DIR Fees, DIR Fees 2024, Independent Pharmacy Accounting, Pharmacy Growth

Making Data Work for Your Pharmacy Featuring Nicolette Mathey

Have you explored the potential of what sales and marketing can do for your pharmacy?  

Most independent pharmacies have lots of data that they can use with sales and marketing to help grow their pharmacy. You can use this data to grow revenue streams that can help you avoid DIR fees, increase strategic partnerships, and overall help your patients!  

These are the things that Dotti from ATRIUM24 can help you with.  

In this episode of the Sykes Bottom Line Pharmacy Podcast, Nicolette Mathey joins us for a discussion on sales & marketing, data, why these things are important, Scotty’s $10 haircut, and more!  

Also – stay tuned to the end for a special song by Kendell Harris.  

The Bottom Line Pharmacy Podcast is your regular dose of pharmacy CPA advice to fuel your bottom line, featuring pharmacists, key vendors, and other innovators.

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

Scotty: What about my $10 haircut at Walmart? How’s this look?  

Bonnie: Why did you do that?   

Scotty: Because I needed a haircut.  

Kendell: $10 in 10 minutes.  

Bonnie: Scotty, I’ve told you this. You get your haircut and immediately before you leave, you go ahead and get like, immediately on the schedule, four weeks, five weeks, whatever you need.  You don’t leave there without her giving you an appointment.  

Scotty: I do that, but then things come up. I got podcasts to get on and stuff.  

Nicolette: From here, the haircut looks nice.   

Bonnie: I love the girl I go to, they do them like at eight o’clock at night. I take the whole crew up there. 

Kendell: Oh, yeah? The whole crew?   

Bonnie: Well, I go alone because that’s my time, but everybody else, we just open the door, and everybody runs in. My husband, the kids, everybody.   

Nicolette: My mom actually owns a hair salon, and so no one has done my hair but my mom. My whole life and no one’s allowed to do my hair. So, there’s that.  

Bonnie: I have a friend that’s mom cut his hair forever and he, she didn’t do a great job and he… 

Scotty: Fired her?  

Bonnie: Oh no, but he wants somebody else to do it. So, it’s a whole thing.   

Nicolette It’s a thing.   

Bonnie: She’s gonna know.  

Scotty: I wouldn’t want to be in that predicament.  

Bonnie: What’s going on, Nicolette? What’s new?   

Nicolette: We’ve been working, I mean, still, it’s, it’s interesting because we’re still the same old. So, I often think back to the summer of, I think it was 2014, 2015, when pharmacies would just email me their raw data exports from their PMS, and I would just kind of look at them and try to figure something out and determine patterns. This was before AI.   

Bonnie: Oh, wow.  

Nicolette: We used to tell our kids that, like, you know, before cell phones, we had beepers. That was my day. Yeah, before AI, we had spreadsheets and stared at them.   

Bonnie: Speaking of that, I got a $24 Apple charge on my phone the other day. I had to do some investigating, but it was for, like, an AI being premium chatGPT service.  

Kendell: Oh, wow.   

Bonnie: Uh huh. I tracked it down to my 15-year-old. So, this technology. I can’t. They’re using that stuff. He said he was just using it for ideas for papers. 

Kendell: Straight A’s.  

Nicolette: But. Well, I mean, you have to use what’s out there, but you can’t overuse, I guess. Like where’s the balance?  

Bonnie: I’m concerned about my 15-year old’s level of right and wrong, maybe, in those scenarios.  

Scotty: You might want to address that.  

Bonnie: Especially the fact that he could, I don’t understand what $24 is getting you because I could get a lot of free information.   

Kendell: Not premium though, evidently.  

Bonnie: What’s premium do?  

Scotty: I don’t know.  

Kendell: I don’t know. This is funny.  

Bonnie: It’s not.  

Kendell: And he has access to your Apple account evidently. 

Bonnie: Well, yes, unfortunately, you know, Nicolette probably knows about this. I mean, they have to, nobody uses cash and when he’s not with me and he needs to run to McDonald’s with his friends, he just uses my, he’s linked to me.   

Kendell: So, I had a funny experience. I was telling someone who’s like, I was at physical therapy, and I was telling them about Napster and all that kind of stuff. 

Bonnie: Oh! Napster!  

Kendell: They’re like, what’s Napster? Oh, I told them about it. I told them about dial up. So, I think she thought I was her age and she’s starting a conversation, and I was like, yeah, I’m not your age. I was around with dial up internet she’s like “what is that?”  

Bonnie: I was in college with Napster. It was the best. I still have some CDs that I, you know, made myself from the music I downloaded.  

Kendell: I want to know, like, so Napster, right, back in the day we waited 30 minutes for one song and now it’s just like a whole video instantly. In the future, when we’re talking about getting data for pharmacies and selling, we’re going to be like, back in the day they used to do what?  And then today, with Dottie, Hottie Dottie, what’s going to be the big swing? 

Nicolette: I’ll tell you what I can’t wait to be like that was back in the day is all these data feeds. So, we work with all the PMS’ and get the data feeds in and FTP’s.  We’re trying to go more towards API. So, then you don’t have to have all the server load and you get everything in real time.  But FTP file transfers are kind of like the fax machine of communication I feel like, and it’s just, I can’t wait till that when we used to say, wow, remember when we used to do that. I’m here for that. So, let’s get all the data connectivity figured out between all our different companies. That would be wonderful.   

Scotty: Nicolette, you get this data from the script system and walk us through, what are you doing with that data?  

