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Independent Pharmacy Accounting, Pharmacy Growth, Startup Pharmacies

Infusion Revolution | Episode 1 | Opening an Infusion Pharmacy 101

Welcome to the first episode of our special series: Infusion Revolution where we discuss all things owning and operating an infusion pharmacy.

From accounting and tax best practices to industry changes and trends, you can catch it all on this podcast series.

On this first episode, it’s all about Starting an Infusion Pharmacy 101! We sit down with Greco De Valencia, VP of Pharmacy and Senior Loan Officer at Live Oak Bank to discuss:

  • Complexities of starting an infusion pharmacy 
  • Financial implications of entering this market 
  • Understanding startup costs and working

Join the discussion with us!

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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More resources on this topic:

Schedule an Rx Assessment

Video: Future-Proof Your Pharmacy: Essential Advice for 2024

Podcast: Finishing The Fight: What’s Next For Independent Pharmacy

Podcast: Startup Pharmacy “The Pharmacy” on How to be Successful

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

Greco De Valencia, VP of Pharmacy, Live Oak Bank: I mean, I feel it’s a great opportunity too for pharmacists to continue to talk about their value. But I know what we’re going to talk about a little bit today is how pharmacists are continuing to diversify. And some of it might be partnering up with different franchise groups and then also going into different types of medication administration like infusion. It’s, I just think right now, you know, we always say it, you gotta be looking at what else can you be doing and how else can you be marketing yourself? 

Bonnie Bond, CPA: Mm-hmm. Absolutely. 

Scotty Sykes, CPA, CFP®: Sure, for sure. So, you mentioned Infusion, Greco. We’ve seen an uptick in Infusion here with some vital care franchises, which is the franchise group for Infusion suites, if you will, and they’re growing pretty rapidly, I understand. And so, what are you seeing in the infusion space? What’s developing there? What’s new and different there? 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Yeah, I mean, you know, I came across Vital Care probably about maybe five years ago and they’ve been around for a very long time. And you’re right,  they’re a franchise group for infusion pharmacies and just learning a little bit about the model and learning more about the space. I had dabbled; we had dabbled at Live Oak Bank a little bit in the infusion space back in like 2015 with a few infusion pharmacies here in California and then there were some changes to reimbursements. So, that kind of went away and that was really my first entry point into understanding about infusion and you know the circle of people that are involved in it with the patient. So it’s pretty fascinating stuff you know I think I think it’s one of those things it’s one of those markets that now in 2024 as you look on you know, I think they’re projecting that, you know, the infusion drug space, the, you know, just the infusion space is going to grow to almost $40 billion in an industry. And, you know, when you’re looking at a lot of the medications that are in the pipeline that are coming out, many of them are going to be  administered through intravenous administration. So, you know, that type of basic infusion. And, and so what we started to see from about 2000…like I said, maybe not ‘18, you know, 2018, 2019, we started to see more of the independents starting to find the Vital Cares, partner with them as a franchise and open up another arm of business. If you want to look at it like that from their retail independent or their long-term care or their compounding and focus on these infusion patients, infusion prescribers, infusion medications. And those that have been doing it have been doing very well. Bigger margins, bigger dollars, higher cost. But it’s been a good partnership for a lot of the independents. 

Scotty Sykes, CPA, CFP®: From what I’ve seen with infusions, the ones we work with, it’s definitely a higher margin, much higher cost, but can be very, very lucrative if you know what you’re doing, for sure.  

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Yeah. Yeah. Yeah. 

Bonnie Bond, CPA: And I don’t know if you see the same Greco, but we’re working with many, I would say actually the majority we’ve noticed that we’re working with are actually not  pharmacists at all. It’s a lot of investors… 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Yeah. Yeah. 

