Cristina Iepure

Cristina Iepure is the pharmacist in charge and manager of record of Remedium Pharmacy in North Chelmsford, Massachusetts, near Lowell.

Under Iepure’s leadership, Remedium prioritizes two key practice areas that many larger pharmacies and pharmacy networks overlook: patient compliance and personalized medicine.

As advocates of the “triad relationship” — the principle that patients, physicians, and pharmacists must work together to solve complex medical problems — Iepure and her team have earned widespread acclaim in the tight-knit New England pharmacy community for simple yet effective innovations that improve compliance. These include packaging medication in specialized blister packs and providing hands-on guidance and support to patients with complex medication regimens. And, with Iepure’s encouragement, Remedium goes above and beyond standard pharmacy practice with free, on-demand local delivery and other value-added services.

Iepure specializes in several growing areas of pharmacy practice. She is a compounding specialist in dermatology and autoimmune medicine and holds a variety of certifications from recognized pharmacy organizations, including Specialty in Compounding for Hormone Replacement Therapy from PCCA (Professional Compounding Centers of America) and Specialty in Personalized Analgesic Medications from the LP3 Network. Iepure is a Future Advanced Fellow in Anti-Aging Metabolic and Functional Medicine with the American Academy of Antiaging Medicine.

Iepure graduated in 2004 from Romania’s University of Medicine and Pharmacy Iuliu Hatieganu with a degree in pharmacy. Prior to coming onboard at Remedium Pharmacy in 2015, she held various pharmacy-related positions in retail, long-term care, compounding pharmacy settings for more than a decade.

Iepure and Remedium proudly support public institutions and charities in and around greater Lowell. Iepure recently brokered substantial donations of medical diagnostic equipment and personal protective equipment to two senior centers in the area, ensuring continued safe delivery of essential services and support to vulnerable seniors during the COVID-19 pandemic. In her personal capacity, Iepure makes in-kind donations, such as canned food, to local faith organizations.

Iepure lives in Andover, Massachusetts, with her husband and two beautiful children. When she’s not attending to patient needs at Remedium, she enjoys working out, exploring New England’s great outdoors, traveling the U.S. and abroad, and cooking for friends and family.

Where did the idea for Remedium Pharmacy come from?

The idea for Remedium Pharmacy in North Chelmsford, Massachusetts, came from identifying two needs: patient compliance and personalized medicine through medication compounding. From my conversation with doctors, I realized that a lot of medication dose increases (which happen because the patient does not respond to treatment) are often the result of the patient not being compliant. Once the patient is put on specialized packaging, like blister-packs, the normal medication dose stayed the same, or even decreased, while the patient started showing positive results from the medication. It was clear that the previous unsatisfactory result was a consequence of non-compliance. In collaboration with doctors and caretakers, we focused our strategy on having as many patients as possible on blister-packed medication. The need for personalized medication via compounding also came out from clinical experience. As one example, patients that could get addicted to opioids can alleviate their pain via compounded medication. That fact alone justifies a focus on compounded medication.

What does your typical day look like and how do you make it productive?

I still spend a lot of my time on the bench, working alongside my colleagues at Remedium Pharmacy. There is no replacement for being close to the working process if you want to get the pulse of the business. Noticing inefficiencies and taking them out gives more than ten times the return on time invested. Of course, this needs to be balanced by delegating tasks that are well understood and unlikely to be made more efficient. But being present and engaged with day-to-day tasks is irreplaceable.

How do you bring ideas to life?

It is important to have the ideas connected to real-life situations. Then both the refinements of the ideas and their execution become simple, or at least natural. Having ideas in an armchair and expecting them to translate into practice mostly does not work. You need to be in the thick of things, to actually experience what works and what doesn’t, if you want to know whether the ideas can or should be implemented. Of course, you need to keep an open mind and be able to accept and implement changes. Ultimately, maintaining a practical fit between idea and practice is the most important thing for ease of implementation.

What’s one trend that excites you?

A trend that excites me is the use of genetic information to guide drug therapy. It’s hard to know how far away we are from mass adoption of these techniques, but they are coming. Milton Friedman speculated a long time ago that one reason why medical solutions do not advance as fast as we would like is that the solutions are likely to be found in individualized treatment. It does not get more individualized than using a person’s genetic information to tailor their medication treatment. A lot of things need to fall into place for such treatment to be adopted at scale. At the very least, cheaper genetic sequencing and a consensus on the ethical treatment of genetic information need to exist.

What is one habit of yours that makes you more productive as an entrepreneur?

