apothagram - Fagen Pharmacy!

APOTHAGRAM
®
DECEMBER 2014
RxMobility™: Connect with
Your Tech-Driven Customers
Page 8
Marketers’ Corner: 5 Tips
to Get Past the Gatekeeper
Page 13
Hyaluronic Acid: Know
When to Use Which Form
Page 6
Building Relationships with
Congress
APOTHAGRAM
®
DECEMBER 2014
CONTRIBUTORS
EXECUTIVE EDITOR
Stephan Beek
EDITOR AT LARGE
Amy Deatsman
MANAGING EDITOR
Annie Bulloch
TECHNICAL EDITOR/WRITER
Fernanda Cantu
DATES TO REMEMBER
PRODUCTION EDITOR/
GRAPHIC DESIGNER/
PHOTOGRAPHER
Chanell Shorter
GRAPHIC DESIGNER
Kristi Crawford-Hughes
PRODUCTION COORDINATOR
Peggy Arasin
TABLE OF CONTENTS
3
4
5
6-7
8
9
10
11
12
13
14
15
16
» Pharmacist of the Month
» Technician of the Month
» Consultant’s Corner
» Formula Spotlight
» New Technology
» PCCA Science
» New Products
» 2014 Leadership
» Public Affairs Update
» Marketing
» PK Software
» End-of-Year Savings
Register at pccarx.com/education
SEMINARS, SYMPOSIUMS & WEBINARS
Rx Skin Therapy Workshop
February 18 | The Cosmopolitan, Las Vegas, Nevada
Featured speakers: Toni Griffin; Kristen Riddle, PharmD
HRT Symposium
February 19-21 | The Cosmopolitan, Las Vegas, Nevada
Featured speakers: Alison McAllister, ND; Pamela Smith, MD, MPH;
Filomena Trindade, MD, MPH; Baylor Rice, RPh, FIACP; Jerra Banwarth,
RPh, FIACP; Andrea Branvold, MS, RPh; Danyce Ashton; Erin Michael,
MBA, CPhT; Del Doherty, PharmD, PhD, MPH; Gary McCrory, RPh, CCN
TRAINING (Houston, Texas)
Aseptic Technique Compounding Course
January 21-23 | February 25-27
Comprehensive Compounding Course (C3)
January 12-16 | February 9-13
Marketing • Sales • Business Session
January 16 | February 13
PK Software
January 16 | February 13
Advanced Compounding Techniques (prior C3 attendance required)
January 16 | February 13
CANADA
Quick-Ed: Pain, Wound, Scar and Dermatology in a Day
February 7 | River Rock Hotel & Casino, Richmond, British Columbia
Featured speaker: Sebastian Denison, RPh
Comprehensive Compounding Course (C3)
March 2-6 | PCCA Learning Centre, London, Ontario
AUSTRALIA
Comprehensive Compounding Course (C3)
February 23-27 | PCCA Learning Centre, Sydney, Australia
» In the News
FIND US ONLINE
facebook.com/pccarx
twitter.com/pccarx
youtube.com/pccarx
DON’T FORGET!
PCCA Silver, Gold, Platinum
and Diamond members – use your Member Rewards
level status to register for PCCA educational events at
reduced rates. Your invited prescribers are entitled to
reduced rates as well.
P H A R M AC I S T O F T H E M O N T H | 3
Steven Irsfeld, RPh
of Irsfeld Pharmacy in Dickinson, North Dakota
I am a second-generation pharmacist. My
father and three uncles are pharmacists,
as is one of my cousins. My daughter just
graduated from pharmacy school as well,
so we’re on to the third generation. I began
compounding in 1998. Irsfeld Pharmacy has
been PCAB accredited since 2012. In April
2014, I was appointed to the North Dakota
Board of Pharmacy.
FAVORITE PCCA FORMULA
I was just in Vancouver for the first PCCA/
A4M HRT Conference, and one of the
speakers mentioned that a high percentage
of marriages end in divorce between the ages
of 40 and 55. It has always been my opinion
that the use of bio-identical hormones for
men and women, as needed, will continue
to save marriages. PCCA Formula #9496,
Progesterone 20 mg/Gm Topical Cream
(VersaBase®) (BUD Study), for example, is
a simple formula, but it has the potential to
change lives. It is by far our most commonly
dispensed formulation and will continue to be
a large part of our practice in women’s health.
COMPOUNDING SUCCESS STORY
Our pharmacy has provided consulting and
compounding services to our local hospice
for the last 16 years. In that time, we have
had the opportunity to make so many unique
compounds for hospice patients. One of the
more interesting challenges came from a
patient suffering from venous insufficiency.
He was losing circulation in his extremities,
which made them turn black, and they
were extremely painful. His hands began
to contract almost into fists, not allowing
us to rub pain-relieving compounds into
those sites and with reduced blood flow, oral
medications were ineffective as well.
Members’
Bright Ideas
I worked with the hospice nurse and the
physician and we came up with a compound
incorporating ketamine and lidocaine in
a 30% pluronic gel base (PCCA Formula
#6035, Poloxamer 407 30% Gel). The
compound was applied cold and we were
able to drizzle it in between his fingers and
his clinched fist, eventually gelling into
all the painful areas. The pain relief was
so amazing that he was able to be moved
around in his wheel chair so he could enjoy
his favorite activity, bird-watching, during his
final days.
THIS WORKS FOR ME!
My advice to a new compounder would be
to be passionate about helping your patients.
Surround yourself with great people. I could
not do what I do without the support of my
family and my staff. My wife of 27 years is my
biggest support, and I have been blessed with
an unbelievably passionate staff that truly
wants the best for our patients.
Houston many years ago. He was referring
to helping patients in need and said he had
three kinds of pricing:
1. Regular price.
2. What that patient can afford.
3. No charge if needed. His words resonate
when dealing with patients with and
without the means to afford their
prescriptions.
Hire a marketer. If you think you can’t afford
to do this, you can’t afford NOT to do this.
Network with like-minded practitioners. I have
been meeting with five other PCCA members
(Clint Daniel, Wayne Myers, Doug Chadwick,
Randy Robin and Scott Popyk) on a monthly
basis for over 10 years, and we try to get
together in person on a yearly basis. Our group
was meeting long before PCCA’s Concierge
Compounding program was in place. They
are an invaluable resource as colleagues
and friends, and we share most everything.
