The role of the pharmacist in positive health outcomes – and drug company profits – is often cited in discussions around adherence to medication regimens, holistic prescribing practices and the navigation of insurance payment structures.
In an attempt to demystify that role, Medco CEO David Snow told attendees at the Cleveland Clinic’s Medical Innovation Summit last week that pharmacists are not in fact doling out health information to patients. “I’m not dissing retail [pharmacy], but…there’s a fiction that a pharmacist comes out and dialogues with you,” said Snow. “In reality, a high school student hands you a script from the shelf.”
In a follow-up dis to retail pharmacists, Snow added that Medco’s “robots” are “twenty-three times more accurate” than human pharmacists, in terms of errors in dispensing prescriptions. Physicians were also taken to task during Snow’s talk, titled “The Case for Smarter Medicine.” A large majority of the labels on drugs dispensed by Medco contain genetic information relevant to patient outcomes, and yet, “no one is doing the recommended testing or screening,” said Snow. “We call physicians who don’t prescribe correctly,” which is a more difficult telephone call to make than the one to non-adherent patients, he said.
Among chronic disease patients, 65% stop adhering to medication within 12 months, and poor management of chronic and complex disease leads to “$350 billon in excess healthcare costs annually,” said Snow, citing a statistic from a 2005 RAND Corporation study.
Responding to Snow’s comments, Chrissy Kopple, VP media relations for the National Association of Chain Drug Stores (NACDS), said in an email: “If there were any doubt about [Medco's] intent to impose mandatory mail order on more patients, depriving patients of their choice of pharmacies, then these comments should erase such doubt at this point.” Kopple wrote that “Americans trust their community pharmacists and find them highly accessible,” and cited three national surveys as evidence. For a view of the pharmacist contrary to Snow’s portrait, see the New Yorker’s recent profile of Dr. Don.
Medco and Express Scripts, the first and third largest pharmacy benefit managers (PBMS) in the country, respectively, are currently awaiting Federal Trade Commission (FTC) scrutiny on a proposed merger, which retail drug stores and pharmacists have sought to prevent. In testimony before the FTC, Dennis Wiesner, a pharmacist and member of the NACDS, said there is “only one stakeholder that would benefit [from the merger]: the new mega PBM.” Citing cases brought by “over 30 State Attorneys General,” Wiesner said PBMs have “accepted rebates from [drug] manufacturers in return for placing higher priced medications on prescription drug plans’ formularies,” among other things, and that an even larger mega PBM would “have even greater ability to dictate one-sided, unfavorable contract terms to pharmacies, health plans and employers, ultimately harming consumers.”
“Pharmacists help to ensure that patients understand their medications and take them as directed,” and they “collaborate with doctors and other local healthcare providers to assist in medication decisions,” said Wiesner in his FTC testimony. “Community pharmacies also provide critical, cost-effective services like immunizations, disease state management and monitoring, and health education and screening programs.”
In his own testimony before the FTC, David Snow argued that Medco depends on retail pharmacies, since “more than 85% of prescriptions filled for Medco customers are filled through our networks of more than 60,000 retail pharmacies…Medco is dependent on the continued existence of strong independent retail pharmacies.”