Bonnie Bond, CPA: Which is kind of good for us because a lot of them are really looking for some help understanding the ins and outs of the pharmacy industry. So they kind of almost need that more than your normal pharmacist that already is kind of to use to those things. So that’s been interesting to me. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Yeah. Yeah. I think, you know, in general, like specific to the franchise model, like, you know, like Scotty brought up Vital Care, like, I think whenever there’s a franchise model involved, you’re going to have like some of the owners or franchisees are going to be broken up into a few buckets. And I think I always look at it like, you know, there will be those investors, entrepreneurs who might’ve been successful in other arms of the business. And then you’ve got, you know, individuals with backgrounds in the medical space that they may be going into, like for example, maybe a nurse that’s worked a lot with infusion patients. And then you’ve got, you know, your traditional pharmacist, right? And so I think there’s, that is that bucket. And we have seen that specific to Vital Care, we have seen that mix. And I think, you know, the big value proposition that any franchise group really brings but specifically, to Vital Care when pharmacists are looking to stand it up is a lot of that back end support. You know, that’s kind of I think something that we as bankers and lenders, you know, anytime you’re entering into a space like infusion, you know, the barriers to entry are fairly high, mostly on the payer side. And so, I think there’s a lot of that back-end support being able to get into the networks, helping with, you know, understanding how to purchase the drugs, you know, adjudicate claims, reconcile claims. A lot of that back-end support and frankly that’s you know a big piece of it. More importantly I think you know independent pharmacists if they’re going to go into or if they’re going to venture any type of franchise partnership you know they’re going to have to be comfortable in that space and a lot of them sometimes maybe aren’t as comfortable in the sterile compounding space because some of it is you know most of it is sterile  of some kind and so you know individuals who aren’t comfortable with that you know, it’s a good thing to go into. We’ve seen some independents be very successful in partnering. 

Scotty Sykes, CPA, CFP®: And they do provide that turnkey kind of behind the scenes support, which is critical, which allows, you know, that growth, which allows the operators that may not have a pharmacy background per se to step into the space, get a PIC in place and, you know, dive into it. You know… 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Yeah. 

Scotty Sykes, CPA, CFP®: Pharmacy is a different world and I think as you know and I think some of these operators that are, don’t have that pharmacy background kind of you know, they’re kind of jumping into a spiderweb. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Uncharted territory. Yeah. 

Scotty Sykes, CPA, CFP®: And, this is not like a Gold’s Gym franchise or some other types of franchise that a lot of people have experience with. This is a Vital Care 

Scotty Sykes, CPA, CFP®: Infusion pharmacy, it’s a complex industry. So due due diligence is paramount. And let’s talk about that due diligence, Greco. If you are an owner operator looking to start up maybe an infusion and whether you have a pharmacy background or not, what would you think is some of those key due diligence plays there? 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Yeah, I mean, and, you know, I’ll extend the conversation to just anything in the healthcare space, because we’ve also seen pharmacists partner with franchises that are in the home health space, right? So, you know,  from a broader perspective, I think anytime, like, let’s take, let’s take an independent pharmacist who obviously knows the independent pharmacy space has done very well, whether it being compounding or long term care, and they’re looking to diversify into another entirely different business model. You know, I think the first thing you need to understand is you know, who are the key stakeholders in the industry that you’re getting into, right? So, you know, does that mean that, you know, the pharmacist is one of the key stakeholders? Does that mean that perhaps there’s a sales rep or there’s some type kind of account executive or somebody that’s out there touching the referrals? Are they really critical to it? And just, you know, kind of what’s the team that you’re going to have to build here? I think in the independent pharmacy space, pretty straightforward, right? I mean, they got the pharmacist, PIC, they have some techs, and that’s kind of the team, right? 

