The Bottom Line Pharmacy Podcast: Driving Independent Pharmacy Profitability in 2024 Featuring Nicolette Mathey

The independent pharmacy of today is sitting on lots of data and opportunity to expand into areas of healthcare such as long-term care and other clinical services that can help your pharmacy become the healthcare center in your community.  

But as a pharmacy owner, how do you know what to do with all the data available to you?  

In this week’s episode of The Bottom Line Pharmacy Podcast, Nicolette Mathey from Atrium24 shares her insights on long-term care, GLP compounding, the double DIR cliff pharmacies are facing, and more!  

Join the discussion with us!

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More resources about this topic:  

Podcast – Making Data Work for Your Pharmacy

Webinar – DIR Fees Accounting Best Practices

Podcast – Opportunities with Clinical Services

If you prefer to read this content, the video transcript is below:

Scotty Sykes: So, Nicolette, welcome back to another episode of The Bottom Line Pharmacy Podcast. Nicolette Mathey with Atrium24 today.  

Nicolette Mathey: Yeah. 

Scotty Sykes: One of our regulars on the podcast if you will welcome glad to have you back on.  

Bonnie Bond: Just sent somebody your way this morning on a call. 

Nicolette Mathey: Glad to be here. Lot going on in pharmacy. 

Scotty Sykes: There is a lot going on. I mean a lot. You got this Change Healthcare fiasco, the DIR fee hangover, the change in reimbursements. What else, Nicolette? What else do you want to add to that? 

Nicolette Mathey: There’s a lot of opportunity too.  

Scotty Sykes: Oooo, I like it. 

Nicolette Mathey: So you always try to… 

Bonnie Bond: Keep it on the positive. 

Nicolette Mathey: Yeah, cause you have to. So we definitely need to advocate for change in reimbursements and in everything that’s going on the legislative side. And in the meantime, what are we gonna do? So, I think it’s interesting with all of this happening with double DIR going on and now, DIR is paid at the point of sale, so it’s supposed to be more transparent. So I’m really looking forward to, we’re not there yet, but when pharmacy owners actually have that visibility and real-time analytics into what the heck’s going on so that they can make informed decisions. Because just historically, you know, with your cash flow, you guys know best, pharmacies don’t know which way’s up. It’s just so hard to predict everything. So you can never completely eliminate that, but I definitely think now is the time to understand in the pharmacy business, what are our levers that we can push to drive profitability? And the only way that we’re gonna understand that in each unique pharmacy instance, because every pharmacy that we all work with is very unique. The only way you’re gonna be able to do that is to analyze and dissect the data in real time with data analytics tools. And so, I’ve become painfully aware of how complicated that is now that I’m not really a pharmacist day to day anymore.  I don’t even know what to tell people what I do when they ask me, but I, I guess I own a tech company, so I’ve been learning a lot about DevOps and SecOps and IT ops, and they abbreviate everything, but like with half words, pharmacies like acronyms, but technologies like half words, but it’s like cybersecurity, as you alluded to, is a big thing.  

Scotty Sykes: It is. 

Nicolette Mathey: Even just managing your cloud environment and infrastructure. And we don’t really think about it. Even our pharmacies, we have to worry about cybersecurity with our PMS and all of our patient information. And then our servers are either on-prem, which just means on-premises. I don’t know why we had to abbreviate that. But the servers are on-prem or they’re in the cloud. And so like Pioneer, for example, you have a server on site, but the data is also in the cloud. QS1, the data is pretty strictly on-prem. So, it’s just interesting to learn. Now that the cards are kind of on the table a bit with DIR, we should be able to apply some business analytics to it to tell us what the heck to do. Push on this, pull back on this. This is not where you should be focusing your business. And then there’s just so many opportunities clinically when we talk about long-term care at home and medical at home, because there’s some new payer opportunities there. It’s exciting. 

Bonnie Bond: Yeah, that’s a big opportunity for sure. 

Scotty Sykes: I’ll tell you those pharmacies that have jumped on that long-term care at home, heavy, boy, it’s paying, it’s paying right now. It is worth it. It’s weight in gold. 

Nicolette Mathey: Yeah. And I mean, I’m still watching it. And of course, I want more analytics around it because it’s plan-specific. So, you have to be able to identify your patients. I mean, most pharmacies are already providing these services anyways. You’re doing the delivery, you’re doing the adherence packaging, you have patients with activities of daily living issues or transportation or mobility issues. So they already qualify. And you’re still doing the volume game with those long-term care patients, you’re filling a lot of prescriptions. So, if you can increase, like what are you, so you guys are seeing on the books, like an actual increase. 

Scotty Sykes: Oh, I, for sure, for sure, I’m definitely seeing those that are heavy in long-term care, their margins are high. Yeah. 

Bonnie Bond: And people are definitely into it or looking into it as an, you know, an option in addition to what they’re doing to offset some of this craziness. 

Scotty Sykes: Like you said, their patients are already there, so it’s just, you know, getting them into that program, if you will. 

