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Let’s Not Supersize That Rx Just Yet

I saw this headline on a LinkedIn update today from one of the many groups I subscribe to: New Survey: Walgreens’ Customers Flock to Independent Pharmacies.

Walgreens made a bold move and exited some major benefit networks. Thousands of people were forced to change pharmacies, but they actually found the move beneficial. Maybe they don’t have the McDonald-like drive thru pharmacy anymore. Nor do they have the nationwide access to their prescription at any of the Walgreens pharmacies they happen to be closest to when they remember they need to refill their medication.

What they DO have is a wide choice of independent pharmacies, where the transfer of medications is easy, and the care more individualized. I am not at all surprised that people who switched from Walgreens pharmacies to independents were more pleased with their service. When you go to a nice restaurant for a sit-down meal, are you not more happy with the service than with McDonald’s? The difference here is that you don’t have to pay more to get more.

I hope this reflects a shift in consciousness of healthcare consumers. I was speaking with someone just the other day about how Walgreens has dramatically hurt pharmacy. While they have made medications easily accessible, they also stress quantity over quality. They are the McDonald’s of pharmacy.  How many scripts can you fill in a day? The focus was no longer on the overall health of the patient, although advertising may make it seem that way.

The pharmacy used to be only run by independents, where the pharmacist knew all of their patients. But with our crazy, technology driven, fast-paced world, the convenience of a drive-thru pharmacy changed the mentality of nearly everyone when it came to medications. Pharmacists wonder why it is so hard to change the perception of people to understand that pharmacists don’t just stand behind a counter, that they actually do so much more. I can’t say that Walgreens is to blame for the shift, but it certainly took advantage of our current societal craziness and need for instant gratification. It took the fast-food mentality and ran with it, and made a killing.

Most of their pharmacists don’t have time to see their customers, let alone get to know them. Many of them want to, but the corporation won’t allow it. The independents still know their customers, and many are implementing Medication Therapy Management (MTM) services, or even Collaborative Drug Therapy Management (CDTM) services. Many, like Maui Clinic Pharmacy where I trained, are sponsoring Community Pharmacy Residencies. Pharmacy is changing, and I think this shift back to the community is just what we need. Thank you Walgreens.

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Drugs By Microchip Implant: How To NOT Empower Your Patients

I receive daily updates on happenings in pharmacy and healthcare from ASHP daily. It’s a great resource, even when it notifies me of scary stuff such as the following: Looks like we can put the control of our medications in the hands of someone else now. Some may think how wonderful it is that we can now bypass adherence issues and control people’s medications from afar. This would even bypass the community pharmacy. Less pills, right? Less bottles and waste even? More CONTROL by the doc, but less control by the patient.

I pose these questions to you:

– Is it in the patient’s best interest to take control of their health out of their hands? Is it not our goal to EMPOWER them to make healthy choice, to teach them that they know their body better than we do?

– Who will monitor side effects? The patient now no longer has the option of stopping their medications. While I agree this is a problem, I feel it has also saved many lives.

– Would you want your medication managed by a distant doc with a piece of technology that could go awry?

We need to teach people to be healthier, empower them and educate them. This only serves to teach them that they are incapable of taking care of themselves. Where is the incentive to change lifestyle habits?



Novel Microchip Implant Delivers Teriparatide To Osteoporosis Patients.

ABC World News (2/16, story 10, 0:35, Sawyer) reported that “researchers at MIT, Mass General Hospital and Harvard Medical School” implanted “a microchip in seven women battling osteoporosis.” The devices “automatically deliver the right amount of drugs, daily,” which “can be inserted in your doctor’s office.” In addition, “the doses are preprogrammed.”

USA Today (2/17, Vergano) explains that it was “a medical first,” and that the chip “worked inside patients as drug-delivering pacemakers, following a prescription plan sent by radio signal.” Researchers “presented the study, a ‘safety’ trial of the devices, at the American Association for the Advancement of Science meeting in Vancouver.”

The Los Angeles Times (2/17, Brown) adds that researchers “implanted the devices in eight women in Denmark, positioning the chips beneath the skin near the waistline and programming them to release daily doses of the hormone.” The authors noted in the study published online Thursday in the journal Science Translational Medicine, “After four months, the chips were safely removed from the patients’ bodies.”

