The right prescription

A tour of John Dobbs' new pharmacy in Fort Myers yields two clues to how an independently owned drugstore can compete with giants such as CVS and Walgreens.

Clue one: A long counter where pharmacists will make custom medications for patients.

Clue two: Shiny new technology and equipment, including a machine that can automatically sort and package pills.

Dobbs, a 37-year-old who most recently served as Gulf Coast Hospital's emergency room pharmacist, says making custom medications for patients is a high-margin business. He says filling 10 such prescriptions a week will pay for his occupancy expenses in the newly opened 1,360-square-foot PharmiCare store off busy Daniels Parkway in Fort Myers.

Increasingly, patients seek medications in forms such as creams and gels that aren't available at chain drugstores. In a process known as “compounding,” pharmacists like Dobbs have turned to manufacturing them for patients. For example, some patients might need medications in the form of a gel or liquid if they have trouble swallowing pills. “Pain management is a huge thing,” says Dobbs.

Meanwhile, Dobbs and his partners invested $250,000 to equip the pharmacy with the latest hardware and software. For example, a new $100,000 Parata machine will sort and package medications for patients, saving valuable time for pharmacists who otherwise have to do it manually. Dobbs says that will help him win volume business from assisted-living facilities, too.

To manage insurance claims, among other clerical requirements, Dobbs paid about $9,000 for a pharmacy back-office system called RX30. He's joined a buying group called Epic Pharmacies that specializes in supplying medications to independently owned pharmacies.

Backed by an initial $200,000 from Canadian physician and angel investor John Stickney, Dobbs partnered with critical-care nurse Denny Bauman last year to open PharmiCare. It has taken nearly a year to find suitable space and obtain the necessary pharmacy licenses and permits, though Dobbs says the biggest holdup was with Lee County's permitting process. “Lee County put me back two months,” Dobbs says.

Dobbs says he's not worried about the increasing socialization of medicine and the threat of lower reimbursements it might bring. If the move toward socialized medicine gains traction in the U.S., it will create a two-tiered system where older, wealthier people will pay cash for better care like they currently do in Europe. He estimates 30% to 40% of his customers — many of them wealthier retirees who have second homes in Southwest Florida — would be willing to pay cash for personalized care.

Such personalized care would include in-person and phone consultations, home delivery of medications and administration of prescription drugs by a nurse. “We want to capture that business,” Dobbs says.

Once the Fort Myers store is running smoothly and is profitable, Dobbs and his partners plan to open other stores on the Gulf Coast, including Naples, Marco Island and Tampa. Dobbs says options include franchising or company expansion, but he says he's careful not to expand too fast. “Health care is not something you can expand rapidly,” he says.

Dobbs declines to share sales projections, but he says he hopes to be filling 50 prescriptions per day in the first year and 200 a day in the second year of operation, excluding custom medications.

Although he has never operated a retail pharmacy before, Dobbs has plenty of experience working for others. Before he joined the hospital, the pharmacist worked for big chains such as Eckerd and CVS when he moved to Florida in 2003, gaining insight into his future competition.

Dobbs grew up near Syracuse, N.Y., where he worked in a neighborhood drugstore in high school. “That was the cool place to work,” he recalls. He continued to work at pharmacies through college and pharmacy school, but became disillusioned with large drugstore chains and joined Lee Memorial's hospitals in 2007. “You get burned out,” he says. “The chains don't support you.”