Chris Lane, who takes over the role of NACDS chairman this month, began his career in pharmacy, taking a pharmacy degree from the University of the Sciences College of Pharmacy in Philadelphia. After working for CVS Corp. and Duane Reade, he joined Wakefern Corp., the largest retailer-owned grocery cooperative in the country, in 2003 as vice president of pharmacy.

In 2005 he added responsibility for health and beauty care to his portfolio, followed by a series of promotions, first to vice president of grocery, direct store delivery and commercial bakery, then senior vice president of nonperishables followed by senior vice president of product divisions. He is currently executive vice president with responsibility for day-to-day operations and strategic planning for the New Jersey-based cooperative, which is comprised of 50 members who own and operate 352 supermarkets in 10 states stretching from New Hampshire to Virginia. The company reported retail sales of $16.5 billion in its last fiscal year ended September 2018.

Lane is stepping up to the NACDS chairman’s role from that of vice chairman, and he previously served as treasurer of the trade group’s board of directors. He is taking the position at a time when NACDS’ influence has never been greater, and when the challenges facing the retail pharmacy business have arguably never been more formidable.

As a board member and vice chairman, Lane has had an opportunity to appreciate the leadership that NACDS president and chief executive officer Steve Anderson and outgoing chairman Mark Panzer of Albertsons Cos. have provided during the past tumultuous year. He also credits the diversity of the NACDS board, which includes regional drug chains, midsize grocers, large grocers and even mass merchandisers along with the largest drug chains, with bringing keen insights from different points on the spectrum of retail pharmacy.

Like Panzer and other recent NACDS chairmen Martin Otto of H-E-B and Randy Edeker of Hy-Vee Inc., Lane comes from the grocery industry, and that breadth of retail background within the board of directors has given NACDS a broader, more holistic perspective that Lane intends to continue. Among the benefits of that diversity is a keener grasp of the relationship of nutrition to health and the opportunities that opens up.

Despite the enormity of challenges confronting the industry as a result of the country’s public health crisis, Lane sees opportunities ahead as well and is focused on helping NACDS and its members to capitalize on them.

Chris Lane

CDR: You were trained as a pharmacist and have been watching NACDS for a long time. How do you view its role in the industry?

LANE: Our members really help define our values and role as an organization. We conducted a survey last year of our chain members and asked all the companies, “What are the main priorities you want NACDS to focus on?” Three major areas were consistently cited by companies of all sizes.

The first area of focus that emerged was advocacy on and around important public policy issues. They know that the intense public policy issues facing the industry are so important to pharmacies and the future of neighborhood health care.

The second area our members look to us for is as a knowledge base and resource for providing timely information about pharmacy regulations and compliance and developing positions on public policy.

The third area the members told us that they wanted us to focus on is supporting the business community by presenting opportunities to do business and to learn through our meetings. It’s important to note that while NACDS is focused primarily on pharmacy, our member companies have their whole business to consider. NACDS understands that and talks about the larger store at its meetings and conferences and takes a holistic approach to business through its work and advocacy. And I hope to bring a perspective that balances the concerns of both pharmacy and total store.

In my role dealing with consumer packaged goods and the front end of the business, I’ve always felt that NACDS has done a great job, and I’m hoping to continue that ­legacy.

CDR: As you prepare to become NACDS chairman in April what issues are at the top of your agenda?

LANE: It’s important to get things done on big issues that impact patient care. First and foremost, the goal is to protect patient access to pharmacy care and to health care in ­general.

DIR [direct and indirect remuneration] fee reform is the No. 1 issue. They’ve increased exponentially over the last five years, and the vast majority of these fees are retroactive, with assessments to pharmacies coming months after a pharmacy claim is settled. These big bills represent one of the biggest challenges for pharmacy and our customers. DIR fees have also led to an increase in out-of-pocket expenses for Medicare Part D beneficiaries, threatening favorable health outcomes for those patients.

Reducing out-of-pocket drug costs — through means beyond DIR fee relief — is another important issue. I was honored to be at the White House last fall when the president signed the Patient Right to Know Prices Act and the Know the Lowest Price Act bills, both of which now let pharmacists tell patients when they can save money by paying out of pocket instead of using their insurance plan.

Another goal would be to establish pharmacy quality incentive payment programs. What we have found is that even the top-rated pharmacies in the country are only being reimbursed a fraction of what they should be.

