Pharmacies dispense medications, and by default are a part of the drug distribution channel. Drug Channels, a blog by Adam Fein, which covers topics across the entire pharmaceutical industry, regularly writes analyses that include pharmacy. The public has a similar perception centered on drug (medication) distribution. The dictionary is also among those that primarily identify pharmacies and pharmacists as distributors of medication. Consider two common definitions of Pharmacy and Pharmacist:
pharmacy (noun) /ˈfärməsē/ — a store where medicinal drugs are dispensed and sold
pharmacist (noun) /ˈfärməsəst/ — a person who is professionally qualified to prepare and dispense medicinal drugs.
But it is interesting to note that many pharmacists do not identify as part of this channel. Their definition of pharmacist and pharmacy would be very different, and would include, or even focus on, many aspects of patient care. Consider AACP’s (the American Association of Colleges of Pharmacy) description of the role of the pharmacist listed on their website:
Pharmacists are essential healthcare professionals, who enhance patient care and promote wellness.
While the disconnect between the public’s perception of pharmacy and the professionals engaged in its practice is troubling, one needs to look no further than the “top” pharmacies (at least as far as drug distribution goes). Represented on the list are such giants as Walgreen, CVS, Rite-Aid, and many, many mail order pharmacies. Unfortunately, most Americans use pharmacies that, as a rule, focus only on drug distribution. Very little patient care takes place in the large retail pharmacy chains and mail order pharmacies.
One reason this perception has been so pervasive is the nature of the industry that has grown around pharmacy over the last 30 years. The main beneficiary of a product-focused definition of pharmacy is the pharmacy benefit manager (PBM) industry. These giants of industry are lucrative, cash generating machines. As long as pharmacy reimbursement focuses only on drug distribution, the PBM industry remains in tight control of not only pharmacy, but also pharmaceutical manufacturers and insurers.
So the fight for pharmacy comes down to a battle to change public perception. Chain pharmacies like CVS and Walgreens are doing little to help change the public’s view of the profession, but independents and smaller chains are starting to turn some heads. There are some cracks.
The most recent fissure in the PBM oligopoly of the drug distribution channel are the emerging high performing pharmacy networks appearing at both the state and national levels. These networks are independent of the PBM industry and market not drug product, but savings on the total health spend of its patients created by pharmacy directed patient care. The same definition of pharmacy that AACP extolls. These pharmacies are paid using a very different model than the drug channel based networks. These pharmacies are reimbursed not only for the drug product dispensed, but also for the savings they generate in the healthcare system. These networks are attracting significant attention and interest.
The push for quality in healthcare and the emergence of these pharmacy networks is not a coincidence. Over the last few years, it has become increasingly apparent that by working directly with the patient to manage medication use and to achieve therapeutic goals, pharmacy can save the system a lot more than the current drug channel based model that works to manage access to expensive drugs. The difference is the pharmacist-patient relationship.
So pharmacy is at a crossroads. I do not know which definition will win going forward, but I do know that it will be pharmacy that loses if it continues to be simply a drug channel.
Pharmacists need to work closely with their patients. They need to help them reach their therapy goals. Because pharmacists see their patients regularly, they are able to create meaningful relationships with their patients. With this access, they must, in short, make every encounter count.