Nicolette Mathey: Yeah. And I think it’s just smart to apply data analytics to everything that we can to get it all in real time in front of us. Pharmacies are just kind of swimming in data right now, and they don’t really know how to discern it. So typically in other industries, I’ve been researching other industries quite a bit too, and learning a lot. And in other industries, I mean, you would hire a consultant like McKinsey or something like that to come in and analyze, like what’s going on with my business and what should I do? Independent pharmacy, we don’t really do that. I mean, there’s consultants that exist. I’ve been one for the better part of a decade, but still it’s inefficient, especially given like the profit margin that pharmacies have and the dollars that they have to work with. There’s not a lot of dollars at the end of the day in independent pharmacies to be able to spend on non-essential functions. So, if you could get some sort of data analytics tool that shows these pharmacies, even based on all your unique-isms, that’s not a word, this is what you should do. You should , you have 67 patients on this one plan where they do recognize long-term care at home billing. And then these are the steps and the attestations and the things that you should do to be able to bill for those patients. That’s one side of the spectrum. Because we have pharmacies we work with in rural Alabama, I love to pick on them, and they’re heavy in long-term care. But then we have pharmacies in Miami, Dallas area, even California where they’re, you know, they have a higher cash pay population. They’re not really into long-term care. And they’re really doing well with the weight loss, all the GLP stuff cash. So, there’s just tons of opportunity. It’s just a matter of, yeah, and then make a plan and double down on it. 

Bonnie Bond: And you’ve got to figure out what works for you in your area for sure. 

Nicolette Mathey: So, I feel like hopefully we’re coming out of the double DIR situation. Hopefully cash flow will start to stabilize. 

Scotty Sykes: I think we got a couple more weeks of that care mark. It was at mid, mid May, I believe somewhere around there. Definitely by the end of May, it’ll, it’ll all be over, hopefully. 

Bonnie Bond: Yeah.  

Nicolette Mathey: Yeah. So, I talk with a lot of, you know, we have like single store owners where, you know, the owner works the bench and they’re trying to get out and visit doctors or even just call offices, email offices, Facebook message offices to try to grow their business. And then we have just multi-store, multi-state owners too. Of course, the smaller operators are really nervous and concerned with all these cashflow issues. And we’re hearing these like doom and gloom metrics too, right? That 20 to 30% of pharmacies might close this year. And I mean, there’s 2022 NCPA Digest, there were like, actually have the number here, 19,432 independent pharmacies. So if you’re talking 20, 30% closure, I mean, that makes up almost half the pharmacies in the country. There’s just over 56,000 pharmacies in this country in total. So, the smaller operators that I talked to, and rightfully so they’re concerned, and it won’t take that much to push them into profitability. So if you can get involved with the GLPs, because everybody and their moms ordering them online from somewhere, we’re really seeing that. And that’s what the offices want.  

Bonnie Bond: Right. 

Nicolette Mathey: So, during COVID, the offices wanted vaccines, they wanted testing. Now these offices want GLPs. They want somebody to counsel their patients. They want somebody to educate the patients on how to inject themselves. They want someone to educate the patients about protein intake and supplementation and things like that. So that’s a huge opportunity. 

Scotty Sykes: It’s just a, it’s just an entirely different environment in pharmacy than it was four or five years ago.  

Bonnie Bond: Yeah. 

Scotty Sykes: I mean, it’s completely, that is the fun part.  but if you’re not. 

Nicolette Mathey: Yeah. That’s the anchor. 

Bonnie Bond: And we were talking this morning about the data. Yeah. The data this morning, that’s what we were talking about, is never before have I seen where the pharmacists themselves are really having to take this data, almost every day, and really look into the details of it and figure out what they’re losing on, what they’re making money on, and then groups, the person we were talking to, you know, you have to look at family groups almost, for some people, to keep that client base. If it makes sense, not just looking at the drug itself, but everything that entire family maybe fills and it’s a lot. 

Nicolette Mathey: Yeah. It is a lot. And even the smartest of us can’t quite figure out, and I’m not that person, but the smartest of us can’t figure that out. You know, I work with Ben Jolley quite a bit in the Pharmacy Inside Out group, and he’s so great at giving information and posting on the Facebook groups and all that. And I mean, it’s complicated even for him.  

Bonnie Bond: Hehehehe. Right.   

Nicolette Mathey: So, by design, we’re not supposed to let him figure it out. Yeah, he is. Yeah. 

Scotty Sykes: He’s a smart dude. 

Bonnie Bond: Yeah, he’s the smartest of the smartest.  

Scotty Sykes: He’s a smart guy. You just see his brain working. He’s a smart dude. 

Bonnie Bond: Yeah.  

Nicolette Mathey: Yeah, 8% So we’re not supposed to figure this out by design. And then once you do figure it out, as we’ve seen in the past with different analytics tools that I’ve been a part of building, once you do figure it out, they have algorithms.  

Bonnie Bond: It’ll change again. 

Scotty Sykes: They’ll change it. 

Nicolette Mathey: Yeah, and they’re like, all right, we’re going to turn that spigot off. So that’s just how it works. So definitely… 

Scotty Sykes: So, when is that gonna happen to the long-term care at home? 

Nicolette Mathey: I mean, it’s not home runs. I mean, we all know you can’t hit these home runs in this and make yourself a target and risk that much in audit. It’s just the risk tolerance that we all have is not there. Risk your contracts, like you can’t do that. But with the long-term care at home, I think that’s like singles. And then you can do it at volume too. And you can do it across multiple plans. And I think it’s only gonna expand. So I think that’s a long-term strategy for long-term care.  

