Counting bills: Expert tips on generating new revenue streams for your pharmacy business

Updated on July 16, 2021 (Originally posted on August 21, 2018) The Tablet

by Derek Desrosiers, BSc(Pharm), RPh

Nelli Jakac with Danuta Mossford

Pharmasave pharmacist Nelli Jakac (right) speaks with patient Danuta Mossford about her myDNA results, a new clinical service Jakac offers in her Vancouver pharmacy.

Given the significant generic drug price deflation that pharmacy has seen in the past few years, and, in particular, the recent drop in prices on nearly 70 of the most commonly prescribed drugs in Canada by the pan-Canadian Pricing Alliance (pCPA), it is imperative that you strive to maximize other revenue streams in your pharmacy.

Millions of dollars are coming out of the bottom line of pharmacies right across Canada and independent pharmacies are likely to be hit the hardest. However, through some thoughtful business planning and clever marketing, there are a number of tactics you can employ to help mitigate the negative impact of these price deflations while adding further value to your business.

  1. Find a niche product or service offering that fulfills a demand in your surrounding community. Make your pharmacy a destination for specific products and/or services that nearby competitors are not selling or offering by finding a niche and exploiting it. If you offer value, the public will reach into their wallets and pay you for your services and knowledge. You just have to be brave enough to ask.
  2. Implement a vaccination program. This is not just flu shots. Ensure that pharmacy staff members are asking all clients about their vaccination history so that you can offer all types of vaccines to clients who are not up-to-date with their immunizations. For example, you can offer a range of vaccinations, such as tetanus, pneumococcal and basic travel vaccines like hepatitis A and B (and more if you have the training and are comfortable with it).
  3. Offer all types of health coaching. Some private payers like Green Shield Canada (GSC) pay for this type of coaching. GSC pays for cardiovascular, diabetes and asthma health coaching for certain eligible clients. Training is available online through the BC Pharmacy Association’s 24/7 eTraining portal ( And once you are trained, you can offer this health coaching as a fee-for-service offering to those clients who do not have private pay coverage for it. Many clients are willing to pay for such coaching if they see value in the service.
  4. Provide the maximum allowable number of follow-ups when doing medication reviews. The follow-ups will help ensure clients follow the care plan developed for them and have better outcomes, while also increasing revenue opportunities for you. A standard ($60) or pharmacist consultation ($70) medication review and four follow-ups ($15 each) can generate $120 to $130/year per client.
  5. Maximize opportunities for prescription adaptations. Most pharmacists are doing adaptation work every day but may not be billing for it. Look at prescription renewals, changes of dose, formulation, or regimen of a new prescription or make an appropriate therapeutic substitution. These services generate between $10 and $17.20 per service.
  6. Seek compensation wherever possible. If a prescription is inappropriate, do a refusal to fill. This service generates a $20 fee. Refer to section 8.5 of the PharmaCare Policy Manual for more information.
  7. Offer pharmacogenomic testing in your pharmacy. Many clients are willing to pay for this service out of pocket and others can claim it through their extended health plan. Margins are excellent for this service. A multi-panel test through myDNA generates a profit of about $100 for the pharmacy.

Before implementing any changes to your pharmacy, ensure to review all of the relevant regulatory requirements and consider developing an official business plan. Know where you want to take the business over the next three to five years. Have some specific plans for the type of pharmacy practice you want to have and who your ideal customer should be. Get professional assistance to write the business plan. Your banker will appreciate it! Then it is off to the races with your implementation of pharmacy services. While you cannot expect to replace all of the lost profession allowance revenue through service offerings, implementing new services and adding unique product lines will increase the likelihood that you can recover some of the lost value for your business. 

Derek Desrosiers, BSc(Pharm), RPEBC, RPh is President and Principal Consultant at Desson Consulting Ltd.


This article was corrected on Aug. 23, 2018.

Due to an editing error, the print article stated that a refusal to fill could include a lack of signature or date, for example. However only the following reasons are valid reasons for a refusal to fill fee:




Significant Drug Interaction (drug-to-drug)


Prior Adverse Reaction


Therapeutic Duplication


Sub-Therapeutic Dose


Dangerously High Dose


Treatment Failure


Potential Overuse/Abuse


Suspected polypharmacy / Multi-doctoring


Falsified / Altered Prescription


Consulted Prescriber – Changed Dose


Consulted Prescriber – Changed instructions for use



This article is featured in The Tablet. The Tablet features pharmacy and industry news, profiles on B.C. pharmacists, information on research developments and new products.