The U.S. market for prescription drugs is about $260 billion a year. Three-quarters of the prescriptions are for chronic conditions – and that’s likely to expand as baby boomers get older. This week in our series, The Business of Health, WKSU’s M.L. Schultze reports, the question is not if the business of pharmacy will grow, but in which direction. And Northeast Ohio is trying out some new versions of old models.
Like a lot of people, Susan Lord didn’t give her pharmacist much thought … until her pharmacist gave her mother’s medications a lot of thought – and her a word of caution.
“We got to the pharmacy to pick them up and the pharmacy technician says, ‘Wait a minute; the pharmacist has to talk to you.’ And the pharmacist comes over and says, ‘I need to know why your mother’s on three blood pressure medicines at the same time. And I thought, Oh, this is probably why she’s dizzy and falling on the floor, among other things.”
Now Lord keeps a careful list of all her mother’s medications – including dose sizes – and she asks a lot of questions.
The dean of pharmacy at the Northeast Ohio College of Medicine, better known as NEOMED, Charles Taylor, says that’s one vision of pharmacists of the future.
“The entire U.S. population moves through a community pharmacy in one week. That is a wonderful touch point to say, ‘You know I had a question about this.’ That’s what we’re there for. We love pharmacies as being a gathering spot to learn.”
Taylor says that doesn’t preclude another vision of pharmacy’s future: scripts by phone or internet, often supplied by the pharmacy benefit management companies like CVS.
No need to talk to anyone unless you want to.
Taylor acknowledges insurance, costs and something called pharmacy benefit managers – the middlemen that negotiate drug prices -- will keep long-distance pharmacy going and growing. And many of his graduates will find their jobs in that world.
But NEOMED also is betting on the alternative – one taking shape at its main campus in Rootstown.
Connectivity in a whole new -- and old -- way
This month, the school and Ritzman Pharmacies will open NEOMED’s first drug store, though you might not recognize it as such.
It’s across the foyer and fountain from the wellness and physical therapy centers, connected to a new doctor’s office -- and very much at the center of patient care.
Ritzman Marketing Director Christina Cyrus acknowledges it’s a lot different than the original Ritzman’s in her home town of Wadsworth.
She points across the room, still mostly supports and open construction, to what will be. “The concierge desk will be right here ..."
This will be the newest of the 26 Ritzman’s that dot the Ohio map from Akron down to Delaware. And it’s a blending of two very different kinds of connectivity. The person-to-person contact of the 1950s with the fit-bit-and-beyond connectivity of the 21st century.
"In the back, here, the pharmacist can really kind of own this whole area, so if someone comes in with a script, they can do that consult there. This is a genius bar for technology so if they need help with their Wi-Fi scale or their blood pressure monitor or anything, that consultation and that technology guidance can happen right here at the practice.”
'Where healthcare happens'
Notice she said practice. Not pharmacy. And definitely not store. Ritzman COO George Glatcz, says there’s a key difference.
“At a store, you sell stuff. And a practice is a place where healthcare happens.”
Pharmacist Beth Husted is helping to design the space. She’s given an awful lot of thought to the behind-the-wall area where prescriptions will be filled. And if she’s done that just right, she says, she and other pharmacists will spend very little time there. That’s because they’ll be out among the sleek, curving displays, egg-plant-colored accents, private consultation rooms – and people.
"To me is going to be the icing on the cake, to have that pharmacist out there and being able to engage all the time instead of being back behind that invisible barrier of a counter in between you and the patients that you care for.”
The bigger view
And Northeast Ohio is not alone in thinking about how to physically and philosophically blend community pharmacists into healthcare in hopes of better outcomes and lower costs.
Back in 1996, the city of Asheville, N.C., started a programthat found patients teamed with pharmacists stayed on their meds and had better outcomes for chronic conditions like diabetes, asthma and hypertension. A report earlier this year for the National Governors Association called for community pharmacists to be more integrated into care. The team approach is built into the Affordable Care Act as one way to control costs.
Ohio Gov. John Kasich signed three bills regarding pharmacies late last year, two to expand pharmacy services and the third to take a closer look at the impact of pharmacy benefit managers. Click here for a link to them.
Dr. Wanda Filer is president of the American Academy of Family Physicians. It does draw a line at the move in some states to allow pharmacists to independently prescribe medications. But overall, she says says pharmacists are critical to what she calls “our medical neighborhood.”
“The recognition that we’ve all got skills and knowledge to deploy for the patient is very important … Putting that patient at the center and making sure that everyone on the team is communicating with each other is really critical.”
Mega mergers, competition, costs and pharmacy benefit managers
Ritzman’s hopes to become a model for independent pharmacists. But it’s facing a big challenge nationwide: mega-mergers. If Walgreens and Rite Aid merge as announced this fall, it and CVS (which already took over Target pharmacies) will control about half the retail pharmacy market in the U.S.
Then there’s the pressure from a relatively new player in healthcare: pharmacy benefit managers. They largely decide what drugs your insurance will cover, what cost will be and what share the pharmacists will get. Supporters say they’ve saved and will save billions, even trillions, of dollars in healthcare costs. But critics say the actual savings are unclear because the deals are done in secret.
And their impact on small and independent pharmacies is enough of a concern that the House Judiciary Committee held hearings in November, in which Chairman Tom Marino acknowledged: “I have a dog in this hunt.” (fade down)
His daughter has cystic fibrosis, and the costs of dozens of drugs fluctuate.
“But what I find very, very important is the one-to-one, face-to-face communication with a pharmacist.”
Ritzman’s COO George Glatcz says the only way for small chains and independent pharmacies to compete with that is to convince patients and others they have a big stake in doing it differently.
"It’s not just about picking up your prescription and getting groceries along the way. It’s about picking up your prescription and getting health-care consultation along the way."
And he says, making the argument that a pharmacist's time is money – in the long run -- saved.