It has become very obvious that it isn’t a fair and equitable process. And honestly, sometimes it isn’t clear how a pharmacy is being reimbursed. So NACDS has been very clear that we need to develop a process that will allow pharmacists to improve patient care and achieve better outcomes.

We also support expanding the scope of business so that our pharmacists can optimize care and offer new vaccinations, certain tests, care plans and medication ­synchronization.

Finally, and it’s a big one, is taking the lead on opioid abuse prevention. NACDS has been very aggressive on this issue. We are supporting legislation that limits the first fill of a prescription for an opioid medication for acute pain to seven days.

NACDS is also working aggressively on prescription drug monitoring programs. NACDS supports the establishment of a nationwide prescription drug monitoring program database that would make the process more effective. We support manufacturer funding of take-back envelopes so that pharmacists can return unused medications back to the manufacturer upon customer request. And NACDS supports mandatory electronic prescribing that ultimately helps prevent abuse.

CDR: NACDS and its members seem to be more willing to take a stance and get involved in public health issues, such as the opioid epidemic. What motivated that change?

LANE: This is a public health crisis that requires all of us in the health care system to work together to help solve.

CDR: CMS [the Centers for Medicare and Medicaid Services] is expected to release the rule on DIR very soon. Do you hope that the government will address problems in a flawed system while adhering to the idea that pharmacies should be paid for how well they ­perform?

LANE: Yes. We have no problem with being reimbursed based on how we impact patient outcomes. But it has to be a process that is fair and understood by all stakeholders. And again, the whole health care community should be part of developing that ­process.

CDR: At RxImpact Day, you had a chance to interact with [Health and Human Services Secretary Alex] Azar and other officials. How do you feel the industry and NACDS are perceived in Washington?

LANE: It’s amazing when you’re in Washington to see the impact that Steve Anderson and the NACDS staff have. Clearly for me and all the board members who were present during those couple of days, there’s no question that NACDS has a voice on the Hill. That gave us an opportunity to sit with Secretary Azar and really talk about the serious issues that are facing pharmacy today.

We have to work together to make sure that the health outcomes of the consumers are what we’re all focused on — because issues remain with our health care system.

Everyone at RxImpact Day was willing to listen and talk about potential solutions. It was a deeper conversation that focused first on patient care, and then on cost efficiencies. We discussed how the patient — and the health care system — can be improved. And if we can continue to keep that focus, we’re going to be able to get through some of these important issues and improve care for everyone.

CDR: How do you view the Trump administration’s approach to pharmacy and health care?

LANE: The administration has been clear that it wants to reduce the cost of prescriptions for patients. We are 100% on board with that, because that improves medication adherence, which drives better outcomes, and also reduces the cost to the health care system. So now, it’s about how we come up with a plan to accomplish that.

CDR: Do Secretary Azar and others in the administration understand what the issues are?

LANE: I think everyone understands what the issues are. The bigger concern is how to develop policies that deliver the best care possible in a cost-effective way for patients and providers. There are a lot of stakeholders in health care, and it’s complicated, make no mistake about it. But Secretary Azar seems focused on making sure that he can make some big changes and improve patient outcomes. Naturally, we are aligned with that.

CDR: What was it like when you got down to brass tacks?

LANE: We met with the chair of White House Domestic Policy and found that everyone agreed that the current model is unsustainable. We met with so many people — from senators and congressmen to the secretary of HHS [Health and Human Services] — who expressed their commitment to make changes.

CDR: So you may have some good news to talk about at the NACDS Annual Meeting?

LANE: I certainly hope so. I won’t take any credit for it. I’ll give it all to [outgoing NACDS chairman] Mark Panzer. Mark has been a great chairman, and he’s led the way on many issues, including DIR fee reform. He’s made great progress, and we’re excited to build upon that.

CDR: You talked before about securing a bigger role for pharmacists. Where would you like to see that go? Let’s say all the legal hurdles could be overcome. What would you like to see pharmacy be able to do?

LANE: I would like to see pharmacy continue to evolve. A pharmacist is a highly trained medical expert with a doctorate degree that requires six years of education and training. Luckily for me, I only had to do five years! But seriously, let’s leverage that expertise in a way that benefits patient care.

There are so many things that we could do to improve disease state management, and we’re already doing great things with vaccinations today. At ShopRite, we have dietitians in most of our stores, and in many cases, we’ve actually moved the dietitian’s counseling office right next to the pharmacy. That proximity enables our pharmacists and dietitians to work closely and approach a customer’s health and wellness goals more holistically. And I have been getting more letters from customers about how the dietitian has changed their life, and how the dietitian and pharmacist are working together to improve their health.