Knowledge is power, go out and get it.
And, lastly, HAVE FUN! All work can be
stressful, but we all spend too much time
at it to not find your own ways to make it
enjoyable for yourself and those around you.
Please Note: Views/therapies expressed in
above article are those of the interviewee and
may not be endorsed by PCCA.
Each Pharmacist/Technician of the Month
is awarded one FREE education event for the
year. To find out how you can become the next
Pharmacist/Technician of the Month, contact our
Marketing team at coremarketing@pccarx.com.
I try to adhere to something the infamous
PCCA Member Robert Boudreaux once said
at a PCCA Seminar at the JW Marriott in
“Get pharmacy students involved with personalized
medicine so they can help get the word out.”
“Spray 5% diclofenac solution to throat area to help
relieve swelling and pain after tonsil surgery.”
“Talk to nursing/medical assistant students about
compounding – they’re very receptive and will take
new innovative ideas into their new career.”
“Place an open editorial in major
newspapers explaining compounding and
include patient testimonials.”
“Suspension formula for a cat: Use triple
fish suspension.”
“Gather all of your sales data. Find what
niche you’re growing in and make a
marketing plan.”
4 | TECHNICIAN OF THE MONTH
Stacy Pearman, CPhT
of Fagen Pharmacy in Valparaiso, Indiana
I have been a technician for about 10 years,
and began compounding in 2011.
FAVORITE PCCA FORMULA
My favorite compound is PCCA Formula
#9957, Lidocaine HCl 10%/Prilocaine HCl
10%/Tetracaine HCl 4% Dental Gel (BUD
Study). This formula is so much fun to make.
I also HATE going to the dentist so I can
appreciate the role this drug plays in the office.
I also like PCCA Formula #10728, Naltrexone
HCl 4 mg Capsules Size #3 (PCCA RAM™).
This drug is so versatile. We use it for patients
with Lyme disease, fibromyalgia, and multiple
sclerosis. And when making anything with the
RAM, you can be confident that you are getting
consistent and accurate results. The RAM is a
godsend -- my favorite piece of lab equipment!
COMPOUNDING SUCCESS STORY
One of my most rewarding patient success
stories is a woman with numerous allergies
who we were able to help. She was referred
to us because of her inability to tolerate
most ingredients used in standardized
prescription medications.
Her most significant health concern was the
inability to treat her pain from post-herpetic
neuralgia after having shingles. Since she
knew she was not allergic to coconut oil, her
physician agreed to write a prescription for
acyclovir 5% in coconut oil.
The patient called our office after two days of
use, stating it was the first time in two years
that she had been without pain. I am elated
that this woman is now pain-free, and just
as importantly, I look forward to helping
her solve any future medication challenges
through compounding.
APOTHATIPS
1. If you know that you’re going to use
progesterone powder tomorrow, stick it in
the freezer before you go home. It makes
it so much easier to work with.
2. Invest in one of PCCA’s suppository
fillers. I used syringes for a few years then
finally broke down and tried one. The fact
that I ever wasted my time with a 35 mL
syringe drives me crazy! The filler is THE
way to go. Just be sure to properly clean
the filler between compounds to prevent
cross-contamination.
Fagen Pharmacy is owned by Gerald A. Fagen.
Please Note: Views/therapies expressed in
above article are those of the interviewee and
may not be endorsed by PCCA.
Each Pharmacist/Technician of the Month
is awarded one FREE education event for the
year. To find out how you can become the next
Pharmacist/Technician of the Month, contact our
Marketing team at coremarketing@pccarx.com.
Did You Know?
You have access to monthly telephone conference calls that touch on
various topics related to running a successful compounding pharmacy.
Even better: participating in these calls is free! Join in each month
to learn from your compounding colleagues and PCCA experts.
MARKETING POWER HOUR
If you want to hear tips and tricks for marketing your pharmacy, dial in
to our Marketing Power Hour on the first Wednesday of each month
at 8:00 a.m. Central Time.
U.S. members call 1.877.273.4202
Canada members call 1.888.350.3035
Australia members call +61 1800453429
Access code for all: 7099708#
NUTRITIONAL GRAND ROUNDS
Get the latest in nutritional news on the Nutritional Grand Rounds call,
held the first Wednesday of each month at 10:00 a.m. Central Time.
U.S. members call 1.877.273.4202
Canada members call 1.888.350.3035
Australia members call +61 1800453429
Access code for all: 5045408#
PUBLIC AFFAIRS
If being informed about regulatory and legislative news is important
to you, join our Public Affairs call on the third Wednesday of each
month at 11:00 a.m. Central Time.
Call 1.877.273.4202
Access code: 874400930#
COMING IN FEBRUARY 2015:
PCCA invites you and your staff to join our monthly Quality Compounding call. Join experts discussing qualityrelated topics and answering your questions. The dates, time, and call-in information will be announced soon.
CO N S U LTA N T ’ S CO R N E R | 5
6 Easy Compounding Formulas for Itchy
Winter Skin
By Jerra Banwarth, RPh, FIACP, PCCA Education and Training Manager
Winter is just around the corner. Everyone will be turning on their
heaters, which can be damaging to skin and make it itchy, dry and scaly.
What recommendations can we as compounders make for dry skin?
Patients who complain of dry, cracked skin, or itchy and scaly skin
may benefit from some of the below suggested formulations. These
formulations utilize different ratios of PracaSil™-Plus and Spira-Wash™.
Why PracaSil-Plus? Because it’s silicone-based, PracaSil-Plus can help
soften and soothe irritated skin. Additionally, it has anti-inflammatory,
antibacterial, and antifungal properties. It can also be used without
active ingredients for acne flare-ups, rosacea, and diaper rash.
SPIRA-WASH IS A WATER-WASHABLE BASE AND IS
USED TO SOLUBILIZE SODIUM HYALURONATE IN
FORMULATIONS, AND IS A HUMECTANT.
• PCCA Formula #10416, Urea 15%/PracaSil-Plus Topical Gel
(Spira-Wash), is great for moisturizing the feet, elbows and
hands. Apply a light application to these areas several times day to
encourage hydration. If knuckles or hands crack, an application after
hand-washing may be beneficial.
