BOSTON — These days, everywhere community pharmacy operators turn there seems to be a new challenge. But in a roundtable discussion held by Chain Drug Review, industry executives indicated that they’re more than up to the task.
Over the weekend, chain drug stores and other prescription drug providers began to feel the fallout from the reduction in average wholesale prices mandated by the settlement of a class-action lawsuit. And later this week, they will have to comply with new federal regulations or risk disrupting patient care for users of durable medical equipment, a group that includes people with diabetes.
Battles in the states over Medicaid reimbursement levels continue to flare up. And the ongoing fight over health care reform legislation is full of both promise and peril for the industry.
Those subjects receive their fair share of attention in the Chain Drug Review roundtable, which involved representatives of major pharmacy retailers and key suppliers.
In light of the problems that confront the pharmacy profession, one might expect that a downbeat mood would have pervaded the meeting, which was held in conjunction with the National Association of Chain Drug Stores Pharmacy & Technology Conference in Boston. The opposite was true.
While fully cognizant of the current difficulties, the executives collectively articulated a vision of a profession on the brink of finally realizing its potential for improving patient outcomes and limiting overall health care costs.
"That’s how the industry is going to change," said Kermit Crawford, senior vice president of pharmacy at Walgreen Co. "It’s going to go from being product- to customer-focused, and from a transaction-based environment to an outcomes-based environment."
"The language we now use is very different," explained Papatya Tankut, vice president of pharmacy professional services at CVS Caremark Corp. "It’s about healthier outcomes. It’s about improving the care of patients. It’s about continuing care."
Reasons for optimism are at least as compelling as causes for concern. Many of the goals included in health care reform legislation — improving access, affordability and efficiency among them — are in close alignment with retail pharmacy’s strengths, according to the roundtable participants.
"As it exists today, the health care system is not sustainable. Everyone around this table realizes that we play a valuable role that can and should be expanded," said Ron Chomiuk, vice president of health and wellness sales and contracting at Wal-Mart Stores Inc. "If we wait for some big mandate to make these changes, shame on us. There are things that we need to be doing to change health care and improve outcomes. We should not expect the government to do that."
With a drug store, on average, within five miles of where most Americans live or work, the industry has unparalleled reach. Illustrating that point is the recent push by many drug chains to get a head start in deploying seasonal flu shot programs and to prepare for the distribution of the H1N1 "swine flu" vaccine, which gives the industry a chance to show its health care potential, executives said.
"It’s going to be a challenging fall, but pharmacy has the opportunity — if we prepare appropriately — to demonstrate our worth as an important health care entity," said Dan Miller, vice president of pharmacy operations at Rite Aid Corp.
In-store clinics, too, are pivotal in demonstrating the health care capabilities of chain drug retailers, roundtable participants pointed out.
"These clinics are a tremendous opportunity for pharmacists and for pharmacy in general," said Sean Spears, senior director of pharmacy and trade relations at Esai Inc. "There’s a great message here, but I don’t think we’re doing enough to communicate it. These clinics offer a great service at a very cost-effective price and offer the public a great alternative to emergency rooms."
Another task at hand for the industry is to maximize the impact of the professionals who staff those outlets by enabling pharmacists to spend the lion’s share of their time counseling patients and interacting with other health care providers. Executives cited technology as one key enabler in that regard.
"One of the interesting advances is the heightened awareness of the benefits of greater pharmacist involvement and the role of technology in facilitating pharmacy’s expanding role," said Brian Bertha, senior vice president of marketing at McKesson Corp.
John Fegan, vice president of pharmacy at Winn-Dixie Stores Inc., noted, "We need to capitalize on the technology that will give our pharmacists the ability to do more than count and pour. If everybody came in and wanted prescriptions filled and wanted to talk for 45 minutes to a pharmacist, we would be in big trouble. We’re not currently set up to do that."
Greater pharmacist-patient interaction also will help ensure that the right medications are used as directed to bring about the intended results, executives added.
