"Business has been fantastic," Meeker said. "Originally, I thought that not accepting insurance would hurt the business, but when we explain that we prefer to spend time assisting our patients instead of filing forms, most of our clients have no problem billing their insurance company."

She has also found that consulting with patients is an essential and much-appreciated service and has designated one room of the pharmacy suite for use in patient consultation. Most consultations pertain to hormone therapy or pain management, and a receptionist arranges appointments. Meeker consults with patients for a flat fee of $85 for 30 to 60 minutes and bills follow-up consultations at the same rate.

"Soon after I opened the store, I found that many patients who would ask me questions about hormone preparations would also tell the that their practitioners didn't know much about the advantages of treatment with bioidentical homones," she said. "Rather than suggesting a referral to another doctor who was more knowledgeable about BHRT, I would do a hormone consult with that patient and would then make recommendations to his or her physician. In doing so, I've educated a lot of prescribers in the area and have been able to explain our services to staff members at local medical clinics. Now, many of our prescribing physicians are knowledgeable about the preparations that we provide and have retained patients who might otherwise have changed practitioners."

Most prescribers for Meeker's pharmacy are family practice physicians. At present, there are about 50 regular prescribers and 450 others in the pharmacy database. About half of her patients are word-of-mouth referrals.

The pharmacy, which is located in a medical arts building across from a hospital that is the primary medical center of Southern Oregon, comprises about 1450 square feet and resembles a laboratory more than a traditional pharmacy. The main entrance, which opens into the waiting room, is similar to that in most medical offices, except for windows on one wall that enable patients to watch compounding activities. Windows also span the entire front of the suite so that passersby can look into the lab.

Business is brisk. Staff compound about 50 to 60 prescriptions per day, and the pharmacy is open Monday through Friday from 9:00 am to 5:00 pm. According to Meeker, she didn't have to recruit employees; because of the pharmacy's excellent reputation, they found her.

"My staff is the foundation of my business," she said. "I have always hired qualified staff who could work in any of several capacities in the pharmacy. I work with each new employee closely at first to find his or her strong points, and then I match those skills to the tasks we perform. That way, each person is working in his or her element; and so far, everyone has been very happy with that arrangement. I've made sure that all staff complete training in compounding at PCCA. I believe that your business is your staff, and when you invest in your staff members, you invest in your business."

On staff at Prescription Compounding Solutions are a chemist, a part-time staff pharmacist, a receptionist, three pharmacy technicians, pharmacy students, and a delivery driver. Because many patients are elderly or too ill to drive to the pharmacy to pick up their compounded prescriptions, the pharmacy provides a delivery service.

In addition to working in the pharmacy, Meeker also trains chemistry students from Southern Oregon University and pharmacy students from Oregon State University. The students research various disease states and options for treatment, and also work in the lab. Those who are registered technicians help make ointments and creams.

Revising the Plan As Needed

Establishing Prescription Compounding Solutions and maintaining its success has not always been easy. "My biggest challenge since we opened," said Meeker, "has been fast growth, which is risky; money goes out faster than it comes in because you're buying supplies, stock, and other essentials. I'm constantly revising the projections in my business plan because I'm reaching goals faster than I envisioned I would. I have to constantly adjust the plan and my vision of the future to accommodate that growth, to address the need for added space and remodeling, and to hire additional staff members. A year after we opened, I had twice the staff that I had originally projected I would need."

In characteristic fashion, Meeker took effective action when she realized that her business was growing so quickly. She and her banker discussed expansion and the importance of having enough qualified staff to handle new business, and Meeker also got good advice from friends and from PCCA staff.

"I realized that when you first open a business, you do everything yourself," she said. "You're the bookkeeper, the receptionist, and the pharmacist. As your business grows, you have to be willing to let others wear some of those hats. I've contracted out payroll, bookkeeping, and accounting. If I'd continued to perform all those tasks myself, I would have been swallowed by the business. Having the vision to know when to give up doing certain things is important, too."

Setting Goals for the Future

Part of Meeker's business plan addresses goals for the future. She envisions the pharmacy as expanding during the next 5 years into a health solutions center with a variety of practitioners (other PharmDs, nurse practitioners, and healthcare professionals who have goals similar to hers) with whom prescribers can consult about difficult treatment problems. Creative thinking and treating every patient as an individual will always be important to Meeker, who foresees an equally bright future for compounding as an art and practice.

"There's so much momentum from compounders, physicians, and patients to make compounded preparations more available that I believe the current demand will increase exponentially," she said.

Like most successful entrepreneurs, Meeker has a golden rule. "Another pharmacist once told me that it is essential to treat every client as if he or she is your most important patient. That's especially true in compounding pharmacy. I've made that the mission of this practice: each of our patients is treated like a friend and a valuable client. We want our patients to have confidence in us and to turn to us if they have problems with their treatment. We have established a great rapport with most of our patients and our prescribers, and we've been able to help them more because we know them. That approach has helped us to be very successful as well."

Meeker's success is an inspiration to anyone who finds a compounding-only pharmacy appealing. "Do what you say you will when you say you will do it," she advises. "That will build your reputation among patients and prescribers as a good compounding pharmacist."

For additional information about establishing a compounding-- only pharmacy, contact Angie Meeker, PharmD, Prescription Compounding Solutions, 691 Murphy Road, Suite 101,

Medford, OR 97504. E-mail: angiem@rxcompounding.net

Copyright International Journal of Pharmaceutical Compounding Mar/Apr 2003
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