Bonnie Bond: Yeah. 

Nicolette Mathey: So, there’s tons of opportunity for smaller operators, definitely in the GLP space. But for the larger operators.  

Scotty Sykes: Talk to me about the GLP space, like how? How, I mean, right now they’re getting reimbursed, you know, less. 

Nicolette Mathey: Oh, yeah, yeah. Yeah, no, so not the brand names, not the brand name…   

Scotty Sykes: Are you talking about like compounding?  

Nicolette Mathey: Compounding. 

Scotty Sykes: Yeah. 

Nicolette Mathey: So I’ve learned so much in… Man, I’ve learned so much and I’ve done a ton of webinars on them inside of our software tool and we’re even doing more. It’s hard when you layer a gray area on top of a gray area, on top of a gray area sometimes. So, now I do think, and I had a webinar with Frier Levitt too, and I really like called them to it and asked specifically, because they talk all legalese, but I’m like, do you think this is a good idea? Do you think pharmacies should do this? And they said yes, it is. But probably the grayest place we can go is utilizing a 503B pharmacy for commercial copies of the compounded GLPs. So that’s what I mean by like gray on top of gray. And I didn’t even really understand this fully, but when you think about what’s the difference between 503A and 503B pharmacy, and then we start to think about, are you talking about 340B? No, we’re not talking about that at all. That’s a totally different thing. But if you talk about 503A, that’s a normal pharmacy who compounds. That’s just your regular pharmacy. When I had my store, we were a hybrid, we were a 503A. It just means that you compound the things, you dispense them, pursuant to a prescription, patient-specific. You’re not a manufacturer, you’re not a wholesaler, you’re not making big batches of compounds. You can do some anticipatory compounding, but basically what you’re making is for a specific patient. When you get into 503B, that’s when it becomes a manufacturing situation. So 503Bs are actually registered with the FDA and it’s national. They’re inspected by the FDA. They have to comply with CGMP. The Good Manufacturing Practices, they’re viewed and inspected and they’re held to the standards of an actual manufacturer in this country, whereas traditional pharmacies 503A’s are not. And the 503A traditional pharmacies are regulated by the state boards. So what we’ve kind of learned, and you could always do this, the FDA did put out some draft guidance to clarify in June of 2023. But you could always, as a traditional 503A pharmacy, you can buy from a 503B, just like you buy from Cardinal and McKesson and buy something off Trexade, you can buy from a 503B, put it on your shelf, and then just dispense it when a prescription comes in for it. That’s a little gray because some state boards aren’t used to that, and pharmacies aren’t used to that. That’s not something we ever really do. But for example, one of the 503Bs that I work with they have an eye drop product. So, it like takes three different eye drops, preservative free and puts it in one drop. And so patients who have cataract surgery, they only have to use that one compounded eye drop and the pharmacies can sell it to them for less than their copay. Usually if you were to get like the brand name drugs. So pharmacies can buy that eye drop, like any mom and pop in the country can buy that eye drop from a 503B, put it on the shelf, go market to their doctors, like their cataract surgeons, hey, we have this, they could write the prescription. Sometimes though the state boards are getting involved. And even though the 503B is licensed to ship into your state through your state board, the state boards are getting involved and saying, well, no, you can’t do that. It’s a draft guidance from the FDA. We have to wait till it’s final. That’s not really how pharma works. Final guidance through the FDA takes seven years sometimes.  

Bonnie Bond: Yeah. 

Nicolette Mathey: So that’s not, you act on, you act on best practices. You act on guidance. So, then that’s a little bit of a gray area, 503B selling to a 503A. Then now we have the GLPs. So now you have patented products from Lilly, patented from Novo, but they’re on the FDA shortage list. So, since they’re on the shortage list, a 503B can compound a commercial copy. So, they’re using the same amount of phenol, the same amount of the active ingredient, they’re actually buying the API, the active ingredient powder of Semiglutide or Trisepatide. They’re buying it from the same manufacturing plants in China and India who supply Lilly and Novo, which is crazy. So, they’re compounding a commercial copy and then the 503B can sell them to pharmacies. So long story short, too late. The GLP opportunity is…if you own a pharmacy, you have patients coming in looking for these brand name drugs. They’re on the shortage list, I can’t order them, I don’t really wanna order them because I don’t wanna pay $1,000, $1,500 to get this drug, bill it through the insurance, bill it through the coupon, lose $50 to $500, wait to get paid, I don’t wanna do that. It’s not good business. So they’ll send it to the chains or they’ll turn it away or they’ll just say, I can’t get it, because they can’t. However, if, you know, and these patients, they’re paying $500 sometimes, they’re paying sometimes more. Sometimes they’re paying the whole cash price, $1,200, whatever it is. These patients, if you can buy a commercial copy of that drug, since the patent is kind of on a shelf right now because they can’t supply enough anyway, if you can buy a commercial copy from a 503B that’s licensed in your state, and then you go tell the doctors in your town, hey, we have a commercial copy of the compound from an FDA registered and inspected facility since it’s on the shortage list, this is how it works. If you wanna write a prescription for your patients for this, they would have to write it for the generic name. They can’t write it for the brand name because they’re not A-B rated, there’s no available generic. But if you write for this specific generic name, we can dispense it for that patient that comes in. And then doc, your patient’s not going to some online Yahoo pharmacy, getting their shipment in the mail hot, who knows? You know, you get the, you don’t want your patient to get a vial and some syringes in the mail. What do they do with that? I mean, there’s pharmacies that we work with doing 500 of these a month, 700, 1300 actually, Amy just saw in our dataset today. So that’s a lot. And I mean, we’re seeing an average margin of, I had to think, is this a CE? Not a CE. We’re seeing, nope, we’re seeing an average margin of at least $100 per prescription, sometimes up to $400 or $500 per prescription, depending on your market, depending on your competition, or where you’re at. But even with those price points and those margins, it’s still a better option for your patient because it’s still cheaper than they would be getting these shortage branded products that you can’t get anyway.  