OTHER GOOD HYDRATING FORMULAS INCLUDE
• PCCA Formula #10414, Sodium Hyaluronate 0.5%/Urea 10%/
PracaSil-Plus Topical Gel (Spira-Wash), can hydrate or moisturize,
while urea helps promote hydration due to uptake of water by
the stratum corneum. Sodium hyaluronate is used in anti-wrinkle
formulations as well.
• PCCA Formula #10413, Sodium Hyaluronate 0.5%/Spira-Wash
Topical Gel (PracaSil-Plus) – can be compounded without urea
if desired.
Consider compounding one of these abovementioned formulas for
staff use, and let their testimony sell the formulation.
FOR PATIENTS WITH PSORIASIS
• PCCA Formula #11026, Zinc Pyrithione 0.2%/Clobetasol
Propionate 0.05%/Cyanocobalamin 0.07% Topical Gel (SpiraWash/PracaSil-Plus), may be beneficial. Clobetasol propionate
is a potent corticosteroid used to help reduce the itching and the
inflammatory response, and zinc pyrithione has antibacterial and
fungistatic properties.
FOR PATIENTS WITH ECZEMA
• PCCA Formula #11187, Cyanocobalamin 0.07%/Urea 2%
Topical Gel (PracaSil-Plus), is suitable for children. Vitamin
B12 (cyanocobalamin) topically has been studied in children
and is applied twice daily. 1 Cyanocobalmin has been shown
to reduce inflammatory cytokines associated with eczema. 2
Orally, cyanocobalmin has poor bioavailability; therefore topical
application has been the preferred route, studied in both children
and adults.
Since many people ski at this time of year, consider a formula
containing sunscreens, such as PCCA Formula #10685, Sodium
Hyaluronate 0.5%/Oxybenzone 3%/Octinoxate 5% Topical Gel
(PracaSil-Plus). Patients get the best of both worlds…sun protection
and skin hydration. Get the word out!
REFERENCES
1. Januchowski R. Evaluation of topical vitamin B(12) for the treatment
of childhood eczema. J Altern Complement Med. 2009 Apr;15(4):387-9.
2. S tücker M, Pieck C, Stoerb C, Niedner R, Hartung J, Altmeyer
P. Topical vitamin B12 – a new therapeutic approach in atopic
dermatitis-evaluation of efficacy and tolerability in a randomized
placebo-controlled multicentre clinical trial. Br J Dermatol. 2004
May;150(5):977-83.
PCCA has joined the National Community Pharmacists Association in a fundraising campaign to
help raise $50,000 for the NCPA Foundation by the end of 2014. PCCA will match designated NCPA
pre-convention program registrations at the 2014 NCPA Annual Convention and individual donations
through 2014—up to a combined total of $50,000. Donations must be made by December 31, 2014.
Please visit ncpafoundation.org to make your donation, today!
About the NCPA Foundation: Donor support helps the NCPA Foundation preserve the legacy of independent pharmacy through
scholarships to pharmacy students, research/programs to improve the success of independent pharmacy and patient care,
community health awareness programs, and aid to community pharmacy owners for their recovery in the event of disaster or
other adverse circumstances. The foundation was established in 1953 and is a non-profit 501(c)(3) organization. Contributions
are tax-deductible as charitable donations to the extent permitted under federal tax law.
6 | F O R M U L A S P OT L I G H T
Hyaluronic Acid: Know When
to Use Which Form
By Melissa Merrell Rhoads, PCCA Director of Formulations and Pharmacy
Consultant, and Courtaney Davis, CPhT, PCCA Senior Formulation Specialist
There are a few forms of hyaluronic acid (also known as hyaluronic
acid sodium salt and sodium hyaluronate). So, the consulting
department often gets questions regarding when to use which form.
PCCA carries three forms of hyaluronic acid:
• Hyaluronic Acid Sodium Salt (PCCA #30-1705)
• Hydrolyzed Hyaluronic Acid (PCCA #30-4301)
• Sodium Hyaluronate (Cosmetic Grade) (PCCA #30-3856)
Sometimes they are interchangeable. Following is an explanation of
the properties of each chemical and the types of formulas in which
they may appear.
1. Hyaluronic Acid Sodium Salt:
• Used primarily for injections and other sterile preparations
• High molecular weight
• Maximum concentration is 2% in water
• Powder must be hydrated before incorporating into a preparation
(except for concentrations of ~0.3% or less)
This is the form that is used in sterile preparations. It may also be used
in other formulations such as cosmetic or suppository formulations;
however, it is more expensive than other forms typically used in
non-sterile preparations. If it is used in a gel formulation, note that
it has a high molecular weight and will make a very thick gel. A 2%
concentration would be the maximum allowed in water as it is very
thick and difficult to filter at this strength, although the viscosity can
vary a bit from lot to lot.
PCCA FORMULAS UTILIZING HYALURONIC ACID
SODIUM SALT:
PCCA
Formula #
4087
2427
8280
9777
PCCA
Formula #
4292
3744
7688
7776
4038
5855
3592
Non-Sterile
Ascorbic Acid 10% Topical Cream
Ascorbic Acid 10% Topical Serum
After Shave Balm
Estradiol 0.01%/Estriol 0.2% Compound VersaBase™
Cream
Sunscreen Topical Cream (Lip)
Topical Cream Base
Collagen Hydrolysate 0.5%/Hyaluronic Acid Sodium
0.05% Topical Eye Gel
*May substitute the above cosmetic formulas with either of the other two
hyaluronic acid forms due to the low concentration or hydration process in the
compounding procedure.
9910
9909
yaluronic Acid Sodium 5 mg Compound Base MBK
H
Vaginal Suppository
Hyaluronic Acid Sodium 5 mg Compound Base MBK
Vaginal Suppository
* May substitute the above suppository formulas with sodium hyaluronate
(cosmetic grade).
9920
Hyaluronic Acid Sodium Salt 2% (W/W) Aqueous Gel
* This formula is used as an ingredient in PCCA Formula #9911, Hyaluronic
Acid Sodium 5 mg/Gm Compound Vaginal Cream. The hyaluronic acid
sodium salt may be substituted with sodium hyaluronate (cosmetic grade) – see
PCCA Formula #8693, Sodium Hyaluronate 2% Gel, as the substitute.