Nicolette: What does ‘Dotti’ do? 

Scotty: Well, we’ll get into Dotti, but I mean, what are you doing with that data? What’s important about that data?  

Nicolette: We’re looking at it, at my company at Atrium24. We’re looking at it from a sales and marketing perspective. So, some of that will tie into your workflow and your operations because to sell something, it can’t get stuck in your workflow. It can’t get caught up in the retail dumpster fire, which is what I lovingly call a community pharmacy. But we focus on sales and marketing. So, when we look at the data and when we put it in Dotti in a dashboard, now you have all your sales reports. It automatically loads a CRM for you. So, a CRM is a customer relationship manager. And most pharmacies don’t have one, they don’t know what it is. And that’s fine because I didn’t know what it was either. But it all goes back to, why did we spend two years and a lot of dollars building this very specific sales and marketing tool for pharmacies? Why did we build it?  And it really goes back to two core memories I could say that I have that were really big pain points for me, both when I worked at PDS as a consultant and when I had my own pharmacy, which I sold just a few weeks ago after wearing Scotty out on the whole transaction.   

Bonnie: Congratulations on that.  

Kendell: Yeah. Congrats.  

Nicolette: Thanks. It’s still weird. It’ll probably be weird for a while. But when I worked at PDS, we did a lot of really cool things. There were a lot of really smart people there. And it always bothered me that we had these data feeds that started to feed the early versions of our analytics tools, but we as consultants didn’t see that data. We didn’t use the data to help us do our jobs and consult with the pharmacies.  So, all the free text kind of bothered me. You would get on a call with one of your clients with one of the pharmacies and you would have to ask. So, what’s going on? So, how’s business? So, what can I help you with? What, if I had just had that data teed up in front of me, I, as the consultant, could have seen and visualized things to tell you, rather than relying on you to understand and interpret what’s going on and to tell me. So, one of my best friends is a software developer, and he built our original version of the Atrium software, like, four years ago.  And still every week, he visualizes data for me, and he said, you know, if you’re going to build software, whatever job you have, if you’re going to build software to help you do your job, you have to assume that no one’s going to care. No one’s going to look at it. No one’s going to log in. No one’s going to do the thing. No one’s going to use it. So, if you’re going to build something, build it for yourself to show you what you need to see to do your job better or to do your job quicker or to kind of document your processes. So that made a lot of sense to me. So I was like, kind of selfishly, I wanted to build something. If I’m going to continue consulting and have a SaaS company and have a technology company, I want to take all the data that’s out there, visualize it in the way that makes sense to me on how I help pharmacies. And that way I don’t even have to talk to you. I can just log in, look at your dashboard and be like, okay, this, you need to go market in Tennessee to pain management, doctors, orthopedic surgeons, and ENTs. These are the things that are potentially profitable in your area. These are the marketing materials you should create. And so, what we did with Dotti. I hated the whole onboarding process of clients, so someone can literally sign up for it in the middle of the night, enter all their pharmacy information, it automatically, the billing system is all integrated, it’ll just bill them automatically, whatever the monthly membership rate is that they choose, there’s three tiers. There’s a free trial in it too, so they can try it out for a couple weeks. And then it automatically fills out all their contracts and data release forms, sends it where it needs to go to turn on their feeds, saves the contracts in their admin profile for me, populates their dashboards as soon as we get the file from the PMS, so, all that busy work. That’s the goal for all of us is to like, forget the busy work, forget the free text. Sometimes I like computers more than people. Sorry.  

Bonnie: How great would it be if we could do that to our onboarding process here at Sykes.   

Nicolette: Yeah, and you can.  

Scotty: That’s our hardest part of the process is when we onboard. Onboarding is No fun.  

Bonnie: Oh, man,  

Scotty: But, you know, I want to talk about the marketing piece because I think, Nicolette and you and I talked about this at PCCA. I’ve talked to others in the industry about this, where more and more you’re beginning, I think I’m beginning to realize how important marketing is in a pharmacy. It is especially in like a compounding pharmacy or what other kind of pharmacy, but that marketing component is critical. So, in a retail setting, exactly, how important is that marketing piece? And maybe expand on that.  

Nicolette: Yeah. So, what’s incredible to me is we all have a business and we all run a business. We’re really good operators. We’re really good at compliance. We’re really good at just workflow. And if you think about it, how are pharmacists trained and, a fellow pharmacist, we had this conversation last week and, and she said to me “you know, pharmacists are trained to find out what’s wrong. So if somebody sends you a prescription to check, you’re not looking at what’s right with the prescription. You’re not like, Hey, congratulations, this is the right patent. This is the right drug. You’re looking for what’s wrong.  So, pharmacists are hypercritical. And we’re trained to always find the mistake, find the error. Is there a drug interaction? Is there an issue? Could the patient take this drug the wrong way? If they don’t take it with food, maybe it’s not as effective or maybe it’s going to upset their stomach or whatever it is. So, pharmacists, our personality type is typically pretty critical.” And that made a lot of sense to me because even in software development, I get that feedback from that kind of world sometimes where it’s like, you’re very critical or I’m like, does that mean I’m important or does that mean I’m negative? But that’s the pharmacist. So that’s typically a pharmacists lane is to criticize. And I don’t mean it in a negative way. I mean, if you miss something, someone could die, right? That’s how we’re trained. So, I think having that understanding, it really does make sense why most pharmacies and pharmacists who run their own business, they don’t have a sales and marketing division because sales and marketing is optimistic and its aggressive and it’s outgoing. And that’s kind of the opposite.  