Scotty Sykes: And there’s a big demand, like you said. 

Bonnie Bond: Mm-hmm. Right. 

Nicolette Mathey: Yeah, it’s huge. And that’s what the doctors want. Just like they wanted all the COVID stuff and all the patients wanted all the COVID stuff. And we had never experienced anything like that before. Patients come into us asking for all these things that we wanted to sell. And here we are again, this is the next opportunity. So some state boards are being a little crazy though. And they’re kind of still deciding or telling pharmacies that it’s not, they shouldn’t be ordering from 503Bs. It’s not, it’s not valid and they can’t cite anything in any literature that I’ve been able to find to date and I’ve been looking for months and talking with a lot of different pharmacies. We’ve even called state boards and talked with them and sent them information. We got a pretty good movement and opinion in Georgia working with some of our pharmacies there and now they’re able to do it. But I have pharmacies in Massachusetts who, yes, we think it’s okay to do, but their board is still on the fence. And they’re like, listen, it’s not worth it for me to anger my board. It’s just, I… might I win? Yeah, maybe, but they can make my life pretty miserable.  

Bonnie Bond: Right. For everything else, yep. 

Nicolette Mathey: Yeah. So, it’s interesting. It’s, it’s a lot of gray areas layered on top of each other, but really at the end of the day, when this opportunity is done with the GLPs, meaning that, that Novo and Lily and they’re able to keep up. The drugs come off the shortage list. You still might be able to compound like the sublingual or like a different dosage form. Still might be able to do that depending on the patents. I tried looking it up too. I thought it was just going to be like one simple patent. Oh no… 

Scotty Sykes: Like 20 of them.  

Nicolette Mathey: Oh my gosh, at least I couldn’t make heads or tails of it. So, there’s that. So, who knows if you’re going to be able to, you know, now I understand why patent attorneys make so much money. But who knows if you’re gonna be able to make a different dosage form compound once they come off the shortage list. But what are you supposed to say? Make hay while the sun’s shining? What do we do on farms? Is that what we do?  

Bonnie Bond: Sounds right. 

Nicolette Mathey: Do you do that? Assuming you want hay, I don’t know. 

Scotty Sykes: Yeah, I was talking to a compounder, heavy compounder. He said he’s planning on this lasting a couple of years and then who knows from there, but. 

Nicolette Mathey: But you hate to have it pass you by. 

Scotty Sykes: Yeah. 

Bonnie Bond: It’s kind of like that time Scotty and I almost got into the COVID testing. We let it pass us by. 

Nicolette Mathey: Yeah? That was a good time. 

Scotty Sykes: Testing was everywhere. Same thing, COVID testing came, and then it fizzled out. 

Bonnie Bond: Mm-hmm. And then it went away. 

Nicolette Mathey: You always have the bell curve. 

Scotty Sykes: There’s always, there’s always those, you know, new and hot things and, you know, you got to jump on that stuff any chance you can.  

Nicolette Mathey: Yeah. You do. I mean, pharmacists and pharmacy owners are typically risk-averse, which is good. And we’re very used to things having to be perfect. That’s how we were trained. You know, when you check a prescription, it’s got to be perfect. Can’t be good enough, close enough.  

Scotty Sykes: Black and white. Yep. 

Nicolette Mathey: Yeah, it has to be. But in business…I’ve been reading this book, The Hard Thing About Hard Things, and it was awful. I’ll probably have to read it again because it was just, my mentor made me read it, which I admire and appreciate, but it was about being the CEO of a software company, which that’s what I am now. And just how the job of the CEO, the job of the person in that seat is to make the decisions with the information that you have available at that time. And if you go kind of one way or the other too much, if you wait and you’re like, I don’t have enough information to make this decision, I need to wait, you’re not being aggressive enough. You’re gonna let opportunities pass you by and the business will fail. But if you’re reckless on the other end and you just like, you know, hip shot, make these decisions and don’t even assess any data or seek any outside opinion or do it, then the business will also fail. So, but that’s the job. Somebody’s gotta make the decisions, and somebody has to discern the data. Somebody has to just, you just use your historical, just knowledge and use what resources you have. But you know, you’ll never have enough information to be 100% sure like you have to be when you check a prescription.  

Bonnie Bond: Right. 

Nicolette: You check the prescription, you’re like, I am sure this is correct. But in business, that’s not how it works. 

Bonnie Bond: Yeah, they’ve got to be able to flip the switch between the two. This is hard. Yeah. 