Sterile
yaluronic Acid Na Salt 10 mg/mL Injection Solution
H
(PF)
Hyaluronic Acid Sodium Salt 0.1% (Phosphate Buffer)
Ophthalmic Solution
Hyaluronic Acid Sodium Salt 0.1% (Citrate Buffer)
Ophthalmic Solution
Hyaluronic Acid Sodium Salt 0.4% (150 mOsmole/
liter) Ophthalmic Solution
*No substitutions of different forms of hyaluronic acid for any sterile preparations.
2. Hydrolyzed Hyaluronic Acid:
• For cosmetic use; not for use in sterile preparations
• Low molecular weight – increased permeation through the skin
• Maximum concentration is ~ 10% in water
• Powder may be added directly into a compound without hydrating
first (up to 3% concentration)
This is a very low molecular weight hyaluronic acid (20-70 KDa). It
has anti-aging properties with increased permeation through the skin
compared to high molecular weight hyaluronic acids. Since it has a
low molecular weight, the viscosity is much lower when compared
(Continued on next page)
F O R M U L A S P OT L I G H T | 7
with the other hyaluronic acids. The percentage of use for anti-aging
is 0.1% to 1% (0.2% is suggested for reducing the appearance of
wrinkles). This chemical should not be used in sterile preparations.
It allows for hydration up to 10%, so you can prepare a concentrated
stock compound then a small volume can be used in various cosmetic
preparations. Since the chemical hydrates more easily, you can add the
chemical straight into the preparation instead of having to hydrate it
into a gel first like the sodium hyaluronate.
PCCA
Formula #
9597
9396
9398
9397
9601
PCCA Formulas Utilizing
Hydrolyzed Hyaluronic Acid
yaluronic Acid 0.2%/Plukenetia Volubilis 2% Topical
H
Cream (NataCream™)
Renovage™ 3% Compound Topical Cream (VersaBase®)
Pomegranate Seed Oil 1.6%/Acetyl-D-Glucosamine
5% Compound Topical Cream (VersaBase)
Renovage™ 3%/Acetyl-D-Glucosamine 5%/
Niacinamide 2.5% Compound Topical Hand Cream
Estradiol 0.01%/Hyaluronic Acid 0.1%/Plukenetia
Volubilis 2% Topical Cream (NataCream)
* No substitution is recommended for the above formulations due to the
therapeutic effectiveness of the hydrolyzed hyaluronic acid from the low
molecular weight.
11023
Hydrolyzed Hyaluronic Acid 10% (W/W) Aqueous Gel
* No substitution due to the high concentration – the other forms will not
hydrate at this concentration.
3. Sodium Hyaluronate (Cosmetic Grade):
• For cosmetic use; not for use in sterile preparations
• High molecular weight
• Maximum concentration is 2% in water
• Powder must be hydrated first before incorporating into a
preparation (except for concentrations of ~0.3% or less)
This is a high molecular weight form that can be used in cosmetic,
vaginal and suppository formulations. It forms a very thick gel upon
hydration. This form is the most cost effective.
A COMMON QUESTION ABOUT SODIUM
HYALURONATE (COSMETIC GRADE):
Q: If I need to use sodium hyaluronate in a cream or gel, why do I need to
use the sodium hyaluronate 1% or 2% gel to add to the compound? A: If you try just putting the pure powder into a cream or lotion, it
does not hydrate very quickly and you may get some clumping or
particles. The exception is in Spira-Wash™ or a Spira-Wash/PracaSil™Plus combination base, where you can use the actual sodium
hyaluronate (cosmetic grade) powder, but only up to ~0.5%.
PCCA
Formula #
10413
10685
10414
10710
10949
PCCA Formulas Utilizing Sodium Hyaluronate
(Cosmetic Grade)
Sodium Hyaluronate 0.5%/Spira-Wash™ Topical Gel
(PracaSil™-Plus)
Sodium Hyaluronate 0.5%/Oxybenzone 3%/
Octinoxate 5% Topical Gel (PracaSil-Plus)
Sodium Hyaluronate 0.5%/Urea 10%/PracaSil-Plus
Topical Gel (Spira-Wash)
Sodium Hyaluronate 0.5%/Beta Glucan 0.5%/
Glycosaminoglycans 5% Topical Gel (PracaSil-Plus)
Phenytoin 5%/Misoprostol 0.0024%/Arginine HCl
1%/Sodium Hyaluronate 0.5% Spira-Wash Gel
* The above formulas do not require the chemical to be hydrated first because
they use the base Spira-Wash or a Spira-Wash/PracaSil-Plus combination.
You may substitute with either of the other two forms of hyaluronic acid, but
the cost will be more.
8676
10648
4158
9757
10073
4171
8887
5274
8889
9097
10642
Sodium Hyaluronate 0.5%/Niacinamide 5%/Acetyl
Hexapeptide 5% Topical Serum
Hydroquinone 4%/Ascorbic Acid 20% Topical Serum
Lidocaine 1% Topical Gel
Diclofenac Sodium 3%/Sunscreen Topical Gel
(VersaBase)
Bioadherent Oral Gel (Unflavored)
Progesterone 1.6%/Vitamin E 40 U/mL Topical Cream
Glycosaminoglycans 4%/Shea Butter 3%/Vitamin/
Amino Acid Topical Lotion
Diclofenac Sodium 3% Topical Gel
Sodium Ascorbyl Phosphate 5%/Collagen Topical Gel
Sodium Hyaluronate 1.2%/Beta Glucan (1,3) 0.05%
Topical Solution
Ascorbic Acid 20% Topical Serum
* The above formulas all utilize the sodium hyaluronate (cosmetic grade) chemical
and hydrate within the procedure. You may substitute with either of the other two
forms of hyaluronic acid, but the cost will be more.
8692
8693
Sodium Hyaluronate 1% Topical Gel
Sodium Hyaluronate 2% Topical Gel
* The above formulas are utilized as ingredients in many cosmetic and vaginal
preparations. Since the sodium hyaluronate (cosmetic grade) requires hydration
prior to incorporation into a final preparation, these formulas for stock gels offer
a time-saving solution – they can be prepared ahead of time and will reduce
the time spent compounding the final preparation for dispensing. PCCA has
numerous formulations in the database that utilize these stock gels. You may
substitute with either of the other two forms of hyaluronic acid, but the cost will
be more.
