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Competition Bureau signs off on sale of 13 Loblaw-owned stores and pharmacies

BY Ryan Chavis

OTTAWA, Ontario — The Competition Bureau, an independent law enforcement agency focusing on Canadian businesses, has approved the sale by Loblaw of two No Frills stores to Metro, and two Shoppers Drug Mart stores to the Jean Coutu Group. Additionally, the bureau approved the license of nine pharmacies within a Loblaw store to Remedy's Rx.

The transactions are being executed under the March 2014 Consent Agreemnt between Loblaw and the Bureau relating to the company's acquisition of Shoppers Drug Mart. The transactions are meant to maintain competition in the retail pharmacy sector in Canada.

Competition, in general, translates into lower prices for the consumer as well as more choice, a wider range of service options and increased innovation, the bureau said. When reviewing Loblaw's aquisiton of Shoppers Drug Mart, the bureau studied the level of retail competition in every market where both a Loblaw-owned grocery store and a Shoppers Drug Mart were present. The bureau discovered competition concerns in 27 such markets. As part of the Consent Agreement, it is required that Loblaw sell the remaining 14 retail stores. That process is ongoing, according to the bureau.

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Walchirk emphasizes embracing change in rapidly expanding community pharmacy industry

BY Michael Johnsen

ORLANDO, Fla. – Addressing 3,000 independent pharmacy attendees representing more than 1,000 pharmacies at the McKesson ideaShare 2014, Mark Walchirk, president of McKesson’s U.S. pharmaceutical unit outlined the myriad of opportunities open to community pharmacy today, and how McKesson is investing in its independent pharmacy offerings to help those independents realize every one of those opportunities.

“The pace of change right now in healthcare is as rapid as I’ve experienced in over 25 years,” Walchirk said. “With all that change, it creates both challenges and opportunities,” he said. “We feel very confident that to succeed, McKesson and independent pharmacies have to engage, adapt and take action.”

There are a number of growth factors driving that pace of change, Walchirk said, including the healthcare reform that’s bringing more covered patients into stores; an aging population; growth in specialty and generics; new drug launches; and adherence opportunities. “Adherence opportunities is something I have a personal passion around,” Walchirk said, noting that between 20% and 30% of prescriptions are never filled and half of all prescriptions are not adhered to. “If you can improve adherence by 10%, 20%, 30% in this country, what a huge opportunity that is for growth in prescription pharmaceuticals, and frankly what a huge opportunity that is for the health of our country, to ensure that they take the medications as they’re supposed to based on the therapy.”

But there are challenges, too, Walchirk noted. Challenges such as the growth in preferred networks, reimbursement pressures, a consolidating marketplace and the intense competition for patients.
Walchirk outlined a plan to focus on three key areas to promote independent pharmacy’s success: increase access to those preferred networks, increase traffic in the stores, and drive efficiencies and expand the business opportunities.

Take preferred networks, for example. “Going forward, that’s going to become more and more focused around shifting to performance based networks,” he said. “What will happen in these limited preferred networks is, those stores that perform at a high clinical level associated with Star ratings, or some other metrics in the future, will be able to be part of that network, and perhaps, those stores that are at the bottom of the performance scale will be left out of the network. Quite frankly, that, I believe, is a huge opportunity for independent pharmacy. Because, let’s be honest, it’s difficult for an independent pharmacy owner to compete on a purely cost basis. But it’s not difficult for an independent pharmacy to compete as it relates to the relationship you have with your patients and the opportunity to improve clinical outcomes.”

To help independent pharmacy get there, McKesson has formed initiatives like its “Know your Number” campaign where pharmacies are encouraged to know their Star ratings through EQuIPP, an online information management platform that helps pharmacists measure and understand clinical performance. McKesson also has held 100 town hall meetings across the country to inform independents of their Star ratings. “It’s absolutely critical that you understand this crucial part of reimbursement and how it will impact your business going forward,” Walchirk said

There are also a number of tools available through McKesson to help increase foot traffic at the stores, including Health Mart’s regional advertising suite and the physician outreach program. “These are specific tools that we have to increase foot traffic in your store,” Walchirk said.

