When Bob Nickell decided to leave his job as a general retail pharmacist in order to start his own independent pharmacy, he knew he would have to create a niche in order to survive. He came up with the idea for The LivingWell Pharmacy in 1994 and the store opened for business in 1996. He spoke with Alexa Apallas about the decline of independent pharmacies.

Small independent pharmacies are going extinct, mainly because of the HMO reimbursement policy. Clients come in with their $10 co-pay card thinking they can get their prescription filled anywhere. But it might cost a small pharmacy $85 to fill that prescription, and they would only be reimbursed about $87, including the co-pay. There are preferred pricing practices for larger chains, though, partly because they buy in large volumes, so they might be able to fill that same prescription for $75 or $80, making a much larger profit. The cost of drugs has increased dramatically, while the rate of reimbursement has gone down dramatically, so it just doesn't make good business sense for small pharmacies to try and compete. If we were a traditional pharmacy, we wouldn't even be here today.

I got the idea for The LivingWell Pharmacy because I would ask people behind the counter (at health stores) what I should take, and I got all kinds of bizarre answers. As a pharmacist, it bothered me that I wasn't getting educated answers from the salespeople. At The LivingWell, we want to be the health care place where people can get everything they need, from herbs to Tylenol, along with a good education about our products. We are knowledgeable about homeopathy, aromapharmacy, herbs, and nutrition.

We also do compounding, which is the old-fashioned art of pharmacy. We take the raw chemicals that are used for drugs and formulate them into products that are not found at general pharmacies. For example, children with Tourette's syndrome only had two medical options an adult-strength dose of Clonidine or an adhesive patch. However, children need different doses of Clonidine each day depending on their activity level, how much sleep they got, and what they ate. A lot of them didn't like the patch, which was something sticky on their skin, so I used compounding to create a topical cream.

Another way I set myself apart from other pharmacies is by flavoring medications for children. A lot of children's medicines taste so horrible that parents can't get their kids to take them. This year, I bought a flavoring system, and now I can offer medicines in over 31 flavors. I've seen a big increase in business from families. Finding niche markets is what keeps this pharmacy going.

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