Scotty: Yeah. Taking chances.  

Nicolette: Yeah. And some pharmacists and pharmacy owners do have a little more of that temperament, that outgoing temperament, that optimism. Most don’t, but regardless, no matter what your personality type is or what type of environment you thrive in, ideally you need to put yourself in that seat and then you need to put someone else in your business in the seat of sales and marketing, but so many of us, we don’t even know the difference between sales and marketing. So, marketing is getting leads, getting people interested, putting the information out there and gathering interest. That’s marketing. Sales is actually closing a deal, making a sale. So, some of us will do some social media and we might want to dabble in digital marketing, so online getting leads, right? So, we might want to have a cool website, have social media, do some Tik Tok videos, do some email blasts, some SEO, and that’s pretty advanced for a critical pharmacist. And I say that with all the love in the world, because I am one. But that’s not sales.  So, who’s actually closing these deals? So that’s kind of the one, the one side of it is like, man, I’ve been consulting for over 10 years, and I never really had a tool to help me do it.  And so we built it,  and my software developer friend said, Nobody’s going to look at it, and I’m okay with that because that’s why somebody would pay a consultant to be like, Hey, I’m looking at this for you, I’m gathering all this information for you so I can help you to execute.  And then on the other hand is when I had my pharmacy about four years ago, I hired Jen, Jen Rolewski, if you guys have seen her bopping around with the curly blonde.  She has the opposite personality type that I do. She’s an Eli Lilly trained pharma rep. And, I mean, when you get hired with Lilly or with Big Pharma, the training is so intensive. And you even go on site to Lilly, and you get all this training and it’s on just a product or a couple products and you get trained in all the studies and all the things, you know, so they don’t put you out into the wild for a long time. They have you do ride along’s with superiors and you have different team leads and things like that. So, when I hired her in my pharmacy about four years ago and I said, okay, you’re going to be the rep and she was probably the, I had already been through a few reps. Just tried and failed. So, when I brought her in, she was like, okay, here I am, where’s my materials? What’s the message? What’s the territory? Do you have like a routing plan? What CRM am I using? Like what are we doing? Like, who are the targets? What’s the territory? What’s going on? And I was like, what? I don’t know, man, just meet the team, grab up some folders and sticky notes and go out there. So, that’s what most of us do. If we even think from a pharmacy owner perspective, I need to have someone, if it’s not me, going out and talking to local providers, because those are your referral sources, and figuring out, hey doc, what do you send your patients online to get? What do you have trouble with? On the pharmacy side, what’s a headache for you? Or do you send any compounds out of state? Whatever it is, you don’t know unless you go ask. So, every pharmacy is different. Every community is different. Every opportunity is different.  But when Jen kind of planted that seed four years ago, I was like, dang, I have no idea. And then we had a lot of marketing materials, a lot of things, but it was such a, just a sludge, right? Like, oh, she would go out and she would do her thing and ask all these questions. And, you know, she would come back and say, okay, Nicolette, this is awesome. I got to talk with this doctor and this office manager and these nurses and everything. And they’re really excited. They’ve been sending all their compounds out of state. They want to send them all to us. So here, here’s the forms I showed them. We marked them all up together. Here, make these changes so I can go back to the doctor’s office and then they’ll start sending in the scripts to us. Well, she always says things would go on my desk to die. So, we just put, I’m like, oh, yeah, yeah, I’ll get to that. I’ll do that. And she would come back in “Okay, do you have that sheet ready? Because I have to get back to the doctor’s office. Did you type up the compound order forms? Did you do things? I got to get back.” And I’m like, “man, I was working on it, but then so and so called out and then we got an audit and then the board inspector came in and then the order was late and then, you know, oh,” and she’s like, “oh, everything just goes on your desk to die.” So that, was another, all these different things and experiences and failures really is what caused us to build Dotti and build what we did. Because man, is she an incredible tool? We have sales and marketing resources in Dotti. So we have over 120 different PDFs. So, we have retail, compounding, specialty, and we’re starting into long term care. We have info sheets, sell sheets, order forms, um, just different marketing pieces. And, our clinical pharmacist, Annie actually combs through our data share on the retail side to see what’s potentially profitable around the country. And then if anything’s statistically significant amount of claims in the past 90 days with a gross profit average of over 40 or more, she’ll look at it and say, okay, what kind of doctor would write for that drug? And so, we have over 40 different physician specialties where Annie will be like that one’s got to go on the OBGYN form, that one’s got to go on ENT. These drugs have to come off. So, that’s how we solved for things going on the owner’s desk to die, is Atrium’s kind of doing that in the background for everybody. We’re watching the CVS Caremark aberrant list, because that’s a weird thing with over 1,200 drugs now. We keep that updated every month. So, if you do dispense anything off there, it’s on your dashboard, and it’s showing you, like, hey, 5 percent of your Caremark revenue came from something off that list.  A few of our pharmacies do dispense off there, but still it’s all these little pain in the butt things that were really hard to nail down, that’s what we put on a dashboard and in a tool to help these pharmacies.  

Scotty: So, you’re pulling in that data and then you’re saying, all right, this data is profitable, this data is profitable, who’s prescribing, you know, is there a pattern here with a doctor or whatnot? All right, well, then let’s go talk to that doctor, let’s take them some materials, let’s grow that area of business. So that’s kind of what you’re trying to get at.  

