5/29/2020 An Unconventional Pharmacy That Gets Results: Bringing Integrative Medicine to the Pharmacy

An Unconventional Pharmacy That Gets

Results: Bringing Integrative Medicine to the
Pharmacy
2015-10-22 09:44:10
Dennis W. Song, RPh, CHC

Flower Mound Pharmacy and Herbal Alternatives is a different type of community pharmacy. From its
name alone, you can see the pharmacy integrates both traditional pharmacy practice and alternative
medicine modalities. The pharmacy itself looks like a cross between a full-service community
pharmacy and a health food store.

In addition to dispensing prescriptions and compounded medications, the pharmacy offers specialty
foods for patients who have food sensitivities (eg, gluten intolerance), a complete line of vitamin and
herbal supplements, delivery service, private store accounts, diabetes management classes, and
other disease state management programs. There are also separate private and semi-private rooms
for nutritional, herbal, and pharmaceutical consultations. The pharmacy even features a clinical room
that is used for various patient care services, such as immunizations and disease state testing.

There is a practicing nutritionist and lifestyle educator on staff who provide dietary planning and
nutritional counseling. These services are complemented by a physical activity option that is based on
a referral network of exercise trainers and physical therapists. Now, the pharmacist can offer specific
recommendations when the doctor tells the patient to “eat right and exercise.”

All of these elements are integrated into the drug therapy program and become part of the patient’s
total wellness plan. Outcomes and results, such as pounds lost and reduction of cholesterol and
glycated hemoglobin (A1C) levels, are documented and communicated to the physician. It is one-stop
shopping for health and wellness, all located in the pharmacy.

Connecting Clinical Outcomes and Drug Therapy

Flower Mound Pharmacy has a growing opportunity to offer services such as immunizations, blood
pressure screening, and cholesterol and A1C testing because of the emerging health care models for
reimbursement. Although these services are currently paid for by our patients, the pharmacy is
preparing for true third-party payer reimbursement based on outcomes. Medicare Part D and the
Affordable Care Act allow pharmacies to be compensated for medication therapy management (MTM)
and improvement of certain quality adherence measures, but they are paid for completing the process
and claims data, not for improving patient outcomes. The pharmacy has already proactively
established the link between clinical outcomes and drug therapy. This has been accomplished through
the measurement of reductions in cholesterol, A1C, and blood pressure seen with drug therapy and
integration of supplements and lifestyle changes.

When starting therapy, patients bring in or physicians fax baseline blood work results to the pharmacy.
A drug/supplement/lifestyle holistic treatment plan is implemented, and after 3 months, in-store testing
for cholesterol and A1C are performed and the outcomes are assessed. The pharmacy has seen
drastic reductions in A1C levels, averaging 1 to 5 points. Not only has this built loyalty among existing
and newly referred patients to the pharmacy, it has increased profits with in-store testing, supplement
sales, and improvement of adherence to drug therapy.

Patient-Centered Ambulatory Care

Based on the principle that “an ounce of prevention is worth a pound of cure,” the pharmacy practices

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5/29/2020 An Unconventional Pharmacy That Gets Results: Bringing Integrative Medicine to the Pharmacy

a holistic, prevention-based approach to patient health. Whereas most pharmacies are reactive, “sick-
based,” and product-driven, Flower Mound Pharmacy is a true patient-centered ambulatory care
pharmacy practice. Its process has advanced to the stage where some local physicians include the
patient’s lab work and medical history along with their prescription order so that the patient’s drug
profile contains a record of all of their prescription medications and supplements. In fact, there are a
few physicians who write prescriptions for the vitamin and herbal supplements and refer patients to
the pharmacy.

Although Flower Mound Pharmacy staff realize that patients use different sources to get their
prescriptions, the importance of a “pharmacy home” and a “primary care pharmacist” are conveyed to
each patient. Medication history printouts are provided by the patients and incorporated into the
pharmacy system. This gives the primary care pharmacist a comprehensive look at everything the
patient is taking to treat their health condition. The pharmacist can now perform a complete and
proper drug/supplement/disease-state screening for interactions and assess appropriate drug therapy.

Flower Mound Pharmacy aims to provide a variety of treatment options. The pharmacy serves as a
health care epicenter that facilitates a true collaboration among health care providers from across the
spectrum.Along with traditional prescriptions and compounded medications, our pharmacy specializes
in therapeutic interventions that include vitamin and herbal supplements and therapeutic lifestyle
changes. The pharmacy also offers alternative treatment modalities, such as acupuncture and
biofeedback. It has a network of allopathic medical doctors (MDs), doctors of osteopathy (DOs), and
alternative practitioners. Vital to the success of the model is naming a conventional MD or DO as the
primary care provider and using the alternative practitioners, naturopaths, and therapists as
“specialists.”