Scotty Sykes, CPA, CFP®: Where you’re getting scripts in the door, you’re filling scripts out the door, like, you know, what’s, how’s the revenue work? Where’s that revenue coming from? How do I get that revenue? and so forth. Yeah. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Yeah, yeah. Yeah, so I think that’s first, you people got to kind of understand who those key stakeholders are and how the, to what you just were saying, the kind of life cycle of the revenues and the business, how that goes. Next, you know, you got to know what the startup costs are. What are the what are the costs to stand something up? You know, we’ve seen some people get into other business models where it’s like $250,000 to $300,000. Right. We’ve seen some people get into some of the more weight loss management, health coaching, businesses that are being successful now with a lot of the growth of the GLP medications. So they’ve been getting into these side businesses, but the standup for those are very low, right? And then we’ve seen some that are getting into home health and it gets a little higher, right? Mostly because of the labor costs. And then some that are starting to go into the franchises like the Vital Cares of the world and infusion spaces where that cost is going to be much higher, you know, they have to understand what that is because that plays into a big, big piece of where are you going to reach your break even point and how much liquidity are you going to need to make sure that you can continue to operate the business as it stands up. 

Scotty Sykes, CPA, CFP®: And how you’re going to source that liquidity. You know, that just what comes to mind first and foremost is it takes several, several months to get the contracting in place, to get the pieces in place, to even start that revenue cycle, if you will. And meanwhile, you have to have a location. You have to have a PIC. So, you could be a year into it, if not more, paying rent and paying payroll. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Yeah. 

Bonnie Bond, CPA: Yeah, that’s a good point, Scotty. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Yeah. 

Scotty Sykes, CPA, CFP®: A lot of these people want benefits too. So you got that startup cost perhaps of a year to 18 months, before you even open of payroll and rent. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Yeah. 

Bonnie Bond, CPA: Yeah, I would say, because I work with a lot of startups, but now working in the last year or so with a lot of these infusion pharmacies, it’s definitely, there’s a lot of money out front and definitely like you mentioned the rent because you’ve got to get this stuff in there. It’s specific and straight, but I definitely see where the payroll is running way before, you know, for the pharmacist that has to kind of get in there and get things going before things really start to rev up. So there’s definitely more payroll costs because normally in a startup, you know, you really don’t start to see, you know, a pharmacist’s salary start to roll until you really open the doors and then there’s some scripts coming in. This definitely seems to be a little more out front prior to really getting things going. A larger outlay. 

Scotty Sykes, CPA, CFP®: And a lot of these places are in city, you know, urban areas too, bigger markets and rents a lot higher in these. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Yeah. Well, I think anytime you’re getting into a business, any kind of, I mean, all right, we see this in the pharmacy space, right? There’s a managed care portion to the business, PBM reimbursements, right? Reimbursements on the prescriptions. Anytime you’re getting into any kind of business model that has a managed care piece to it, there is going to be like Scotty was talking about, there’s going to be that ramp up period because you have to get in the contracts, you have to get those types of things… 

Bonnie Bond, CPA: Yeah. For sure. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Much different than, you know, like I said, we’ve seen some people go into adjacent businesses where it’s cash. Well, you start to see those revenues coming in and cashflow coming in much quicker because it’s a cash-based model. So the startup costs for those are much lower. You know, you get the startup costs for managed care, things are going to be much higher because it just takes that much longer. And to Scotty’s point, you know, you’re already, you’ve got the lease, you know,  maybe you’re doing some tenant improvements to make it up to make it up to a code and to and to regulations for the specific type of business that you’re going to be operating. And then you’ve got the payroll, right? And so all those three things start accumulating costs before those managed care reimbursements start to come in. And so I just think, you know, going back to Scotty’s point about what people need to know, I think you need to know how that works, right? It’s not turnkey. 

Bonnie Bond, CPA: Right. And be prepared for it. You just need to make sure you have the working capital in place to make it through that period of time. With any pharmacy, that’s the case. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Yeah. Yeah. Yeah. 

Scotty Sykes, CPA, CFP®: And I want to talk about working capital, but before I get to that, the startup costs, mind you, once you pass $50,000 of startup costs, which is the payroll, the rent, things like that, that is not, that is deducted over 15 years. Isn’t that right, Bonnie? 

Bonnie Bond, CPA: That’s right. It’s actually if it’s under 50, you can take the first year a $5,000 deduction. Once you get over 50, then it starts dollar for dollar going down.  