Nicolette: Yeah. Yep. Yeah. Because if you think about it, Let’s say you’re at your kid’s baseball game and you learn that one of the moms on the team works at the local GI office, the gastroenterology office and you’re like, oh, hey Tina, I didn’t know you worked at Dr. Jones office down the street. That’s great. Did you know that I work at the pharmacy here? Oh, okay. Well, do you guys write for compounds? Oh, you do. Do you have any trouble getting them? Where do you send them?  Oh, you send them out of state. Cause that’s usually what we hear or, oh, you have trouble with prior Auth’s or like you know, CVS and Walgreens are bugging you for refills all the time. Well, we actually have pretty good solutions for that. Can I pop in some time? Who should I talk to? When’s a good time? You know that kind of thing makes me a little uncomfortable, but you just have to do it and then we have these opportunities all the time. You see somebody in the coffee shop, you have a mutual friend, you, whatever, you have to capitalize on that to grow your business because of your health, you’re actually helping them. You’re not being self-serving. You’re helping the office; you’re helping the patients. That’s what you’re there for. So instead of just staying behind our bench and being reactive, we have to have some sort of outward-facing, collaborative type of sales and marketing outreach. So, if you have atrium in the background working for you, if you say, oh my gosh, I need to go to the local GI’s office tomorrow. We don’t really work with any GI.  What’s potentially profitable in gastro? What kind of materials? Because if you just go to the doctor’s office, you say, Hey doc, I’m a pharmacy. I can fill whatever you need. They’re like, Okay, we just asked the patient what their pharmacy is and just prescribe it to there. We don’t care. We don’t get involved. We don’t steer, but if you can kind of change that narrative a little bit, you would log into Dotti, you already have your brand kit loaded into Dotti, and you can click on the gastro folder and download that, she automatically adds your branding to the resources because it was another pain in the butt thing I got tired of doing is manually branding all these things for all these pharmacies and loading the resources. So you always have the most up to date version of the RX order form, or if you’re in a state like New York, Alabama, maybe where it’s mandatory to e-scribe, or you’re not allowed to use order forms we have idea sheets or just different things, but the whole use case is you have the most updated, clinically appropriate order forms, or cell sheets, or info sheets for retail, compounding, specialty, for that type of doctor. So, you can just print it out and go, and you know that these are kind of real time. You know, you don’t have discontinued drugs on there, or drugs with old data that they all got macked and they got taken off the plan or whatever and then you say to the GI, like, “Hey! This is what works for other local GI offices” or whatever it is. This is what people in our community, in our network present to other GI’s. Do you write for any of this stuff?  And then at least you have something that you’re leading with, and you can start the conversation.  

Scotty: So, if you’re a pharmacy owner out there, and I mean they’re wearing 20 hats.  

Nicolette: Yeah. At least.  

Scotty: Yeah. How, do you, at least how do they expand into this area? How do they add this pharmacy?  I’ve never done anything like this, I want to capitalize on the opportunities around how do I get started? Do I have to hire a marketing person to do this? Do I need a sales rep? How do they, how do they get their dip their toe in there?  

Nicolette: Yeah. And that’s the perfect question because that’s.  That is everyone’s question. And, most pharmacy owners fail when they explore this, just as I have in the beginning, because they think that’s the first step they think, okay, I get it. I need to focus on this in my business let me hire somebody because it’s not me. So, they hire a sales rep. You could go all across the spectrum. So, you could hire a six-figure ringer sales rep with active relationships. I don’t recommend that actually. We’ve done it and we’ve piloted it out. We’ve tested a lot of things. I don’t recommend it or on the other end of the spectrum, you can hire somebody pretty green, pretty inexpensive.  That’s actually what I recommend when you are ready to hire. And then I’ll back up from there. But that green person, you have to incorporate them into your pharmacy team. You have to give them a little bit of that Eli Lilly training, where like, you work on the bench for a couple weeks, you learn how all this works, become a team with our team, and become a true Bonafide employee in the OIG’s eyes, so that if we bonus you on your performance, you’re a true employee, you’re not a 1099 that we’re pretending is an employee, you know how to ring the register, you know how to answer the phones, you know everybody who works here, you celebrate the birthdays with us, you really work here, but that’s still, that’s not the first step because a lot of pharmacy owners, they have no sales and marketing system, they have no structure, they don’t know their targets, they don’t have any materials, they don’t have a CRM, so if you hire somebody and say “okay, okay, this is day one of your employment, I’m going to want to see a return on investment in you within 90 days or else I’m going to fire you” they might not tell them that some of them do but then you just send them out in the wild. Well, they’re not the, we didn’t set them up for success. They’re not going to be successful. So, if you do go out and hire someone and that’s your first step, you don’t have a system, you didn’t build a position for them to step into and know exactly what’s expected of me. Am I doing a good job? How can I grow? If you don’t have that built, you need to understand that if you’re hiring someone, you have to give them the time, the space, the tools, the resources to build out that system for you. And that’s fine, but that’s going to add another three months at least. On your return on investment from them. Yeah, it’s still valuable because like if you think about so right now if you would if you know, everybody would audit their pharmacies, do you have a sales and marketing system?  Do you know who your top prescribers are by profit? And by volume, do you know their trends? Have they increased or decreased over the past three months? Have your top ten prescribers in profit changed over the past three months? And why? What are your most profitable compounds? What are your most profitable specialties? So, if you don’t know those things, do you have a brand kit loaded where like your business cards, your folders, your marketing materials. Do you like them? Do you know your Pantone colors? Like, do you have it all tightened up?  And if you don’t, that’s fine. Most of us don’t because we’re busy running a very complicated pharmacy business in a challenging industry but if you’re going to focus on it, give yourself that time and space to focus.   