Bioidentical Hormone Replacement Counseling

The pharmacy specializes in bioidentical hormone replacement compounding. Working directly with
approximately 24 physicians, nurse practitioners, and physician assistants, the pharmacy has
established collaborative practice protocols. A standing order protocol format allows the pharmacist to
reassess the patient, evaluate lab work that is faxed to the pharmacy, and initiate a hormone regimen.
This service is welcomed by the physicians because it decreases the excessive administrative burden
of nurses and medical assistants pulling charts and interrupting the patient work flow.

The dispensing workflow process includes a fax from the physician of the lab work and medical history
instead of a traditional prescription. After a phone interview of the patient, recommendations for a
compounded prescription are then made by the pharmacist. Risk factors are identified and mitigated,
and a protocol prescription is faxed back to the physician. The compound can be started by the patient
without having to wait for an “OK” from the physician. This protocol provides additional patient history,
a second clinical assessment, and a double-check of appropriate hormone/drug therapy. After new
hormone therapy is initiated, follow-up counseling is performed at the first refill, and all outcomes are
reported to the physician. This process has been very well accepted by practitioners who want to
provide compounded medications to their patients, but do not know how to prescribe them.

Like the patient-centered medical home, the pharmacy practice is an outcomes-based model that
relies on patients to take ownership of their health. MTM is not just a transactional targeted medication
review, but a true clinical management of the patient’s drug therapy. This is accomplished by
compiling a complete medical history with lab values for high-risk patients. A pharmacy clerk has new
responsibilities and serves as a “patient care coordinator,” similar to a nurse in a physician’s practice.
He or she takes a record of the patient’s demographic information, medical history, and primary health
concerns. Utilizing the term “patient goal” encourages the patient to become vested in their own
health. The labs are obtained by the pharmacy from the patient or via fax or electronic communication
from the physician. Possessing the patient’s medical history has now transformed pharmacists into
practitioners. It is now very difficult to dispense a prescription without knowing if it is appropriate for
that patient’s medical condition. Gone are the days of simply screening for allergies or drug
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interactions.

Challenges and Benefits

There have been both challenges and financial rewards from using this new model. Community
pharmacy revenue has traditionally seen reimbursement from prescription fees, which have been
progressively shrinking. Flower Mound Pharmacy takes a 3-pronged approach—comprising
prescription fees, OTC and dietary supplement sales, and clinical services and consulting fees—to
ensuring its long-term financial sustainability.

Revenue from prescriptions accounts for more than 70% of total gross revenue, but provides less than
10% of gross profit; most of the operating and gross profit are generated from vitamin and supplement
sales. Scheduled private consultations paid for by the patients provide an additional $12,000/year in
revenue. In addition, these consultations drive dietary supplement sales, which amount to more than
$250,000/year.

A true and measureable impact on our health care system can be achieved by improving the lifestyle
habits of each patient. Therefore, the biggest challenge going forward is to have third-party insurance
payers realize the value in health care savings achieved by the preventive measures patients take that
lead to improved health outcomes. The pharmacy believes that the patient must be personally
invested in their own health and make therapeutic lifestyle changes. Drugs and medications only
alleviate symptoms and manage disease states, primarily by reducing modifiable risk factors such as
blood pressure, cholesterol, and blood sugar levels. Regardless of the causes of a medical condition,
prevention and adherence to the treatment plan mitigate risk factors. Flower Mound Pharmacy utilizes
services such as medication synchronization, behavioral interviewing during counseling sessions, and
incentive and reward programs to motivate their patients to lead healthy lives.

Typically, retail community pharmacies generate most of their income during the winter cold and flu
seasons. Flower Mound Pharmacy has changed the paradigm to a sustainable prevention-based
model that ensures a continual traffic flow from patients who take a vested interest in their health. This
is a unique pharmacy that the public visits to stay healthy, not just get well.

Flower Mound Pharmacy is not just a retail dispensing pharmacy, it is a community pharmacy practice
that is education-based and outcomes-driven. In a world where we are drowning in information and
starving for knowledge, Flower Mound Pharmacy provides the education, resources, and tools to help
our patients lead healthy, happy lives.

Dennis Song, RPh, CHC, is the owner and head pharmacist of Flower Mound Pharmacy, a wellness-
oriented local pharmacy with an integrative approach to health through medicine, supplements,
nutrition, and alternative therapies in the North Dallas-Fort Worth area. Dennis and Kathy, his wife,
opened Flower Mound Pharmacy over 18 years ago with the goal of providing patients a reliable
source of information, support for their health concerns, and unique services. Some of the distinct
services the pharmacy offers include compounded prescriptions, integrated natural and alternative
treatments, prevention and education programs, and specialty foods for people with dietary allergies.
Residents voted the store the 2014 Best Pharmacy in Denton County. Additionally, Song continues to
be actively involved in the Texas Pharmacy Association, having served as its president from 2011 to
2012. In 2012, the American Pharmacists Association Foundation and Student Affairs Administrators
in Higher Education awarded Dennis the Bowl of Hygeia, an annual award recognizing civic and
community leadership among pharmacists.

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