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    Pharmacy Is Dead

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


    Health care then—and pharmacy with it—is shifting as a whole. CVS is making the move to fill a needed hole in the health-care system, but also because it is reading the larger signs of how pharmacy is going to fit into that shifting landscape.

    Many analysts have speculated that the deal is due in part to pressure from Amazon’s potential move into the business. But there may be other factors at play. As Adam Fein of Drug Channels—an oft-quoted expert in the economics of pharmaceuticals—noted, CVS is also responding to pressure from other vertically integrated PBMs already in the market. UnitedHealth owns OptumRx, Humana has its own internal PBM, and Prime Therapeutics is owned by 14 not-for-profit Blue Cross and Blue Shield health plans. CVS has had trouble entering the medical benefit department, and a deal with Aetna could move that forward.

    Also of note, UnitedHealth announced that it was buying DaVita Medical group and its nearly 300 medical clinics, only days after CVS’ announcement. Clearly, PBMs and insurers are looking for ways to bring health services in new ways.

    Related article: CVS Partners with New Anthem PBM

    On the pharmacy side, Walgreens recently announced that it is partnering with NewYork-Presbyterian to bring telemedicine services to patients through kiosks located at pharmacy locations. These kiosks will enable patients to consult with physicians and will, similar to CVS’ plans, create a new health clinic space in a pharmacy.

    If CVS—by far the largest and most profitable pharmacy operator, and a company willing to spend $77 billion to get into the insurance world—is right, then the future of health care is integration. The pharmacy of the future will no longer be only about dispensing pills, it will be about providing a variety of health services. It will be about value, rather than volume.

    As Perry Cohen, CEO of The Pharmacy Group, told Drug Topics, the deal “shows that retail pharmacy needs to find new revenue streams to maintain profitability.” Traditional retail pharmacy is dead—Amazon and others will come along to beat pharmacies on price and accessibility. The challenge for pharmacies is to add value where value is needed.

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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.