Pharmacy News: Pharmacists offer extra options to compete with mail-order drug firms
Pharmacists offer extra options to compete with mail-order drug firms
The average adult fills about a dozen prescriptions and refills every year; after age 65, they fill more than 30 prescriptions annually. For many people, their local pharmacist may be as familiar as their doctor – and often a lot easier to get time with. Some pharmacists are building on that position, expanding their role from drug dispenser to drug educator and chronic disease coach. By doing so, they may fill a void created by the shortage of primary-care physicians while boosting their business.
Janis McGannon has heart disease, Type 2 diabetes, high blood pressure and high cholesterol. A few months ago she accepted an offer from a nurse at the Bay Street Pharmacy near her home in Sebastian, Fla., to join a new “healthy heart” program at the pharmacy.
At a meeting of the program’s participants, Theresa Tolle, a pharmacist and the owner of Bay Street, gave a talk to about a dozen customers about cholesterol: what it is, how it works and how it can be managed. After everyone was weighed and measured, they received a goody bag that included a pedometer to encourage them to walk 10,000 steps a day.
The next month, the topic was blood pressure. In addition to having their pressures checked and discussing the medications they were taking, participants learned about using light weights and stretchy bands for exercise.
In between monthly meetings, McGannon, 74, logs onto a Web site to record what she’s eating and how much she’s walking. Tolle and the nurse e-mail her regularly to check on her diet or offer tips to keep her on track. Medicare doesn’t cover the $20 monthly fee for the program, but McGannon thinks it’s worth it. “Most of us need to be reminded to do these things, and I’m reminded every day,” she says. “It’s right there on the computer.”
Pharmacists are perfectly positioned to help address the drug “adherence” problem: Research shows that only about half of people take their medications as prescribed. They may fill a prescription but not take the drugs as instructed, for example, or they may discontinue a course of treatment before it’s completed; often, people such as McGannon – who take multiple pills for multiple chronic conditions – simply forget.
Bay Street is one of 50 independent pharmacies offering the heart program nationwide. It and a diabetes management program launched two years ago – available at more than 400 independent pharmacies – were developed by Augusta, Ga., pharmacist David Pope, who is working in partnership with drug wholesaler Cardinal Health. “We’re providing a communication tool to allow pharmacists to step into a coaching role,” says Pope.
In recent years, both independent and chain pharmacies have come under pressure from mail-order pharmacy services, in part because some insurers require that their members get their drugs through the mail. Drug chains and mass-market retailers such as Walmart have fought back with some success, offering $4 generic prescriptions, for example, and 90-day supplies. As for independent pharmacists, “it makes so much sense . . . to offer services beyond just filling prescriptions,” says Steve Lawrence, a senior vice president with Cardinal.
In the past year, Walgreens has rolled out a diabetes education program that provides customers in 10 cities with one-on-one sessions about the drugs they’re taking, how to use a blood glucose meter and other issues. The program is provided through insurers or employers; more than 1,000 people have participated so far, says Colin Watts, chief innovation officer for Walgreens.
In January, CVS Caremark kicked off a program that identifies insured diabetes patients who aren’t getting the drugs they need. The company contacts these patients and invites them to talk with a pharmacist by phone or in person at the store. The company plans similar programs for heart disease, high blood pressure and high cholesterol.
Primary-care physicians are generally supportive of such efforts as long as the pharmacists coordinate care with doctors. “Answering questions about prescription drugs is important,” says Roland Goertz, president of the American Academy of Family Physicians. “But with the time pressures physicians are under, they can only accomplish so much.”
For many patients, pharmacists are the easiest to access and the most trusted medical professional they know. In a Gallup survey released in December, pharmacists ranked third among professions for honesty and ethics. That put them behind nurses (No. 1) but ahead of doctors (No. 5).
When pharmacists reach out to patients, patients may find themselves turning to them for advice and information more frequently. That’s what’s happened in Janis McGannon’s case. Now that she knows Thesesa Tolle and the nurse at Bay State, she calls them or stops by when she has a question about her medication.
“Theresa’s very willing to sit down with you and talk about how to take [a drug] and how it will affect you,” says McGannon. That’s not always the case with doctors, she says: “Sometimes they just gloss over things. They just say, ‘You’ll be fine. Call my office if you have problems.’ ”
Pharmacists want power to change prescriptions
The Ordre des pharmacies du Québec has called on the provincial government to introduce new legislation that would widen the mandate of Quebec’s 7,700 pharmacists.
The Order has requested that Quebec pharmacists be able to make changes to prescriptions without having to send a patient back to the doctor and to diagnose simple health problems and order laboratory tests, among other things.
“Seven days a week, pharmacists in Quebec are forced to send their patients back to the walk-in clinic or emergency room just to get their prescriptions renewed or dosage adjusted,” Diane Lamarre, the Order’s president, said Monday.
With the average wait in emergency rooms running at 17 hours, Lamarre said expanding the role of pharmacists could improve patient care and relieve pressure on the health-care system.
“People ask pharmacists for help and the pharmacists want and can do more, but current legislation prevents them from doing so,” said Lamarre.
Other Canadian provinces already allow pharmacists to prescribe certain drugs, administer vaccines and refill prescriptions.
Parti Québécois health critic Agnes Maltais supported the proposal.
“If pharmacists could do more, we’d help ease the overcrowding of ER wards and above all, we’d help make life easier for thousands of families,” she said.
The proposed series of legislative amendments are now before Quebec’s health department. The Order has asked they be made into law by the end of 2011.
Yves Robert said Monday that the Quebec’s College des médecins has no problem with pharmacists renewing prescriptions for stable patients. It is even open to the idea of extending the existing prescription renewal period from 12 months to 24 months.
But giving pharmacists the goahead to order laboratory tests and resolve health problems, even though minor, is another matter, said Robert, the College’s secretary.
“How medical assessments can be conducted in the neighbourhood pharmacy requires further discussion,” Robert said. “That’s entering into the zone of diagnosis.”
A January 2010 survey by CROP commissioned by the Order found that 92 per cent of respondents believed pharmacists should be able to renew or temporarily extend prescriptions and 91 per cent said they trusted pharmacists to help them deal with simple problems.