From top to bottom, retail pharmacy will prove pharmacist role in improving patient outcomes
Pharmacy’s value as part of an outcomes-based healthcare alignment was the highlight of the closing business presentation at the National Association of Chain Drug Stores’ 2013 Annual Meeting. And now it’s up to NACDS members to expose Congressional leaders to that value quotient on a regular basis.
That was the message shared by incoming NACDS chairman Bob Narveson. It goes to show that even as the gavel passes from the head of one of the industry’s largest pharmacy chains to one of the smaller chains, innovation in patient care is happening at all levels.
"To be successful, we’re going to have to maintain access to patients [incoming from the Affordable Care Act]," Narveson told DSN as part of a pair of exclusive video interviews. (The first video interview one can be found here.) "We’re going to have to step forward and we need to get to the point where we realize that there’s more to taking care of patients by just putting pills in a bottle" he said. "We have to get to the point where we have face to face MTM, where we’re working with our patients on their medication adherence and where we continue to drive home that and we can prove it."
And both Narveson and Thrifty White, one of DSN‘s PoweRx Players, have put their money where their mouths are. Thrifty has enrolled as many as 24,000 patients on a Medication Synchronization Program, where patients receive all their medication refills on a single day. "We have people with as many as 20 medications on Medication Synchronization," Narveson said. "It’s very difficult to maintain those pills on a regular basis," he added. "It’s programs [like these] that need to be brought forward to help impact that $290 billion [in cost associated with medication non-adherence]."
According to a study conducted by Virginia Commonwealth University in 2012, patients enrolled in the program have 3.4 to 6.1 times better adherence rates vs. people not enrolled in the program.
Pharmaceutical distribution agreements critical for Cardinal, McKesson
Cardinal Health announced the renewal of its pharmaceutical distribution agreement with CVS Caremark to supply pharmaceuticals to the company’s retail pharmacies and distribution centers, as McKesson, which generally serves the PBM side of the business, also announced the renewal of its current distribution agreement with the pharmacy retailer.
The renewal of the agreements was not only critical for both companies but, as Adam Fein, president of Pembroke Consulting and CEO of Drug Channels Institute, wrote in his blog post, “CVS Caremark Renews with Cardinal and McKesson,” it also “demonstrates wholesalers’ value in the brand-name pharmacy supply chain.”
“In theory, the largest self-warehousing chain drug stores and mail pharmacies have the size and scale to perform the functions of drug wholesale distribution. Yet in 2012-13, these larger companies all elected to buy brand-name drugs via a drug wholesaler rather than directly from a manufacturer,” Fein wrote.
It is also important to note that Walgreens and Alliance Boots recently entered into a 10-year contract with AmerisourceBergen on sourcing pharmaceuticals and also has the option on a potential 23% equity stake in ABC in three years.
This deal takes the pharmaceutical buying leverage to a new level and creates a generic acquisition juggernaut, as Drug Store News senior editor Michael Johnsen pointed out in “Walgreens, Alliance Boots and AmerisourceBergen help redefine economies of scale.” There’s also another benefit — the potential collective bargaining power of close to 12,000 retail pharmacy outlets, between Walgreens and ABC’s Good Neighbor Pharmacy Provider Network, that can be leveraged against PBM contracts.
Rogue Internet pharmacies should be primary focus in efforts to secure supply chain
A House Subcommittee on Health hearing Thursday focused on efforts to strengthen the country’s pharmaceutical supply chain, and particularly on draft legislation meant to accomplish that.
While often touted as the safest in the world, the U.S. drug supply chain remains vulnerable to counterfeit, adulterated and stolen medications. Given the potentially dangerous risks of using such medicines, it is imperative that they be kept out.
But as testimony by National Community Pharmacists Association spokesman and pharmacy owner Tim Davis, as well as statements by Republican Rep. Morgan Griffith of West Virginia made clear, requiring community pharmacies to implement complicated and expensive track-and-trace technology would place a tremendous burden on them — specially independents.
In Davis’ words: "At the present time, the technologies that would be required to implement such a system are not fully developed and have not been designed or scaled to be feasible or affordable for use in individual community pharmacies."
But a major source of counterfeit, stolen and adulterated drugs isn’t the corner drug store, but online pharmacies. On Tuesday, the Food and Drug Administration launched BeSafeRx, an interactive map on its website that allows users to find legitimate online pharmacies licensed by state boards of pharmacy. Such a tool could be useful because, according to a report released in October 2012 by the National Association of Boards of Pharmacy that examined more than 10,000 online drug sellers, 97% were found to be doing business illegally.
The dangers of such rogue pharmacies can’t be overstated: In May 2012, the FDA alerted consumers about fake versions of Teva’s attention deficit hyperactivity disorder drug Adderall (dextroamphetamine saccharine; amphetamine aspartate; dextroamphetaine sulfate; amphetamine sulfate) that were being purchased online amid a shortage at the time. The fake version contained the wrong active ingredients, specifically tramadol and acetaminophen, which are used to treat acute pain. It’s worth noting that while approved by the FDA for treating ADHD, Adderall is also a common target for prescription drug abuse.
As Davis said, most pharmacists are well-aware of the possibility of counterfeit and diverted drugs and thus purchase only from trusted sources. For that reason, the federal government might have more success keeping such contraband out of the country by thwarting the efforts of rogue Internet pharmacies and encouraging consumers to avoid them as well. Efforts like BeSafeRx and the National Association of Boards of Pharmacy’s campaign to register .pharmacy as a top-level domain reserved for licensed online pharmacies are both steps in that direction — not forcing community pharmacies to devote disproportionate resources to solving a problem that isn’t really about them.