Scotty: What about a pharmacy that’s in a very small town of 5, 000 people? There’s not a whole lot of doctors. Right. I mean, is this applicable to them? Does this, does this even matter for a small town?  

Nicolette: Yeah, I mean, it’s different. It’s going to be different than, you know, my community here in Palm Harbor, outside of Tampa, or in your more, like, uh, metro areas. Right. But you still, you know, and we’ll talk with pharmacies. I’m thinking of one store that we have in Alabama. It’s a mutual client.  And they do, you know, all these pharmacies come to us, and they say, yeah, we don’t do too much, just retail. We’re like, oh, well, do you do vaccines? Yes. Do you do special adherence packaging? Yes. Do you do delivery? Yep. Diabetic shoes, supplements, nutrient depletion, like they do a lot of different things. So then when we ask them, like, all right, well, what, what do you make money on your P& L? Like what’s an actual profit center for your pharmacy? And then do you have.  Just like a sales slick for each one of those services that’s geared toward prescribers and, or that’s geared toward patients. Do you have it on your website? Do you post about it on your social media? Like, do people know about it? So, in the rural areas, it’s usually just getting their brand kit loaded up. You know, some of these pharmacies have been around a long time and they don’t even have a true brand per se that’s cohesive across the company. So, a lot of them work on that and then just getting with the local offices, like, yeah, you all know each other really well, but have you gone and talked with them in a while and said, asked the local referral sources, the local prescribers, hey, how’s everything going? Like what are your frustrations with pharmacy? Is there anything I can help you with? Is there anything that your patients aren’t, you know, orthopedic surgeons, you could do a knee scooter rental program or something. Although orthopedic, that would be more rural but, that would be more city. In rural areas, your generalists are your specialists. So, you might see that the local family doctor is writing for all the ENT meds. They’re writing for all the podiatric meds. They are the OBGYN. Like, they do everything.  So just finding out from them. Do they know about compounding? Are they interested in it? Um, and then when you think about compounding, you can ship to your whole state because you’re not billing PBMs. Usually, it’s cash. And so you don’t have the service area restrictions. So, if you compound, have you saturated your entire state? Probably not. I, I haven’t. And then if you have, you know, if you’re rural, if you don’t have a lot, have you gone out into like 50 miles expanded, a hundred miles expanded, 300 miles expanded? Where is the next biggest city? Where are those specialists? Where are they sending their compounds? Probably out of state. And then from there, you know, Florida, we don’t have many neighbors here. It’s a, I don’t know how many hours to get to the closest neighbor, but a lot of our clients, they’re like right on the borders of multiple states. And a lot of them have licenses in other states too. So you can ship to whatever states you’re licensed in compounding.   

Kendell: And something you said very early that kind of just completely resonated with me was you spoke on the difference between marketing and sales. And I can imagine, correct me if I’m wrong, but a lot of pharmacists might feel easier to get into marketing where they feel like “oh yeah, it’s important to have a brand, a brand kit and all those things” is there a resistance do you sense or in an industry and people as far as sales, like actually closing the deal and making those conversations? Because we have one client.  And I’m doing my best impersonation. He always says, “you know what, Kendell, you know, I make all my money from relationships. That’s all I do is just make relationships, million-dollar relationships.” Y’all probably know what I’m talking about. But some people get it, but in general with pharmacists, it’s hard for them to actually get involved in the sales piece or do you even recommend they get involved? There’s that something that you hire someone what’s that dynamic when it comes to closing the deal? 

Nicolette: Yeah. And we definitely see that, um, that pharmacists shy away from that or they it’s a fine line in healthcare that, that you don’t cross. We always just want to do what’s best for the patient. So that’s why I never got really behind switching prescriptions. You know, because one PPI is more profitable than the other. I don’t like that. I don’t subscribe to it unless there’s a clinical purpose. So, I always look at it from “what’s a way that we can find new potentially profitable business or what can we bring in that’s not switching a patient current therapy” unless they’re having angioedema on an ACE inhibitor or something, which is rare, like, unless they’re having an issue, but on the sales piece, we always used to say educate and invite. So that feels a little better than sales. You know, because pharmacists are educating patients. So, educate them about it. Educate them about this nutrient depletion. How if they’re on a birth control pill, they’re going to be depleted in their B vitamins, they’re going to feel tired. Educate them about what it is and then invite them. You know, here’s a couple that we recommend, and you have maybe your good, better, best lines or whatever and then you know, they’re getting an antibiotic, educate them about this is really going to clear out the bad bacteria and the good bacteria in your gut and it might cause some diarrhea, might cause some side effects because you’ve cleared out all the good flora. So, we recommend this probiotic to replenish your GI tract with good bacteria, build it back up, especially since you’re going to be on an antibiotic and just kind of get you all out of whack and that’s really the sales piece that pharmacists, you know, if you, if you. Position it like that. They feel more comfortable. If you’re like, okay, sales, we got to sell 10 probiotics a week.  Go, we’re going to make a little thermometer chart. That could be off putting to people.  

Bonnie: Thermometer chart. 

Nicolette: Yeah. Yeah. Right. Like, oh, we should sell 10 probiotics this week.  But educating and inviting is better.  

