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It's Easy Being Green

I'm sure you can guess from the title what this post is about. Today we're going to talk about greening the community pharmacy.


In case you aren't really an environmentalist yourself and need some convincing as to how this will benefit you, let's look at why going green makes great business sense:

  1. Reduced expenses: Reducing waste, in any form, ultimately improves your profit margins. Considering the average net margin for independent pharmacies is around 3% according to the last NCPA I saw, we need to take all we can get.

  2. More business: When I was in school for my MBA I took a marketing class and learned about the so-called 'LOHAS' market, or 'Lifestyles of Health and Sustainability.' To sum it up, this group is health conscious and concerned about sustainability and green initiatives. Many individuals in this group have a strong desire to 'vote with their pocket book,' spending at businesses that are truly making a difference beyond shareholder (or business owner) value. They have high expectations for the companies they frequent, but they are also among the highest-income consumers and have some of the highest levels of completed education. In other words, they're your commercial-paying customers that might shop your front-end store too and help pay your bills.

So what can you do to go green and help your pharmacy and the planet?


Here are some ideas to get you started:


Compostable Prescription Vials


I was pretty surprised to find this out, but there are actually companies in the business of manufacturing completely biodegradable prescription vials. Check these two out to get you started:

  1. iBottles

  2. Pharmacy Lite

Not only is this a great thing to do for the environment, but when I spoke with one of these companies over the phone they told me about an independent pharmacy that had started to see an uptick in transfers since switching. Many patients told the pharmacy they decided to transfer their prescriptions because of the biodegradable vial and being concerned about their own waste production.


Take a look at this pharmacy, for example, that is using it to draw in new business. Now that's something the chains aren't going to be able to compete with!


Prescription Vial and Stock Bottle Recycling Program


Most other bottles are made of HDPE or PP, both of which are recyclable. When I explored this in the past, I was told by a commercial recycler that stock bottles and prescription bottles were considered high-quality, food-grade plastic and carried a high value relative to other types of plastic waste.


Even if you switch to compostable vials, your customers will still appreciate being able to bring in vials from other pharmacies to recycle them. Plus, every time they come in it's basically free foot traffic for your store (you'll be paid for the plastic, so it doesn't really cost you anything to run the program).


If you have patients concerned enough about the environment they bring in bottles from other pharmacies for recycling in your store, they'll probably be very interested in your compostable vials and I would imagine you would get transfers out of them in the process.


The best way to do it? Put a sign up on your vial recycling bin advertising your compostable vials and reel them in.


This site, which I initially found through the Association of Plastics Recyclers, has contact information to help you get started and learn about the plastics recyclers in your community who might be able to work with you.


Reducing Bag Use


I understand the necessity in many pharmacy workflow setups to bag every prescription, but it always makes me sick how much waste that brings. The majority of customers probably don't recycle them, and even if they did it's not as good as not using the bag in the first place.


One of the chains I worked for did this well by having the old-school will-call system with the hanging bags. We always bagged the vial and leaflet directly in it.


I was uneasy about it for a while, but eventually started to realize the advantages. In addition to not using prescription bags, the technician ringing the patient up was able to get a second set of eyes on the vial to be sure it matched the prescription leaflet. On a handful of occasions, those techs caught errors before they left the pharmacy.


MedsOnCue


Another big form of waste: those leaflets we print for every prescription and are read by easily under 1% of all patients.


One solution? MedsOnCue. I've talked about this company before, but one super-cool thing about them is that in many states they have gotten BOP approval to have patients opt-out of leaflets and have only MedsOnCue instead.


If you're filling 3000 prescriptions a month and you get half of those on MedsOnCue you would save 1500 sheets a month plus the toner. When I did the calculations, even this small savings in paper would be enough to offset a lot of the cost of the service, plus patients will appreciate the counseling videos (be sure to advertise it to make your pharmacy stand out!).


Medication Take Back Program


Prescription drugs themselves can contribute to a lot of pollution if not disposed of properly. Not only does a medication take back program help with opioid and prescription drug abuse, but it also keeps medications out of the water supply.


There are cases of hormonal agents, for example, even causing hermaphroditic fish species to change sex, so it is a true threat to the environment.


I've also seen chemotherapy quite regularly in my bin, which otherwise could have ended up in the water stream.


Check out my post on this topic for a guide to implementing this program.


Improved Inventory Management

Inventory management software

If you have multiple stores, using a software program like SupplyLogix is a no-brainer. The software automatically taps into your computerized inventory and usage at all your stores and then, for each store, populates suggested inventory transfer to use up the 'crumbs.' If you have a 100-count bottle with 10 left in it (more complaining on that later), you can transfer it to a store that will actually use the drug.


Without a program like SupplyLogix, it's really just too unrealistic to be able to consistently move inventory between stores. I've tried with only two stores using a shared Google Sheets and it doesn't work. It's too time-consuming to constantly update it.


One of the chains I worked for used this program and we made a habit of preparing the items once a week to ship out to the other stores (be sure to check your state laws so you know they allow it) and it was an easy thing to add in our routine.