The AP (2/17) reports, “If this early-stage testing eventually pans out, the idea is that doctors one day might program dose changes from afar with the push of a button, or time them for when the patient is sleeping to minimize side effects.”

“The device, made by closely held MicroCHIPS Inc., based in Waltham, Massachusetts, delivered doses of a generic version of Eli Lilly & Co.‘s injectable osteoporosis drug teriparatide [Forteo] to seven women, ages 65 to 70, without adverse effects, according to” the study, Bloomberg (2/17, Lopatto) explains. “The technology is designed to provide a more convenient and accurate method of drug dosing, which could improve patient compliance in taking medicines.”

WebMD (2/17, Boyles) reports, “Each device contained 20 doses of the drug sealed in tiny reservoirs on a specially designed microchip.” It adds that “immediately after implantation it became evident that the device was not working in one patient, and it was removed,” but “an analysis of the remaining seven patients confirmed that the microchip delivered the osteoporosis drug in comparable doses to daily injections with no unwanted side effects.”

“A dose is released when an electrical signal — which can be pre-programmed or initiated wirelessly — melts the metallic membrane covering the reservoir, releasing the drug,” MedPage Today(2/17, Fiore) reports. Researchers “saw that the implant increased biomarkers of bone formation” known as “type I collagen pro-peptide (P1NP)…after the implant was activated, while type I collagenolysis fragment (CTX) was normal and didn’t vary after activation — signals that show the device increases bone formation and not bone resorption.” The authors said that “there were no toxic or adverse events, and many patients reported that they forgot they had an implant.”

HealthDay (2/17, Salamon) reports, “Roughly 1.5-by-2.5 inches in size, the microchip significantly improved patient compliance with a drug regimen that normally requires painful daily self-injections,” the researchers said. “Although a fibrous membrane grew around the device, which was expected, the microchip delivered the drug as effectively as daily injections, the study said.” In addition, “blood tests done after the 12-month study period indicated rates of bone formation similar to when the women self-injected the drug.” Also covering the story are the National Journal (2/17, Fox, Subscription Publication), the Wall Street Journal(2/17, Winslow, Subscription Publication), the Financial Times (2/17, Cookson, Subscription Publication), Reuters (2/17, Steenhuysen),BBC News (2/17, Amos), and the UK’s Daily Mail (2/17, Macrae).

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Express Scripts Monster

Seems that, in light of a potential Express Scripts/Medco merger, Express Scripts is taking over a lot more than the drug program for the state of Maryland……. what is going on here? Remember when you studied economics and they said that too much big business was bad? So is too much government control. What about the government allowing and then controlling big business? Whose best interest do they have in mind???

Express Scripts Receives $2.4B Pharmacy Deal From Maryland.

The Baltimore Business Journal (2/9, Lambert, Subscription Publication) reports, “After months of delays and appeals, Maryland awarded Express Scripts Inc. on Wednesday a $2.4 billion contract to manage its prescription drug program for its employees, retirees and their dependents.” According to the Journal, “the deal was approved by the state Board of Public Works after Express Scripts had been in a nearly year-long battle with Rockville-based Catalyst Rx, the drug provider for the state, over who would be awarded the new contract.” The contract was supported by Gov. Martin O’Malley and state Treasurer Nancy K. Kopp, “while Comptroller Peter Franchot voted against it.”

“In today’s meeting, Franchot said the state Department of Budget and Management did not use the same criteria to evaluate Express Scripts…and Catalyst,” the St. Louis Business Journal (2/9, Subscription Publication) reports. “Express Scripts…will take over as the prescription drug provider for Maryland on May 15.”

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Vitamins increase mortality risk?

Vitamins and Mortality

These folks are saying that taking vitamin supplements may increase risk of death. They neglected to take into account the utilization of primary care and specialists in this population. I would say that many people are trying to take their health into their own hands with use of supplements and activity, at the expense of regular care. This is pushed partly by lack of trust in our healthcare system and providers, and largely by the cost of care.

So, with the increased supplement use, did doctor visits go down? Were these people taking supplements in lieu of prescription medications that would have helped them and were necessary?