Nicolette Mathey: Yeah. And we all learn too. Yeah, it’s just awful. I hate the feeling of like, when you realize you’re like, oh wow, I’ll never do it that way again. But it happens. 

Scotty Sykes: So long-term care the compounding piece with the GLP ones what else?  

Nicolette Mathey: What else? So, in doing a lot of research and understanding how pharmacies need to dedicate more of their budget to data analytics, now that we have more data available to us, we need to get more information in to help drive our decisions. Now that the DIR is not retroactive, now that we can identify the patients, both for GLPs, you can run reports and identify which patients and doctors you should market that to and for long-term care at home understanding which payers pay, which patients aligning that. So with all that, what’s interesting is the average pharmacy, according to the Digest, top line is $4,847,000, which of course that varies greatly. But if you say it’s a $5 million pharmacy across the board as an average, in the healthcare industry, businesses spend 4 to 8% of their revenue on IT in healthcare. Now that could be imaging, that could be the EHR software, that could be a lot of things. In retail, because I kind of feel like pharmacy straddles healthcare and retail.  

Bonnie Bond: Mm-hmm. 

Nicolette Mathey: It’s both sectors really, so we both have the data. 

Scotty Sykes: For sure, it’s retail on steroids. 

Nicolette Mathey: Yeah, so retail entities spend between 2 and 5% of their revenue on IT, so point of sale systems, inventory management systems, even things like CRMs, which I know that’s kind of become my life’s work here, but pharmacies don’t really work in CRMs, which is a Customer Relationship Management tool, but that’s how you drive your sales funnels. And that’s how you just analyze, these are my top prescribers, these are my top patients, these are the messaging that I need to do, these are my lead and lag measures, these are, that’s how you push your levers to grow the profitability in your business. But anyhow, when I was doing this math, I was like, okay, healthcare is between 4% and 8%, retail is between 2% and 5%. If we call it 5%, if we say pharmacies are supposed to be spending 5% on their IT, of course it has to earn a return on the investment. Anything that you spend money on, especially in retail, it has to earn a return on the investment. But I don’t think you can take it, and let me know what you think. I don’t think you can apply this math on the top line, because pharmacies’ top lines don’t really matter. You could be selling specialty drugs and you’re a $20 million store, but you have a 5% profit margin or something. Or you could be a traditional pharmacy, $5 million a year, 20% and that’s healthy, but 20% gross profit. But then you still have to pay all your operating costs. So what do they say? I know they used to say back in the day, a good pharmacy operator will net at the end of everything after all operations, what, between 4% and 8%? 

Scotty Sykes: 3% and 7% 

Nicolette Mathey: All right, close enough between three and seven. So that’s good. So even if you take that 3% and 7% and invest your IT budget on that, like what are the IT expenses that pharmacies usually buy? So your PMS and you have to have that. It is a good chunk and it seems to be going up just everywhere across the board. 

Scotty Sykes: Yep. It’s a good chunk.  

Nicolette Mathey: But your PMS and then you’re gonna have just whatever else you need. Phone systems, whatever else you’re gonna have. IVR, maybe you pay for reconciliation services, or maybe you pay for some medical billing outside of your PMS, if you’re doing anything like that. But surprisingly to me, even with all that data and looking at other industries, pharmacies don’t traditionally spend or have a budget for their sales department or their sales and marketing arm or I mean maybe marketing like back in the day it used to be newspaper ads and radio ads and things like that but that’s not that’s not really the lever to push to drive profitability anymore. So, I feel like now is the time to actually build out those analytics tools and I mean that’s what I’m working on. We have our CRM with prescribers in this, but I have plans and a really great dev team lined up with us at Atrium to specifically build out payer analytics, patient analytics, and show pharmacies with triggers because you know I used to work for PDS. My joke lately is I used to work for PDS, don’t hold it against me because it’s kind of polarizing, which is strange. At PDS, we learned a lot about the behaviors of pharmacy owners. So I’m working on the data pieces, but you can’t just death by data, just hit these people over the head with all these data. It’s like, all right, that’s great, but I got six fires going on out here. Two people called out. So, there are ways 

Scotty Sykes: Yeah, I mean, give me the short and sweet on this. Yeah. 

Nicolette Mathey: To put the data in front of the right people at the right time through triggers and through tasks and through like, these are your top opportunities. And I’ve learned a lot too over the past, probably like five years really head down on this. One of my best friends is a software engineer. He works for a big national company, but he lives here locally. Our kids go to school together and everything. And he does like, he does the, what is he like, the product manager for multimillion and billion dollar government projects. And so his job is keeping everything on the timeline, keeping everything on budget, informing everybody like is the whole project working? Because they say in software, plan that it’ll cost twice as much and it’ll take twice as long. And I hate that, but it’s so true. But he always says, it doesn’t matter what you build. You have to assume nobody’s gonna look at it. So, whatever you build, it has to be exactly what you said, Scotty, like do this. This is the very specific thing you need to do today. And if you don’t get to it today, this is your list for tomorrow. And it’s a little different based on the best opportunity. So are we there yet? No, I don’t think anybody is, but that’s where I’d like to go. 

Bonnie Bond: How is Dotti? 

Scotty Sykes: Yeah, and you know… Are we talking about Hotty Dotti right now? Dotti? Yeah. 