For more information, please contact PCCA’s Pharmacy Consulting Department.
Always make sure you have checked the PCCA Formula Database and are following the most up-to-date version of a formula as changes are continuously made to existing formulations to
provide the highest quality.
8 | N E W T E C H N O LO G Y
RxMobility™: Connect with Your
Tech-Driven Customers
Many pharmacy owners use technology to improve their internal processes and procedures – like converting
to a more friendly point-of-sale (POS) system, a more efficient computer software package, or better quality
control systems. But what about improving the interaction between your pharmacy and your customers?
Pharmacies now use apps for mobile devices that better manage their patient’s medications and therapy
reminders on the go. Now, you can do the same for your patients with the RxMobility patient app.
RxMobility will:
• Increase your pharmacy’s visibility
• Build customer loyalty
• Improve refill rates
• And decrease customer acquisition/retention cost
With RxMobility, contact with your pharmacy is instant – the app creates a visual presence and a direct
link to your pharmacy. Your customers can order refills, create medication schedule timers, or call the
pharmacy directly through the app. Plus, it’s FREE (your patients can download the app via the App Store
or Google Play)! It’s all about increasing compliance and improving prescription refill rates, resulting in
increased revenues and improved patient outcomes.
RxMobility’s in-house design team will customize the app with your pharmacy’s branding and logo.
The process takes about 12 weeks. The app is HIPAA-secure, PIN-protected, and can be designed to fit
multiple pharmacy locations. The RxMobility package includes:
• Apple (iOS) app
• Android app
• Push notification service
• Five personalized training modules
• Technical support
Pharmacy owners often look inward to innovate pharmacy processes. But don’t forget to look outward for innovative ways to connect the customer to
the business. By developing a connection with patients outside the pharmacy through a mobile app, your pharmacy can bring better service and value
to your customers. If you are not reaching out to your customers from a mobile media interface, remember that the competition already is.
For more information, contact PCCA at 800.331.2498.
PCCA #45-2260: RxMobility™ Pharmacy App
PCCA #45-2261: RxMobility™ Monthly Fee
$2,000.00 USD*
$250.00 USD
* Special limited time pricing – must sign up before December 31, 2014. Regular price: $3,000.00 USD.
LIBIDO HEALTH (WW #10287)
Research has indicated that as many as 43 percent of women and approximately 31 percent of men
report experiencing sexual dysfunction at some point in their lives. The ingredients found in Libido
Health have demonstrated the ability to support alertness and sexual motivation, overall energy
levels, hormone balance, circulation and oxygen utilization. Libido Health is a non-gender-specific
formulation, and can be used for libido enhancement by men and women alike. The product should be
taken at intervals of two weeks on and two weeks off for best effect.
Interested in carrying the Wellness Works line of supplements, customized with your own
pharmacy logo? Log on to wellnessworks.com to learn more or call 800.331.2498.
P CC A S C I E N C E | 9
PCCA Spira-Wash™ Gel: An Ideal Vehicle
for Wound Preparations Targeting
Bacterial Infections
By Michelle R. A. de Almeida, PharmD, PhD, PCCA Academic and Scientific Liaison
Summary: One of the most significant features of PCCA Spira-Wash Gel
Base (PCCA #30-4678) is meadowsweet flower extract. This extract has
been used as an anti-inflammatory agent and also shows antimicrobial
potential. Spira-Wash also contains zinc, which has been shown to accelerate
wound healing. Our R&D team tested Spira-Wash to confirm that it is
effective at killing bacteria. They were pleased with the results, which
confirmed that Spira-Wash Gel does have this antimicrobial effect, making it
an ideal vehicle for treating a variety of bacterial wound infections.
Keep reading to understand the science behind these statements.
In spite of the well-known use of plants to treat many diseases
worldwide, these natural remedies have become more attractive for
wound management in recent years. The application of plant extracts
or plant-derived compounds that have potential antimicrobial
activity against a wide range of wound pathogens have been shown to
promote wound-healing benefits.1 However, there have been only a
few wound dressings developed using natural ingredients that led to
commercially available antimicrobial dressings.2
PCCA Spira-Wash Gel Base, is a soft, adherent gel, which is easily
water washable, with incorporation of meadowsweet flower
extract (Spiraea ulmaria) in a polyethylene glycol (PEG) ointment
base. This natural extract traditionally has been used as an antiinflammatory agent due to its high content of phenolic compounds,
and also shows the potential to inhibit activity of various pathogenic
microorganisms.3 In addition to the ingredients cited above, zinc
makes up part of the gel composition and has many beneficial effects
in the wound healing process when applied topically. Zinc has
been shown to accelerate wound healing by antibacterial actions,
anti-inflammatory effects and acceleration of reepithelization.4
Spira-Wash is intended for use in dermatologic formulations with
different applications such as wound care, an occlusive agent, a topical
humectant or infection treatment.5
To confirm the antimicrobial efficacy of Spira-Wash, our R&D team
headed two different in vitro microbiological assays using specific
bacterial and fungal strains, chosen due to their high incidence of
occurrence in a variety of wound types.
The zone of inhibition (ZOI) assay is a convenient and useful in
vitro method with wide application, particularly when screening for
antimicrobial activity against target organisms of clinical relevance.
Briefly, the assay plate consists of an agar layer which is seeded with
sufficient target organisms to form a lawn. The test samples are added
to wells made into the agar and the plate is incubated for diffusion of
test materials through the culture medium. They become more diluted
the further from the wells they are. Antimicrobial activity is indicated
by clear zones of no growth around test wells in a background lawn
of the target organism.6 Spira-Wash showed excellent antibacterial
activity, and provided similar average ZOI values against all four
bacterial strains tested [E. coli (ATCC 25922), P. aeruginosa (ATCC
27853), S. aureus (MRSA) (ATCC 33591), E. faecium (VRE) (ATCC
51559)]. No ZOI was detected for C. albicans (ATCC 10231) (Table
1). It is known that meadowsweet flower extract, an ingredient in
Spira-Wash, features considerably weaker fungal activity.3
The time-kill assay is an in vitro standardized suspension-based
method performed to determine the killing rate of bacterial isolates
over time by new antimicrobial agents under carefully controlled
conditions. It is commonly used to assess the bactericidal ability
of antimicrobials. The kill curves are constructed by plotting log10
CFU/mL of surviving bacteria versus time and the bactericidal effect
can be seen by a 3-log10-unit decrease in the CFU/mL at the time
specified.7 Spira-Wash presented a gradual decrease in viable cell
counts of gram-positive bacteria (E. faecium and S. aureus), producing
a reduction of 2-log10 in the initial inoculum of both bacteria in the
first two hours of treatment, and completely killing them at 24 hours.