Exercising and keeping a healthy work-life balance helps me stay productive. When I started working at Remedium Pharmacy, I was involved in all aspects of the business. It’s easy to get so immersed in the problems of the business that personal life gets neglected. This becomes counterproductive very fast. However, it is crucial to let go of some control and let the processes you installed do their work. The benefits of exercise cannot be overstated. Use that treadmill! If you feel that exercising takes a lot of time away from family and work, you can use that time to get informed by your favorite podcast. But exercise is one of those activities that repay their time investments several times over.

What advice would you give your younger self?

Start early. Be thoughtful but still start early. There will be a lot of unknown and unforeseen problems, but those types of problems will exist no matter how much previous planning there is. There is no substitute for actually starting and solving the problems as they come up. The one caveat to the “start early” advice is to ask thoughtful questions about the viability of the business. Peter Thiel’s list of seven questions to ask about a new business is a good starting point, but that list needs to be adapted for small business. Once the prospect for the business looks good, proceed with caution — but proceed.

Tell us something that’s true that almost nobody agrees with you on.

Ninety percent of success is being present in the middle of things to observe and take advantage of opportunities. It is seductive to think that it is brilliant ideas that lead to business success. Instead, it is the day-to-day improvements and the opportunities noticed while engaged in the business that carry the day.

As an entrepreneur, what is the one thing you do over and over and recommend everyone else do?

Put yourself in the shoes of the customer. At Remedium Pharmacy, I spend as much time as I can spare trying to visualize and experience the customer’s experience. The nature of pharmacy operations also means that I need to put myself in the shoes of the patient caretaker as well as in the shoes of the doctors collaborating with the pharmacy. The streamlining of patient and provider experience when interacting with Remedium Pharmacy is the main operational guidance for us.

What is one strategy that has helped you grow your business?

A strategy that has helped me grow the business is maintaining and enhancing relationships. Whether we are talking about patient relationships or provider relationships, keeping all of the stakeholders satisfied is the only way to grow a pharmacy business. Fortunately, being efficient and keeping stakeholders happy is often one and the same thing.

What is one failure you had as an entrepreneur, and how did you overcome it?

When I started operating the pharmacy business and for a good while after, I made the mistake of not delegating enough. This often resulted in inefficient use of my time and caused some things to fall through the cracks. I learned that the secret to delegation is the standardization of operations, and we successfully implemented that at Remedium Pharmacy.

What is one business idea that you’re willing to give away to our readers?

I recommend improving patient-doctor-pharmacist communication using better technology. Right now, a lot of time is wasted during inefficient telephone interactions between all of the caretakers and the patient. While phone conversations remain important, much could be achieved through automation or other technology. Whoever manages to integrate all of the systems involved in pharmacy-related patient care in a way that streamlines the communication process will possess a winning business.

What is the best $100 you recently spent? What and why?

I recently donated canned food to my local church. It is humbling to think about how lucky we are to have not only life’s necessities but so much more. As I am writing this, we are still in the middle of the COVID-19 pandemic. Helping the less fortunate is the least that we can do.

What is one piece of software or a web service that helps you be productive?

At Remedium Pharmacy we use Asana for daily task management. It is an invaluable tool that keeps improving all the time. The downside is a lack of integration with our pharmacy software, but that is a possibility that we are looking into. Since using Asana for business purposes, I started using it for personal purposes and it works wonders.

What is the one book that you recommend our community should read and why?

“Rework” by Jason Fried and David Heinemeier Hansson. This book attempts to adapt the ideas from software engineering to the world of business. The book is not afraid to debunk longstanding myths and it is chockfull of ideas that can be implemented in the pharmacy world as well.

What is your favorite quote?

Teddy Roosevelt’s “Man in the Arena speech” still resonates: “It is not the critic who counts, not the one who points out how the strong man stumbled or how the doer of deeds might have done them better. The credit belongs to the man who is actually in the arena, whose face is marred with sweat and dust and blood; who strives valiantly; who errs and comes short again and again; who knows the great enthusiasms, the great devotions, and spends himself in a worthy cause; who, if he wins, knows the triumph of high achievement; and who, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who know neither victory nor defeat.”

Key Learnings:

• Having ideas in an armchair and expecting them to translate into practice mostly does not work. You need to be in the thick of things, to actually experience what works and what doesn’t, if you want to know whether the ideas can or should be implemented.
• It is seductive to think that it is brilliant ideas that lead to business success. Instead, it is the day-to-day improvements and the opportunities noticed while engaged in the business that carry the day.
• A strategy that has helped me grow the business is maintaining and enhancing relationships. Whether we are talking about patient relationships or provider relationships, keeping all of the stakeholders satisfied is the only way to grow a pharmacy business.