Chain Drug Review, October 8, 2018

CHAIN DRUG REVIEW PHARMACY ROUNDTABLE Its exciting to be able to provide a higher level of patient care something on provider status on the presidents desk and enacted into law WOLDT Thats good Let me ask you this If the pharmacist does get a bigger role and starts doing things that he or she hasnt done before I assume this means technicians will have to do more and also the role of technology I would think would have to expand I dont know if anyone wants to comment KONRAD I think its twofold Providing additional efficiencies for the pharmacist will free up their time to take on a bigger role And weve seen that over the past five years in particular with immunizations I know all of us in that pharmacy space had to push our pharmacists down that path initially Now pharmacists are fully embracing it They are finding the time because weve created some of the efficiencies But to that point utilizing our technicians at the top of what they can do and ensuring that theyre doing the tasks that are appropriate for them is extremely important to free up that pharmacist But its evolution of the pharmacist as well because they need to give up some of that autonomy in order to be able to provide that care WILLIAMS One crux is the primary care provider shortage Boards of pharmacy are working toward enhancing the roles of pharmacists by implementing rule and law changes Point of care testing immunizations and collaborative practice agreements are some of the areas we are assisting the communities we serve by doing more than just dispense Retail can really make an impact on biosimilars Bob Belknap Boehringer Ingelheim ANDERSON Were in all the states on the tech pharmacist ratio Idaho eliminated the ratio KONRAD Thats right We were able to increase access cut overall costs Rina Shah Walgreens brand when a product goes generic Fifteen 20 years ago we could say dispense as written and now immediate conversion of brand business I mean everybody is in on it KONRAD For people that work for drug companies WOLDT All right As Bob noted you guys have a whole lot of opportunities for specialty patients What do the patients prefer What does your experience tell you Do they want it in the mail Do they want to go to the store How much do they value the face toface interaction RUMBARGER I think its very situational I think it depends on the complexity of the disease theyre managing We do see about 30 of new starts come though the pharmacy itself And about half of those are delivered to the pharmacy because people dont want to take a day off Colleen made that point earlier People dont want to take a day off from work to wait at home for their medication So I really think it depends on the complexity of the disease state The more complex the patient thats where our care management nurses get a little more involved But the beauty is they can still have that connection to their local pharmacist because thats where theyre getting their regular medicines and were still managing off of one profile So whether they get the medication delivered through the pharmacy or get it delivered to home we still have the ability to manage the entire patient WOLDT Anybody else on specialty Id like to switch now to scope of practice which is maybe a concern for all of us Wed like to see that enlarged Idaho recently had a step in the right direction and I know Jocy Rite Aid is one of the companies that Continued from page 52 industry I think its in a very unique position today though You listen to some specialty manufacturers talk about all of the reasons they take those same approaches They make some valid arguments There will always be a role for retail in specialty distribution for patients Im just not sure its going to be the same role that they play in small molecules WEITZMAN The only thing I would add just to build on your point Brian is that retail independents still exist because these are very scrappy entrepreneurs sometimes visionary business people who have found a way to survive in this tough environment Finding those little niches with respect specifically to specialty not only can be lucrative for the independent but really important for that community especially if youre in a rural area or in a pharmacy desert Theres a real need in those communities Weve seen some big successes from owners who show ingenuity WOLDT Bob as a manufacturer and as you look at the specialty market does it matter how the product gets to the patient Do you have a role in that BELKNAP I think we do I think patient choice is always important If you look at the CVS model they can deliver where you want it Specialty products require a high level of engagement from the pharmacists There are many reasons for limited specialty networks including limited product availability special handling and specialized patient counseling The original question was on biosimilars That is an area that I think retail can really make an impact on We still dont know who is going to drive the biosimilar script Is it going to be the physician The patient I dont think so I believe retail has a significant opportunity if biosimilars become interchangeable and you have the ability to substitute for brand WEITZMAN Just a comment about biosimilars and linking it back to the question of whether you let government intervene or not If you look at the model in some other countries where interchangeability has been legislated the adoption of biosimilars basically turns into the equivalent of our generics So that is a place where a stroke of a pen could really flip something quickly and change the industry Otherwise were swirling around the circle of who is in charge BELKNAP Retailers have gotten very good at conversion of has taken advantage of that situation Can you talk a little bit about what youre doing there KONRAD Sure Alex Adams executive director of the Idaho State Board of Pharmacy is quite innovative and one of my heroes He understands the value of pharmacy or I should say of the pharmacist and he has really stretched every pharmacist in Idaho to practice at the top of their license And our pharmacists have embraced it Right out of the gate July 1 they were allowed to have prescriptive authority for multiple conditions UTIs statins and diabetes medications and setting up protocols Its very easy There was no additional training required because theyre registered pharmacists and Pharm D s Its been wonderful The pharmacists in Idaho really feel that they are being valued now more than they ever were before I know their peers in other states are looking in and waiting to do the same Its exciting to be able to actually provide a higher level of patient care Its interesting because we still have to educate the patients about these new capabilities Even with the need for more education you can see the landscape gradually changing Even technicians being able to immunize in Idaho That piece has helped pharmacists spend more time with patients and direct more of their attention to driving better health outcomes So its exciting and its great to see Im hoping other states and boards of pharmacy will see the value in this and follow suit WOLDT Anybody else on the expanding scope of practice I know the provider status issue is a big one and Steve maybe you could tell us where things stand trying to get that enacted ANDERSON We have been asked to have the bill focus on issues related to the opioid epidemic and how we can play a role in that There could be a few separate legislative vehicles that could include such an approach So that could be a step in the right direction and I think it can help address one of the great needs that we have in this country right now Every community in the country has been devastated by this epidemic and every member of Congress wants to do something to help their constituents This is a subject youll hear about in the midterm elections a lot because they want to localize their elections in this current political environment as much as they can and what they can do in Washington So thats where we are right now in terms of a best case scenario that we might be able to get ANDERSON Which is where we really want to be SHAH I think were having to work on this hand in hand with that because weve had other states like Oregon and California with prescriptive authority Its really the reimbursement for the pharmacist and the technician to do these services and that would be the accelerator to actually allow us to get that to the next level because Medicare reimbursement allows pharmacists to administer immunizations So we were able to increase access to care lower overall health care costs because physicians didnt have to that at a higher cost higher payment model So if theres a way that we can tie the two together that would be key What Alex Adams has done is fantastic it has opened up so many doors and we actually should have technicians administering immunizations Pharmacists went to school to do that but also to take care of patients on their entire medication regime And in order for this to be successful it is really the payers being able to acknowledge and recognize pharmacists as a provider so that we can get reimbursed for these types of services That would be great if it was either an advanced selfprovider status or if it was in parallel with provider status WOLDT Matt let me ask you As one of the leading vaccine makers in the world youve obviously observed this growth in pharmacy as a channel for vaccines So how do you view the expansion of the pharmacy role I mean this has gone extremely well I think and so as a pharmaceutical supplier youd like to see pharmacists do more I assume MAZEFFA Absolutely I think its fantastic I had two vaccinerelated conversations with members of this panel right before we started today it feels like vaccines is the opening conversation we have had with retailers for the past three years where its really about how we can work together to increase adult immunization rates Everybody can look at the stats Were great when its about our own kids adults not so good So what are the opportunities for adult immunizations in the pharmacy and to tie it back to the earlier conversation how can we identify other vehicles to drive that adult patient into retail in the first place Yes the expansion of the pharmacists role is fantastic To get back to your comment Jocy about being able to care for the patient because they can And how do we open the doors for access LINDHOLZ Expansion of the Continued on page 56 Chain Drug Review October 8 2018 55