Kendell: You’re not getting a pizza party. No Krispy Kremes for you.  

Nicolette: But then if you do have that salesperson, even if it’s a physician liaison, community liaison, pharmacy liaison, they might not have the word sales in their title. But if you have someone going out and doing community, you know, fairs, or talking to local providers, or going to local businesses, or things like that, they don’t, and they probably shouldn’t, have the level of clinical acumen that your pharmacist has, or, you know, you should always kind of have that person where if it gets real technical, you could say, oh, you know what, can my pharmacist call you? Or, because the pharmacist might not always be able to come in. That’s just not feasible. Can my pharmacist call you or can I give you my pharmacist’s email address or cell phone number or whatever it is? And you guys can communicate with them that way. That way, anytime you get a clinical question to come up about compounds or whatever, you can just shoot them a text, or you can email them, or you can call them up. Here’s their direct line, but if you frame it from education, it feels better than sales, because they need to be, they need to feel comfortable in that solution that you’re providing to actually execute that sale. It’s like educating the patients, those opportunities, and then educating the doctors in your area about the services that are in their community. So, it’s a big educational work.  

Scotty: I like that a lot. Yeah, I mean, if you tell a patient, hey, this antibiotic is going to tear up your stomach. Here, take this probiotic to help you. Okay, I’m not educating them, but that instantly, like, is going to be a sale because somebody’s like, yeah, that makes sense. Right?  And I would imagine even if they don’t instantly do it and they think, ah, whatever, this is a scam when they get home after a few days, they may change their mind and come back.  

Nicolette: Yeah. Yeah. That’s where a lot of pharmacy owners, they’ll give the patients some literature.  Because, you know, just however information flows nowadays, we don’t really take people’s word for it. We’re like, ah, I’m going to look it up myself. I’m going to Google it. I’m going to research it. I’m going to read some reviews. I’m going to do all these things. So, you hate to educate someone on something and then they go buy it on Amazon or something like that. So that’s why a lot of pharmacy owners private label supplements and things like that too. So that you don’t lose that sale to online.  

Scotty: Yeah.  

Kendell: Oh, I got one thing for you, Nicolette. I see on your page, it says, “need a speaker?”  So, you sold the pharmacy. Maybe you have some time to do some traveling and some speaking. We got to keep that in mind, guys. We have an event at the, in the Edenton office. Maybe we can get Nicolette to come in.  

Bonnie: Our pig out day. 

Scotty: Our pig out day. We are having a pig out day.   

Kendell: So, what, tell me a little bit about that. Any specific topics that you speak on currently or anything that you can speak to a bunch of accountants about folks in, in the pharmacy.   

Nicolette: You know, so far, it’s just been pharmacy events and just really about sales and marketing or like, you know, both my parents own their own businesses. My dad’s always been a salesman and, he has a water filtration company and my mom’s a hairstylist. She owns a hair salon. So yeah. So, it’s always been just business, just in the summers. My parents would be like, all right, kids were poor. We don’t, you know, we don’t have any money because their business, my mom’s business, especially is seasonal down in Florida, we have snowbirds. 

Bonnie: Oh yeah. Yes.  

Nicolette: Well, they all go back up North in the summer, so like, okay, summer, we’re poor. We’re not going to Toys R Us. See, all these things my kids aren’t even going to know anything about. Toys R Us, there was no Amazon. But with that, I always look at it from a business perspective. Like, yes, we have a pharmacy. Yes, you’re a pharmacist. And… you have to work on your business most of the time. So, you can be a pharmacist, you can work on those relationships. That’s why we all got into independent pharmacy, I think, is, because I worked for chain pharmacies for a long time, I worked for hospital pharmacy, and your hands are so tied, there’s so many hoops, and just so much, and it gets discouraging after a while. I mean, we all see these walkouts that are going on. Right now for labor issues and patient safety issues and yes an independent pharmacy You don’t have to do that. You don’t have to subscribe to that. You can do the right thing You can take care of your patients  But you can’t you can’t do it. Kathy says if there’s if there’s no money, there’s no mission  I believe so you have to fund it. You have to figure it out. So, that’s typically what I speak about is just looking at it from a business perspective. If I didn’t have a pharmacy, I would have had probably a hair salon or a pet shop, a pet shop that would have been fun. But it’s all the same principles. It’s all, every business needs a CRM. Every business needs targets. Every business needs some sort of system and structure of how are you going to feed the beast, whatever the beast is. How are you going to bring that business in? Because we all know in pharmacy, we don’t want more prescriptions right now. We don’t want more volume. We want the right kind of business. We want the type of business that we want to dispense, what we want to specialize in. So, we don’t have to be everything to everybody.  So that’s the speaking gig situation. And then I actually, funny enough, I talked with Chris Cornelison yesterday. If you guys know him, he’s a speaker. He’s a real deal speaker. He’s on some fancy speakers, bureau or circuit or something. He’s got some exciting things in the works, and he’s been speaking in other industries as well about culture and leadership.  Um, so there’s definitely a place where we all, no matter what exactly, we all need to look for inspiration, we need to look for focus. We need to look for like, what can we do to ensure the longevity of our pharmacy, to help the people in our community, because like, pharmacy is a mess. Healthcare’s a mess. You see these poor patients,  they’re just getting another medication added, and then they’re having side effects of that, so they added another med on, and then they saw another doctor, they got another med, and then they got a new diagnosis, and they got three new meds, and it’s like, they’re out of refills all the time, things are out of stock, prior auths, stuff’s not covered, open enrollments right now, patients also need their flu shot,  their RSV shot that just came out, if they’re, um, a little older and  a kind of new COVID shot just came out. So, patients need a lot of education  from someone they trust, not just Google. They need a lot of medication management. They need a lot of symptom management. People don’t want to take pills and I don’t blame them. I don’t want to take pills. So, what can you do lifestyle wise? I mean, you think about these GLPs and all the weight loss that’s going on and there’s not really a protocol to get people off of these GLPs, right? So that’s going to be a huge area for pharmacists. What nutrient depletions do we have now that all these patients are losing weight?  And which is great, but are they, is their protein intake adequate? Are they moving more? Are they, and then who’s going to come in and fill that gap? It should be pharmacists, but it should be pharmacists in a systematized strategic way so that we can support it.  So, there’s a lot of work for everybody to do.  