Greco De Valencia, VP of Pharmacy, Live Oak Bank: What? Wow, I did not know that. 

Bonnie Bond, CPA: So, in a… yeah. So, in this situation, when you have like a large startup, know, your larger startup amounts, those are probably gonna get limited and you’re not gonna be able to take any of it immediately. So it’ll be amortized over 15 years. Anything that you spend before opening the doors. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: So, let me make sure I understand that. So, let’s say someone’s… 

Scotty Sykes, CPA, CFP®: Interest doesn’t count. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Right, okay. But everything else, so what you’re saying basically is, like, let’s say someone is doing for this purpose an infusion pharmacy, right? And they’re gonna have to do a build out of the clean rooms, they’re gonna have to get everything kind of ready. And overall the cost of all the things, shelving, everything basically.  

Bonnie Bond, CPA: Well let me be clear on that. So, anything that’s actually a capital expenditure, like the leasehold improvement, now if you’re doing leasehold improvements, that’s gonna be 15 or 39 year anyway. But if you’re, any of your major equipment purchases or technology purchases, cameras, whatever, chairs, those will still be capitalized and then you can accelerate depreciation if you need to do that. But I mean rent, payroll, 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Yeah. 

Bonnie Bond, CPA: Your operating expenses. 

Scotty Sykes, CPA, CFP®: Utilities. So… 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Wow, really? So, anything over $50,000, you can depreciate that over a 15-year time? 

Scotty Sykes, CPA, CFP®: So yeah, it’s like if you open the door, let’s say you got $100,000 of startup costs, and when you open the door, that $100,000 is written off over 15 years. And when I say open the door, you’re open for business. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Wow. Really? 

Bonnie Bond, CPA: You’ve got revenue coming in. Now, even if it’s only if it’s a startup and you only filled two scripts that day, you’re open and you’re available to fill a script. You’re good. But anything leading up to that day you open is other than the capital expenditures and interest. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Yeah. Wow. 

Scotty Sykes, CPA, CFP®: Yeah, they limit you big time. That’s a big limit. And so if you’re talking heavy investment upfront, you know, with the managed care, having to go through this 12-18 month period, whatever it is to get going, that’s a lot of expenses. And that’s, you know, you’re eating it. You’re really eating it because you’re not getting that deduction right up front when you open. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Yeah. 

Bonnie Bond, CPA: And again, that’s with any business, but your normal independent pharmacies as well. I mean, I’ve seen people spend $100,000, $200,000 easy in a normal pharmacy situation that they, especially ones that take a really long time to get open and they have racked up expenses over time.  

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Interesting. 

Bonnie Bond, CPA: Yeah. 

Scotty Sykes, CPA, CFP®: You’ve got to plan for them. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Wow. I did not. I mean, you know, obviously I’m not a, don’t live in your guys’s world, right? So why would I know that, but I would, I will say that a lot of people, I think view that a little bit as like a sunk cost and…  

Bonnie Bond, CPA: Yeah, they think, I’ve spent $100,000, I’m gonna be able to write that off this year. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Yeah. But it’s over, but what you’re saying is it’s more anything over $50,000 once you open those doors and your generating revenue, then it becomes something over 15 years. 

Scotty Sykes, CPA, CFP®: Yeah, it’s a 15 year write off. So it… 

Bonnie Bond, CPA: It’s not even up, I just mean up to $50,000, you can take $5,000 the first year. But yeah, even if it’s only, so yeah, anything over $5,000 is what we should say. If you spend $5,000 is all your startup cost are, then you can take that whole thing that first year. But if you spend $25,000 you’re only gonna be able to take the $5,000. $20,000 of it will be amortized over 15 years. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Yeah. Okay. Well, I mean, well still though, I mean, it’s good that people know that they can depreciate that. I mean, you know, every little bit.  

Bonnie Bond, CPA: Yeah, you don’t lose it. It’s drawn way out. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Yeah. 

