As the business of pharmacy has evolved over the years, medication therapy management (MTM) services, immunizations and point-of-care testing have become increasingly important to independent retail stores. 77 percent of community pharmacies nationwide offer MTM, while 76 percent provide immunizations for seasonal influenza. Testing is prevalent for the flu, strep throat, cholesterol screening and hemoglobin A1c.¹

Additionally, some pharmacies are participating in public health testing for COVID-19 as the nation responds to the ongoing pandemic.² Looking forward, pharmacy advocacy associations anticipate significant demand for a COVID-19 vaccine; therefore, store owners should start preparing now to administer it.³

All these converging trends point to a need for independent pharmacy expansion or remodeling to create new in-store space for meeting with patients in a private setting. In most cases, it makes sense to create or rework a single multipurpose room that can be used at different times for MTM consultations, immunizations and testing.

Building a private consultation room

Undertaking an independent pharmacy expansion to accommodate patient care services starts with an assessment of your available space. A typical modern pharmacy layout occupies roughly 1,700 square feet, about equally divided between the front end and the prescription department.⁴ You'll need a minimum of 70 square feet to frame out or repurpose a dedicated patient care area.

You should also consider the following factors:

• Placing the private consultation room near the prescription pickup counter will improve the pharmacist's workflow by cutting down the number of steps taken to meet privately with patients.

• With the advent of COVID-19 testing, it's advisable to include a sink where patients and staff can wash their hands. That would increase the room's minimum size to 100 square feet and would require a plumbing hookup. Keep in mind that plumbing can easily account for half the total construction cost of your independent pharmacy remodel, especially if your store doesn’t have a basement and lines would need to be trenched through your floor.

• The room must conform to regulations set forth in the Americans with Disabilities Act (ADA).⁵ In particular, pharmacy design standards require the doorway to be at least 36 inches wide and the interior of the room must have at least a 5-foot radius to allow for passage and positioning of a wheelchair. Think in terms of the space required in an ADA-accessible restroom. Additionally, the room should not be positioned on a raised platform unless you have space to build a ramp leading up to the platform level.

• Depending on your local authority, you'll likely need a general building permit, along with associated permits for electrical and plumbing work. For initial guidance, check to see which version (2013, 2015 or 2018) of American Standard Building Code Requirements apply in your authority's jurisdiction.

• Anticipate that it will take a minimum of 12 to 14 weeks from the time you get your project designed and hire a contractor until the room is finished and ready for daily use.

• Construction costs will be higher in urban areas than in rural locations.

• Your return on investment will accrue from new revenue streams. Ballpark estimates range from an average of about $75 per MTM visit to roughly $20 per immunization. Individual consultations for wellness, nutrition and smoking cessation also represent excellent opportunities to generate revenue that would offset your construction costs over time.

Case in point

In a real-world scenario, an independent pharmacy reconfigured its design to allow for construction of two rooms dedicated to patient care services. A nutritionist uses one private consultation room to meet with patients while the other room is reserved for administering vaccines to school-age children.

The pharmacy owner reports that, after building the two new rooms, his gross margin has increased approximately 30 percent compared to his previous margin, which was largely based on dispensing drugs. Anecdotally, the owner believes the new services have also increased foot traffic and corresponding OTC sales.

As this case illustrates, undergoing a thoughtful independent pharmacy remodel can facilitate new revenue streams that bring in additional revenue, as well as create buzz in your community that sets you apart from your competitors. What's more, you can use a multipurpose room for other business-enhancing activities such as having private conversations with referring physicians or long-term care providers.

Despite the challenges in the current patient-care environment, now's a great time to start thinking through pharmacy design standards and accumulating the financial reserves to support a modest construction budget. If you're handy with a hammer, saw and paintbrush, you may be able to save costs through sweat equity. Otherwise, it's a relatively straightforward process to get lined up with a designer and local contractor to help take your store to the next level in patient care.

^{1. National Community Pharmacists Association. 2019 NCPA Digest. http://www.ncpa.co/pdf/digest/2019/2019-digest.pdf}

^{2. Centers for Disease Control and Prevention. Guidance for Pharmacies. https://www.cdc.gov/coronavirus/2019-ncov/hcp/pharmacies.html?fbclid=IwAR3iN830jGJl9nL4ZC_3-6oYqtfBb_uJGkaQK1bzupq-sMnFluKJnIkTACI}

^{3. Drug Topics. Pharmacies Must Prepare for a COVID-19 Vaccine. https://www.drugtopics.com/view/pharmacies-must-prepare-for-a-covid-19-vaccine}

^{4. National Community Pharmacists Association. 2017 Community Pharmacy Start-up Benchmarking Report. http://www.ncpa.co/pdf/2017-ncpa-startup-report.pdf}

^{5. U.S. Department of Justice. Information and Technical Assistance on the Americans with Disabilities Act. https://www.ada.gov/2010_regs.htm}