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Express Scripts- Medco Merger The Final Straw for Community Pharmacy

I read NCPA’s blog The Dose, and sometimes it takes a few days to get to the email in my inbox with the initial blurb. Today’s talked about a New Mexico independent pharmacist. Being from there, I had to see if it was someone I know. I was impressed and saddened by what was put forth. Instead of just giving you the link, I am going to post the whole blog here. Read on, and then go write your senator with your story.

Blog is found HERE

New Year, Same Problems for a New Mexico Independent Pharmacist

Published January 17, 2012 pharmacy benefit managers 1 Comment

By John Coster, RPh., Ph.D.

NCPA routinely speaks to policymakers (and anyone else who’ll listen) about the value independent community pharmacies provide and the concerns of these pharmacists, which are often shared by their patients as well. Those efforts continue, but there’s no substitute for pharmacists expressing their views directly to elected officials, the local media and others.

One case in point is a recent message from rural New Mexico pharmacist Jake Mossman of Taos Pharmacy, who opposes the Express Scripts-Medco pharmacy benefit manager (PBM) merger, as does NCPA. The former Taos News’ Citizen of the Year passionately articulated his concerns for his pharmacy and his patients in an email to Senator Jeff Bingaman (D-N.M.).

Below are some excerpts from that message, shared here with Mr. Mossman’s permission, as an example of how community pharmacists and patients can get involved, both with NCPA and directly with elected officials.

Our income is down 39.4% for 2011 compared to 2010.  While our prescription volume did decrease by 19.2% this does not account for the severe drop in revenue which is twice the drop in prescription volume.  In addition, the decrease in prescription volume was largely due to the fact that we were unable to maintain adequate inventory on hand to serve our customers timely because of such a significant decrease in revenue. 

 “Our income is 92% from prescription revenue and 90% of that is from third party reimbursement.  As a result of the precipitous decrease we have reduced staff by 6 [full-time employees] and will reduce hours even more this week.  We have had to take all of our 401k money out and a $50,000 mortgage on our home which had been paid off over 10 years ago to continue pharmacy operations. 

 “We are fighting for survival and shrinking as quickly as we can without totally abandoning our employees to stay afloat.  We have changed our software vendor, our PSAO (third party contract representative), and our pharmacy suppy vendors to try to reduce our costs and eliminate the possibilities of revenue leaks.

 “Our financial strength in the past was based upon our high generic utilization percentage.  That has now become our Achilles heel as generic reimbursement has been slashed and product costs have skyrocketed.  Daily we identify claims that we are reimbursed for at less than our cost to purchase the drug.  This is a result of reduced reimbursement rates and increased drug costs.  In the past we have contributed greatly to cost containment to payers by our high generic substitution rates.  Ironically, we are facing insolvency for the same reason.  All of this happened within one calendar year as we noticed the downturn began in September, 2009.

 “Our PSAO must negotiate with Caremark, owned by CVS a mega drug chain and mail order provider, for our reimbursement rates.  We must negotiate with one of our largest competitors for our payments!  The merger of Medco and Express Scripts would dwarf even the CVS/Caremark giant and worsen this situation. 

 “I have always been an enthusiastic, progressive pharmacist.  We have been providing clinical services (cholesterol testing, A1c testing, diabetes, medication and nutrition consultations, and others) since 1996.  We were recognized as Innovative Pharmacy Practice in 2000 by the New Mexico Pharmacists Association.  I was named Citizen of the Year by the Taos News in 2007. 

 “I spend all my time scrambling to squeeze out every penny from the PBMs and my suppliers to avoid failure.  I feel I cannot serve my patients, my community, my employees, or my family in my role as a pharmacist.

 “Independent businesses account for almost 60% of employment in this country.  Independent pharmacies provide inexpensive access to healthcare advice to millions of Americans especially in smaller communities, rural communities, and inner city neighborhoods.  The elimination of independent pharmacies would result in incalculable increased costs to the healthcare system.

 “The hardest ‘pill to swallow’ is the fact that independent pharmacy is actually an important component to reducing the cost of health care delivery.  We can help eliminate avoidable hospital visits if given the time and reward for changing drug therapy to address therapeutic duplications, patient side effects, and lack of adherence.  We are trusted by the public to have their best health interests in mind.  We should be paid to help them achieve the best possible outcomes from their drug therapies.  We can help them reach goals, feel better, stay out of the hospital, and reduce the costs of medication therapy.  If we are lost the system becomes less personal, medication error rates increase and overall health care costs skyrocket. 