Nicolette Mathey: How is Dotti? Yeah, she’s young, but when she grows up, that’s the girl I see her being. She’s just gonna be a lady with all her stuff together. She’s just gonna tell everybody straight what to do.  

Bonnie Bond: That’s great. 

Nicolette Mathey: Yeah, but she’s doing really well. We’re really helping pharmacies in the GLP space because I’ve been digging in on the data side and on the content side to just really, and I’ve been getting positive feedback too, because it’s a tricky dance being out there. And it’s like give and take. I ask a lot of questions, but I don’t ever wanna be such a taker from people and industry experts. And like, I don’t wanna just cut like, oh, here comes Nicolette, she’s gonna ask me for all these questions and all this insight. So I try to understand their pain points too, connect them to people, like just make it valuable for both, like so that people don’t cringe when I, when I call them. Scotty, I’m sure I bother you all the time about numbers too. And I appreciate you. 

Scotty Sykes: I’ll get a text message here and there.  

Nicolette Mathey: Yeah.  

Scotty Sykes: And I’m like… 

Nicolette Mathey: You’re like, yay. Yeah. But it’s just, it’s important that like in the GLP space, the positive feedback that we’ve had is, you know, you’ve saved me a whole lot of time because I don’t have the time to go research all this myself. So that’s what I strive to do. I understand the pharmacy owner, user, the pharmacist, the workflow of the pharmacy, pharmacy billing, all that fun stuff. And so when I’m out kind of vetting these companies or trying to discern all the data or all the data points or all the decisions that pharmacy owners have to make, it’s like, you know, you can tell pretty quick which opportunities you should run away from,  and then which ones might have some merit,  but then they have to check certain boxes. So, the webinars that we’ve been doing and putting in Dotti have been going really well. We’ve been having a lot of people just watch them and take action from them, which is exciting.  

Bonnie Bond: Mm-hmm. 

Nicolette Mathey: And then we’ve created a ton of marketing materials. So, it used to be me making all like the clinical marketing materials, like the Rx order forms, because you have to have the drug name and the strength and the dosage form and the SIG and the quantity, especially for compounds. Then you have to have information sheets to educate the prescribers about the compounds. Pricing information, vendor information, where to buy all the stuff from. And then you have to have patient information. So patient bag stuffers, social media posts even like the images, all the kinds of things. So, I was trying to do all that, but now I’m trying to also keep Dotti stable so she doesn’t fall in on herself as we grow. So, we’ve been growing pretty rapidly and that scares me a bit too, but we’ve been investing a ton in the infrastructure of the tool. So now we have a clinical pharmacist, Annie, and she’s been with us two years, but she’s really dug in and her job is to do all the clinical work. So, it was kind of funny. Yeah, all the, even like the cell sheets to prescribers, there’s a lot of words that have to go on there. And you can’t really have like a graphic designer from the internet do it, because they don’t know. There’s gonna be like, tell us what to put on the thing. So, Amy’s been really great doing that. Jen’s still here doing her thing, talking to a bunch of pharmacies because she’s our, our Eli Lilly rep.  

Scotty Sykes: Marketing pieces and stuff like that. Yeah. 

Nicolette Mathey: Yeah. So, she’s helping these pharmacies. Her main point with the GLPs is like, listen, this is what your prescribers wanna hear right now. So go give them the message, but this is your way in. So don’t let this be the beginning and end. Let this be the thing that builds your relationship with the office so that when this goes away, they’re looking to you for the next thing they need. And so, this is a perfect time when they want to see you when they want to talk to you about the GLPs, when they’re having a pain point, this is the perfect time to come in and help solve for that need, and then build and maintain the relationship. Yep, and you can’t do it without a CRM, because what happens if you have a rep out doing it, then they leave. They had a spreadsheet, where’d the spreadsheet go? Maybe they’re not documenting. So, if you walk into an office, you need to know, have we been here? Have we done a lunch? What did we tell them? What did they ask? Who’s who in this office? So that’s where a CRM comes into place. You can just log all your interactions. So, it’s been, it’s been going good. There’s just a lot more work to do. 

Bonnie Bond: Nice. 

Scotty Sykes: Always be more work to do. That’ll never stop. Always be more work. 

Bonnie Bond: Every single day. 

Nicolette Mathey: Especially for you guys, all the tax law and all that fun stuff changes all the time. 

Scotty Sykes: You know, we’re going to have a tax change coming up next year, year or so with the tax cuts and jobs act.  

Scotty Sykes: So that’ll be fun. That’ll be busy. So stay tuned for that. We’ll have all the updates for pharmacies, but, yeah, you know, it’s…It’s just… 

Bonnie Bond: None of us are in occupations that you can just like learn and be really good at and then you master it and it’s over. It’s continuous… 

Scotty Sykes: It’s always changing. 

Bonnie Bond: Continuous learning. 

Scotty Sykes: Well, Nicolette, Bonnie, you wanna do the bottom line segment? I know I gotta call it. Coming up here. Coming up on our hour. 

Bonnie Bond: Thanks for jumping on again with us Nicolette.  

Nicolette Mathey: Yeah, thank you for having me. 

Bonnie Bond: We’ll touch base with you again in a few months and see how everything’s going. 