For gram-negative bacteria (E. coli and P. aeruginosa), it took one hour
to completely inhibit the growth (4-log10 reduction) (Figure 1). HOCl
(hypochlorous acid, 0.01%) was used as antimicrobial control and
exterminated all bacteria within one hour of test initiation.
In conclusion, the two antimicrobial activity assays determined that
Spira-Wash has relevant antibacterial activity, showing rapid bacterial
activity against gram-negative bacteria. This biological property can
be attributed to the high levels of phenolic acids and flavonoids in
the base’s plant extract ingredient. These findings support the use of
Spira-Wash as an ideal vehicle for treating a variety of bacterial wound
infections.
For more details on the Spira-Wash studies cited above, please refer to
the technical reports at pccarx.com/studies.
Table 1: Zone of inhibition (ZOI) values for Spira-Wash Gel vs.
bacteria and fungi.
Spira-Wash Gel ZOI (mm)
E. facecium
E. coli
S. aureus
P. aeruginosa
C. albicans
(Continued on page 10)
Average
S.D.
n
6
8
8
7
0
1
1
2
1
0
3
3
3
3
3
10 | NEW PRODUCTS
Did You Miss Our Free Webinar
On Our Hot New Products?
Then you may not know about our two new, revolutionary bases
and automated syringe filling machine – a real time-saver!
MUCOLOX™ - PCCA #30-4782
MucoLox is new and unique to the compounding market. A watersoluble mucosal delivery system, its muco-adhesive properties
increase contact time to mucosal surfaces. This helps to create
gradual and continued release of the API. That makes MucoLox an
ideal choice for use in oral, rectal (including enemas), and vaginal
compounded preparations.
SUSPENDALL™ - PCCA #30-4825
SuspendAll is our new, all-in-one oral suspension base with superior
anti-sedimentation technology. Its patent pending formula allows
rapid redispersion of ingredients with agitation and minimal
separation. It thins as it’s shaken and thickens upon standing.
The only base made with a unique, natural sweetener derived from
monk fruit, SuspendAll is the go-to compounding vehicle base for oral
suspensions. This natural suspending agent offers outstanding stability, a
pleasant taste, and is free from parabens, gluten, casein and dyes.
SYRFIL™ 20 OZ FILLING SYSTEM - PCCA #35-5100
SYRFIL™ 32 OZ FILLING SYSTEM - PCCA #35-5101
Save time with the SyrFil Syringe Loader, an automated syringe
filling system that fills a variety of oral/topical syringes, one at a time,
quickly, easily and accurately. The machine’s design makes cleanup
easy, helps eliminate material contamination, and assures accurate fills
every time.
The SyrFil can handle different viscosities: creams, gels, suspensions,
etc., and is compatible with many PCCA bases, including the
Lipoderm® and VersaBase® lines. It fills 0.5, 1, 3 and 5 mL (up to 60
mL*) syringes (oral/topical Baxa Exacta-Med®, luer-lock, as well
as other syringe types). Two reservoir sizes are available (and the
cartridges can be partially filled) for more efficient filling of large
quantities of syringes.
For more in-depth information on these items, visit our Video on
Demand (VOD) library on the Members-Only Website to watch our
recent webinar about them. It’s free! If you need help getting onto
VOD, email websupport2@pccarx.com or call us at 800.331.2498.
Contact Customer Service or your sales rep for more product
information and to place your order.
PCCA SPIRA-WASH™ GEL: AN IDEAL VEHICLE FOR TREATING BACTERIAL WOUND INFECTIONS (Continued from page 9)
Figure 1: Average CFU/mL values for Spira-Wash Gel vs. bacteria.
3. Gniewosz, M, Synowiec, A, Krasniewska, K, Przybyl, JL, Baczek,
K, Weglarz, Z. (2014) The antimicrobial activity of pullulan film
incorporated with meadowsweet flower extracts (Filipendulae ulmariae
flos) on postharvest quality of apples, Food Control, 37: 351-361.
4. Aksoy B, Atakan N, Aksoy HM, Tezel GG, Renda N, Ozkara HA,
Onder E. (2010) Effectiveness of topical zinc oxide application on
hypertrophic scar development in rabbits, Burns, 36: 1027-1035.
5. PCCA (2013) Loxasperse. Available at: http://www.pccarx.com/
bases/Loxasperse. Accessed: April 2014.
REFERENCES:
1. Süntar I, Akkol EK, Nahar L, Sarker SD (2012) Wound healing and
antioxidant properties: do they coexist in plants?, Free Radicals and
Antioxidants, 2: 1-7.
2. Tan SP, McLoughlin P, O`Sullivan L, Prieto ML, Gardiner
GE, Lawlor PG, Hughes H. (2013) Development of a novel
antimicrobial seaweed extract-based hydrogel wound dressing,
International Journal of Pharmaceutics, 456: 10-20.
6. Smith SL, Vaughan NH. (2013) Assays optimized for detection and
quantification of antibacterial activity in shark cell lysates under
high salt conditions, Fish & Shell Fish Immunology, 34: 1223-1227.
7. Pfaller MA, Sheehan DJ, Rex JH. (2004) Determination of
Fungicidal Activities against Yeasts and Molds: Lessons Learned
from Bactericidal Testing and the Need for Standardization, Clinical
Microbiology Reviews, 17: 268-280.
2014 LEADERSHIP | 11
Insight into PCCA:
International Seminar Panel Discussions
At the recent International Seminar, a couple of panel discussions were held involving PCCA
Senior Management and our Public Affairs team. Several important topics were discussed
concerning new membership programs and the compounding landscape. Following is a quick
recap of the main points.