McKesson also is making strides to improve efficiency across its generic business. “I will assure you that we’re very focused on making sure we have a complete portfolio, that we’re very competitive on our generic pricing and that we continue to drive sourcing benefits, building scale in our generic purchasing, so that we can help bring that scale and better pricing to all of you.”

Following Walchirk on the stage was Elizabeth Estes, chief idea officer at Ebus Innovation, to speak to ideaShare attendees about good innovation. There are three kinds of innovation, she noted, including disruptive innovation that creates a market where before there were none (e.g., digital medicine), sustaining innovation that augments an existing market (e.g., Google and Novartis’ commitment to develop the contact lens blood-glucose meter) and everyday innovation (e.g., the kind of innovation independent pharmacies employ everyday).

As an example, Bretton and Stay Walberg of Jamestown Pharmacy invested in McKesson’s medication packaging solution and then marketed that solution to their community as a complimentary convenience program. That convenience program, branded Care-Fill, netted the community pharmacy 600 new patients and increased their prescription count by 57%.

Finally, McKesson’s Frank Starn, president of global sourcing, and Steve Courtman, president of Health Mart, welcomed Hashim Zaibak of Hayat Pharmacy to the stage as the 2014 recipient of McKesson’s Pharmacy of the Year award.

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KEY LEARNING: CE sessions begin with bang

BY Antoinette Alexander

ORLANDO, Fla. — Even before the official start of this year’s McKesson ideaShare conference, the Gaylord Palms Resort and Convention Center was buzzing with attendees eager to take advantage of the robust lineup of continuing education courses held on Sunday and Monday.

This year’s agenda is packed with more than 30 accredited courses to equip attendees with the latest thinking and best practices in clinical services, new drug therapies, financial management and marketing.

Sessions that kicked off the event on Sunday included:

  • “Statins and Statin Adherence: The Good, the Bad … Well Really It is Mostly Ugly.” Presenter Janelle Ruisinger, clinical associate professor at the University of Kansas School of Pharmacy and director of the KU Community Pharmacy Residency Program, discussed some of the common reasons for statin non-adherence, identified the differences between individual statins and spoke about ways pharmacists can improve adherence. According to Ruisinger, nearly 75% of new statin users stop their medication by the end of the first year, up to 50% stop taking their medication within months of the initial prescribing and 25% stop after one month. While the reasons for non-adherence vary by patient, the most common reasons are side effects like muscle complaints. To help pharmacists, Ruisinger provided such tips as utilizing adherence tools like medication synchronization and adherence packaging, providing oral and written easy to understand instructions, considering switching the statin, considering a lower dose of the current statin and monitoring for concomitant drugs that may increase risk of myopathy.
  • “ACOs: Position Your Pharmacy for Inclusion.” Bruce Thompson, director of pharmacy services at Hennepin County Medical Center in Minneapolis, examined patient populations that community pharmacies can work with to assist health systems, urged attendees to analyze the opportunity with their health system and discussed how to develop a business plan to be included in their health plan. According to Thompson, those pharmacists that successfully position their pharmacy to be included in accountable care organizations can benefit by gaining additional prescription volume, obtaining a loyal patient base, providing better patient care and becoming part of a healthcare team.
  • “Coaching at the Counter — Opportunities for Enhancing Communication with a Patient-Centered Approach.” Nora Stelter, associate professor of pharmacy practice and coordinator of introductory pharmacy practice experiences at Drake University College of Pharmacy and Health Sciences, discussed the shift in healthcare toward a quality focus and the importance of medication adherence. Among the key points discussed during the course was the action pharmacies can take to improve and measure performance. When reviewing at your dashboard, Stelter suggested  analyzing patient engagement and adherence performance; determine areas of focus and tactics (i.e. ask every time a prescription is picked up how they are doing and use motivational interviewing or health coaching techniques); and monitor progress and make adjustments accordingly.
  • “Diabetes and Quality: How Does Your Pharmacy Measure Up?” Jonathan Marquess, VP of professional and clinical affairs for the American Pharmacy Cooperative, outlined the impact of diabetes on patients and the healthcare system, discussed the Pharmacy Quality Alliance and measures related to diabetes and described why diabetes quality measures are important to pharmacy. According to Marquess, now is the time to start assessing whether a pharmacy is meeting quality goals and how it ranks compared with peers. Steps pharmacies can take to help improve patient adherence include medication synchronization, motivational interviewing, blister packaging and central fill.
  • “Game Changers in Pharmacy Practice.” Geoffrey Wall, professor of the Department of Clinical Sciences at the College of Pharmacy at Drake University, discussed some of the game-changers impacting pharmacy and how they affect the way pharmacists care for patients. Game-changers include, but are not limited to, biosimilar drugs, corticosteroid tapers and COPD, and the rise in the price of generic medications.
  • “Social Media: Brand Management vs. Brand Damagement.” Samantha Timmerman, chief marketing officer of Pharmacy Development Services, discussed the importance of not setting and forgetting your social media presence. Some tips that Timmerman shared with attendees included: be a resource for all things happening around town by linking to other web sites and Facebook pages, create Facebook events for the pharmacy’s next diabetic education course or customer appreciation day and invite the pharmacy’s entire online community, post healthy recipes, and crowdsource to let your online community help guide buying decisions.
  • “Practical Steps for Integrating MTM into Your Daily Practice Routine.” Pharmacy of the Year winner Hashim Zaibak, majority owner of Hayat Pharmacy in Milwaukee, Wis., helped attendees understand the obstacles when starting a Medication Therapy Management (MTM) program and how to overcome those obstacles. According to Zaibak, MTM is a great way to impact patient outcomes and establish an emotional connection with patients. It also is an opportunity for provider collaboration, one of the best programs to use clinical knowledge and can provide additional income (e.g., clinical services revenue and prescription volume).

