The localized outbreak of measles in the UK is alarming in more ways than one. There can only be sympathy for the victims of this sudden return of a disease that had almost slipped from the perception of an entire generation. In addition to the discomfort — and on occasions serious complications — of the disease itself, there is now a sense of something approaching panic in the region where the incidence is highest. Anguish over the risks is evident in the faces of the parents and young children jostling with adolescents in long queues outside special vaccination centres that have been set up.

But there is a more general reason for concern. The background to this sudden recrudescence is well known. Urban myths about the risks of the MMR vaccine were given prominence more than a decade ago in a campaign by a local newspaper in the area where the most cases have been registered. The result was wide refusal of the MMR vaccination across the region. The subsequent clear rebuttal of the myth never received equivalent publicity — such is often the nature of the media. “Titanic sinks!” is a story. “Titanic doesn’t sink” isn’t.

Consequently, the ill-founded conclusions from the pseudo-research that lay behind the perception of risk remained as the accepted wisdom among a large swathe of the population over many years. Bolstered by the apparent absence of measles, there was even a small sense of triumph: “We were right to avoid the risks of vaccination — because the vaccination is anyway unnecessary. There is no measles,” ran the logic…

…until recently.

Emergency clinics and modern treatment techniques will probably manage to bring the outbreak under control over the coming weeks and months. But it is a wake-up call, not just to parents hesitant about the merits of immunization programmes, but to everyone involved in healthcare planning and healthcare provision. Because the circumstances in which urban myths can flourish have gone through a revolution since that local paper spread ignorant pseudo-science in the valleys of South Wales.

The entire communication game is changing. It has always been changing — but most of the time slowly. More recently, it’s been changing faster. And now it’s changing very fast, out of all recognition. That’s an earthquake for everyone involved in every aspect of healthcare communication.

There was a time, thousands of years ago, when most information came from the person with the loudest voice. But gradually technology took over. And in the last couple of centuries these technologies tended to concentrate the power of communication into very few hands – consolidating a system in which a few people at the top told everyone at the bottom what the people at the top wanted them to know.

Over the same period, the healthcare business moved on, leaving behind the vestiges of witchdoctors and barbers. The new healthcare establishment tended to dominate communication too — leading to a culture in which the doctor told the patient what the doctor chose to tell the patient, and prescribed the treatment he or she chose — perhaps influenced by the drug industry, and perhaps even by research … but most patients never saw much of that.

More recently, after years of patient docility, another trend started to emerge, principally among patients, who wondered if they were getting the best deal from being at the bottom of this top-down approach. The effect was a small rise over the last 50 years in activism — and even skepticism and distrust.

Then technology took another step forward — a giant leap for mankind. The internet. Communication — all types of communication — moved into a different dimension. The monopoly of authority over communication started to crumble.

Now, no single powerful voice can dictate unchallenged to everyone else. Everyone else can, if they wish, communicate among themselves, changing the balance, dethroning the former authorities.

From the perspective of democracy, this is unquestionably a good thing. From the perspective of healthcare communication, it raises as many questions as it answers. Of course researchers, regulators, drug firms and doctors can make use of the new technology in their own work — and are doing so in many cases with transformational consequences. But their voices are only some of the voices among so many others. There is much to be said for patients, consumers, customers, even the public, acquiring a new status in healthcare information and discussion. Patients, consumers, customers, the public, can no longer be taken for granted.  The paternalistic top-down approach has been more or less neutralised by the rise in technology and the rise of — for want of a better expression — people power.

It would be foolish to suggest that everyone who has traditionally been at the top until now — doctors, researchers, drug firms — is necessarily wrong. Importantly, it would be equally foolish to suggest that everyone else is always right. It is flying in the face of common sense to contend that all healthcare issues are best solved by a form of popular democracy. This can go right, or it can go wrong. In some instances, a majority can come up with an answer that looks right, but isn’t. Vox populi is not necessarily vox dei — as the UK measles outbreak demonstrates. If patients or the public have the right to question the traditional sources of information, they also have a duty to maintain a similar degree of healthy skepticism about all sources of information — including from other patients or consumers or customers or the public. The web 2.0 and the smart phone are not the weapons of a coup d’état. They are merely the tools to permit a better debate.

At the beginning of the Reboot Camp – held at New York City’s Alexandria Center on April 12 – Intouch Solutions’ CEO Faruk Capan declared the days of Don Draper effectively over. The route to patients’ hearts and minds isn’t Old Fashioned cocktails and intuition; it’s solutions based on patient, provider and payer needs, and making disparate data streams pool around brand objectives.

