DEERFIELD, Ill. — Earlier this month, Walgreens president Richard Ashworth succeeded Chris Lane, executive vice president of Wakefern Food Corp., as chairman of the National Association of Chain Drug Stores. The change in leadership went according to plan, but the manner in which it occurred did not.
New chairmen normally take the reins at the NACDS Annual Meeting, which was not held this year because of the COVID-19 pandemic. One of the highlights of the event, if it had taken place, would have been a speech by Ashworth outlining his perspective on chain pharmacy, as well as his priorities as NACDS chairman. The following interview attempts to cover the same ground.
Ashworth knows the pharmacy business from the ground up, making him well equipped to guide NACDS at a time when the companies it represents and the people who work for them are facing unprecedented demands. Ashworth joined Walgreens as a store clerk while still in high school. After earning a Pharm.D., he became a pharmacist at the drug chain and began a rapid rise through the ranks. Over the course of his career, Ashworth, who also holds an MBA, ran the pharmacy, health care commercial, retail and other business segments. He served as president of operations prior to becoming Walgreens president last February.
Q: Your chairmanship of NACDS is beginning during a global health crisis. What new demands has the COVID-19 pandemic made on chain pharmacies? How has the industry responded?
Ashworth: Since about mid-March, our nation has faced one of the most challenging times in our history. Throughout all of this there is one thing that has not changed: community pharmacies’ continued commitment to our communities and our patients across the country.
Even with the many challenges, both professional and personal, this has been our industry’s finest hour. The professionalism and dedication of all of our member companies has been truly remarkable and inspiring.
Never before has community pharmacy played such a critical role in our nation’s health care.
As an industry we have worked together and risen to the challenges. And as critical businesses, we’ve been able to keep our doors open to ensure patients have access to their medications and pharmacists they know and trust, and also are able to have their needs met for many other essentials.
We have made changes to the way we work in order to keep our employees and customers safe, and many within our industry have also actively hired thousands of workers, both to ease the strains of our current employees and to help those in need of work.
Q: The current situation is putting a tremendous amount of stress on the health care system. If pharmacists were allowed to play a bigger role in patient care, how would that alleviate some of the problems we’re seeing? What can pharmacies do to help expand patient access, improve outcomes and lower costs when things return to normal?
Ashworth: The coronavirus pandemic has forced the industry to respond and advance at rapid speed, and the response effort has further demonstrated the valuable role that pharmacists can play. We know the impact pharmacists can have as part of patients’ care teams, how the pharmacist-patient relationship can help improve adherence and outcomes, and how pharmacies can serve as a critical access point in the community.
With COVID-19, NACDS member companies have responded quickly and taken continuous steps to meet the prescription drug needs of patients. Many have also taken additional measures such as waiving fees for prescription delivery, adjusting operating hours and/or dedicating special shopping hours for seniors.
Access to COVID-19 testing is a critical need, and a number of retailers have worked together to meet this need while collaborating more broadly with federal, state and local authorities.
This has provided our industry with an opportunity to quickly advance our profession and the role of pharmacists. The Department of Health and Human Services recently updated guidance authorizing licensed pharmacists to order lab tests, administer tests and communicate results related to COVID-19 for the duration of the crisis.
This was a significant step to allow pharmacies to quickly set up testing locations where pharmacists oversee patients’ self-administration of COVID-19 testing in communities across the country.
We are continuing to work to have pharmacists recognized as nonphysician providers under Medicare Part B, which is a critical reimbursement mechanism to allow pharmacies to bill for COVID-19 tests and serology tests when available, and also to administer the COVID-19 vaccine once it is developed.
Q: Pharmaceutical companies are trying to develop vaccines and medications for COVID-19; some existing drugs might have the potential to benefit coronavirus patients; and then, of course, there’s a lot of misinformation about treatment. What should pharmacy operators do to help patients understand COVID-19 and legitimate ways to combat it? How can they contribute when the time comes to inoculate large numbers of Americans?
Ashworth: The industry is working in close collaboration with federal and state health officials to meet urgent needs. We are following their guidance and working closely with state boards of pharmacy and other authorities to ensure access to medications that have been seeing heightened demand.
As mentioned, our industry stands ready to assist when a vaccine for COVID-19 becomes available. Pharmacies have an excellent track record of providing immunizations and expanding access, and our network of locations and trusted pharmacy professionals plays an important role.
Q: In addition to spearheading NACDS’ response to the current crisis, what matters do you hope circumstances will allow the association to pursue during your tenure as chairman?
Ashworth: As chairman, there are number of areas where we can work to advance the industry and, in some ways, this crisis is accelerating these efforts. Right now, the priority is and will remain to continue working to meet the needs of patients and communities throughout the pandemic.
However, we must also continue working to further shape the future of pharmacy. And that’s partially dependent on creating the proper environment, both on top line and costs, for pharmacies to efficiently operate and also continue to advance efforts to expand pharmacist and technician roles. Here’s what needs to be done in a few key areas:
Future of Pharmacy
- Create the proper environment for reimbursement for the work pharmacies do.