Nicolette Mathey: Yeah, and hopefully I’ll see you guys at the summer shows. 

Scotty Sykes: We’re gonna be there. Are you going to all of them? 

Bonnie Bond: Yeah, what’s your first one.  

Nicolette Mathey: Yeah, we’ll be at Pioneer. Yeah. 

 Bonnie Bond: Pioneer. Scotty will not be a pioneer. 

Scotty Sykes: I will not be there. 

Nicolette Mathey: Yeah, you’re having a baby. Aww. No, you’re not having a baby. 

Scotty Sykes: I’m having a baby. 

Bonnie Bond: He’s not having a baby. His wife… 

Scotty Sykes: No, I’m definitely not. I don’t know how Carole’s… I don’t know how y’all ladies do it 

Nicolette Mathey: I don’t know. 

Bonnie Bond: It’s one of those things like after you do it you’re like, how did I do that? In the moment it’s like a… 

Scotty Sykes: She’s been sick the whole time. 

Nicolette Mathey: I was wondering about that, because I told Jen that your wife’s having a baby and she was talking to you at NCPA and she was asking you. She was being nosy, like she does, asking you if you’re going to have more kids and this. You’re like, I don’t know, Carole has a pretty tough time. So we were wondering how she’s doing. Oh, oh, that’s right. And you don’t know if it’s a boy or a girl, right? 

Scotty Sykes: Never found out. No, we don’t know. 

Bonnie Bond: She looks great though. She looks great. I mean, she’s so little.  

Scotty Sykes: Oh, she looks beautiful. She’s wonderful. 

Bonnie Bond: I think it’s a girl. I’m guessing girl right now on the podcast. 

Scotty Sykes: She’s half the size she was with Pete.  

Nicolette Mathey: Really? 

Scotty Sykes: So, it’s going to be all petite, but Carole’s only like 5’1 So she’s all, so it’s going to be a petite little baby, whatever it is.  

Bonnie Bond: Yeah, she’s little. Yeah. 

Nicolette Mathey: Do you have names picked out for boy or girl or how does this work? 

Scotty Sykes: Now you’re talking to the wrong person. I put the crib together, I’ve done my chores, huh? 

Bonnie Bond: You let her name the baby 100%. She can name the baby 100%. It’s on her. 

Scotty Sykes: We can’t, we can’t figure out a name. That baby’s not gonna have a name for a day or two. 

Bonnie Bond: That’s how I was. I couldn’t finalize anything until I saw it. 

Scotty Sykes: We’re gonna butt heads on that. She’s stubborn, I’m a little stubborn, so it’ll be. 

Nicolette Mathey: I can’t imagine. Talking about data, I wanna know all the metrics and data and things of the baby I can. Wanna know every single thing, wanna know the gender immediately. 

Bonnie Bond: We have another employee that’s having a baby around the same time too, so it’s super exciting around here.  

Scotty Sykes: She don’t know either. 

Nicolette Mathey: Come on. 

Bonnie Bond: And she doesn’t know what she’s having either, so it’s like. Yeah, it’s great. It’s lots of fun. Especially when it’s not me. I get to come see the babies, and I get to go home and sleep. Hehehehe. 

Nicolette Mathey: Yeah, right? You gotta be careful. No. Yeah, oh my gosh. I had three kids in three years, like three year time span, and so I named the first two. I don’t know. 

Scotty Sykes: How is that even possible? 

Bonnie Bond: It only takes nine months, Scotty. 

Nicolette Mathey: That’s right. That was awful and wonderful.  

Scotty Sykes: I guess, I don’t know. 

Nicolette Mathey: But I had three kids in two years. They asked me questions.  

Bonnie Bond: Well, that is a really good way to explain it. 

Nicolette Mathey: Yeah. Mm-hmm. Yeah, you have four of them, right?  

Bonnie Bond: Yeah, but they’re like, I have one graduating high school.  

Scotty Sykes: And Eli and Peter on the same T-ball team. 

Bonnie Bond: Yes, we did T-ball last night, that was fun.  

Scotty Sykes: And tonight at 7 o’clock. 

Bonnie Bond: And tonight.  

Nicolette Mathey: Aww. T-Ball. 

Bonnie Bond: Yeah, fun fact, I have one going to college next year and one starting kindergarten.   

Nicolette Mathey: Aww, hey that’s different ways to do it.  

Bonnie Bond: It’s different ways to do it, yes. 

Nicolette Mathey: Cause my kids ask me like questions about when they were little. I’m like, dude, I don’t remember.  

Bonnie Bond: I don’t. 

Nicolette Mathey: I’m like, it’s a blur. I don’t know. We got here, we’re good.  

Bonnie Bond: You’re alive, you’re healthy. It’s all that matters.  

Nicolette Mathey: They are 13, well 13, 12 and 10 right now. I don’t know. But I named my first two girls. I named Juliet and Josette cause I’m Nicolette, my mom’s Annette and her sisters are Charlotte and Claudette, her mom’s Antoinette.  

Bonnie Bond: Oh my gosh! 

Nicolette Mathey: So, I’m like, if it’s a girl, yeah, if it’s a girl, I’m naming the girl. So we have Julie and Josie are our girls. Yeah, there’s the TOT. 

