The role pharmacies play is expanding. Are consumers better off?
1. “We are your new doctor.”
When American youngsters start gearing up for football and cheerleading season this year, the 400,000 playing in the Pop Warner youth sports organization will have to get the usual medical permission to play. But they won’t have to get it from their pediatrician: Instead, as of this month, they can just stop in at the local CVS Caremark store for their sports physical. The drugstore chain runs the largest chain of walk-in health clinics in the United States, with 628 in its stores as of December 2012, up 14% from the year prior, according to Merchant Medicine, a firm that tracks the industry. And CVS says it plans to have 1,500 walk-in clinics by 2017. Other drugstores, including Walgreens and Rite Aid, have also installed clinics.
These drugstore chains provide services people once turned to their primary-care physician for, such as wart removals, jellyfish stings, immunizations—and now, physicals. Nurse practitioners perform the actual examinations, while many pharmacists are certified to do immunizations and alter patients’ medication. And if the American Pharmacists Association gets its way, pharmacists will soon have more medical cred: Proposed regulations would officially recognize them as health-care providers, which experts say would allow them to bill for more services besides just dispensing drugs, like switching the dose or the medication itself.
While insurance will cover many of the drugstore’s other services, the clinics don’t accept insurance for any of the check-ups, because they aren’t considered equivalent to full-service annual physicals that are covered by health plans. Drugstores counter that for many patients and parents, the cost of popping into a walk-in clinic—typically about $40 to $80—is well worth the convenience of not having to schedule (and, often, wait for) an appointment with a doctor.
2. “Health reform is making drugstores bigger—not necessarily better.”
Thanks to health-reform efforts to lower costs, including the Affordable Care Act, experts say many drugstores are preparing to take a bigger role in the health-care system—and get millions of newly insured patients—by beefing up stores into souped-up pharmacies that look and feel nothing like the drugstores of yore. New bells and whistles include webcams facilitating virtual diagnoses, in-store blood-pressure cuffs, and high-tech systems to keep patients on their proper medication, such as mobile apps that remind them to refill their prescriptions and take pills. “Our pharmacists are doing many things that go beyond what a pharmacist might have done, say, 10 years ago, says Dr. Jeffrey Kang, a physician and Walgreen’s senior vice president for health and wellness services, who has described modern stores as “our grandfather’s Walgreens on steroids.”
While some of these new services can certainly help consumers, experts say they have the downside of keeping pharmacists extra busy, and perhaps not as available as in the past. “It puts pressure on pharmacists to be in five places at once,” says Erin Albert, a professor at Butler University’s College of Pharmacy in Indianapolis. (A fifth of Walgreens and nearly 61% of CVS stores are now open all day, every day, which CVS says allows pharmacists to serve customers whenever they need.) The changes also represent a threat to the mom-and-pop pharmacist, since they lack the resources and scale of the bigger chains to strike deals with insurance companies and hospitals. “I don’t know how independent pharmacies can survive this enormous amount of regulation,” says Richard Hartig, owner of a small chain of pharmacies in the Midwest.
That said, the indie drugstores may still have an edge when it comes to customer service: A third fill their prescriptions in under 10 minutes, on average, while only 11% of chains do the same, according to a report by pharmaceutical firm Boehringer Ingelheim. (Average wait time for all pharmacies is about 45 minutes.) “You can automate health care only so much,” says John Coster, a pharmacist and senior vice president of government affairs for the National Community Pharmacists Association. “The personal touch goes a long way, and that’s where we specialize.”
3. “We’re raking in the dough, but would still like a raise.”
Over the past few years, pharmacists have climbed in the rankings of top-paying jobs. According to the Bureau of Labor Statistics, the annual salary for pharmacists in 2012—based on an average of median weekly earnings—was $97,604, up 36% from a decade earlier. Still, pharmacists say they deserve a raise, as they’re taking on more responsibilities that were typically the job of doctors. “While we gladly accept the roles that we’re taking on, we need to be paid for providing these services,” Butler University’s Albert says. Indeed, the American Pharmacists Association recently announced a $1.5 million campaign to lobby for extra compensation for pharmacists through recognition by the government as official health-care providers, allowing insurance companies to reimburse them for bonus services.
4. “We know your deepest secrets.”
As drugstores have taken on a more central role in the health-care system, they have also gathered a giant trove of consumer medical data. Uniquely positioned as the stop between the doctor’s office and the patient’s home, and the main supplier of many people’s medications, pharmacies know a lot about each of their customers —from whether a person has diabetes, to what kind of embarrassing rash they got, to when they took the morning-after pill. “Pharmacy data is a wealth of information,” says Julie Stone, a benefits consultant with human-resources firm Towers Watson.
While such data is governed by medical privacy laws like the Health Insurance Portability and Accountability Act, or HIPAA, that restrict how it is shared, drugstores have begun using the data to take a more active role in patients’ lives. CVS, for one, is increasingly leveraging its data to alert pharmacists when patients stop taking medication for diabetes, asthma, breast cancer and even depression, among other conditions. CVS pharmacists have staged roughly 4 million “interventions” so far through face-to-face discussions or phone calls, and send automated reminders to patients who are overdue for a refill to get them back on the wagon. Health experts say the role is appropriate for pharmacists: “People interact with their pharmacist more than they might go to the doctor,” Stone says.
Privacy advocates worry that drugstores aren’t careful enough with their sensitive information: Data leaks have occurred at several pharmacies, for example, when customers’ prescription records were simply discarded outside the stores, a blunder the companies vowed would not happen again. But other businesses—like health insurers and employer wellness programs—are also harnessing pharmacy records to keep track of consumers, and say the practice will ultimately make patients healthier and keep them out of the hospital. “What happens if we know they are consistently not taking their medication?” says Martin Rosen, co-founder of Health Advocate, a company that provides wellness coaching services to employees in corporate health plans, and also analyzes their health data. “Could we have a nurse drive out to provide the medication?”
5. “Getting you to take your meds is in our best interest.”
Think of it as the new version of a spoonful of sugar: Drugstores are increasingly helping consumers get prescription refills before they even realize they’re running low. Pharmacies, including CVS, call customers to remind them—and sometimes their doctors—to request a new refill when they’re due to run out. The concierge-like services certainly make it easier than ever for consumers to get their prescriptions—“with the push of a button,” says a CVS spokesperson—but they aren’t completely altruistic. Hospitals are now paying CVS and Walgreens to help keep patients on their meds so they don’t bounce back into the emergency room.
Why? The Affordable Care Act began fining hospitals for high readmission rates in October. Some hospitals pay drugstores a cut of whatever they save, rather than an upfront fee, incentivizing pharmacists to make an extra effort to keep patients healthy. But at a time when prescription revenue has plateaued -- falling 1% in 2012 to $325.7 billion, according to research firm IMS Health, drugstores have a more selfish reason to push people to take their meds: The more drugs they sell, the more profit they make. “Obviously compliance helps sales,” says Les Funtleyder, health-care strategist for Poliwogg, a private equity firm. “Better medication adherence certainly helps our business model,” agrees Dr. Kang of Walgreens. “But it is a win-win, because if people are compliant with medications, they have better health outcomes.”
Speaking with a pharmacist often leads to even more spending by the consumer. Nearly two thirds of customers who speak with a pharmacist while picking up a prescription end up purchasing additional over-the-counter medication, according to a recent survey from J.D. Power and Associates.