PHARMACY

Flipping the script: The state of the pharmacy industry

BY Sandra Levy

What’s driving the pharmacy business these days? Besides the usual concerns about government legislation, sales and profits, and the endless battle to find the right pharmacist to man the counter, retailers and suppliers point to a number of other trends that could — if properly developed — help pharmacy operators streamline their operations, increase efficiencies and improve the quality of patient care.

There is no doubt that retailers have their hands full with their pharmacy business, but, at the same time, many merchants are becoming more and more convinced that such things as automated robotic prescription dispensing, pharmacy counseling and medication management, immunizations, home delivery of prescription drugs, and discount prescription pharmacy cards can help them better connect with consumers.

In the end, many have said, retailers need to include many of these services and technologies if they want to stay ahead of the curve and keep their pharmacy counters relevant and profitable.

The question, of course, is what to focus on and how to implement the strategies that best work for individual chains. Finding the money to put these programs into place also is an important issue, though many industry officials emphasized that they often quickly pay for themselves by bringing in new business.

Expanded Care
Pharmacies no longer being able to turn a profit on volume alone has proven a boon to pharmacists looking to flex their clinical muscles. Pharmacy services that go beyond filling prescriptions — from medication therapy management and medication synchronization to vaccines and disease state management — are an increasing part of the pharmacy’s offerings and opportunities for reimbursement.

When it comes to disease state management, one of the largest need areas is in counseling patients with diabetes who tend to visit the pharmacy three times more than an average shopper. In order to help enable such counseling, Franklin Lakes, N.J.-based BD provides education kits supporting such educational opportunities as proper insulin injection techniques.

“We’re moving away from treating patients with diabetes by just dispensing a script and device to how do I get to the patient and help them across the store, from their prescription to OTCs, to foods,” said Stephan Braun, BD’s vice president of retail sales. “For retailers, there’s a whole angle to disease state management and wellness across the entire store, and they can integrate that via an app and counseling sessions so they can become more relevant and create engagement with their shoppers.”

More services from pharmacists who aren’t behind the counter translate to healthier patients, and a boost in sales for the store, Braun said.
“When a pharmacist talks to patients, they get higher loyalty rates,” Braun said. “When a pharmacist discusses regimens, they get higher levels of adherence. [Plus,] about 60% of patients who talk to a pharmacist will end up buying another product other than the script they came in to fill. That’s a tangible benefit, and it’s a real differentiator for the pharmacy.”

Another area of engagement through which pharmacists work to boost adherence is medication therapy management, which Sandra Canally, CEO of the Compliance Team, said is a path to both enhanced patient care and more revenue. Such clinical services leverage the pharmacy’s role in its patients’ lives to offer services that help them.

“It’s about identifying the needs in your community and actually reaching out to meet those needs through medication therapy management,” Canally, who founded the pharmacy accreditation organization 24 years ago, said. “These are growing areas for the pharmacy to identify as business opportunities and adding services to better meet their patient population.”

Helping patients with chronic pain manage opioid prescriptions and medical marijuana are two additional trends that bode well for pharmacies’ profitability. “There are ways to prevent the opioid crisis as part of the pharmacist’s role in medication management, and monitoring the patient so patients don’t have difficulty moving forward,” Canally said, noting that they open an avenue for pharmacists and physicians to work closely. “Care coordination between prescribers and pharmacists is key.”

Vaccines and travel clinics also are offerings that pharmacy operators are exploring to expand their clinical reach.

“There are a lot of pharmacies adding additional vaccines and counseling for healthcare workers, executives and others who travel to other countries,” Canally said. “That’s a growing opportunity, especially with medical tourism and folks traveling for medical services to other countries. Prior to going to these countries, they need to know what vaccinations they need, as well as any public health issues.”

More pharmacies also are offering point-of-care testing for patients. Recently approved devices that can help diagnose a patient with diabetes have joined other tests for such conditions as the flu and strep throat — BD’s Veritor Plus system can help detect the flu, strep and respiratory syncytial virus — giving pharmacies the ability to provide test results in minutes and differentiate themselves from competitors.
Yet these patient interactions necessitate a private space, which pharmacies also need to be able to use for MTM to vaccinations. Corona, Calif.-based Uniweb is focused on space solutions for pharmacies — and a growing part of its business has been creating consultation areas in places where space is tight, according to Ron Mackert, Uniweb vice president of marketing and sales.