But a continued evolution of the pharmacist is still critical, as pharmacists become a more important part of the entire health care system. Some of the NACDS board members that I’ve been fortunate to spend time with are in rural areas where the pharmacist is the only health care ­professional.

A retired senator we met at RxImpact Day told us: “When I was growing up, the pharmacist was everything. He was the nurse, the doctor, and when you were sick, you went to the pharmacist. You didn’t think about anything else.”

And if that pharmacist were to disappear, what would those people do? So pharmacists, to me, are invaluable in the health of our patients. As Mark Panzer noted, 91% of the population in the country is within five miles of a pharmacy. So the access is there. We are equipping pharmacists with all the tools they need to provide that level of care, and working on adequate compensation for those ­services.

CDR: When you say the pharmacist and the nutritionist are working together, is that something they welcome? Are they enthusiastic about that ­cooperation?

LANE: Very much so. The dietitians are among the most enthusiastic associates that we have. And our pharmacists have another health care professional to partner with. Pharmacists are clinically trained medication experts. Dietitians are able to assess how a customer’s diet impacts their health. Giving patients access to both of these perspectives can really help patients to improve their health.

Patients often say, “I’m off my medication” or “I take half of the medication that I used to.” Those are important matters that dietitians and pharmacists can handle in the store. Non-pharmacists always joke, “You’re just counting pills back there.” It’s obviously much more difficult than that and much more involved than just filling prescriptions. I see the pharmacist as playing a key role in health care management. It’s exciting to see how pharmacy as a major health and wellness resource continues to evolve. That evolution is already happening.

CDR: How many dietitians do you have at Wakefern?

LANE: We have 110 registered dietitians servicing nearly 140 stores. They provide complimentary health and wellness services through one-on-one consultations, supermarket tours, support groups, weight management classes, cooking classes and more. They help customers make the best nutritional choices based on their unique health care needs.

CDR: It seems that Wakefern is placing a well-being umbrella over the entire organization.

LANE: We certainly are. We feel that, as one of the largest employers in the state of New Jersey, it’s incredibly important that we support the health and well-being of the 75,000 people who work for Wakefern and our member companies. Our dietitians support our associates just as they do our customers.

They’re addressing so many different health concerns, from heart disease to diabetes to gluten intolerance. They also provide services like cholesterol screenings, smoking cessation classes and more.

These are the kinds of services that today’s customers — and employees — are looking for, and through our health and wellness program, we are providing this guidance.

CDR: How do you help shoppers understand what’s in the center-store aisles?

LANE: We have a label system that provides key nutritional attributes to help customers identify — at the point of purchase — the best foods for their own specific needs. Even if the dietitian isn’t out in the aisle, the label will tell you if the item is organic, low sodium, gluten free, heart healthy, and more. Our customers can go online to learn more and also to access healthy recipes and ideas. We have a communications platform designed by our dietitians called Well Everyday, which we’re featuring in store, online, in our circulars and on social media, that promotes these services.

CDR: You talked about expanding the scope of health care services at Wakefern and in the larger industry. Do you see things like vision care, audiology and routine diagnostic tests migrating to a pharmacy setting?

LANE: Yes, I do. Looking over the last decade, you can see the expansion of retail health clinics in chain drug stores and supermarkets like ShopRite. I think it started when some of the larger drug chains purchased companies that operated the clinics. Now we have stores that can provide lab results. With the complexities of today’s health care system and the shortage of physicians, I don’t think there’s any question that pharmacists — and certainly even grocery stores — need to play a bigger role in helping people manage their health care needs. And knowing firsthand how busy families are these days, I think we can all agree that convenience is an increasingly important factor.

CDR: How is technology going to change health care and pharmacy practice?

LANE: Technology is changing every aspect of our business, including our approach toward our pharmacy business. It’s amazing to think of the possibilities — now the Apple Watch can even detect an irregular heartbeat.

Customers want more control and access to information about their own health, and technology enables this. They want easy access to their vitals. They want to know if they can be prescreened, they want to understand their disease state and how their medication works. Technology is a critically important piece of that. At Wakefern, we spend every day talking about what’s next and trying different things. About a year ago, we hired experts who focus exclusively on innovative ­technology.

Technology is disrupting everything in health care, and health care is primed for disruption, so it’s exciting to think of all the progress taking place and how these advances will benefit patients.