PUBLIC AFFAIRS PANEL TOPICS COVERED:
•
•
•
•
•
•
•
atest news on USP Chapter <800>
L
Updates on the Drug Quality and Security Act
The legality of office-use compounding
W hat to do if the FDA comes to inspect your pharmacy
The current status of domperidone, legal issues surrounding it and the possibility of a forthcoming USP monograph
Updates on the Express Scripts situation and the tools PCCA has created to educate the public about it
Updates on legislative efforts
SENIOR MANAGEMENT PANEL TOPICS COVERED:
•
•
•
•
•
•
CCA’s main focuses for 2015, and each panelist’s vision for the compounding industry in five to ten years
P
New tools for dealing with third-party insurance
Efforts to educate pharmacy benefits managers about the value of compounding
The new PersonalMed™ Preferred Provider Network
The It’s Personal campaign to educate practitioners and the public about compounding
Quality and consistency in compounds
Please visit the Public Affairs page on the Members-Only Website to learn more about each topic.
Members Complete PCCA Event “Triple Crown”
In 2014, a member from Canada and one from Australia each completed the “triple crown” by attending PCCA events in the U.S., Canada and
Australia. Chetan Hegde of McKenzie’s Chemist in Mount Lawley, Western Australia, attended the PCCA Australia Annual Conference, the
PCCA Canada HRT Symposium, and the PCCA International Seminar in Houston. Dennis Wong, BScPharm, FAARFM, CCN, ABAAHP, of
CD Whyte Ridge Pharmacy in Winnipeg, Manitoba, Canada, attended the PCCA Australia Networking Event, the International Seminar, and
PCCA Canada’s A4M HRT Symposium.
WHAT ADVICE WOULD YOU GIVE OTHER MEMBERS CONSIDERING ATTENDING AN OVERSEAS PCCA EVENT?
Chetan Hegde: It’s a good way to communicate
with and learn from other pharmacists from all
around the world, and to be exposed to the different
compounding markets to gain new ideas and
opportunities.
Dennis Wong: I would suggest attending at least
one international event, as you have to experience
it yourself to know what you’re missing. By going
to these events, I learned many things, met many
people to network with, and was able to enjoy a little
sightseeing.
1 2 | P U B L I C A F FA I R S U P DAT E
Congressional Leaders Tour PCCA
Headquarters
Follow the conversation at twitter.com/pccarx_pa
This fall, PCCA has hosted three senior Congressional leaders at our Houston facility: Senators Lamar Alexander (R-Tenn.),
Patty Murray (D-Wash.), and Congressman John Shimkus (R-Ill.).
The purpose of the visits was for the lawmakers to tour the facility and learn more about compounding, as well as discuss the practical
implications of federal policies on the industry and our patients. Site visits like these provide critical background that helps lawmakers make
informed decisions as policies are debated and voted upon on Capitol Hill, and we were pleased to host them.
Senator Alexander visited the facility in October. He is likely to be the incoming Chairman of the Senate Health, Education, Labor and Pensions
Committee (known as the HELP Committee) when the 114th Congress convenes in January. Importantly, the HELP Committee has jurisdiction
over compounding and the FDA. He is also a senior member of the Senate Appropriations Committee. Senator Alexander is a lead author of the
Compounding Quality Act that became law last year.
Congressman Shimkus is a senior member of the Energy and
Commerce Committee, which has jurisdiction over compounding
and FDA issues in the House of Representatives. Importantly, he
serves on the Health Subcommittee. Congressman Shimkus is a friend
to our industry, and also has a history of working with colleagues on
both sides of the aisle. He was first elected to the House in 1996.
A senior Democrat on the Senate HELP Committee, Senator Murray
visited PCCA in November, and is expected to assume the role of
Ranking Member of the Committee in January. Senator Murray
was first elected in 1992, and also serves on the Appropriations
Committee as well as the Budget Committee. Because the HELP
Committee often works on a bipartisan basis on health issues such as
compounding, we are especially pleased that both Senators made the
trip to PCCA.
As we start to invite elected officials to PCCA, we encourage you to do the same. Become more involved with your local leaders, letting them
know all of the innovative ways compounders serve their community. If you want to learn more about how to get in contact with your local
elected officials, contact PCCA Public Affairs at publicaffairs@pccarx.com.
MARKETING | 13
Marketers’ Corner: 5 Tips to Get Past the Gatekeeper
As a marketer, your job isn’t just to get the word out. Your job is to move practitioners to act, starting with the gatekeepers.
These techniques, shared during a recent Marketing Power Hour, will help you move the needle on the bottom line.
5 TIPS TO GET PAST THE GATEKEEPER
1. Keep it simple – do not flood the gatekeeper with too much
information. Come in with two to three key ideas and something
you can leave behind in case you’re not able to see the practitioner.
Use visuals and third-party stories – something they can hold in
their hands. But most importantly, always use simple language.
2. Don’t ask the gatekeeper to see the practitioner right away. Ask
them questions and make them feel like they are a part of the
process.
3. Get personal. Send the gatekeeper a handwritten thank-you note
addressed specifically to them. Let them know that you value their
time.
4. Ask what the best way to communicate with the practitioner is.
And ask who the decision maker is and everyone who may be
involved in the decision making process.
5. Treat everyone in the office like they’re the CEO. Don’t sell to
the gatekeeper because more times than not, they aren’t the
decision makers.
HOW TO MARKET BASES TO PRACTITIONERS
• Take a small container of the product with you. It’s always great for
the practitioner to have the opportunity to sample the product –
feel the product. Most of them are very impressed by just the feel –
especially with PracaSil™-Plus.
• Get to know your audience: Find out what the practitioner is
writing prescriptions for. Give them a handout with just a couple of
formulation options. The key is to provide information that is short
and easy to read and that drives them to action. (If you know of
formulas that have worked well with other practitioners in the past,
promote those.)
•O
ne of the most effective marketing tools is providing practitioners
with photographs. Ask a patient if they’d be willing to take pictures
of their progress. With their permission, use these photos to market
the product. If you have an iPad, you can easily pull up the images
and show the practitioner the troublesome wound you helped
heal, or the old scar you helped fade. (You’re on the therapeutic
front lines every day, improving patients’ lives through the power
of compounding. Turn your patients’ success stories into case
studies and submit them to PCCA Science. They could be chosen
for publication! Learn more: see PCCA Document #98888, Case
Study Submissions Guidelines, under Documents on the MembersOnly Website.)