Bonnie: And I know, GLP’s, I need some of that so that I’m not so hungry.  

Kendell: She said, “I’ve been thinking about it.” Bonnie’s been on a diet lately and she’s just been ill.  

Bonnie: I’ve been on a diet for 24 hours and I am so hungry. I mean, I feel like it’s 1030 in the morning and I feel like I haven’t eaten lunch and it’s 2:30 or something. Oh, I’m so angry.   

Nicolette: I’m a big believer in eating every couple of hours.  

Bonnie: I am too.  

Nicolette: I even had my doctor write me a… yeah, but you got to eat the right stuff. But I even had my doctor write me a note when I worked at the chain that I had to eat every two hours because I was pregnant. I was pregnant for a three-year span, like an elephant. I had kids three years back-to-back and being so busy working at these chains, you couldn’t eat. You couldn’t eat for like eight hours. I said this isn’t going to work for me. So, way back then, I got in the habit of eating every like two hours. And, yeah, no, you’re not you when you’re hungry.  

Bonnie: I’m definitely not.  

Scotty: Eat a Snickers.  

Nicolette: Yeah, just do it. No, I feel, you know, I’ve started working out.   

Bonnie: Well, me too, 24 hours ago.   

Nicolette: Hey, whatever, that counts. But just to get more energy. Because we all sit at computers, or we sit in front of computers all day and it’s like, woof, man, got to do something. But then if you’re working out, you’re hungrier. So, but I don’t know. Yeah, no, I think, I mean, protein, definitely protein and eating frequently. And then having kind of like, carbs are probably the killer though.  

Bonnie: I love them.  

Nicolette: And even like, I know, I know, I know, but then they make you tired. Like protein. You got to have protein. You can have fruit because it has natural sugars, but you got to know which fruits, Bananas have a ton of sugar, Grapes have a ton of sugar, get you some Strawberries, a small Apple, that’s better. 

Kendell: We got somebody to call, Bonnie, for motivation whenever we start craving crazy stuff.  

Bonnie: She just said whatever, just eat it. It’s not going to be motivating. I’m just kidding.  

Nicolette: If it’s going to haunt you, just maybe eat a third of it, you know, in moderation.  

Bonnie: Oh man, I would.  

Scotty: We could hire you to come speak to all our employees about wellness. 

Kendell: See, there you go. Boom.  

Nicolette: And then I’ll be in the back, sneaking a Snickers, because we talked about it.  

Bonnie: You know what’s funny? I got addicted to when I get my coffee in the morning, they started making these Chocolate croissants. And they are just so good to me. And then every day I’m like, I’m not ever eating one of those again. And then the next morning when I go, I’m like, I’m going to do it one more day. But for like the last week and a half, they have not cooked them anymore.  So, it’s like a sign. 

Nicolette: It is a sign. See, but if you really want a chocolate croissant, or me, it’s popcorn. I love popcorn. It’s my favorite food group. I could eat it every day. Multiple times a day, I don’t care. I’m going to eat it. But if you tell yourself, like, I’m only going to have popcorn on the weekend, or there was even one diet that I was doing one time where you have to eat, you know, pretty clean because you don’t want all these pro inflammatory and just modified fake stuff. Eat pretty clean all week, and then on the weekend you could have a two-hour period where you eat whatever you want.  

Bonnie: For two hours? I’d be like “nom nom nom”  

Nicolette: Yes. Yeah. So, you do. And then you feel sick and then whatever, but it’s not going to completely derail you. And then you start thinking like, oh, I’m going to make brownies. I’m going to make my two hours. You’re like doing all these calculations. I want to have brownies and popcorn on my Snickers and have my thing because it’s just hard.  

Bonnie: Kendell, remember when you did the keto?  

Kendell: I was killing the keto. I was working out in the office downstairs. I was feeling good about myself post tax season, I said “I’m going to be looking good after-tax season.” But, uh, yeah. That was about five years ago. Oh my God. That’s rough, though. Bonnie usually motivates me to get started on something and then vice versa.  

Bonnie: Yeah, how do I invite other people? And then I don’t do it.  

Kendell: She’s like, I’m started. And I’m like, well, I’m not letting you just lose all this weight by yourself now. Come on now. Don’t leave me behind. She’s not sustainable.  

Bonnie: I just want to be…  

Scotty: Bonnie, you’re not even like fat.  

Bonnie: Don’t say that, I want to be in better shape.   

Kendell: No, that’s not it. Bonnie, stop.  

Bonnie: No, it is. I mean. 

Kendell: Mm – hm. No, she sent us a picture of like, when she first met her husband, and they were hugging. She’s like, I want to look like that again.  

