Chronic Care panel

Pharmacy plays key role in chronic care

BY David Orgel

Chronic care management has become an all-consuming topic for retail pharmacy. It has moved beyond a niche industry topic to a high-profile, national conversation that involves healthcare costs, government policy, emerging technologies and, most importantly, daily life for millions of consumers.

The pharmacy industry is now debating next steps in chronic care management to identify strategies that support the best outcomes and sustainable business models for an era of value-
based reimbursement.

Chronic care moderator Andre Persaud

Andre Persaud

“Today we have the majority of the population with a chronic care condition, rising costs in our system, our population living longer, changing policy, increased consumerism, emerging technologies and the real possibility of disruptive entry into the pharmacy business,” said Andre Persaud, a business advisor and senior industry executive with 25 years of retail and drug store experience. “What an exciting time to be discussing chronic care management.”

Chronic care management was the focus of a panel moderated by Persaud at the recent DSN Industry Issues Summit in New York City, at which much of the discussion centered on challenges related to diabetes, and the role pharmacy can play in keeping patients healthy.

To see a PDF of this story as it appeared in print, click here. 

“If we can keep the patients at the center and keep the focus on their needs, we’re going to have success,” said Crystal Lennartz, chief pharmacist at Health Mart. “As pharmacists, we know we touch the patient 12-plus times a year more than a primary care provider does, so how can we use those touches to really empower the patient to make a difference?”

Key role of the pharmacist
Community pharmacy can play an important role in filling gaps created by primary care shortages, said Becky Dant, director of professional services at Issaquah, Wash.-based Costco.

“There are a lot of disease states that pharmacists are capable of managing, including blood pressure, hypertension and diabetes,” she said. “If we’re involved with the healthcare systems in our communities and have agreements with those systems, we can manage some of these less complicated patients to goal, and refer them back to the provider when they’ve been titrated to goal on their blood pressure medications or their diabetes medications.”

Leon Nevers HEB

Leon Nevers

Leon Nevers, director of business development and procurement at San Antonio-based H-E-B, pointed to the need for new business models to better address chronic care.

“I think in the future we’re just going to have to shift from volume transactions — and honestly, we’re already evolving into that — by discussing things like health clinics and new diabetes management tools and different things that are going on in the industry,” Nevers said. “We’re going to have to be reimbursed for that and manage the data and show outcomes.”

Having the ability to prescribe certain medications is an important component for pharmacists as they play bigger roles in chronic care, according to Earth City, Mo.-based Medicine Shoppe International vice president Todd Treon.


“The community pharmacist is engaging and playing a more important role,” he said, citing activities that include more collaboration with physicians and sharp growth in the level of screenings. “I think as you look ahead to how that paradigm will shift, it goes to prescriptive authority. Arguably, you now have 38 states where there’s some level of prescriptive authority that’s available to the community pharmacy. That enables them to extend as a point-of-care destination.”

Technology’s impact on diabetes
Marcus Silva, director of U.S. marketing and analytics at BD Medical–diabetes care, said the extreme prevalence of diabetes and the staggering costs — more than a billion dollars globally in the short term — create an opening for solutions from technology.

“It’s no surprise we’re seeing advances in technologies,” he said. “We’re seeing wearable devices that can connect to CGM, connect to smart meters, connect to healthcare professional offices, even connect to paying members’ iPhones through an app. These advances give us hope that someday we could potentially eradicate the complications and burdens associated with diabetes. And we do know that to truly maximize patient outcomes, you want to marry the advances in technologies to best-in-class fact-to-face counseling.”

Becky Dant, Todd Treon Brahim ZabeliGiven that chronic diseases overwhelmingly impact the elderly, technology for this segment of the population needs to be as user-friendly as possible, Tampa, Fla.-based Smart Meter vice president of sales Brahim Zabeli said.

“The elderly are the least likely to be able to use a connectivity tool,” he said. “They’re the least likely to be able to use a smartphone or be willing to understand how it works. The trick is to make the technology very, very easy. Without that, there’s not going to be any adoption.”

Pharmacists are giving more thought to how their roles integrate with their larger organizations’ efforts to address such chronic care diseases as diabetes. In the grocery channel, the opportunities to reach beyond the prescription counter include marrying pharmacy guidance with resources on the food side of the store.

“In the grocery environment, we have opportunities to learn more about nutrition as pharmacists, or bring in nutritionists as experts to help our patients shop through the store,” Dant said. The goal is to “help patients make better food decisions, be able to better identify healthy choices — whether it’s snacks or meals — and help them with preparation.”

Pharmacists are taking a somewhat different tack in the independent channel, which differs from grocery in aspects that include a smaller front end, Lennartz said.

“So it’s less about the interaction with the front end, and more about curated products and services to meet the needs of the patients,” she said. “One of the ways that we’ve really seen our Health Mart pharmacies go the last mile is not just with in-home delivery, but in-home services, such as comprehensive medication reviews, so they can meet the patient where they are.”

