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    Pharmacy Is Dead

    The CVS/Aetna deal won’t kill traditional pharmacy—it just shows that it’s already dead.


    The Pharmacist

    So how would this deal affect pharmacists?

    Hoey called on regulators to look at the previous actions of both companies. In 2015, he said, Aetna was fined $1 million by CMS for “significant disruption to patients and community pharmacists that occurred as a result of the company’s inaccurate representation of ‘in-network’ pharmacies in some plans.”

    CVS, he continued, is “already the pharmacy benefits manager for Aetna, and independent pharmacies have been foreclosed from Aetna’s Part D preferred networks for the last two years. Consolidation of the two companies will only strengthen their ability to steer patients to CVS/Aetna-owned retail or mail-order pharmacies.”

    Balto echoed similar concerns, saying that the deal could “hamper the ability of community pharmacies to compete.”

    Related article: The Future of Independent Pharmacy

    In a statement provided to Drug Topics, NCPA said that “When given a level playing field independent community pharmacies are more than ready to compete and thrive. Too often the marketplace, dominated by powerful PBMs, makes that a challenge. That is why further consolidation is always a concern.” According to NCPA, this deal could show how CVS has been “escaping accountability for their business practices.”

    John Norton, the Director of Public Relations at NCPA, clarified. PBMs’ business models, he said, are “enabled by a lack of transparency. Momentum to make them operate in the open is gaining steam (just look at the proposed Part D rule and what they want to do with DIR fees).” He said that CVS partnering with Aetna is almost an acknowledgement of that, as CVS seems to be shifting its focus by moving forward into the primary care arena.

    The Death of Traditional Pharmacy?

    And, at least according to CVS, is to shift focus to a new health care arena.

    In its statement announcing the proposed merger, CVS stressed that the deal will be creating new centers of health care. The current model, CVS said, isn’t working for consumers. To fix that, CVS says it will combine its resources with Aetna’s to give access to “high-quality care in lower cost, local settings whether in the community, at home, or through digital tools.”

    CVS added that pharmacy locations will be become much more than just pharmacies, but will “space[s] for wellness” and include: clinical and pharmacy services, vision, hearing, nutrition, beauty, and medical equipment.

    All of that fulfills what CVS sees as a hole in the market. CVS CEO Larry Merlo put it this way: “…The traditional health-care system lacks the key elements of convenience and coordination that help to engage consumers in their health. That's what the combination of CVS Health and Aetna will deliver." The end goal of the merger, then, is to create small-scale health clinics that combine a variety of health services at what CVS claims will end up costing patients less than other traditional methods.

    Related article: PBMs Look to the Future

    But is Merlo right? Paula Muto, MD, FACS, a practicing vascular and general surgeon for more than 20 years, says that there is room in the system for this type of clinic. Muto is the CEO and Founder of UBERDOC, a service that connects patients with a specialist. She told Drug Topics that current government and insurance regulations have affected the system in such a way that doctors can no longer identify patient needs.

    Muto said that CVS is local and can provide symptom or pain relief 24 hours a day, and that only an ER can offer that same level of service. “But it is also expensive and inconvenient and being sick is already an inconvenience - why shouldn’t it be easy to seek care?” she added. “Why have we put barriers in place? Probably because the value of a doctor-patient visit is no longer visible.”

    Because they are responding to inefficiencies of the current, Muto concluded, they are filling a needed niche.

