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When AnnMarie Cloutier, PharmD, says, “I want to be more of a clinical wellness center, instead of a standard pharmacy,” it’s not because of the various challenges facing independents, such as low reimbursement rates, tightening margins, deep discounting big box stores, and mail order, to name just a few. “No,” she says. “I just truly believe in the model.”


As owner of Apple Valley Pharmacy ( Warwick, N.Y., Cloutier is looking to get away from the mindset of simply dispensing a prescription medication for every ailment or malady. Wellness Naturally“I know it’s counterintuitive from a business perspective to say that I think you should take care of your health instead of popping a pill,” she says. “But I truly believe that. I see alternative measures for a lot of the prescribed medications. Patients take a medication or a combination of medications that cause harmful or even incapacitating side effects. Then they’re prescribed an additional drug to treat the side effect. The symptoms of their original condition are then multiplied.” Cloutier, who in June celebrated her third anniversary as Apple Valley Pharmacy owner, is focused on a multi-faceted approach to patient health, with prescriptions being a part and not the primary focus. She freely admits that if it’s a choice between having patients taking an alternative product or a commercial prescription medication, she prefers the former. “Oh, absolutely,” she says. But at the same time, Cloutier says it’s not always so simple. “It’s usually a lot more complicated than telling them to take a certain herb or supplement. That’s why I look at a person as a whole. It’s not like I can say, ‘Okay, instead of taking a drug you can take an herb.’ Either way, whatever you are taking isn’t going to work if you eat fast food all the time,” she says with a laugh. “So I try to educate them. I also realize that changing all of those habits that are detrimental is never going to happen all at once. So you try to do a little bit at a time.” But that’s the benefit of being their pharmacist, Cloutier points out. “Customers are able to come into the pharmacy routinely to ask questions. They can always walk in and receive counseling from one of the pharmacists unlike having to schedule yearly or biannual appointments with a physician. I run into them at the grocery store, and once or twice a month here.”

AVP Store #1

SIGNATURE PRODUCTS Cloutier was born and raised in Warwick, a town of nearly 7,000 residents in southern New York near the New Jersey state line. She received herBachelor of Science in pharmacy at Northeastern University in Boston, and her PharmD at the University of Rhode Island. She stayed in the Northeast for about a dozen years, and gained a variety of clinical experience, most notably with stints at Northeastern Medical Center, Massachusetts General Hospital, and Solvay Pharmaceuticals, before

AVP Group

The pharmacy itself is about 1,800 square feet, conveniently located behind a row of physicians’ offices. Cloutier describes Warwick and the surrounding area as something of a bedroom community for New York City, about 50 miles to the southeast. As for Apple Valley Pharmacy, she considers it a hybrid store. Among its services are free local delivery, medication compounding, pill packaging for better adherence, breastfeeding product rental and sales (it is a Medela–authorized retailer), immunizations, bioidentical hormone replacement therapy, and nutrition consultations. Of course, alternative therapies are becoming the pharmacy’s signature.

Apple Valley has a full line of homeopathic products, nutraceuticals, teas, and dietary supplements. Cloutier says that Bach flower remedies are hot sellers at the moment. (The remedies are extreme dilutions of flower material developed by Edward Bach, an English homeopath, in the 1930s. Bach believed that dew found on flower petals retain healing properties of that plant. The remedies are intended primarily for emotional and spiritual conditions, including but not limited to depression, anxiety, insomnia, and stress.)

Cloutier says that the pharmacy recently worked with Professional Compounding Centers of America’s Wellness Works division to develop and sell a nutraceutical private label brand with the Apple Valley logo. The pharmacy also carries a full line of Boron mineral products. Looking for ways to pair up a supplement or other natural product with a prescription is part of Apple Valley’s strategy. “We market vitamins and supplements through patient education. Our pharmacy staff is trained to recognize when somebody is on a prescription that will deplete them of a certain nutrient. Then we recommend the proper vitamin protocol to accompany the medication.”

EDUCATION ESSENTIAL Anyone can offer a product. But if you can’t articulate what it does and how it works, it’s less likely to sell. Cloutier understands that completely, saying, “Education is critical.” To soak up as much insight as possible about alternative medicine, therapies, and wellness, she has been a frequent attendee at trade shows and conferences in recent years. When not on the road, she participates in webinars and does a lot of reading and research. Cloutier is also in the process of getting her board certification in wellness from the American Academy of Anti-Aging Medicine, another aspect of what she describes as “an ongoing learning process.”

Through PCCA, Cloutier participates in a network call with other pharmacy owners. “We talk once each month to discuss business and clinical topics, which is quite helpful,” she says. And through contacts she has made from trade shows and meetings, she has become part of a networking group with other pharmacists. “A lot of times we’ll just call each other, which is very helpful, because as a sole owner you are kind of in a vacuum if you don’t reach out to others,” Cloutier says.

“I would say that’s the biggest challenge of owning a pharmacy on your own. Making sure you know what’s hot, what’s trending, what product mix you should have in the store, even down to billing. It’s more advantageous for me to call a colleague than it is to wait for the next conference.” With wellness, Cloutier seeks to learn as much as possible about items she is carrying in her store. “I contact the company of any product I may be interested in carrying,” she says. “I ask if the product is GMP [good manufacturing practice] certified, where the ingredients are sourced from, and how they verify quality. Some manufacturers do get inspected by the FDA [Food and Drug Administration] and I ask how often. I strive to carry products that go through rigorous testing and source their ingredients as locally as possible. And also, owners can be as savvy as possible, but they can’t be available 24/7, so if you don’t educate your staff and they don’t have that buy in, it’s never going to work.” Cloutier says that customers will sometimes mention a product that she doesn’t have. “They’ll say, ‘It’s half the price of what you carry.’ And I’ll assure them that I have no idea where it came from. It could claim to have a certain amount of a specific property, but you don’t know how much is really in there. Nobody is validating it. So I look for companies that do their own internal validation.”