Scotty Sykes, CPA, CFP®: Yeah. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Well, and you know, when we’re looking at acquisitions, I think always the prevailing conversation is if you’re doing an asset purchase, you know, the largest portion of the  business you’re buying is the goodwill and amortizing that over the 15 years is a tax benefit, you know, non-cash expense lowers your taxable income. Why not take advantage of that? It’s kind of the same thing that in this situation, right?  

Bonnie Bond, CPA: Yep. It is. Yep. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: I mean, if you have those costs, you should take advantage of it. That’s really good. That’s really good to know. 

Bonnie Bond, CPA: Yes, just like Goodwill. Same thing. 

Scotty Sykes, CPA, CFP®: And I’ll just add to this, keeping up with these expenses is very important because there are some of these expenses, as we mentioned, that you can classify as equipment, things that are in depreciable buckets that you can write off a lot faster. So how you categorize those startup expenses is very important to maximize your deductions once you do open. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Yeah. 

Bonnie Bond, CPA: Yeah, like I said, if you bought, if you did improvements or you bought a robot for $100,000, usually people don’t need to accelerate depreciation in the first year of a startup situation because they just don’t need it. So then you would be a five, that would be a five year item that would be depreciated every five years. But at least that’s quicker than 15. So yeah. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: When you guys have clients, so when you have independent pharmacists and they start to break off into other business models, specifically in the healthcare space, are you guys seeing any type of classifications from a tax perspective that might change or is it all pretty much within the same fairway of independent pharmacies as far as just treating tax-wise?  

Bonnie Bond, CPA: Those sorts of things are going to be across the board. Depreciation, you know, useful life, lives of different assets and all that kind of thing. All that is across the board. Now where we see differences is when you hit different industries, different tax credits, things like that. That’s why we love zoning in on the pharmacy industry because you can really spend a lot of time digging deep into things that are specific to the pharmacy industry. But depreciation rules are depreciation rules, basically. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Yeah. So are you, are you guys still, and is it still the same cash accrual whenever there’s any types of receivables coming in from those third party,  are you guys treating the cash accrual thing the same kind of way as far as you would with the independents? 

Scotty Sykes, CPA, CFP®: So there are receivables, there are certainly receivables. Now the Vital Care model is a little different in how they do that, but there are receivables in an infusion space oh yeah. And it’s a little, it’s different because some of it’s medical or, know, it’s a whole, the AR thing is really a whole other can of worms. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Yeah, yeah, yeah.  

Bonnie Bond, CPA: Yeah. And then there’s some situations where people especially with an infusion situation, they choose to do this and pay cash. So, there is a cash element also where there’s not receivables because that’s what they want to do. So, there’s some of that, but it’s not the same players in the vendor space for the receivable situation, but that same process is happening. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Well, I…We definitely see on the payer side with infusion, like Scotty was saying, you can go through the prescription benefits. Sometimes it’s on the medical. I have yet to see some with cash, that’s, mean, hey, look, there’s people out there with lot of money. They might want to do it. You never know. 

Bonnie Bond, CPA: Exactly. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: And so yeah, we’ve seen those on those things. And then of course, from a labor perspective, whether you have a nurse on staff or you contract with the nursing, you know, that’s a big thing too. And so, yeah, I mean, it’s just, you know, it always fascinates me. You know, you always hear about different business models that are within the healthcare space. And like I was saying, you know, the franchise model, I think is being more embraced by, in our space, independent owners. And it’s not just an infusion. There’s other models out there too, in fact, there was a really interesting article and I think it was in pharmacy times that one of the pharmacists wrote just specifically about that, like pharmacists embracing partnering with franchise models to help the business or help their entrepreneurial spirit. And you see it a lot in the dental space, you know, you see it a lot in other industries. There’s no reason why it shouldn’t be limited in ours. Yep. 

Scotty Sykes, CPA, CFP®: Well, you got like the Happier At Home, that’s the home medical franchise that you can latch on to a pharmacy there. You got, so yeah, I mean, you got like the nurse practitioner in your pharmacy, those kinds of things, the insurance. So yeah, it’s, you know, if the business model is proven and works and it’s a turnkey solution to get you in there and the money. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Yeah. 