HOW OFTEN SHOULD I VISIT THE PRACTITIONER?
To get the answer to this question, you’ll have to ask the practitioner.
But there are three important questions you should always ask:
(1) how often do you want to see me? (2) what is the best way to
communicate with you? and (3) are you a visual person or are you a
research and data person? Bottom line: Do not make the assumption
that your methods will work best for the practitioner.
Want more marketing tips like these? Dial into our Marketing Power
Hour – a free monthly teleconference happening the first Wednesday
of every month at 8 a.m. Central Time. See page 4 for access
information. You can also listen to previous Power Hour recordings
by logging on to pccarx.com/vod. For questions or details, email
coremarketing@pccarx.com.
2015 International Seminar
11.4.15 to 11.7.15
Save The Date.
New Hotel (Hilton Americas). New Month. New Information.
Still the compounding industry’s biggest event.
1 4 | P K S O F T WA R E
PK Software End-of-Year
Reporting
It’s that time of year – when pharmacies contact us requesting advice
on what to do for their end-of-year reporting, often asking the
question, “What items should be run from your system during the last
days of December?”
RECORD YOUR STATISTICS FOR ALL PHARMACISTS,
TECHNICIANS AND DOCTORS
• Why? This information is more labor intensive to do after the fact.
• Where? Statistics for pharmacists and technicians are recorded in
each individual profile.
PRINT OUT A RECORD OF YOUR CURRENT CHEMICAL
AND FORMULA INVENTORY REPORT FOR THE YEAR
(Inventory reporting is only accurate for the present day – this can’t be
recreated later.)
These two reports are located under:
• Reports > Formulas/Drugs > Inventory report
• Reports > Chemicals > Inventory report - items checked into
inventory
YEAR END PROCESSING
For those who utilize Accounts Receivable, run year end processing
located under: Accounts > Account utilities > Year end processing.
Reset your year-to-date statistics for accurate information in the
upcoming year.
•N
OTE: This will assist in clearing all statistics for tech,
pharmacist, patient, doctor, formula, and chemical. Only run
this if you want to keep calendar year statistics. If you report your
statistics by any other method, do not use this tool at the end of
the year.
•H
ow? You can either run individual reports for each technician and
pharmacist in the Log of scripts and/or List of logs report, or take
a screenshot of the statistics tab for each pharmacist and technician.
These reports are only useful if the information they are reporting is
accurate. Update and maintain your formula and chemical database
regularly. The biggest challenge for any pharmacy is upkeep and
maintenance of chemical, formula, and log inventory, so we suggest you
audit your inventory on a regular basis. Some states require reporting of
current inventory. Run your inventory reports and validate the stock onhand for all three categories: Chemicals, Formulas, and Logs. Inactivate
chemicals and formulas you have not used at your pharmacy in over a
year to keep the data you are searching through easier to manage.
Questions or concerns? Please don’t hesitate to contact us at PK
Support at 800.331.2498 or pksupport@pccarx.com.
E N D - O F - Y E A R S AV I N G S | 1 5
We wish
you a merry
write-off.
Get tax-deductible savings* while growing
your Member Rewards with these end-ofyear specials.
HORMONES: THE POWER
OF BALANCE SYMPOSIUM
February 19-21, 2015
The Cosmopolitan of Las Vegas
TOPICS AT A GLANCE:
• S cience, physiology, and starting
principles of HRT
• Vaginal conditions
• Nutrition and supplement support
• U
nderstanding the normal
menstrual cycle and natural
menopause
• Fertility
• Functional approach to detoxification
• Workshops:
• Hormone testing
• Male hormone replacement
• And more
* Under IRS Code Section 179, up to $25,000 of your
compounding equipment or software purchases
made in 2014 may be deductible this year. This also
includes purchases financed through PCCA Easy
Pay. Be sure to check with your tax professional for
eligibility and code requirements.
Don’t forget these stocking stuffers:
SAVE THE DATE FOR THE INDUSTRY’S
BIGGEST HRT EVENT! SECURE YOUR
SPOT TODAY:
pccarx.com/education
Contact your local PCCA Sales Rep or call 800.331.2498 to learn
more. Visit the Members-Only Website to place your order today.
9901 South Wilcrest Drive
Houston, Texas 77099
Phone: 281.933.6948 or 800.331.2498
Fax: 281.933.6627 or 800.874.5760
communications@pccarx.com
IN THE NEWS
PCCA MEMBER IN THE NEWS
Apothecary by Design in Portland, Maine, owned by Joe Lorello,
RPh, was named 2014 Business of the Year by the Portland
Development Corporation (PDC). The PDC focuses on investing
in job creation, innovation and economic opportunity in Portland.
Apothecary by Design has served more than 51,000 patients and has
patient advocacy at the center of its mission, providing intensive and
personalized case management for individuals suffering from complex
medical conditions such as infertility, HIV/AIDs, and Hepatitis C.
The pharmacy has grown to over 70 employees and two locations
since its formation in 2008. Congratulations!
Jersey, owned by Ahmed Ali, PharmD; and SimfaRose Pharmacy
in Pembroke Pines, Florida, owned by Charles Bonanno, PharmD,
MBA, CGP, all of which recently achieved PCAB accreditation.
For more information about PCAB accreditation, visit the PCAB
website at pcab.org.
Mark Binkley, BA, BS, DPh, of Health & Wellness Compounding
Pharmacy in Nashville, Tennessee, published an op-ed in The
Tennesseean stating that compounding is already well-regulated and
does not need additional restrictions or FDA oversight. This was in
response to a previous op-ed The Tennesseean published, which argued
in favor of more regulation of compounding.
PCAB® NEWS
Congratulations to PCCA Members The Medicine Shoppe
in New Port Richey, Florida, owned by Divyesh Patel, RPh;
Stroheckers Pharmacy in Portland, Oregon, owned by
Ronald Dulwick, RPh; Nour Pharmacy in Clifton, New
VIDEO ON DEMAND
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