Bartell pharmacists help international travelers
SEATTLE —In the 2008 movie “Sex in the City,” there’s a scene in which the character Carrie Bradshaw laughs her way out of a deep emotional slump when, during a trip to Mexico, her friend Charlotte has an accident after drinking some of the local tap water. But as anyone who has had it can attest, a bout with traveler’s diarrhea is anything but funny.
Traveler’s diarrhea results from a wide variety of bacteria, viruses and protozoa, and affects anywhere between 30% and 70% of visitors to other countries. Hot spots for the trots include most countries in Asia, the Middle East, Africa and Latin America.
Over-the-counter medications that relieve some symptoms are a must-have for any international traveler, and are universally available at retail pharmacies. But at least one chain has sought to make a business out of catering to international travelers. Bartell Drugs, a Seattle-based chain with stores throughout Washington’s Puget Sound region, started operating travel clinics eight years ago, and since has expanded the clinics to 10 stores.
“Basically, people would not find enough travel providers,” Bartell’s pharmacist Sharon Woodward told Drug Store News. Woodward, who works at the chain’s store in Issaquah, Wash., was a co-founder of Bartell’s first travel clinic, with fellow Bartell pharmacist Jolene Kalmbach, and is a member of the International Society of Travel Medicine. “There seemed to be a real need for providers of travel medicine.”
More than 15 million Americans flew out of the country between January and May, according to the Department of Commerce, with trips to Africa, the Middle East and Asia posting respective increases of 15.6%, 31.1% and 9.2% compared with the same period last year. Many of those traveling abroad will try to get vaccinations and prescriptions from their general practice physicians or go to commercial travel clinics, but Woodward and Kalmbach saw that existing services weren’t enough, with the physicians often lacking expertise in travel medicine and the clinics frequently overbooked.
That led the two to become experts on travel medicine, reading up on vaccines, medicines and the needs of travelers going to different areas so that they could help fill demand. “We’re not trying to push out any physicians,” Woodward said. “We’re trying to supplement travel clinics that already exist.”
Woodward and Kalmbach benefited from two circumstances. First, Bartell gives its pharmacists great leeway in deciding what services they want to provide, not requiring them to provide vaccinations if they don’t want to and allowing them to provide such things as travel clinics, Woodward said. Second, Washington state has been a pioneer in pharmacy services, particularly in giving pharmacists limited power to prescribe medicines. “We started a lot of things, so even though we’re way up here in the corner, we’ve done a lot,” Woodward said.
Washington pharmacists can make protocols known as collaborative practice agreements with physicians, each of which is signed and dated by the pharmacist and the doctor, and is valid for two years, allowing the pharmacist to prescribe the specified medication—such as a malaria prophylaxis or EpiPen—to a patient. The two- to five-page protocols specify when pharmacists can prescribe drugs and vaccines and to whom—barring, for example, children younger than 14 years of age and pregnant women, both of whom the pharmacist would have to refer to a physician.
In the case of Bartell’s travel clinics, customers can pay $50 for a consult in which they fill out a questionnaire and meet with the pharmacist, who reviews their medical history, destinations and drugs they take. Patients then can get immunizations for $10 plus the cost of the vaccine. Including consultations and booster shots, Woodward said she sees six to eight patients every week and will be able to see patients every day once the store has more staff.
Overall, Woodward sees the program as taking a step further from medication therapy management, with the pharmacist acting as a patient’s healthcare provider. “It’s kind of surprising that pharmacists are prescribing all these things, but it’s actually worked pretty well for these last eight years,” she said.
At his last analyst day, Ryan sets out course for future CVS Caremark
NEW YORK The theme of CVS Caremark’s 2010 analyst meeting held Friday morning here in New York was “Enhancing Shareholder Value.” And that was appropriate as the company used the morning to brief Wall Street on how it plans to lead the industry for years to come in pharmacy services and health care, as well as in the front end of the business, thanks to several recently introduced and upcoming initiatives.
One could say the meeting was a special event, marking the last analyst meeting for chairman and CEO Tom Ryan, who will retire as CEO in May 2011, after 36 years with the company. (As previously reported, Larry Merlo has been named president and COO, and is expected to succeed Ryan as CEO.)
America’s healthcare challenge is opportunity
Ryan kicked off the meeting with a look at some of the healthcare challenges facing the country — all of which represent opportunities for CVS Caremark to demonstrate its leadership in expanding the role of pharmacy.