Obviously, customer attitudes must be taken into account when deciding what products to carry. “You have to look at where you are located, and your demographic, because that will dictate if people will spend for that or not,” Cloutier says. “Then you kind of go from there. You have to keep in mind people’s cultural influences. You would have to know what products to offer or not offer to make sure you don’t insult or offend anyone. Keeping all of that in mind is important.” AVP Store #2

LOCAL GIFT SOURCES Like many independent retail pharmacies, Apple Valley carries an assortment of gift items, but with a bit of a twist. Cloutier explains that there are a lot of local crafters and artistic people in the community, so she buys a lot of handmade, artisan items that are locally made. She even has a family flavor to her offerings. “My mother makes quilts and place mats and things like that for each season,” Cloutier says. “She does a lot of knitting. For example, she makes winter hats for infants and children, which complement our Medela breastfeeding selection.

We try to focus gifts on things that someone will pick up for someone who’s sick. It might be a tea cup or a coffee cup with natural honey that’s made locally. If they are here to pick up a prescription for someone who’s sick, we try to think what could go with it.”

Cloutier also points out that with locally made products, she can often take them on consignment. “We only pay for what we sell, which is nice, because your overhead isn’t huge if the product line doesn’t sell as well as you thought it would. For someone who is interested in getting into this, that might be the way to go.” With any new product, Cloutier generally gives it three months to sell. If it doesn’t move, it’s not for lack of effort. “We usually give initiatives to the staff for the number of units we want sold, that kind of thing,” she says. “We have one item where the company that offers the product will give my staff commission for each product they sell, and then I match it. I don’t do that on every product, but there are some that have a higher price point, so I can still sustain that commission.”

A surprisingly popular item, Cloutier says, were Dr. Comfort slippers. “I wasn’t certain of how the line was going to be received, but they were popular,” she says. “I was really excited about them. I came back from [the NCPA Convention and Trade Exposition] last year and had ordered a whole shipment of them. My staff initially had doubts. They turned out to be a better seller than they thought, because we normally don’t sell footwear. It’s kind of a strange offering, but people loved them. We started selling them in the fall before the holidays with great success.”

TRANSITIONING TO TOTAL WELLNESS Part of Cloutier’s goal to move her pharmacy toward a total wellness destination includes receiving more referrals from physicians for patients who might be benefit from a medication therapy management type of consultation. “With a lot of them, we can help them lower the number of medications that they are on, and change their supplement routine,” Cloutier says. “It also helps that we compound, because we can consolidate some of their supplements into one dosage form, instead of having them taking five or 10 pills.”

In an ideal world, Cloutier would have practitioners coming into the pharmacy to work collaboratively. It might be a nutritionist, or a naturopath – basically anyone who shares her goals for patient care. She would like to have enough office space for those professionals to bring patients into her business, and ideally those patients would eventually become pharmacy customers. “I have a specific vision I’m looking to create – but I’m still not there yet,” she says with laugh. “I’m not big enough in this location to do that.” Cloutier hopes that will change in a few years, when her lease will be up and she will be, in her words, “a free agent.” At that point, if all goes well, she will be in a larger building with greater visibility and more foot traffic.

In the meantime, she has made the best of her existing space. After buying the store, she did a number of renovations. This included putting all of her retail products on cubes, set on casters that can be moved. “Our retail floor can be completely wide open and can accommodate lectures,” Cloutier says. “Space can be opened, and we let providers use it for free. Say that a podiatrist wants to talk about heels spurs Thursday at 7 p.m. They can come in and use the space. We are scheduled to have an acupuncturist come in for three hours to demonstrate stress relief techniques. We have a small lounge area with a coffee table, and she’ll perform that service on people for free. They get an idea of what she does, and it brings people into the store.”

Cloutier also had a flat screen television mounted on a wall to show pharmacy photos, display Power Point presentations during meetings, and provide general information about the business. “So many of our customers come for a retail prescription and don’t know what other services we offer. Somebody came in the other day and said, ‘Oh, you make medication for animals? We have been going to a pharmacy 30 minutes away.’ I’m like, ‘What!?’ So even with brochures and flyers, it can still be difficult to spread the word.” But Apple Valley does get its name out by being a good local citizen, being active in various community and charity events.

It also has a presence on social media with a Facebook page that is updated daily. For a while Cloutier says the staff was generating all the content internally, but as that became time-consuming, Apple Valley has since signed up for the NCPA Digital Pharmacist™ Solution powered by RxWiki (www.ncpanet. org/digitalpharmacist), which is free to NCPA members. (The pharmacy will still contribute its own content on occasion.) Apple Valley also sends out a monthly newsletter, and is moving toward creating more online sales opportunities.

For Cloutier, the most satisfying aspect of her job is simply helping people feel better. “We get a lot of patients who come here who may have gone to a chain and to five or six doctors and pharmacists,” she says. “And when they get to us, we have the time, and the desire to speak to them, and look them in the eye and spend that time with them, and not look at them as a number and rush them through. Some people cry with joy and relief and a thank you—it makes a huge difference.” ■

Published August 2014 in NCPA’s pharmacy journal, America’s Pharmacist. Chris Linville is managing editor of America’s Pharmacist.