Katherine Patterson, global marketing communications manager, growth initiatives, GE Healthcare

Katherine Patterson, global marketing communications manager, growth initiatives, at GE Healthcare, gave the keynote address, which focused on clarity of mission in marketing execution, and the importance of marrying science and emotion for consumers. Marketers too obsessed with social media, or the newest digital platform, might impress only themselves. “It’s like peeing down your leg…hot to you, but nobody else,” said Patterson. In Japan, for example, GE Healthcare’s medical device customers “are moving back toward print” as a preferred marketing channel, although growth markets “want digital,” and they want it on their mobile devices, she said.

Citing Eric Topol, currently director of the Scripps Translational Science Institute, Ben Chodor, CEO at Happtique, said we’re not too far away from a time when physicians prescribe more apps than pharmaceutical drugs. Chodor is betting on Topol’s prediction; Happtique, a mobile health application store, will “curate” mobile apps for docs through a private, customized dashboard of Happtique-certified health apps. The company’s patent-pending software would allow physicians to electronically prescribe apps to patients. Chodor says he’s lobbying the SEC to reimburse medical apps, noting that some private plans already do.

Happtique doesn’t make apps itself, but Chodor appeared before the US House of Representatives’ Energy and Commerce Subcommittee on Communications and Technology in March to support FDA’s regulation and definition of mobile medical apps. “It’s relatively simple to take an app through FDA” [for a medical device designation], and it only costs between $10,000 and $20,000, he said, noting that 75 mobile devices/apps have already been approved. Chodor said the Affordable Care Act’s medical device excise tax – “the absolute worst tax ever” – should not be levied on smartphones or apps.

Asaf Evenhaim, co-founder and CEO of Crossix, reminded Reboot Camp attendees about the unfathomable amount of individual consumer or patient data that exists for marketers, while insisting on the importance of privacy and HIPAA regulations. His company collects this data to create “propensity scores,” which serve as the basis for highly specific predictive models. The models can then be used to predict healthcare purchase decisions.

Where does all that data come from? Some of it is volunteered, some is collected invisibly through cookies, Facebook and other online aggregators, and some of it – but not Crossix’s data – is gleaned from trolling social media channels and blogs. Passive data collection, said Intouch Solutions’ senior vice president David Windhausen, is revolutionizing pharma marketing and health itself. Windhausen said he looks at his Nike FuelBand in the evening, and if he hasn’t been active enough, it’s time to exercise.

Windhausen’s talk lovingly described the Sanofi mobile app “GoMeals,” an app for diabetics specifically, but also for anyone who wants on-the-go nutritional facts about nearby restaurants (among other things). An attendee representing Sanofi – which is an Intouch client – let slip that GoMeals, and possibly the iBGStar glucose meter, would start to integrate passive data from wearable tracker gadgets like Fitbit or the FuelBand as early as this year.

Capping off the Reboot meeting was Augustin Fou, founder and chief digital strategist, Marketing Science Consulting Group. Fou emphasized the importance of recognizing how patients’ habits, expectations, and actions – in the context of healthcare – have changed, and how they continue to change. He referenced a Capgemini Consulting report on “digital maturity” that placed pharma at the very bottom of the list.

Despite regulatory hurdles and because of an explosion in mobile technology, data capture, and the influence patient’s have on the delivery of healthcare, pharma marketers could use a reboot. But they’ll need to back-up some of the dusty old tropes of yesteryear, even those that precede Don Draper. As GE Healthcare’s Patterson noted, Aristotelian rhetoric, comprised of ethos, pathos and logos – in equal measure – works as well in a sales detail as it did in symposia. The occasional Old Fashioned might be okay, too.

Conducted across 46 states and with a group of 400 respondents, the sample was representative of just how many nurse practitioners, physician’s assistants, clinical nurse specialists and certified nurse midwives there are in the US. The demand for NPPs is leading to higher pay and an increased respect within the payer community. Aetna now considers nurse practitioners, for example, to be primary care providers and reimburses them for their services thusly.

When considering what influenced their behavior as prescribers the most, the survey found that NPPs tend to consider efficacy, their experiences with the drug, and price, in that order. As 82% of the respondents indicated they had no restrictions when dealing with sales representatives (17% had certain restrictions, and 11% said they were completely restricted), and that most respondents were open to support from them, why have sales reps and pharma by and large neglected to address this demographic?