Scotty Sykes: And Dotti’s thrown in there somewhere. And Dotti’s like, she’s over there like, what is going on here? Black sheep over there, Dotti. 

Nicolette Mathey:s Mathey: That’s right. What’s happening? Well, I finally had a boy, my third one. And so, I told my husband, I was like, all right, fine. You can name a kid.  

Bonnie Bond: Oh, of course. 

Scotty Sykes: What’s his name? 

Nicolette Mathey: Well, he named him Fisher. Like being a fisherman, it’s very literal, but it suits him. Cause he’s a little, he’s a little guy. He’s a cute little tiny little 10 year old guy, fourth grader. But so, we call him big fish. Cause he’s not big.  

Bonnie Bond: Love it. 

Nicolette Mathey: Yeah. So. Who knows, you might get a big fish or something similar. I don’t know. 

Scotty Sykes: Maybe, maybe. 

Bonnie Bond: Yeah, I’ve seen people that they say, oh, they’re so small and they’re gonna have a small baby and then a nine pounder pops out, so. 

Scotty Sykes: Nah, this ain’t gonna be no nine pounder. She’s tiny, you know how little Carole is. 

Nicolette Mathey: You need some sort of like accounting. You got any like accounting nicknames? You know, like Fisher for the fisherman. You got like… 

Bonnie Bond: Hmm 

Nicolette Mathey: We gotta ask ChatGPT about this. 

Scotty Sykes: Yeah. 

Bonnie Bond: Yes, Scotty get ChatGPT to name your baby. He loves ChatGPT. 

Nicolette Mathey: Yes, that’s the best idea I heard all day. 

Scotty Sykes: Hey, you know ChatGPT is great for like if you want to write a policy. You know, something like, you need to be in the pharmacy by 8 a.m. and da, da. I mean, you could just like do a policy man, boom.  

Bonnie Bond: For so many things, oh my gosh. Write employee policy, handbook, for it, whatever. Amazing. 

Scotty Sykes: Yeah, great for that. 

Nicolette Mathey: Yeah. You know what I’ve been using it for? I have been known to write a spicy email or two and then I get frustrated cause I’m like, it’s just direct.  

Bonnie Bond: It’s too much. Yeah, it’s too harsh or I need to take some time. Mm-hmm.  

Nicolette Mathey: Yeah. 

Scotty Sykes: Sometimes I’m like Nicolette. 

Nicolette Mathey: Yeah, well, it’s just direct. It’s like this. And then I’m busy over here. I’m ADD. I’m doing all these things. So then, so I don’t put the pleasantries in there and it’s not so nice. I don’t mean it that way.  

Scotty Sykes: I don’t take it personally. 

Bonnie Bond: No. 

Nicolette Mathey: Good. So, but for the people I don’t know that well, see, that’s a compliment. If I send you just a real direct email and you’re like, dang, that means we’re close. We’re friends. We’re good. I don’t care about hurting your feelings. It’s fine. Yeah, that’s a compliment. But if it’s to, you know, people where I don’t know them that well or they don’t know that I’m not being aggressive. I’ll put it in chat GPT and I’ll be like, make this nicer. 

Bonnie Bond: I do that. I do that. And as a matter of fact, Ollin notices it because he also loves to use it. And he called me out on, there was an email I had to write one day a few weeks ago. It was, it needed to be aggressive. So, I just wrote it. And he sent it back because he was CC’d on it. And he said, I could tell you did not send that through, you know, AI. And I was like, I did not. No, I didn’t. You were correct. That one had to go out as is. 

Scotty Sykes: It’s great for that. Yeah, it is. 

Nicolette Mathey: Sometimes I’ll pull it the opposite. Sometimes I’ll say that like, make this very direct. Because if you’re talking to software developers, what I’ve learned is no pleasantries. I need this. Yeah. I need this data field mapped here. When will it be done? Any other words, you’re not going to get their attention. You’re not going to get moved. So it’s different. 

Scotty Sykes: Just get… 

Bonnie Bond: Yeah, get to the point, yeah. Hehehehe 

Scotty Sykes: Well, bottom line. 

Bonnie Bond: My bottom line. It’s all about the data. We just learned that this morning with another call we had.  

Scotty Sykes: We did another podcast. 

Bonnie Bond: I mean, it’s at a point you can’t just fill and pray anymore, obviously, but you’ve got to look at what you’re doing and look at the data behind it. Hope you make decisions. 

Scotty Sykes: Nicolette, what do you want to leave the listeners with today? 

Nicolette Mathey: My bottom line, now is the time to dig into your business, to identify the levers that you specifically should push to drive profitability so that you can support the structure of your business and the employees and the patients and the prescribers that you serve. But now is the time with double DIR, with things being more transparent, and with all these opportunities out there, now is the time to really dig in to your data of course, and invest in whatever it takes for you to actually be able to see those levers and push them.  

Scotty Sykes: And my bottom line is just that. You got to look at every aspect of your business. Now what revenue is coming in? Is it profitable revenue? And you got to really find that profitable revenue and run with it. Cause it’s out there, you just got to find it. You got to find what works for you. So, with that Nicolette, thanks again for hopping on, and all our listeners out there, thanks for listening in and we’ll see you on another episode of the Bottom Line Pharmacy Podcast. Thank you. 

Nicolette Mathey: All right, thank you.