Some highlights from Monday morning’s sessions included:

  • “New Drugs 2014.” Tom Frank, director of research and education at the University of Arkansas for Medical Sciences – Northeast, reviewed new trends in drug development and provided a broad-based discussion on new drug options. Drugs he discussed included, but were not limited to, Invokana (canagliflozin), Farxiga (dapagliflozin), Nesina (alogliptin) and Diclegis (doxylamine/pyridoxine delayed release).
  •  “Customer Loyalty Begins on the Outside.” Dave Wendland, VP of Hamacher Resource Group, identified factors that set the stage for pharmacy operation and summarized common issues and challenges facing independent retail businesses. According to Wendland, there are five factors that set the stage: Branding, location, appearance, promotion and people. In wrapping up his presentation, Wendland shared four tips for independent pharmacy: Ensure a strong business foundation, build a rock solid reputation, develop a never give up attitude, and enjoy your profession and your business.
  • “Black Ink: Cashflow Management Secrets.” Tom Shay, principal of Profits Plus Solutions, helped attendees understand how to accurately project their sales, inventory and cash needs. Shay said it is not about eliminating your accountant, but learning a new way of accounting. Why is this important? According to Shay, if you start 100 businesses today, only five will be in business in five years, only two will still be in business in 10 years, and, of those that fail, 54% have a profitable income statement.
  • “Implementing Medication Synchronization.” Wendy Lantaff, PGY1 community pharmacy resident at the University of Iowa, Towncrest Pharmacy, shared how pharmacists can implement a medication synchronization program in their pharmacy. Why synchronize? The benefits include increased efficiency, increased fill rates, reduced hospital readmission due to medication errors, improved patient relationship, better inventory control, less stress in the pharmacy and healthier patients.
  • “340B Contract Pharmacy – Business and Professional Opportunities in a Dynamic Healthcare Marketplace.” Chris Shain and Julie Houston from the McKesson U.S. Pharmaceutical 340B Solutions Team, explained the 340B program, the vendor processes and the impact it may have on business. One piece of advice shared with attendees: Understand a vendor’s model on how they convert to 340B and the impact it may have. For example, do they operate a financial screening model, an all prescriptions model or a gain share model?
  • “The 2014 U.S. Pharmaceutical Market: Looking Back and Looking Ahead.” Doug Long, VP industry relations at IMS Health, shared predictions that will help make retail pharmacies successful in the future. For example, top specialty events to watch for include: growing demand for value driven metrics/adoption of guidelines, patient as a payer (specialty tier in exchanges) and new entrants with more oral medications on the horizon.

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