Chain Drug Review, October 9, 2017

CHAIN DRUG REVIEW PHARMACY ROUNDTABLE Lets have a separate conversation about the value of the care Continued from page 22 munity based service especially in underserved areas In Idaho we had the first technician in the country who administered a flu shot last season And were working on other initiatives around protocol prescribing For example we recently had the first pharmacist in the country prescribe hormonal contraceptives So these are the new mainstays that will continue to show the value of pharmacy the convenient access to quality health care on the customers terms and time line because thats what were here for to serve our patients People are busy People want great health care and fast health care Usually fast and great dont come in the same sentence but they have to We have to figure out a way How do we use every available option to empower our pharmacists and technicians and provide innovative services The health care system cant continue the way it is and were at a pivotal time in history to grab onto our place at the health care table and do a lot of great things Im proud of being with a company that is empowering our pharmacy teams to practice at the top of their licenses And were seeing some great results MCBRIDE I agree Everybody here has some great programs and Steve and NACDS are helping to tell that story in Washington because we have to change the conversation Pick the model that you use internally to explain the health care system People that are uninitiated might say it is confusing for sure What Ill tell you and this is not an indictment of the PBMs but in most health care models the PBM sits in the middle Its about payment and not patient care in the middle Its about the dollars and thats just one piece As Alex said weve got to put aside our differences Health care tends to be a zero sum game whatever I get is going to cost you something The pie is only so big Only when we start to demonstrate the increased value that pharmacy can bring can we say the cost of pharmacy as a percentage of health care should go up because were going to bring down all of the other health care expenses But somehow weve lost that battle and the visibility of what pharmacy can do Weve all talked about collaboration and its going to be extremely important to be working together We were recently at an alliance management conference and they were talking about the fact that youve got to figure out how to cannibalize your own business before your competitors will And with all due respect to many of the retailers in the room who are publicly traded youve likely taken a hit to your share price with the news from Amazon who is rumored to be ready to enter the pharmacy business Theyre going to innovate with or without the people at this table Its true in our business on the pharmaceutical side Were in the generics business which by its very nature is at the tail end Thats how were going to win with our humanity George Riedl Walmart of innovation Nonetheless the stats say that nearly 90 of the prescriptions dispensed today are generics That represents a tremendous savings There is a tremendous opportunity to deliver patient value but how are we telling the story to customers business partners and legislators to demonstrate the value we bring when we work together So its not only about the savings Take Thrifty White If you talk to them I believe youll find theyre at 300 plus days on therapy for some of the patients enrolled in their Med Sync and compliance programs I follow their progress because theyre in Minnesota and I also know that many of you here are doing similar programs within your stores But weve got to get the story out that says we are seeing healthier patients as a result of these programs instead of how much more theyre spending on prescription drugs Because its likely that 90 of the scripts theyre compliant with are generic and most of those are low cost And then we hear in the news about products that are 100000 500000 a year Im not being critical of those medications or the companies that sell them These are typically life transforming medications for people but weve got to move the conversation beyond the cost and make sure that people hear about lives that are improved as a result of these new medications NIGHTENGALE Mike I totally agree and I think that an important piece of that is to segment out those costs that are related to the dispensing of the medication from the value of the care because for years and years any value based proposition has been tied to the prescription right MCBRIDE Right NIGHTENGALE Well that doesnt make any sense Lets have the discussions with the payers and the stakeholders around the cost of dispensing and the product itself and what needs to be done there Lets have a separate conversation around the outcomes and the value of the care WOLDT Kristen are payers either in the government or private sector receptive to this WILLIAMS The good news is there are increasingly more pilot programs in the market that were able to participate in Through participation and collaboration we are constantly learning changing and modifying our practices to benefit the patient COUGHLIN Another element is the cost of mistakes Its no big secret in the medical world that there is a lot of cost litigation errors rework readmissions and so on Im sure within your respective organizations you have an idea of what that is costing I dont know that its publicly acknowledged where you can get to the data But from ScriptPros standpoint