CDR: Do you see NACDS playing a bigger role in the technology space?

LANE: Yes, I do. The NACDS Total Store Expo in particular has been doing a nice job with technology in the last couple of years. They have a technology pavilion where they showcase a number of the latest and greatest technologies that will enhance pharmaceutical ­services.

CDR: For good reason, NACDS is very focused on pharmacy. How does the association impact the front-end business?

LANE: The front end is critically important to a lot of NACDS members, and I appreciate the great job that Total Store Expo is doing. I have always thought of NACDS as a great mechanism for having important discussions with our front-end vendors, and I believe our membership feels the same way.

We have a Retail Advisory Board that reports to the NACDS Board of Directors and makes a presentation at every board meeting. The Retail Advisory Board brings us a very broad perspective from associate members and chain members about what they want NACDS to focus on and what they want us to know.

Next year, as NACDS chairman, I will go with the Retail Advisory Board to Houston, where we will visit an H-E-B store and then a CVS Pharmacy. And we will really learn about technology and the different things some retailers are doing, and will be able to spend time with our associate members.

CDR: With all the current changes in the industry, how difficult is it to keep the association together and moving in the same direction?

LANE: NACDS is unique in that you have a lot of different companies that are in a lot of different spaces. And I think NACDS has always navigated that very well. As you have consolidation, greater pressures are certainly put on ­associations.

The NACDS board — because it’s made up of small regional players, midsize grocers, large grocers and mass merchants, large multinational chain drug stores, and associate members — always has insight into what is happening and what the pain points are. And it has done a very good job of making sure that those pain points gravitate to the top.

Steve Anderson and the NACDS team have done a great job of understanding that and making sure that DIR fee reform is at the forefront. They have put the association in a strong position to be able to address these issues, to be able to invest money, time and resources into the most critically important matters. The NACDS campaign on DIR fee reform in Washington, D.C., is a great example of this effort.

Every day we must continue to focus on how we move more quickly and how we get government to move more quickly, because every day the windows of opportunity narrow. And the big fear is that access to pharmacists is going to be a lot more restricted over the next couple of years if something doesn’t change. And that’s a concern for us.

CDR: You said that DIR fees threaten the regional chains. Things must be even more difficult for independent ­pharmacies.

LANE: Make no mistake about it, everyone — from the largest companies to the smallest — is impacted by DIR fees. For independents, it may be even harder, because of the cash flow challenge from DIR fees.

CDR: Why has the problem reached a crisis point?

LANE: In the last five years, DIR fees have risen exponentially, with very little explanation as to why. And I think that as you look at retail pharmacies, PBMs and insurers, attempts to get costs out of the health care system have led us to this point.

We’re at the point now where something has to change. This is the time where we need to fix it. DIR fees need to be addressed so that we can retain our focus on the important thing — the customer’s health. Unfortunately, it was a train moving very quickly and it got out of control.

We have to talk to the right people, including Congress. We’re trying to get people to understand what a DIR fee is and the flaws in the system. Hopefully, we’ve laid the groundwork so we can come out on the other side in a much better position.

CDR: Longer-term, do you think the basis for remunerating pharmacies will have to change in a fundamental way?

LANE: Yes, and we have to reach a solution that allows pharmacies to be compensated for all the health care services we provide today and can provide in the future that help reduce the overall health care spend.

CDR: Has NACDS weighed in on the rebate issue?

LANE: NACDS has submitted comments based on extensive engagement and tremendous insights from the membership.

CDR: We talked about pharmacists doing more than they have in the past. Are physicians supportive?

LANE: Almost everything we do depends on the individual state, and almost everything we do is done in a collaborative practice with a physician. So even when we’re providing vaccinations or medication profiles or disease state management, it’s almost always in collaboration with physicians.

As you see clinics open up in the stores, pharmacists have more of a role in vaccinations and disease state management. I think physicians understand that — especially in light of the physician shortage — and recognize it as a plus. Physicians have the same struggles with the health care system and reimbursement that we do. So I think that if we all focus on the patient, and the end result of the patient, it’s hard to argue against cooperation between pharmacists and physicians.

CDR: How do you feel about your upcoming NACDS ­chairmanship?

LANE: I am excited about it. There are many challenges ahead, but I also think it’s a time of great opportunity. I’m focused on the critically important issues and responding to the membership of NACDS. NACDS does a fantastic job as an advocate for pharmacy, and my goal is to ensure that I do everything I can to help them in that quest.