“All pharmacies are trying to be more of a total healthcare provider. We build private rooms that can be multipurposed,” he said, noting that the company built a 1,300-sq.-ft. room for Costco that included a counseling station, a store manager station, a pharmacy area and a restroom. Uniweb also offers modular rooms and modular components that can adjust and fit to existing pharmacy space. “The smallest is 8 [feet] by 8 [feet,] and there are larger sizes to meet pharmacies’ needs. Theses rooms are perfect for one-on-one consultations or for giving vaccinations.”

It also is worth noting that the increased clinical role of the pharmacy is the largest impetus for advocates asking lawmakers to grant pharmacists provider status under Medicare Part B. In addition to codifying the pharmacist’s role in the healthcare system, it also would make pharmacies eligible for other reimbursement opportunities.

As they wait for a higher status within Medicare, pharmacies are looking to long-term care services as a way to show their worth to health insurers. Canally said that because payers look for independently approved programs, the Compliance Team offers LTC pharmacy accreditation.
“If pharmacists want to go to a payer and show the additional services they’re doing, they‘re going to stand a better chance of getting recognized by the payer if the pharmacy has been validated by a third-party accreditor,” she said. “The accreditation program is a way to validate the quality as it relates to these services.”

Finding the Time
As pharmacists are making big moves in patient care, they also are acutely aware of the fact that there are only so many hours in a day and only so much space behind the counter, where they must get more
done, faster.

“Retail is reluctant to relinquish any space to pharmacy,” Uniweb’s Mackert said. “Whether it’s in a grocery store or standalone, the line between retail and pharmacy is a hard line that does not get crossed. When the store is built, whatever footprint they have is what they have, so as the prescription volume increases, they can’t increase the space. They have to find a way to increase the efficiency within the same space. We increase the usable space within that same box.”

Mackert said Uniweb’s clients, which include CVS Health, Rite Aid, Walgreens, Wegmans, Safeway, Kroger, Publix, and H-E-B, are big on efficiency. “We give them the ability to process a larger number of scripts without growing the footprint,” he said. “We just increase the usable space vertically and horizontally within the space.”

Alongside optimizing the space for pharmacists and pharmacy technicians, companies increasingly are investing in pharmacy automation to improve efficiency and free up time to enable personalized patient care. Though they come with sometimes hefty price tags, they also are capable of handling much of the more tedious aspects of the job, according to officials at automation companies.

Mission, Kan.-based ScriptPro offers six robots, including the Compact Robotic System 150, which rings up at $138,250. “Most folks have never spent that much on piece of equipment for pharmacy,” said ScriptPro director of sales Brian Glaves. “To get that across is difficult, but when they look at the total price and the cost over five years, and the number of hours the pharmacies are open, the system costs $9.66 an hour.”
Glaves touted the CRS 150’s ability to increase pharmacy’s efficiency and eliminate the costs associated with hiring, training and retaining pharmacy technicians. He also noted that ScriptPro has given thought to which drugs see the most use and its clients’ space constraints.
“The system can handle 150 drugs, so the number of drugs hits the sweet part,” Glaves said. “The average pharmacy may have 1,200 to 2,000 separate NDCs on their shelves, but the top-150 drugs account for 40% to 50% of total sales. The footprint is 20 in. by 68 in., so it’s a very small footprint that can be placed against a wall. One of our customers in the Chinatown section in New York City pays $18,000 a month for their rent, so every square foot has to be utilized. Footprint means everything.”

In addition to taking over the lick, stick and pour responsibilities of the pharmacist, the robot grabs the vial, counts pills into the vial, labels the vial, puts the auxiliary warning on it, shows what the pill looks like, and presents it to a tech or the pharmacist for verification — all in 30 seconds.

Given that 80% of the drugs ScriptPro clients dispense are generics in different sizes and shapes, ScriptPro’s system offers a thumb screw on its cell that adjusts the width of the pill. “You can go from the tiniest to the largest width by adjusting one simple thumb screw,” Glaves said. “The ability to go from one drug to another is paramount in pharmacies as they dispense different generics.”