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    • UBM User
      This is more or less being referred to as merely one of the "steps" in the public execution of "traditional pharmacy." I disagree - on a couple points: 1. Pharmacy has been in a downward spiraling suicide situation for a couple of decades. During my 45½ years in the practice of Pharmacy, I spent the greatest percentage of it in hospitals. I spent a total of about 10 years in discount retail pharmacy over the years, most recently from 2003 - 2004 with CVS. Two tangential occurrences hit during these years and the years immediately bookending them: a. The introduction of Certified/Registered Pharmacy Technicians - we got by quite well before our techs needed certification or registration. By giving them a "license" on the wall and a "title," they took this to mean that they were on par with REGISTERED/LICENSED Pharmacists. Their "rise" is tied closely with the need to make a profit in the arena of hospital pharmacy, what with 3rd parties determining what pharmacists and pharmacies could charge to provide professional service. Make no mistake about it: techs are NOT professionals in the true sense of the word because they have no body of "higher learning" that is unique to what they do, when compared to pharmacists. Retail pharmacies saw them as cheap RPh replacements and pushed for State Legislatures to change Laws/Regulations to allow one RPh to supervise large numbers of techs, while pretending to be "professionally engaged in the practice." I was outnumbered by techs 3 or 4 to one, most days, in a busy store with a hostile pharmacy manager and an equally hostile district manager. The pharmacy manager, herself an RPh of course, let them run the store and when I tried to practice as professionally as possible, they thwarted me at every turn. I finally resigned when a hospital job became open. I go through this LONG explanation to enforce the idea that WE in PHARMACY have been ruining our once-great profession in an ever-accelerating spiral to the inevitable death that we're now announcing on the obituary pages. AND, b. The second tangential thing referred to a number of lines above: the Pharm D degree as being the ONLY degree in Pharmacy anymore. They call themselves "Doctor" and it's almost laughable. I'm one of those dinosaur BS Pharm graduates with ONLY 5 years of education in college. They have one more year, and from what I'd experienced going back about 15 years, when I worked in a big teaching hospital with Pharm Ds out the wazoo, they STILL didn't learn even HALF the actual knowledge required to be a PHARMACIST, and their chemistry knowledge was mediocre at best. Oh, they knew the normal lab values for everything measurable, and knew how to say cool things like "patient is on Vancomycin 15 migs per kig" and other really clinical things like that. They knew what differentiated every type of breast cancer from another kind, but didn't know both the generic and brand names of even the 50 most popular drugs in the hospital. This was before "Google," and they had little books in their pockets to look up such unimportant stuff...some even had PDAs. They looked down their noses at us old farts. Oh, but if you looked on their licenses hanging on the wall, they had the VERY SAME license that we BS folks had. That meant that they had NOTHING on us legally speaking. Many of my colleagues with "only BS degrees" ponied up 10-20K bucks to get "non-traditional Pharm Ds" and for all their trouble, they didn't get a penny more in salary, and the youngsters with the "real" PharmDs looked down their noses at THEM too! Summarizing: Certified/Registered Pharmacy Technicians and the advent of Pharm D-only degree programs started the ball rolling. Read on for my rant on this second item. 2. The second point...Pharmacists have allowed chains and insurance companies (and I would suspect PBMs also) to dictate how they were to practice pharmacy, even if it was because of de facto dictatorial edicts. It took LEGISLATION at the State level to FORCE chains to give RPhs a mandatory 30 min lunch break. This was usually not possible...on my 14 hr shifts I usually ate lunch on the way home, about 16 hours after leaving the house. Now THAT'S a healthy way to live. We had go get used to drive-thru windows, coupons that encouraged patients to transfer Rxs back and forth - you know, "transfer in an Rx and we'll give you a $10 coupon on your next purchase of dog food or beer" promotions. Then when Rx margins got so damned thin, we became "vaccine-givers" to make money for our bosses. What's next..."stop in today and we'll check you for rectal cancer while you wait." I'm just SICK of it. I actively told young pharmacists who'd hold still long enough to listen, to go back to school and get another degree - ANY kind of other degree and go into banking, insurance, real estate, dog-grooming...ANYTHING. I thank God that I got in and was able to work as an ACTUAL healthcare PROFESSIONAL for at least the first 2/3 of my many years in pharmacy. OH, and by the way, hospital pharmacy became nothing but getting used to new ways to make sterile products, requiring the wearing of bunny suits, masks, gloves, shoes, etc like we're transferring E bola virus specimens from one container to another, or juggling turbo-Plutonium. RIP Pharmacy.