- Reduce costs in order for pharmacies to operate more efficiently.
- Expand the services pharmacies can deploy and provide in communities.
- Remain focused on the communities we serve and some of their main challenges — such as mental health and addiction.
The pharmacist’s role has further advanced during the COVID-19 pandemic, but in order to sustain these new responsibilities we still must look at key drivers:
- DIR Fee Reform — we know the exponential growth numbers, and they are not sustainable for any size pharmacy — small or chain. We must reform the way these fees are established and then collected.
- Start paying pharmacists on a standardized basis for their performance through Pay for Performance. We made some progress on this front in early 2020.
Cost to Fill
- In order to drive down cost to fill prescriptions, we need to pursue a multitiered approach.
- Virtual pharmacy — advancements in technology and new ways of communicating exist that can further modernize the pharmacy in a way that would allow one pharmacist to potentially supervise multiple locations. Doing so would lower costs and enable community pharmacy to remain relevant as digitalization continues to revamp industries.
- Expanding telehealth — a great deal has been accomplished on this front during the pandemic, and it will remain important for pharmacy to determine where we fit in for the “new normal” and use of telehealth.
- Pharmacy services expansion — we continue to build on the progress from HHS and, it’s important to note, the service expansion for pharmacists must come with increased responsibilities for pharmacy technicians. Our pharmacists must have more of their time available to practice up to their full scope, and pharmacy tech expansion is key.
- Prescriptive authority — the only way to control chronic conditions is for more pharmacist involvement with comorbidities.
There is great pharmacy innovation being demonstrated in parts of the country, and taking the best of the best can have a meaningful impact while expanding our scope of practice.
For example in Idaho, technicians are administering immunizations, and it’s important to continue to advance this critical role in the pharmacy. Increasing the number of immunizers at each location would improve the patient experience, allow for more effective patient care and treatment, as well as operate more efficiently.
Florida recently joined other states in granting pharmacists the authority to test and treat for influenza and strep throat. Now we can administer the tests and then dispense Tamiflu or antibiotics if results are positive. Expanding this service would reduce overall health care costs and increase access to care and treatment for patients who may not have convenient access to medical care in their community.
An Opportunity to Further Address Mental Health and Addiction
I believe there is an opportunity to do more to help address mental health and addiction. These are very tough times, both professionally and personally, for just about everyone. As an industry we need to continue championing the well-being of our customers, and also our employees, and to make sure they get the support and services they may need.
Further, as an industry, we have the opportunity to expand our efforts around helping to take care of patients with mental health conditions. Walgreens has been working with the National Council for Behavioral Health as well as APhA to provide mental health first aid training to certain pharmacists and team members. The training teaches mental health literacy; understanding risk factors and warning signs for mental health and addiction concerns; and strategies for how to help someone in both crisis and noncrisis situations. So far, the program has been well received, and I would advocate for the industry to consider similar training, which is accredited for pharmacist’s continuing education.
Q: Briefly assess where things stand on the following issues: scope of practice, DIR reform and opioid abuse.
Ashworth: There is a good opportunity to expand scope of practice by taking steps at both the federal — recognition as health care providers — and state level — bringing innovation, such as test and treat in Florida, to other states as well as advancing the role of the pharmacy technician, as in Idaho, where they are administering immunizations.
DIR fee reform is critical to improving health outcomes and medication adherence. The pharmacy counter is where the issue of drug pricing and patients intersect, and pharmacists work every day to find ways to lower costs for patients. Pharmacy DIR fees grew to $9 billion in 2019, an increase of more than 45,000%.
At Walgreens, we have two guiding principles on drug pricing that can be applied across the industry:
- Drug pricing must be transparent as medicines move through the supply chain and are ultimately dispensed to patients.
- Savings must be passed on to patients at the pharmacy counter to lower their out-of-pocket costs.
Our approach is for the pharmacy to pay the DIR to the PBM to lower the beneficiary out-of-pocket cost, and the PBM passes through 100% of pharmacy DIR to the beneficiary at the point of sale. Reducing patient cost sharing coupled with an emphasis on pharmacy quality can lead to improved outcomes while decreasing health care and government spending.
Combating the opioid crisis remains an important issue across the industry. Chain pharmacies have taken a number of steps to further address the crisis, including expanding drug take-back options and providing greater access to naloxone. Pharmacies have championed the use of PDMPs, and we continue to support a national PDMP system in order to streamline reporting and access requirements. We also continue to support wider adoption of e-prescribing in order to further reduce diversion.
Q: NACDS was unable to hold its Annual Meeting this year. What can the association do to maintain strong lines of communication throughout the industry and bring about consensus on important issues?
Ashworth: While it was unfortunate that we could not have the meeting this year, it was absolutely the right decision to cancel. Despite that, I feel COVID-19 has brought our nation, and our industry, closer together. While we are all competitors, we are pharmacies first and we are sharing best practices on how to keep our employees and customers safe, while meeting the needs of the communities we serve, — we are all in this together.