Bonnie: I do.  

Kendell: I was like, wasn’t that high school?   

Nicolette: Time is cruel.  

Bonnie: It is  

Nicolette: Because now you work.  

Bonnie: So, then some days I’m wanting to do this, and then other days I’m like, why not just eat and be happy because life is short. So, that’s the struggle. 

[Transition/Technical Difficulties]  

Bonnie: Is it on my face? My camera is like falling down.  

Scotty: Yeah.  

Bonnie: Sorry.  

Kendell: It’s all good. So, we usually finish the shows off with a nice song. That’s, becoming a habit now. And then the bottom line, so the bottom line for those who just want to skip to the end, which is your key… 

Bonnie: I want to go first!  

Kendell: I was going to go first this time.   

Bonnie: Go ahead.  

Kendell: All right. I’ll make mine short though. Mine’s just going to be short and sweet.  

Bonnie: If you steal it, I’m going to be hot.  

Kendell: No, I’m not stealing yours. I think what I took away was that marketing and sales is related to every business and just like pharmacy business. That’s it. That’s it. That’s it. Whether it was hair or air filtration or pharmacy, it’s an important part and accounting. A lot of the things you said, stuff that we can implement, too. So that’s it. That’s it. I’m done  

Bonnie: That’s basically what I was going to say. I don’t know. I was actually going to quote her, though. I mean, it’s a great point. So, I just reiterate every business needs this. You’ve got to feed the beast.  That’s what I’m taking from this. It doesn’t matter. Yeah, you got to keep her healthy. She doesn’t need to be on a diet. She needs to be full and plump. 

Kendell: She needs Snickers and some carbs to feed the beast.  

Bonnie: She needs carbs.  

Nicolette: Yeah, you got to feed her the right stuff, see?   

Bonnie: That’s right.   

Scotty: My bottom line is 10 haircuts from Walmart are the jam.  

Kendell: He’s feeling himself. I saw you checking yourself out.  

Bonnie: You got lucky, but what may happen next time, because it’s not going to be the same lady there. 

Nicolette: That’s right.  

Scotty: In ten minutes too. Ten minutes. $10  

Kendell: That’s the quick lube of haircuts.  

Bonnie: Kendell, Kendell, would you ever go to Walmart to get your hair cut?   

Kendell: No, that’s a serious part of a man’s personality right there. I can’t play, I can’t let people…  

Bonnie: Kendell’s got to keep it perfect.  

Kendell: If they push that line back one time, it might not ever come back. You got to,listen, I’m just letting you know, this is just the, you know, cultural moment. Once the hairline gets pushed back one bad cut, it could be over. So, I got to save it. I got to save it. Anyways back to the show at hand. Nicolette, save us, right? Save us now. We got off topic. What’s the bottom line? 

Nicolette: You know, we’re coming up. On some uncertain times in pharmacy, there’s going to be some, some regulatory things changing in compounding, there’s going to be some DIR things changing. I don’t know if you guys heard about that.   

Kendell: Oh, yes.  

Scotty: What’s a DIR fee?   

Bonnie: Oh, like Director Fee. Director Fee?  

Kendell: Director fees?  

Scotty: We’ve gotten that from other CPAs before. What are these Director Fees on here?   

Nicolette: Oh goodness.  

Bonnie: That’s when you know you need a new CPA. That may be our new line.   

Kendell: Yeah.  

Nicolette: So, there’s a lot of uncertainty going on and, you just have to think how are we going to offset it? So, if you do have any cash revenue streams, what’s the plan?  You know, like, what’s the structure? What’s the plan? What’s the focus? And I would say that that’s the bottom line. I mean if we’re trying to run a business, we’re trying to support the business. We’re trying to keep our employees employed, take care of them, their families, our communities. We really have to focus on what are we going to do for quarter one and beyond and be strategic about it, like be forward thinking. And have a plan and then execute that plan every day.  

Scotty: Well, there’s a lot of opportunity out there for pharmacy and it’s continuing to evolve as you know, Nicolette and, pharmacies got to get out there and make it happen, just what it has to be. So, and sales and marketing is a key piece of that. No doubt about it.  

Nicolette: Yeah. Let’s you control a little bit of your destiny, which is a good feeling.   

Scotty: Well, we appreciate you getting on Nicolette. And I guess that wraps up this episode of the Bottom Line Pharmacy Podcast.   

Nicolette: Thanks for having me. Appreciate you.  

Bonnie: Thank you, Nicolette.   

Kendell: Thanks. 


Kendell: I got something for you guys. You ready for this?  You ready? Y’all made me do this. I didn’t want to, but you practically made me. We can cut it out if you want to, but I wrote something. I wrote something for you, Nicolette. You ready? Look at her face. She’s turning red already. This is the start. You started it at the beginning. It says “Dotti Dotti. The program that’s a hottie if your marketing is shoddy, you need to get in touch with Dotti. Dotti Dotti, but you don’t want everybody reach out to Nicolette and collect the least that are the best Dotti Dotti.”  

Bonnie: Ohh! See! Hired.  

Kendell: You practically made me do it when you were like “yeah” 

Nicolette: We got to get a beat box on the track. 

Kendell: Uh oh. Uh oh. Scotty, Scotty, you got it. What instrument did you use to go with?  

Bonnie: He will whip that out in like an hour. You’ll have it in your inbox.  

Kendell: Ha ha ha. Dotti, Dotti.  

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