For pharmacies with more square footage, Johnson City, N.Y.-based Innovation offers its PharmASSIST Symphony high-volume automation solution, which uses an intelligent operations management platform that the company said allows for dynamic prioritization and workload balances to automatically adapt to demand changes. It also includes pneumatic vial and cap delivery, a conveying system, workstations for manual filling and several other features. Texas pharmacy benefit manager MaxorPlus recently installed the PharmASSIST in its MXP mail-order facility in Amarillo, Texas.

Free time isn’t just found through automation, though. Software also plays a large role in helping pharmacists keep a tight ship — and in maximizing patient adherence.

Spartanburg, S.C.-based QS/1’s pharmacy software is designed to improve efficiency and profitability by helping pharmacists with the task of medication synchronization, aligning all of a patient’s prescriptions to be filled on the same day.

“Once we have it automated in the system, it tells the pharmacist that the person’s medications are due to be refilled on a certain day, so they can plan accordingly,” Ed Vess, senior manager of pharmacy professional services at QS/1, said. “This improves the patient’s compliance, and it helps pharmacists because it makes us notice more when patients are late, early or don’t show up.”
This offers pharmacists an opportunity for another patient touchpoint, placing a follow-up call to check if their situation has changed. “That TLC and reaching out will help them remain compliant,” Vess said. “You are capturing prescriptions that may not be filled. It’s a win, win, win for pharmacists, patients and the physician.”

Pharmacy software also can help pharmacies keep track of such factors that impact reimbursement as formulary compliance, and they work hand-in-hand with the clinical offerings in a pharmacy. Vess said QS/1’s system can help identify patients who might benefit from a pharmacist intervention. For example, if patients have high blood pressure, they are likely to also have high cholesterol or possibly another circulatory issue.

“Once we identify a diagnosis on the patient chart, it provides the basis for our clinical review,” he said. “Improper or incomplete medication regimens should prompt a call to the prescriber.”

Convenience — Inside and Out
Delivery of medications to homes and in-home counseling also are on the upswing. Canally said that it goes back to better meeting the needs of the patients in their individual communities “so there’s no choice but for the patient to stay with the pharmacy and the pharmacist they’ve known for years.”

As Amazon has grown as a competitor — the company’s long-rumored entry into pharmacy has come partly through the recent acquisition of PillPack, which offers presorted, home-delivered medications — some of the largest drug chains are focusing on home delivery to make their patients’ lives easier, while bringing in some scratch.

CVS Health’s retail division, CVS Pharmacy, rolled out prescription delivery from all of its locations nationwide, with most locations able to deliver within one day, and clients in such metro areas as New York City, Boston, Miami and Philadelphia able to receive same-day delivery.
Besides having their prescriptions delivered — for a delivery service charge of $4.99 — CVS Pharmacy patients also can add to their order some of the most popular health and household items, including cold and flu remedies and products from such categories as baby, personal and feminine care. All of this can be done through the CVS Pharmacy app or by calling the patient’s preferred location.
“The rollout of delivery from nearly all of our 9,800 retail pharmacy locations nationwide represents another step forward for us in delivering innovative omnichannel solutions that help people on their path to better health,” CVS Pharmacy president Kevin Hourican said when the company expanded delivery in June.

The delivery approach is one that looks to meet patients where they are. Another solution growing in popularity that looks to do the same thing in rural and remote areas has been telepharmacy. The Compliance Team’s Canally said telepharmacy offerings are a boon for underserved areas, enabling pharmacy technicians to fill prescriptions at one location while a pharmacist at another location approves the prescription and counsels the patient, thereby saving pharmacies on labor costs involved in hiring additional pharmacists.
“Telepharmacy is all about meeting the needs of patients who are in need of access to health care,” Canally said. “Whether the counseling is done on the iPad or tablet, the technology has increased enough and pharmacies are jumping on it. We’re seeing an uptick in that trend, so we’ve developed an accreditation program to validate the quality of telepharmacy in independent and regional supermarket pharmacy chains.”

Considering Cost
As the Trump Administration works on its Blueprint to Lower Drug Price and the Food and Drug Administration carries out its Drug Competition Action Plan and Biosimilars Action Plan to increase competition in an effort to lower prices, cost is in focus for both pharmacy operators and patients. Prescription discount cards offer a way for pharmacies to offer lower prices, while boosting revenue and improving patient care and compliance.

