1. Table 2: Cost Components of each Service (% of total cost) Table 1: Description of Pharmacy Services Discussion/Conclusion Most of the pharmacist services had an annual net gain during the study period and it seems likely that these services can be sustained in the future A sensitivity analysis of the combined adherence services showed those services were profitable when including the average net gain from the dispensed prescriptions (analysis not shown) Further cost management, such as reducing labor costs, could improve services with net losses Even with greater efficiency, external factors such as competition and reimbursement levels make the sustainability of these services a challenge Funding for this study came from the Community Pharmacy Foundation. Table 3: Net Profit/Loss ($) for each Service Methods Three years of pharmacy records were examined to determine the total revenue and costs of each service. Costs components of each service are shown in Table 2 (see printed Appendix for details). Total revenue was calculated by multiplying the frequency of the service by the revenue per patient or by adding the total revenue paid by insurers. Objective To assess the financial performance and sustainability of pharmacy services including vaccinations (influenza, herpes zoster and pneumococcal), cholesterol screenings, medication therapy management (MTM), adherence management services, employee health fairs, and compounding services provided during a 3-year period at an independent community pharmacy. Background/Intro Over the past two decades, community pharmacists have expanded the scope of their practices to include new pharmacist services. While some community pharmacists appear to be successful in providing these services, others may be reluctant to provide these services because of the limited data on the economic viability and long term sustainability of these services. New pharmacist services may help increase revenue, enhance public image and improve their competitive advantage. Analyses of Sustainability of Pharmacy Services at an Independent Community Pharmacy Doucette WR a, McDonough RP b, Mormann MM a, Vaschevici R a and Urmie JM a a Department of Pharmacy Practice and Science, The University of Iowa, College of Pharmacy b Towncrest Pharmacy, Iowa City, IA ServiceService Description ImmunizationsAdult influenza, herpes zoster and pneumococcal immunizations. Influenza immunizations to children age 3 to 18 with a prescription. Cholesterol Screenings Cholesterol screenings include a full lipid panel and total cholesterol/high density lipoprotein screenings. MTM/Med Check Consultation services with a pharmacist. MTM services include those provided to Medicare beneficiaries, contracted health plans, two supportive living organizations and cash paying patients. Medication Adherence Program Medication Adherence services whereby pharmacists provide medication reconciliation services, update personalized medication records, as well as repackage dispensed medications in compliance packaging including Doc-U-Dose, Med Planner and Bubble packs. MD2 medication dispensing machines also help monitor and improve compliance. Employee Health Fairs Health Fairs to employees at local businesses including cholesterol screenings, blood pressure screenings, height, weight and body mass index. Written results are given to patients. CompoundingCompound medications that are not commercially available and reformulate medications to be preservative and/or dye free. Natural hormone replacement therapy dosage forms, nutritional, dental and veterinary products and services. ServicesProduct a Materials b Labor c Marketing d Overhead e Equipment f Misc. g TOTAL Influenza 2008 2009 2010 56.7 45.3 59.0 4.7 4.9 3.7 33.2 34.8 26.3 2.8 13.1 9.6 0.7 0.8 0.4 N/A 2.0 1.1 1.0 $6,609 $11,893 $20,176 Herpes Zoster 2008 2009 2010 94.2 89.7 86.1 0.6 0.5 4.5 4.3 4.1 0.4 5.1 8.8 0.1 N/A 0.2 0.3 0.4 $44,284 $30,551 $18,591 Pneumococcal 2008 2009 2010 83.4 85.2 86.9 2.0 1.8 1.6 14.3 12.7 11.3 N/A 0.3 0.2 N/A $696 $685 $495 Cholesterol Screen 2008 2009 2010 N/A 23.1 20.8 25.7 39.9 36.3 42.4 32.5 38.7 27.3 0.3 4.2 3.9 4.4 N/A $1,710 $1,999 $571 MTM/Med Check 2008 2009 2010 N/A 11.3 7.1 4.4 77.5 90.9 67.0 9.5 0.0 27.5 1.3 1.6 0.8 0.4 0.3 N/A $4,371 $7,385 $12,582 Doc-U-Dose 2008 2009 2010 N/A 11.3 11.5 11.3 85.7 82.5 81.2 1.0 3.9 0.0 2.0 2.1 7.6 N/A $18,560 $19,283 $19,605 Med Planner 2008 2009 2010 N/A 94.0 83.5 92.2 4.1 14.6 0.0 2.0 1.9 7.8 N/A $4,580 $5,158 $4,668 Bubble Packs 2010N/A17.972.90.09.2N/A $645 MD2 Dispenser 2008 2009 2010 N/A 0.6 0.8 1.2 17.4 12.7 18.6 5.8 17.3 0.0 0.1 0.3 76.2 69.2 79.8 N/A $3,190 $4,369 $2,971 Emp. Health Fairs 2008 2009 2010 N/A 31.9 31.6 28.4 58.6 58.8 63.5 N/A 8.4 7.3 1.1 0.9 $5,968 $5,944 $7,590 Compounding 2008 2009 2010 N/A 39.2 51.6 38.7 32.4 28.7 26.6 2.3 3.2 2.8 0.2 0.7 25.9 16.3 31.3 N/A $6,130 $10,135 $10,220 Service200820092010 Total Influenza2,190.484,706.776,619.71 Herpes Zoster6,919.573,368.15203.19 Pneumococcal28.92-19.78-6.21 Cholesterol Screen-555.91-774.85-96.20 MTM/Med Check2,248.145,224.271,331.36 Doc-U-Dose-7,040.26-7,763.62-8,085.64 Med Planner-260.91-838.91-348.78 Bubble PacksN/A 434.83 MD2 Dispenser305.231,542.991,617.90 Emp. Health Fairs4,031.574,056.002,909.99 Compounding7,340.3614,749.2610,463.27