we have worked with the insurers from the very beginning going back 20 years on error rates in pharmacies and how much they cost Pharmacist Mutual recently updated its statistics and they show that what they call mechanical errors which is getting the wrong drug the wrong strength or an error in the label have actually gone up as a percentage of their overall claims cost That is really a tragedy in this day of automation that really ought to be preventing that Some of the problem is due to just the increasingly complex world of drugs ScriptPro maintains a drug database We add 2000 new drugs to it every month We have 5000 changes Some drugs have 500 variations So you put all of that in the mix and there is a huge opportunity for making errors That is a cost element that I dont know how to quantify from the customer standpoint but we certainly have had discussions and quantification from the insurer standpoint It would be interesting to see just how significant that is in the overall cost because in the world of medicine the cost of errors is a big deal We all know that GOURLAY The one thats often quoted is the 300 billion cost of noncompliance in the U S A Thats a lot of errors if you use your language I agree with Mike because there is no reason for many of the compliance issues that we have Again coming from a different system there are compliance issues in other systems but there are two things that are different in the U S compared to the majority of the world One is the broader use in other countries of calendar packs 20 day supplies 50 to 60 day supplies which reduce the workload at the individual dispensary and take all of that up into automation And its all properly calendar packed for the patient The second one is the ability to have a more common formula for more common drugs Again in the U K but also many other countries they have one formula and its controlled by the government Work needs to be done on both of these issues over time They can have more calendar packs properly manufactured and free up the pharmacist to spend more time with the patient and make sure the drugs are right And also you can have fewer variations of formulas over time COUGHLIN Something that I would like to mention maybe there is an update on this 10 years ago we did some work in the U K with one of the major chains there And they had done a study that showed that there were more errors in giving out the packs than there were in the countable items because it was so easy to grab the wrong pack put a label on it and its out the door So it would be interesting to know GOURLAY Yes thats absolutely correct and since then there has been growth of other generics So for example WBA has the Almus brand which is owned by our Alliance Healthcare division This is a colored calendar pack In retail Rx you become part of the community Jocelyn Konrad Rite Aid designed to avoid errors Its easier for the pharmacist to know the strength because its all color coded There is more cost going into these packs but the drugs are very low cost HOURICAN Nonadherence is one of the most important issues we face in health care today It is what I was referring to earlier when I was asking who we can slow down and spend more time with We all have this data on medications I like to convert the language to people one third of the people who are prescribed a maintenance medication do not come into the pharmacy to pick it up The legislation that we all can partner on together to meaningfully change that situation is mandatory e prescribing We have one state New York we all have pharmacies in New York that we are participating with We have the data to prove that therapy starts have increased in the state of New York and adherence to therapy has meaningfully increased How do we together work to take that data Were working with NACDS and Kathleen Jaeger the associations senior vice president of pharmacy care and patient advocacy on this to help motivate states to recognize that it will help lower their overall health care cost to take that important step forward because obviously if the script is sitting on a credenza at home and we never know about it well never have the opportunity to do that behavior modification that Jocelyn was talking about We have so much we can do in this space And then the other huge component to this is that a third of the people will not continue to their second or third fill How do we spend more time with those patients and encourage behavior modification Thats something were keenly interested in And we need to have more than one state with mandatory prescribing in our humble opinion TSIPAKIS I think the underlying factor is were putting extra administrative tasks on top of the pharmacy teams plates For example all of the new regulation around PDMP prescription drug monitoring program the PDMP guidelines this is really solvable if we all partner together as an industry One of the things that I talk a lot about is why would all the pharmacists need to go check all the PDMPs from multiple states when the switch could do all of that for us If we all agreed even though we dont all want to agree sometimes we could all share the de identified or the identifiable data needed to at least know that a particular opioid was filled somewhere else in real time WILLIAMS When we talk about the value of a community pharmacist Alex you would be more familiar with P products in the U K Have we as an industry in the U S ever discussed a similar nationwide program Continued on page 27 24 Chain Drug Review October 9 2017