"We want pharmacists talking to the patients," said Bill Parks, director of trade operations at Centocor Ortho Biotech Services. "As we develop new biologic drugs in particular, there’s a great need to have pharmacists interacting with the patients."
Medication therapy management (MTM) is designed to do just that. As programs cited by the roundtable participants show, MTM is good for patients and helps limit the total cost of treatment.
"This is a unique opportunity for pharmacy," said Steve Anderson, president and chief executive officer of the National Association of Chain Drug Stores. "If more people are coming into the health care delivery system and there is a severe shortage of primary care physicians to start off with, one of the best messages we have is the importance of medication adherence and the role that MTM plays."
"We recognize that adherence improvements will come, provided that every patient-centered conversation includes the need to adhere to FDA-approved dosing," noted Alice Swearingen, head of channel development and sales at GlaxoSmithKline PLC. "Only then will patients experience the full potential of the treatment. The pharmacist is the final touch point for the patient in this message."
MTM also has the virtue of shifting the focus for pharmacy reimbursement from products provided to services rendered, a change long sought by members of the profession.
"Outcomes are key," stressed Mike Coughlin, president and chief executive officer of ScriptPro. "Pharmacy needs to be embracing the pay-for-performance concept because it’s definitely coming. The fee-for-service, fee-for-transaction model is not going to be here for long one way or the other, and pharmacy needs to get out in front of that transition."
The move toward MTM gained important momentum when it was included in the legislation that established a prescription drug benefit under the Medicare program, and it could get a further boost from health care reform. "If you talk about MTM and the role that pharmacists can play, that represents a paradigm shift for members of Congress. This is real prevention," Anderson explained.
Whatever the fate of current proposals to change the system, pharmacists are all but certain to take on greater responsibilities going forward, according to executives.
"Over the past couple of years, we’ve been working to change the perception of community pharmacy, which many policy makers had not thought was part of the health care delivery system," Anderson said. "This gives us an opportunity to band together and to carry that message forward as the health care reform process unfolds."
Close cooperation between physicians and pharmacists, which traditionally had been limited, is becoming the norm, according to the roundtable participants.
"There’s a dramatic shift in perception under way, because if doctors are now reaching out to pharmacists, they’re going to mention the encounter to their patients. The patients will then reach out to the pharmacists," said Marc Cohen, senior director of marketing at RelayHealth Pharmacy Solutions. "As a result, pharmacists become more than just someone involved in ‘lick, stick and pour’ activity. They become educators and facilitators, and they assume an active role in the center of health care."
During the course of their training, future pharmacists and physicians now have greater interaction than in the past. They develop a team-oriented approach to patient care in which the latter rely on the former’s unequaled understanding of pharmacological agents, their effect on the body and possible adverse drug interactions. That relationship is slowly establishing itself in the real world, as new pharmacists, who hold doctorate degrees, and physicians enter the workplace.
"Good relationships between future pharmacists and future physicians are starting in the schools. It’s a natural course of development," said Chomiuk.
That trend, together with community pharmacy’s increasing sophistication and efficiency in terms of processing scripts and the expansion of the industry’s scope to include such things as in-store clinics and immunization programs, should guarantee that pharmacy’s best days lie ahead, roundtable participants said.
"We as retailers benefit from the fact that there are going to be more visits to the pharmacy and more money spent within the pharmacy if patients can receive valuable clinical services from pharmacists," Bertha said. "That’s a key driver that we’re just starting to look at, and I think we’re going to be pleasantly surprised."
"Pharmacy practice is changing, our language is changing and our pharmacists have to evolve," Tankut observed. "We have to alter our businesses to adopt that evolution, whether it’s through technology, expanded use of technicians or shifts in reimbursement policies. It’s not happening as fast as we’d like, but I’ve seen a positive change over the last several years."
*EDITOR’S NOTE: For the full roundtable report, including in-depth discussions on the topics raised here, please see the September 28 print issue of Chain Drug Review.
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