Bonnie Bond, CPA: Yeah, but I tell you what isn’t necessarily turnkey. Well, one of the clients that I work with is he is killing himself in his area. And he has an established independent store. Now he’s doing the infusion, but he is killing it really going out and selling this, you know, and making sure the providers know of the opportunity and that he’s there and make, you know, building those strong relationships with everybody he can so that, to make it work. So it’s taken a lot. That’s why, you know, even if you’re, and he’s a pharmacist and he’s well known in his area and he’s working hard at it. So, I would imagine you still are, you know, you’re going to really have to hit the ground running in an area if you are not already in that space or have somebody that will be doing that part of it. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Well, I mean, any business, you know, I mean, think  that’s the thing, any business that you go into, whether you’re owning the pharmacy, buying the pharmacy, starting going into another industry, another model, you know, you’re going to have to have this entrepreneurial spirit. You’re going to have to have that hustle. You’re going to have to know how to manage people and grow them. And, you know, I think Scotty, we talked about this a little bit last year. That is, I think, you know, that people management, motivation, growth, whatever you want to put that in as a bucket leadership, I guess you could say that I think has really become a critical piece and often overlooked in a lot of, you know, I know in a lot of independent pharmacies, you know, 

Scotty Sykes, CPA, CFP®: Well, that’s, that’s the, I mean, you know, I talk about accounting is the foundation. Well, it is along with like you as an operator because pharmacies that are not making it in today’s environment, a lot of them are just, they don’t have what it takes to operate and to change and adapt and to lead their teams. I mean, that’s, you got to have it. 

Bonnie Bond, CPA: Yeah, we’ve seen some great stores start, especially some startups, and I think, you know, they have this beautiful store and it’s a great location, and then they just, they open and they just kind of sit there and wait for the foot traffic and then it doesn’t happen and you’re like, what are you doing? You know, we did a little bit of marketing or, you know, we did something on Facebook. I mean, you gotta get out there this day and time and just really, really push it. 

Greco De Valencia, VP of Pharmacy, Live Oak Bank: Yeah. And you got to, think, and you got to also, you know, like I was saying, the, it’s not within their scope. That’s what I was trying to say, right? The leadership people vision is not within their scope because they’re so focused on the pharmacology side of it, or maybe like looking at the books or, you know, treating their customers like the best they can. But I know there’s a lot of, where, you know, on the subject of partnering with others, there’s a lot of individuals out there in the pharmacy space, healthcare space that will help you develop that, help you develop that leadership to make a better team, to make a stronger foundation. Because, you know, with how crazy it gets out there and how thin the margins can be in independents if you don’t have a team working for yourself and making every effort to make it great it’s no different than if you’re in an infusion space where the revenues and the margins might be a lot higher. If you can’t lead a great team or if you’re in, you know, self-storage, right? It doesn’t matter, right? You gotta have great leadership in a team. So, I think that’s definitely something that is overlooked. 

Scotty Sykes, CPA, CFP®: It’s a constant learning. You never stop learning in that area either. 

Bonnie Bond, CPA: And these pharmacy owners are stretched so thin already with everything they’re having to do. I mean, just, you know, we’re already getting on our clients. You need to pull a report every day and look at this and look at your winners, look at your losers. I mean, you know, I go into my independent, they’re on the phone with everybody’s insurance company trying to fight that battle. I mean, you’re trying to sync the patients you’re trying to do, and it’s, they’re counselors, they’re, you know, just it’s a nightmare. I mean, I can’t imagine how they even have time to do some of this stuff that we’re preaching about how important it is. But I think that’s where you’ve got to learn to delegate, find really good key people in your stores that you can trust to pass some of this stuff on. There’s no way you can do it. The ones that we see that are successful are able to do that. Find people that can work this piece and work this piece. And use technology where you can and then use those people in the places that technology really can’t do those jobs. 

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