 “You don’t have to believe me just read the reports.  Fully one-third of hospitalizations result from problems due to medication therapy that could have been avoided with better care by their pharmacist and primary care providers.”


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U.S Public Health Service Report Outlines Mechanisms to Optimize the Role of Pharmacists on the Healthcare Team

WASHINGTON, DC – A new report released by U.S. Public Health Service provides a resource to advance beyond discussion of pharmacists in expanded roles and move toward implementation. The report has also earned support for the recognition of pharmacists as health care providers and clinicians. The report, Improving Patient and Health System Outcomes through Advanced Pharmacy Practice – A Report to the Surgeon General 2011, produced letters of support from prominent members of the medical community including the U.S. Surgeon General, Dr. Regina Benjamin, MD, MBA.

“The report demonstrates through evidence-based outcomes, that many pharmacy practice models improve patient and health system outcomes and optimize primary care access and delivery,” stated Benjamin in her letter of support for the report. “It also provides the evidence health leaders and policy makers need to support evidence-based models of cost effective patient care that utilize the expertise and contributions of our nation’s pharmacists as an essential part of the healthcare team.”

The report provides rationale and discussion points to support pharmacists currently delivering patient care services through collaborative practice agreements with physicians and other primary care clinicians, as an accepted model of improved health care delivery that can meet growing health care demands in the United States. Timing of this discussion is vital as health reform has stimulated exploration of innovative care models and payment reform to improve access to care, improve the quality of care, and provide cost-effective care. The report discusses current and future demands on the health care system, including the challenge of aligning health care coverage with access to care, the increasing burden of chronic care needs and primary care provider shortages.

A copy of the report can be found in the APhA Newsroom and will also soon be available on the Pharmacist Professional Advisory Committee (PharmPAC)site.

“Pharmacists in the Public Health Service have been positively affecting the lives of their patients while saving money for nearly 50 years,” said RADM Scott Giberson, U.S. Assistant Surgeon General and Chief Professional Officer, Pharmacy, and one of the co-authors of the report. “This report demonstrates the value pharmacists bring when they become full members of the health care team. Pharmacists are clearly an important part of the solution to rapidly escalating health care costs and to improving health care delivery. Maximizing the expertise and scope of pharmacists, and minimizing expansion barriers to successful health care delivery models, is the right thing to do for our patients.”

“The discussion and evidence-based models compiled in this report are great examples of the quality care and sustainable patient outcomes that pharmacists provide to their patients and the healthcare system,” stated Thomas Menighan, APhA, CEO and Executive Vice President. “APhA is excited to see the amazing recognition of pharmacists as health care providers that this report has earned in the medical community, especially from Dr. Benjamin. The report clearly demonstrates that pharmacists can increase quality and decrease costs when barriers are removed.  The time has come for pharmacists to be recognized as health care providers and essential members of the health care team. We look forward to further advocating for the recognition of pharmacists’ services and partnering with the health care community to ensure those services are widely implemented.”


CONTACT: Michelle Fritts

January 9, 2012


About the American Pharmacists Association
The American Pharmacists Association, founded in 1852 as the American Pharmaceutical Association, is a 501 (c)(6) organization, representing more than 62,000 practicing pharmacists, pharmaceutical scientists, student pharmacists, pharmacy technicians and others interested in advancing the profession. APhA, dedicated to helping all pharmacists improve medication use and advance patient care, is the first-established and largest association of pharmacists in the United States.


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On a New Order

When I think of pushing forward with initiating new services and knowing that I will have many people shoot me down right away, I must remember the following:

Nicolo Machiavelli, 1513 (per Paul Ridker, MD):  It must be considered that there is nothing more difficult to carry out, nor more doubtful of success, nor more dangerous to handle, than to initiate a new order of things. For the reformer has enemies in all those who profit by the old order, and only lukewarm defenders in all those who would profit by the new order, this lukewarmness arrising partly from fear and partly from the incredulity of mankind, who do not believe in anything new until they have had an actual experience of it.