It is no secret that healthcare costs are rising rapidly, and chronic diseases are on the rise among Americans, Ryan explained. “We have to find a way to deal with this more cost-effectively and more efficiently as a country. Why do we think this is a big opportunity for us? We think this is going to improve our mail-choice business; we think this will improve our MinuteClinic business; we think this is going to drive pharmacy business growth over the next 10 years,” Ryan told analysts.
Ryan also noted the concern over a shortage of primary care physicians, which only stands to get worse as the population ages and more than 30 million Americans gain coverage through healthcare reform.
One area CVS Caremark will look to demonstrate its leadership in is medication nonadherence, which is a nearly $300 billion annual drain on U.S. health care. Nonadherence is a preventable cost, and CVS Caremark is working to help payers drive down that cost, Ryan said.
Enter such innovative offerings as CustomeRx Savings Initiative, Maintenance Choice and Pharmacy Advisor. Through such programs and the leverage of its broad-reaching network, which includes its PBM, MinuteClinic business and retail locations, the company is working to improve outcomes and reduce costs.
For example, its CustomeRx Savings Initiative aims to improve patient’s lives by advocating lower-cost treatment options whenever possible. It is estimated that this year alone, pharmacy interventions will save patients $50 million in out-of-pocket costs by filling scripts for lower-cost alternatives.
“The legislation that was recently passed certainly solves the access [problem], but what has to come has to be a greater focus on both quality and cost,” Merlo added. “Our integrated assets have the unique ability to offer innovative, high-quality, practical solutions that accomplish three things: provide greater access, convenience and choice to pharmacy care; deliver solutions that improve the health of those we serve; and lower the overall cost of health care.”
CVS Caremark also is looking to pharmacogenomics, or genetic benefit management, to drive improved health outcomes and help mitigate costs.
Per Lofberg, president of Caremark Pharmacy Services, discussed how the company is “building the PBM for the next decade.” Clearly, a key factor here is the 12-year collaboration it recently inked with Aetna. As reported, CVS Caremark announced in late July a 12-year agreement with Aetna to provide PBM services to roughly 9.7 million Aetna PBM members and administer about $9.5 billion in annual drug spend, a deal that is believed to be the largest and longest new-term contract ever to have been negotiated in the PBM industry.
“The Aetna deal is clearly a watershed for our company, and actually for the industry as a whole. It was the result of an extensive and exhaustive competitive bidding process, which we obviously view as a significant validation of our integrated model and economics that we can bring to the table, as a result,” Lofberg said. He also noted that the deal is expected to leverage the full-spectrum capabilities of CVS retail, the PBM and MinuteClinic offerings.
In the stores
Of course, with so much focus on other parts of the company, certainly CVS/pharmacy ( i.e., the stores) and the front-end of its business still remain a key component of the company’s future growth plans.
Discussing front-end sales and profitability was Mike Bloom, EVP merchandising and supply chain. According to Bloom, such innovations as store clustering, store brands, its ExtraCare loyalty program and beauty are a big part of the company’s strategic plan.
As reported by Drug Store News, CVS took the wraps off its Urban Cluster store concept, which has a significant focus on consumables and is designed to be a convenient shopping destination for urban dwellers. The company expected to have 300 of its stores converted to the concept by the end of the year, and a total of 1,300 to 1,400 stores reset to the concept over the next few years.
With regard to store brands, the retailer expects its private-label penetration to grow to more than 20% in the next two to three years. To drive that growth and take a leadership role in private label, CVS went back to the old drawing board. The result is a whole new private-label program the company plans to introduce early next year.
“The first thing we did is we conducted customer focus groups where we identified the need for an opening price point value brand. We then defined that the brand would consist of everyday essential products that would help get her through her day,” Bloom explained. Enter Just The Basics, which will launch in February 2011 with more than 100 items. The brand represents a functional, value-priced, smart simplicity positioning.
Turning to beauty, a $3 billion business at CVS, the company is leveraging the success of its Healthy Skincare Center concept and has launched a pilot of a smaller format that will enable it to expand the department into more of its stores, Bloom said.
It addition, it will launch in January an ExtraCare Beauty Club, under which customers will receive a 10% “shopping pass” for signing up, $5 in Extra Bucks for each $50 spent on beauty and $3 in Extra Bucks on cardholders’ birthdays.
Roche buys rights for danoprevir from InterMune
BASEL, Switzerland Swiss drug maker Roche has bought the rights to an investigative treatment for hepatitis C, Roche said.
The company announced Thursday that it had purchased global development and commercialization rights to the drug RG7227/ITMN-191 (danoprevir) from InterMune for $175 million.
Roche said the drug had shown promise in preclinical and early clinical development. The two companies have been developing the drug since 2006.