Brenda Rizzo, author of the report and an advanced practice nurse herself, says sales reps make calls “based upon prescribing behaviors, and on that basis alone, NPPs are pretty much invisible.” Misconceptions about NPPs abound, according to the report, including that they prescribe based on a protocol set by their physician practice partners, that if they have the ability to prescribe, they rarely do, or that they are simply refilling prescriptions that have already been decided on by a physician. Pharma “doesn’t realize that this is an audience that makes independent prescribing decisions, and that having the right information to make those decisions is incumbent on pharma companies; to provide it to non-physician prescribers is equally important as it is to provide that information to physicians,” emphasizes Rizzo.

So what kind of information do non-physician prescribers want? As a group shown to be active attendees of national conferences and maintaining exchange of advice among colleagues and fellow professionals, first and foremost the information should be sharable and accurate to provide trustworthy resources that can further facilitate dialogue and be spread easily. Secondly, NPPs listed printed education materials from pharmaceutical companies as one of their top-rated tools when looking to improve patient compliance. More specifically, 61.3% of respondents, when asked about what kind of support they’d expect from pharma companies, said “Education about the pharmaceutical drug or medical device directed to the NPP for the patient,” 54.5% responded “Disease state information to educate the patient.” and 51.5% said “Assessment tools to help identify problems that can be addressed.”

NPPs, as this study shows, not only want to engage, but expect valuable engagement tools from pharma to help make their jobs easier. With primary care taking on a new definition that includes long-term, patient-focused care, the physician’s ability to orchestrate outcomes is increasingly being diluted and in need of help from nurse practitioners, physician’s assistants and other NPPs. As such, pharma needs to keep a keen eye on these providers: payers, private practices, and health care facilities have already gotten the memo.

To read the March cover story in the PharmExec digital edition, click here.

Epigenetics is the study of changes in human gene expression, in particular from environmental factors.  Pharma is also experiencing epigenetic change.  Human genes are formed from DNA, which are instructions much like a blueprint.  Similarly, the environment is changing pharmaceutical DNA and how brand marketing is instructed.

For example, pharma’s genetic dependence on traditional blueprints (and standard agency recipes), targeting revenue from new molecules in the pipeline, is no longer sufficient for survival.  The environment has limited the availability of new blockbuster brands.

Similarly, the environment is changing the DNA of our belief systems. Here I am speaking of the evidence for effectiveness of patient medication adherence interventions.  How is this changing the DNA of brand marketing?

For more than a decade, we have believed that medication non-adherence was the result of patient knowledge and capabilities.  This has driven marketing focused on “patient education”, “segmentation” to identify profiles of patients based on their “barriers” (or “deficits”) and “tailoring” to help customize needed changes in the foregoing.

We have assumed that patient knowledge, of their disease and treatment, and their health literacy capabilities, for example, are critical to patient adherence.

However, the evidence now tells us that our assumptions were wrong.  More than 100 published studies show no correlation between a patient’s level of knowledge of their disease and treatment, and medication adherence.  How many valid studies show a correlation?  None of which I am aware.  Studies have shown that patient knowledge can be increased, but no increase in medication adherence has resulted.

Similarly, recent systematic reviews show no evidence that health literacy is associated with medication adherence in adult or pediatric populations.  As one of these review papers summarizes:

“A critical element of successful self-management is medication adherence. On this front, the evidence has been mixed. Although patients with limited literacy have more trouble understanding primary and precautionary medication label instructions and are less likely to be able to report the name of their medication, there is no consistent finding of worse medication adherence among patients with limited literacy.”

In fact, there is evidence that patients with “adequate health literacy are more inclined to purposefully not adhere to their discharge instructions.”

Do health literacy interventions improve adherence?  A 2011 systematic review found no evidence.

What about the promotion of health literacy programs?  Again, a 2011 review reports:

“…current research on health promotion for participants with low health literacy provides insufficient information to conclude whether interventions for health literacy can attract the target population, achieve an effect that is sustainable, or be generalized outside of clinical settings.”

“Tailoring” messaging based on patient characteristics has been a proposed as a solution to patient barriers.  However, a 2012 review paper, on the efficacy of tailored interventions for self-management outcomes of type 2 diabetes, hypertension or heart disease, concluded:

“Tailored interventions had no impact on self-management activities such as medication adherence, self-monitoring, exercise, smoking, or diet control.”

So, there is no peer-reviewed evidence to support developing pharma marketing strategy or tactics based on these assumptions of patient deficits.  Money spent in interventions based on these beliefs will produce limited or no ROI, as industry cost-effectiveness evaluations show.

