Pharmacy at a crossroads (not again!) | NCPA Executive Update | June 7, 2019

NCPA June 6, 2019

Dear Colleague,

Doug Hoey

"Pharmacy is at a crossroads!" That phrase drives me crazy. I said so in a speech at the NCPA Annual Convention in October a few years ago:

"I've been hearing that pharmacy is at a crossroads since pharmacy school. I have attended countless presentations in which the speaker implies that pharmacy is at a crucial juncture in which the profession as we know it will be turned on its head – unless radical change is immediately taken!

"The message seems to be binary – either you change everything you are doing, or you make no changes and pray you'll somehow survive.

"For most people, that message inspires them to do ... nothing."

In reality, pharmacy is at a crossroads, but it's a really wide intersection. There's little uncertainty that pharmacy has entered that crossroads intersection, but just in case there was, this week's CVS Health Investor Day presentations should eliminate any doubt. Their conference lasted for more than three hours, and most of the media headlines focused on CVS' announcement that it was expanding its "Health Hubs" concept now in Houston.

Think about these Health Hubs as expanded Minute Clinics but importantly, rather than the current Minute Clinic emphasis on acute conditions, the Health Hubs will put an emphasis on chronic conditions.

CVS says 1,100 Minute Clinics with their one or two patient rooms will be converted to 1,500 Health Hubs, most with three or four patient rooms. CVS says the Health Hubs will do diabetes screenings and help chronic care patients with things like medication synchronization and adherence packaging. They want to do this by "making it local," "making it simple," and "building on the relationships their pharmacists and nurses have" with consumers. Does any of that sound familiar, Community Pharmacy?

It should. It shares similarities with the future of pharmacy that NCPA has been conveying to NCPA membership for years. As a quick review: NCPA continues to strongly advocate for prescription reimbursement issues such as our ongoing five-year campaign to eliminate DIR fees and our work with state partners on Medicaid pharmacy benefit reform. That has not and will not change. However, we also believe that it's not wise for community pharmacies to bet all of their chips on prescription dispensing, especially in light of the hefty generic deflation the industry is seeing. Pharmacy revenue must be diversified beyond the prescriptions we provide and must include the services pharmacies do and can deliver. NCPA has long held the belief that pharmacies must be recognized for the value they provide, and helped create CPESN® as an important pathway to unite community pharmacies to improve patient care and diversify their revenue portfolio.

CPESN focuses on chronic care, in particular the chronic care of patients who need the most help and are costing the health care system the most money. Over 2,000 community pharmacies have stepped forward and joined local networks in their state. Those numbers are growing every day.

CVS' decision to expand its Health Hubs further validates the CPESN strategy. CVS has the advantage that they can mandate their approach to their employee pharmacists and nurses. They also will offer to plan sponsors a predictable experience at their Health Hubs (for bad or for good) and data interconnectivity between their Health Hubs.

On the other hand, community pharmacy has nearly 20,000 pharmacies that could opt to join a CPESN network if they are committed to providing a handful of services excellently (some of which they are likely already providing) and are willing to document those services. CPESN provides the interconnectivity between pharmacies because it is a clinically integrated network – a very important characteristic most other networks don't offer. And, as far as the patient experience, it's been shown time and time again that consumers prefer independently owned pharmacies.

For further validation, this week Pharmacy Quality Solutions released its trend report that included a slide showing which providers have value- or outcomes-based contracts with payers. At the top of the list is physician practices, but right behind those are community pharmacies!

CVS' news was met with a marketplace shoulder shrug. Their stock was up 2.3 percent, but the S&P 500 was also up 2.14 percent. Overall, CVS' stock has fallen from a peak of $112.47 on July 1, 2015, to between $54-$55 as of midday yesterday.

The future for community pharmacy is clear. We are finally at that crossroads we have heard about for so many years. It's a wide intersection, and it may look like things are moving slowly, but they are clearly moving. Be part of that movement.


Doug Hoey


P.S. With this column, Executive Update is switching to biweekly publication. I’ll be back on June 21 with a new column. Look for qAM on opposite Fridays starting June 14.