Bethlehem, Pa.-based FamilyWize offers a card, an app and a website that gives providers and patients information on how they can get discounts on their prescriptions. FamilyWize offers discounts through a partnership with RxSense, a pharmacy benefit manager processor that works with pharmacies and manufacturers. “That allows us to get discounts because we aggregate patients to get their prescription filled,” said Ken Majkowski, the company’s chief pharmacy officer.

The FamilyWize discount card has VIN and PCN routing information that informs the pharmacy of the patient’s insurance benefit or discount, enabling pharmacists to get reimbursed for the prescription while offering patients an average savings of 45% on their prescriptions.
At its inception, FamilyWize targeted uninsured patients, and although it still helps these patients get discounts, the company has seen a new trend — the existence of many underinsured patients who have high-deductible health plans and whose medications are part of their deductible.
“Their discounts aren’t as good as they used to be,” Majkowski said. “Three to five years ago, everyone who had employer insurance had a $10, $25, $50 three-tier plan for a generic, a preferred brand and a ‘not’ preferred brand. Now the drug prices are all over the place, and there
is a deductible.”

Among the large chains that accept the FamilyWize discount are Walgreens, CVS Health, Rite Aid, K-mart and Walmart. The company also works with medium-size and local chains, and it partners with Trinity Health System in Michigan and Fairview Health System in Minnesota, who inform patients being discharged about the savings card. The company’s partnership with Trinity allows for its adjudication information to be transmitted alongside an electronic prescription.
“Our card gets used in about 35,000 to 40,000 pharmacies in the United States. FamilyWize has helped more than 11 million people save more than $1 billion on their prescription medications,” Majkowksi said.

FamilyWize sees discount and copay cards being even more crucial as patients need to obtain more expensive brand-name and specialty drugs in the future, and as the future of health care remains uncertain.

“With the current administration, Medicaid expansion may not take place and some states are deciding not to expand Medicaid,” Majkowksi said. This will probably increase the number of uninsured patients.”

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PHARMACY

Pfizer, BioNTech partner on mRNA-based flu vaccines

BY Sandra Levy

BioNTech AG, a biotechnology company focused on precise immunotherapies for the treatment of cancer and infectious disease has entered into a multi-year research and development (R&D) collaboration with Pfizer to develop mRNA-based vaccines for prevention of influenza.

“Today’s agreement with Pfizer is one of a number of steps that we are taking to rapidly build a sustainable R&D presence in infectious disease, combining our deep understanding of the immune system to treat disease with the cutting-edge technologies and significant infrastructure that we have built-up over many years to develop immunotherapy treatments,” BioNTech co-founder and CEO Ugur Sahin, said, in a press statement. “A significant presence in infectious disease supports our goal of building a global immunotherapy company that provides more effective and precise immune-mediated approaches for the prevention and treatment of serious illnesses, such as the prevention of flu and the treatment of cancer.”

“Innovative vaccine approaches are urgently needed to provide improved protection against seasonal flu, and to respond rapidly and in quantity to pandemic influenza threats,” senior vice president and head of Pfizer’s vaccine research and development unit Kathrin Jansen said, in a press statement. “mRNA vaccines offer a novel approach to code for any protein or multiple proteins, and the potential to manufacture higher potency flu vaccines more rapidly and at a lower cost than contemporary flu vaccines. BioNTech is one of the industry leaders in mRNA technology and we are looking forward to working closely with them to help bring cutting-edge mRNA influenza vaccines to the market to improve people’s lives.”

BioNTech will receive $120 million in upfront, equity and near-term research payments and up to an additional $305 million in potential development, regulatory and commercial milestone payments. In addition, BioNTech will receive up to double-digit tiered royalty payments associated with worldwide sales if the program reaches commercialization, according to the company.

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PHARMACY

Lupin gets tentative FDA green light for generic Natazia tablets

BY Sandra Levy

Lupin has received the Food and Drug Administration’s tentative approval for Nudovra (estradiol valerate) tablets 3 mg and 1 mg and estradiol valerate and dienogest tablets 2 mg/2 mg and 2 mg/3 mg) tablets, an estrogen/progestin combined oral contraceptive indicated for use by women to prevent pregnancy.

The product, which is a generic version of Bayer HealthCare Pharmaceuticals’ Natazia tablets, had a market value of approximately $31.4 million, according to June 2018 IQVIA data.

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