What does the evidence, both academic and industry, show improves medication adherence?  This will be part of what you will hear at the Keynote Panel Discussion at CBI’s Patient Adherence and Support Summit (PASS) on Monday, April 29^th in Philadelphia.  I look forward to seeing you there.

Grant Corbett is principal at Behavior Change Solutions, Inc. He can be reached at grant.corbett@behavior-change-solutions.com.

The line between physician marketing and consumer marketing has blurred as the facets of a brand campaign – from disease and drug-mechanism education to efficacy, safety and lifestyle claims – dovetail across the traditional physician-patient separation.

“We know that DTC advertising is often the catalyst for patients initiating conversations with their physicians about their untreated or undertreated conditions,” wrote Janet Woodcock, director of the Center for Drug Evaluation and Research, in an email on the changes. “The decision to restructure the divisions reflects our commitment to continue providing close oversight of DTC advertising.”

Before it got upgraded to a “Super Office” in 2011, OPDP was fondly (or sometimes not so fondly) called DDMAC (dee dee mac), which stood for the Division of Drug Marketing, Advertising and Communications. When DDMAC turned into OPDP, the office was split into two divisions: the Division of Consumer Drug Promotion, and the Division of Professional Drug Promotion. As OPDP, the steady stream of warning and untitled letters continued unabated, mostly chastising pharma marketers for misbranding, off-label, overstating the efficacy or minimizing the risks of a product, or the misuse of a color scheme, in one famous educational piece created for Novartis.

With today’s announcement, ODPD, pending final review, will rename its two primary divisions. They will now be called the Division of Advertising and Promotion Review I, and the Division of Advertising and Promotion Review II. Review of promotional materials will be separated and organized by therapeutic class, not by professional or consumer. “ODPP concluded that a structure that integrates the review of health care professional-directed and consumer directed promotion across the two divisions” would meet the stated goals of increasing efficiency, improving work distribution, and eliminating redundancy, wrote Woodcock.

“Our ODPD reviewers will continue to use a comprehensive surveillance, enforcement, and education program to foster superior communication of labeling and promotional information to both health care professionals and consumers,” she wrote.

Tom Abrams remains head of ODPD. For a list of the new review groups categorized by therapeutic area, click here.

Regulations concerning the contents of patient package inserts (known in the EU as “patient information leaflets” or PILs) have in the past erred on the side of caution, making sure that all of the necessary information about side effects and cross-prescription conflicts was included. Pharmaceutical companies have also been keen to provide all relevant information in order to reduce their risk of liability. But lost in this mix has been the patient himself, who is often confronted with a confusing and intimidating wall of information that neither educates them about the advantages of patient adherence nor informs them of the potential risks associated with the treatment.

Recently two independent government bodies have stepped up to try and fix this situation through a mix of regulatory changes and better communication with manufacturers.  In January of 2013 the Medicines and Healthcare products Regulatory Agency (MHRA) of the UK sent a detailed advisory letter to the Directorate General for Health and Consumers of the EU concerning PILs.  The letter expresses many concerns about how PILs in their current form are too overwhelming to be effectively used by patients.

Citing the work of (the ambitiously dubbed) CHMEAGPPE (Commission on Human Medicines Expert Advisory Group on Patient and Public Engagement), there is a need for these PILs to use a design that is educational for patients instead of intimidating them.  The letter also recommends the use of “new media” such as websites and emails so that patients are always able to look up the relevant information about a product.  Other bold proposals include a mandated “balance of information” about potential benefits versus potential harm and a requirement for pharmaceutical companies to give patients further resources to educate themselves as needed.

Next, in February of 2013 the Office of the Inspector General (OIG) for the Department of Health and Human Services in the US issued a critique of current FDA guidelines on high risk drugs.  According to the OIG the package inserts don’t provide enough information about the drug’s effectiveness and sometimes fail to adequately protect the patient’s health.

While the reaction to the possibility of new legislation on pharma communication with patients is understandably often negative, these documents have several positives for companies to explore:

Better Communication with Patients: Especially in the case of the MHRA recommendations, the proposed guidelines are hoping to allow companies to use more intuitive ways of displaying information, whether through interactive webpages or simply more readable PILs, so that companies aren’t stuck with blaring warning messages at the top of every sheet of paper given to a patient.