Label at Pickup

A label at pickup section will keep you from damaging items you can't send back (more complaining on that later too) and then being stuck with it until it expires. You know what items are special order and what items you'll use again. Wait until the patient gets there and pays to put a label on it and reduce your medication waste.


Proper Disposal of Pharmacy Stock

Speaking of dropping pills on the floor, you can also help those hermaphroditic fish out by using companies that can properly dispose of your pharmaceutical waste. This includes includes both reverse distributors and waste companies.


It will also keep you out of trouble with the EPA, which has fined retailers with pharmacies in the millions in the past for violations of the Resource Conservation and Recovery Act (RCRA).


90-day supplies


While adherence and reduced labor costs are the biggest reasons to push 90-day supplies, getting enough patients to switch could save a lot of plastic vials, bags (if you use them) and packaging materials (if you mail or deliver).

Advertising


Once you've got your Going Green plan together, be sure to show it off. It blows my mind there aren't more pharmacies actively trying to bring in the huge, high-paying LOHAS market.


Just like large companies do (including the chains, like Walgreens or CVS), you too can put together a Corporate Sustainability page and bring all of this together to show your patients (and future patients) what your pharmacy is doing for the planet. If you implemented most of the things in this article you would have a solid Sustainability page.


Even if it's required by law, like disposing of your pharmaceutical waste properly, you should still show it off. Even the 90-day supplies you can show off. For 90-day supplies, for example, think about measuring how many prescriptions you've gotten converted to 90-day supplies this year. If you need to mark them in the system somehow so you can run a report, find a field to do so. Once you have that count, figure out how many vials you saved from the trash (i.e. 12 vials vs. 4, so 8 vials saved/Rx) and bags (same), then report that to your customers.


The Bottom Line


Going green will not only help the planet, but also help your pocketbook through reduced expenses and increased business. A sustainability plan can become an integral part of your marketing strategy to attract the highest-income segment of the market. There are lots of things you can do that won't take a large investment of time or money, so just do it!

A Note for Drug Distributors and Manufacturers:


In case my friends further up the drug supply chain are reading this, let me tell you about a few things we community pharmacists wish you would change:


Stop making stock bottles in counts we can't use

If I dispense in 30, 60, or 90-count, why are you putting 100 tabs in a bottle? What exactly am I going to do with the other 10? Same goes for a 1000 count bottle. How am I supposed to end up using them all? I can understand for antibiotics, but blood pressure meds?

Give me 30, 60 or 90-count bottles. Not only does this reduce medication waste, but if you use a PPPA-compliant stock bottle I don't have to waste another prescription vial just to fill the prescription. So I reduce plastic waste too. For the big bottles, it might be nice if you gave me maybe a 910-count bottle (because I'm messy and I'll drop a few), but 1000 cannot be divided by 30, 60, or 90.


If you did this with controls, we would love you. Not only do we not have crumbs of oxycodone sitting in our locker, we can give patients a sealed bottle. Do you know how much time that would save, not having to double count, then back count the stock bottle? Do you know how many times patients have accused us of miscounting (and sometimes they have been right), and how much more comfortable patients would feel with controls getting a sealed bottle?


Find a way for us to return items with peeled labels, even for less credit

Every pharmacist knows my pain: someone stickered a drug we won't ever use, the patient never picked it up, and it showed up on my return to stock report.


I'm using a magnifying glass and a spatula to ever-so-carefully peel the tape off of a $3000 drug while praying it doesn't tear. I slowly peel it back, getting excited at the thought that I pulled off the unthinkable feat of making it sparkling enough you'll take it, only to get to the end and have the tape rip off a 2mm part of the top layer of the box.

I consider coloring that part in with a crayon and mailing it to you anyway to see if you'll notice but then (usually) just get pissed off and put it back on the shelf until it expires.


Too late, now. $3000 in the garbage, only because the box has a little boo-boo. That's an insane amount of waste that many countries in this world probably could not imagine. Most patients in this country who are on those drugs, especially if they have trouble affording them, would probably vomit at the idea that this actually happens.


Not only does it happen, though, it happens on a fairly regular basis at nearly every pharmacy I've worked at.


How can we fix this?

Create a 'damaged package' category of medications we can buy at a lower price. Then allow pharmacies to return new medications, with the same dating requirements you currently have, but with a damaged package.


I know what you're thinking - the lot number/expiration might not be readable, the box might be too damaged, etc. - but there could be some ground rules. And if it's too damaged, then the med could be sent back to the pharmacy as an unsaleable product, just like you do now with my box I tried to pass off to you as new.


Also, this would be completely compliant with DSCSA, etc., because they aren't 'gray market' medications, they are brand new medications we bought directly from you with nothing on them but a tiny little scuff on the box. I've had to throw meds away because of cosmetic issues on the box that a patient wouldn't even notice - what a waste!


If we were the pharmacy returning it, at least we get some credit for it, and if we're the ones buying it we can keep an eye on those high-cost meds we know we'll use and snag a good deal on them. Getting a good deal and billing at the same rate gives us a little more cushion, which we really need right now.


Keywords: Waste, environment, green, Earth, planet, RCRA, medication disposal