Identifying solutions on the OTC side
Pharmacy also has a role to play in diabetes beyond the prescription counter when it comes to the OTC side of the store, executives said.

Crystal Lennarts, Marcus Silva, Becky Dant

“People with diabetes who inject insulin tend to visit the store three times more than the average shopper,” Silva said. As a result, pharmacists have an opportunity to “educate them on ways to better manage their therapy, which typically results in the purchase of more things within the walls of the pharmacy that can help improve their self-care.”

Moreover, patients are more likely to patronize more of the store if pharmacies spur loyalty, both through financial incentives and outstanding service, Zabeli said.

“To the degree that retail pharmacy can continue to do what it’s doing from loyalty programs that provide economic incentives, and then also build upon them to treat that customer extremely well, all the better,” he said.

Industry leaders said they generally agree that preventive health has a major impact on managing chronic conditions, and emphasized that a range of stakeholders — from manufacturers to retail pharmacies — all have roles to play in fostering preventive measures.

“No matter what the chronic condition, there’s a lifestyle or [preventive] component to it,” Lennartz said.

She said Health Mart and McKesson have partnered with manufacturers on educational tools for providers, pharmacists and patients, among other initiatives. “Retail pharmacy, no matter what the sector — independent, chain or mass — has a really important role to play from a partner perspective,” she said.

Treon said “there are ways in which we can better partner with payers, manufacturers and other stakeholders to drive value.” He said that at a time of industry cost pressures, independents within his company’s franchise system and also at Cardinal Health have had to adjust to reimbursement realities.

“Our challenge as an industry is to help them to find scale, operating efficiencies and then work together across the partners, from the manufacturers to the payers and every point in between, to help bring it to reality.”


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Last Word: Optimizing specialty supplying

BY Layne Martin

The purpose of any prescription medication — whether it is a branded drug, generic, specialty medication or biosimilar — is to treat illnesses, cure diseases, mitigate symptoms or, in some cases, to help prevent disease. As an industry, it is our collective job to work together to get that medication to patients at the right time and right place in order for them to be successful.

Evolving distribution models
It is no surprise that the specialty pharmaceuticals market continues to grow, with both the number of specialty drugs and the percentage of drug spend increasing. While a number of these products are managed through the specialty pharmacy channel, many specialty drugs also can be dispensed at hospitals, clinics and retail pharmacies. This is particularly true of medications for hepatitis C, HIV and inflammatory conditions, among others.

These medications often have special needs for handling and storage, and may have shorter shelf lives than traditional medicines. This, when combined with the need to ensure access to help patients avoid delays in starting treatment, has changed how biopharma and life science companies think about distribution channels. More products are managed using a just-in-time approach that utilizes overnight delivery to fulfill next-day service to providers.

McKesson is building an ecosystem that connects biopharma and life sciences companies, providers, pharmacies and payers to successfully commercialize medications and maximize our collective impact on patients’ lives. Today, delivery service performance is the price of entry. We are proud that McKesson maintains 99.999% inventory and order accuracy. However, we believe what sets us apart is our ability to work with biopharma and life science companies to help educate and design the right commercial model that reaches a variety of healthcare providers to ensure patient access. This is about designing a commerical strategy that optimizes patient access to medication and supports the efforts of physicians, pharmacists and other healthcare providers to care for patients throughout their treatment journey.

Supporting biopharma companies with the careful coordination of their specialty products through the entire product lifecycle, McKesson’s third-party logistics, or 3PL, services provide a seamless service model for patient and customer ease of access. By combining McKesson’s long-standing distribution services success with pharmaceutical experience, our 3PL services help biopharma companies deliver products accurately and on time to hospitals, physician practices, pharmacies and clinics.

Beyond distribution models, McKesson is focused on helping patients avoid delays in treatment, using its award-winning call center to accelerate patient on-boarding, prior authorizations, medication benefit investigation and access to foundation support, if needed. McKesson utilizes live agent support to identify adherence barriers, and offers solutions that can be paired with financial assistance or educational support programs.

McKesson is committed to working with our biopharma and life sciences partners in designing the right commercial strategy for their medications. Together, we do this to improve the lives of the patients who we communally serve.

Layne Martin is vice president of supply chain services at McKesson Specialty Health.


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Lupin intros clobetasol propionate lotion, cream

BY David Salazar

Lupin has introduced two additions to its topical generics portfolio. The company launched its generic of Galderma Labs’ Clobex Lotion (clobetasol propionate lotion, 0.05%) and Fougera Pharmaceuticals’ Temovate Cream (clobetasol propionate cream, 0.05%).

Lupin’s generic Clobex Lotion and its generic Temovate Cream are indicated to relieve inflammatory and pruritic manifestations of dermatoses that respond to corticosteroids.

Clobetasol propionate lotion had U.S. sales of $12.6 million for the 12 months ended December 2017 and the cream had U.S. sales of $135 million for the 12 months ended October 2017, according to IQVIA data.



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Which area of the industry do you think Amazon's entry would shake up the most?