More Balanced Approach to PILs/Package Inserts: Companies are now going to be able to present data about benefits and side effects on equal footing so that patients will be more informed about the drugs they are taking.  Rather than thinking about side effects as they take the medication, patients will have a more positive outlook on their course of treatment.

Better Dialogue Between Patients, Doctors, and Companies: Patients that have been well informed about the course of treatment being given to them will be able to better engage their prescribing physician or specialist about side effects and benefits.  This can turn into positive feedback for visiting MSLs and give doctors valuable information about the product they’re giving out.

About the Author
Jacob Presson is a Research Analyst at Cutting Edge Information, providing market research to pharmaceutical companies.

Comparing 2011 to 2012, the survey finds that pharma’s performance fell 29% in managing adverse news about a product, 23% in having ethical marketing practices, and 19% in having a good relationship with the media. Alexandra Wyke, founder and CEO of PatientView, addressed specific concerns voiced by patient groups, highlighting, “if a clinical trial recruits patients via a patient group, the companies never tell the patient group the results; if a product goes generic, then the relationship with a patient group ends.”

When pressed for other reasons on pharma’s waning reputation, patient groups reported failure of companies to help southern European obtain affordable access to medicines, a preoccupation with drugs that offer only short-term benefits, lack of effort to develop medicines for neglected diseases, and inappropriate marketing practices. In 2011, people in HIV/AIDS patient groups marked down pharma quite a bit due to concerns that companies were not trying to find better drugs for their disease. “In 2012,” Wyke cites, “we saw greater appreciation of Gilead and pharma overall from these groups now that the industry has shown a desire to move forward with investments in HIV/AIDS R&D.”

Individual companies were looked at using indicators of patient-centeredness; patient information; patient safety; useful products; transparency; and integrity. Novartis lost its position as top dog in the first four areas except for patient-centeredness, whereas Gilead Sciences lost the top transparency spot to Lundbeck, while retaining its top slot for integrity in both years. Lundbeck and Gilead made the top spots overall, respectively, and Wyke points out that “they’re there because they target specific disease areas and have tight relationships with corresponding patient groups,” whereas, large companies like Novartis “have an array of products covering different areas, and thus have to perform across the board to get a higher score.” This may be one reason why the 3 biggest companies in the top 10 lost ground: Pfizer fell from 2nd place to 5^th in rankings, Glaxo-Smith Kline from 4^th to 10^th, and Novartis went from 1^st to 3^rd, trading places with Lundbeck.

Such a marked decline in perceptions from patient groups demonstrates that many companies still do not understand what patient-centeredness means, and with it the fact that patient groups are important in improving market access and policy measures. As Wyke summarizes, “The more sophisticated companies realize a relationship with a patient group is ongoing, you can’t just buy in and buy out as it suits you. And it’s not just financial either; it’s about how to empower these groups, how to provide solutions beyond a simple funding offer.”

Given the amount of activity in the hepatitis C drug development space – as evidenced in PharmExec’s 2013 Pipeline report – patients are scouring the internet for information on the disease, available treatments, and soon to be available treatments. A new Industry Standard Research report examines the digital cracks consumers encounter when looking for information and treatments, and how to potentially fill them.

Andrew Schafer, president, ISR

Unlike other therapeutic areas, like diabetes, for example, there aren’t currently a lot of brands for HCV on the market – yet – and most patients searching online for therapies tend to land on branded sites for products made by either Vertex or Genentech, according to Andrew Shafer, president of Industry Standards Research (ISR) and author of a new report on the HCV category.

However, different search terms returned different brands in the category. For example, consumers looking to find more information about the disease tended to land on branded content for Vertex’s Incivek. Consumers in the pre-diagnosis stage, who used search terms like “Do I have Hep C?” were more likely to land on branded content supporting Genentech/Roche’s Pegasys. In both cases, however, brand.com websites were further down the list of search results. Specific search requests for information about medicines and side effects tended to return similar results, but more general search inquires about the disease, it’s a mixed bag for consumers.

“What’s happening is that there’s not a go-to source for information on hep C,” says Schafer. “Online searchers are getting piecemeal information, so they’re going to another site as their search continues.” Schafer says there are two ways to counteract the problem of fickle web searchers and poor organic results for brands: paid search, or the creation of a destination site for hepatitis C information. “Pharma is getting better at providing independent information to patients,” notes Schafer.

Another consideration for digital marketers in the HCV space is where to focus resources in the social realm. According to the ISR report, consumers are willing to discuss and ask for information about HCV on Facebook at a higher rate – four to one – than they are on Twitter. Shafer speculates that Twitter is used less frequently in this case because discussions are more public on Twitter, whereas Facebook is more of a closed, private social network.

Another opportunity for companies with an established presence in HCV, and newcomers to the space, is to build an “influencer network,” to keep new information and announcements front and center online. Last May, the CDC made an announcement urging baby boomers to get screened for HCV. Although there was a spike in online conversation around this announcement, it only lasted for a couple of days, according to the ISR report. “If someone wants to own [the HCV] space, whether it’s Vertex or Genentech or whomever…I think it’s in everyone’s interest – pharma, patients, providers – to grow the influencer network, so that these kinds of stories have longer legs, and more people get tested,” says Shafer.

This is particularly true in HCV, since “the vast majority of people that have it don’t know they have it,” says Shafer. “From a pharma perspective, increasing your addressable market by going out and testing everybody is probably a pretty good investment.”

Despite an ever-expanding digital medium, with new channels for conversation and new collections of disease-related information popping up all the time, patients still prize face-to-face interaction with experts. According to recent research conducted by McKesson, 72% of patients cite doctors as the top source for information related to their conditions. The internet comes in second, at 54%, followed by pharmacists at 44%.

Physicians may have time to give patients a rough overview of their disease, but discussions around the importance of drug adherence are lacking. Patients who don’t adhere to their medication regimen – an ongoing and multifactorial problem that not only drives up healthcare costs due to unnecessary hospitalizations, but also punches holes in drug sales – are often not getting the kind of instruction from their physicians that could help move the needle on adherence.

“We know from talking to physicians that they aren’t really armed and able to have those conversations around adherence,” says Derek Rago, VP marketing and strategy at McKesson. “Physicians get detailed on a product, but they don’t get detailed on the specific barriers that patients may face when taking the medication.”

Enter the pharmacist, whom Rago calls “the most trusted advisor in the healthcare continuum.” The role of the pharmacist is changing as patients, shooed out of their doctor’s offices, require more instruction on managing chronic conditions, and dealing with the associated challenges of staying on a medication. To address this need, McKesson, on behalf of its pharma clients, has recruited pharmacists working in retail pharmacies to become behavioral coaches, and to discuss adherence issues with patients on their first and second prescription fill. Participating pharmacists are trained to provide “behavioral coaching sessions” which, in the case of a diabetes program for one client, led to an additional four prescriptions dispensed over 12 months, says Rago. By speaking directly with individual patients, pharmacists can ascertain the barriers to adherence, and accentuate the positives of a medication regimen. “We’ll say, ‘what did your doctor tell you about the medication and what you can expect?’ Then we know what they’ve already been told, so we can properly inform them in a very positive way, and see if they have the conviction and belief that they can stay on medication,” says Rago. Patients can then be segmented and engaged differently based on different needs.

Whether or not they’re a part of McKesson’s network of behavioral coaches, pharmacists in general are playing a more active role in patient care, according to recent Manhattan Research survey data. Of the 752 US pharmacists surveyed, roughly two-fifths said they spend more time providing care and support for patients than they did two years ago. Seventy-five percent of the pharmacists surveyed said they wanted access to online patient education materials from pharma.

Just a few years ago, retail pharmacies fretted over the emergence of mail-order pharmacy, and the large pharmacy benefits managers (PBMs) that hoped (and still hope) to convert their patients to mail order, a cost-saver for PBMs. But for the second year in a row, consumer satisfaction with mail-order pharmacy has declined, according to J.D. Power report released in late September. “Customer service is becoming an increasingly important advantage of the brick and mortar pharmacy experience,” said Rick Miller, senior director of the healthcare practice at J.D. Power and Associates, in a release on the survey data. The study also found that 37% of customers using in-store pharmacies are asked if they’d like to speak with a pharmacist, up from 35% in 2011.

Technology shouldn’t be discounted of course; with a rise in ePrescribing, and the ongoing adoption of electronic health records, pharmaceutical companies will be able to deliver co-pay assistance to patients through their prescribing physicians – docs can pin digital co-pay coupons to an ePrescription, for example – with less of a hassle. And all of this tech-enabled automation is freeing up pharmacists to spend even more time working the floor.

“Newer pharmacists coming through the system are more clinically educated, and they have the highest frequency of patient interaction” among HCPs, says Rago. Those bricks and mortar pharmacies eying the future are “moving the pharmacist from the back of the store to the front, because they think that’s what will differentiate them in terms of the pharmacy business as a whole,” he says.