ORLANDO, Fla. -- Pharmacies should live up to their advertising. That was the suggestion of Timothy Sullivan, associate professor at the University of Central Florida, who represented the patient's perspective in a panel discussion on trends in pharmacy benefit management at the National Association of Chain Drug Stores' annual Pharmacy Conference here last month.
"It's not the same when I go to the pharmacy as in the ads. The clerk tells me to come back in 15 minutes. The pharmacist appears to be busy," said Sullivan. "Do what you say," he offered. "If advertising was the reality and I could really expect those services, I don't think I could give that up for anything."
A similar theme was sounded by Patricia Wilson, consultant with Associates & Wilson, which advises corporations on employee health benefit plans. Pharmacists, she said, need to prove the value of their skills "and get beyond the marketing hype. We see much less in interventions than we would like to see.
"Pharmacists," said Wilson, need to "really be the advocate for patients. Support patients in managing overall disease. Employers are beginning to accept that managing the prescription drug benefit contributes to overall care," she said.
"The hottest growth area is wellness initiatives," said Wilson. "Pharmacists can play a role as patient advocates in target marketing, providing patients with information. Target the specific problems employers have."
Mail-order pharmacy companies "are working hard" to improve services, including developing creative approaches to promoting wellness, said Wilson. She also acknowledged that employers have felt some frustration with mail order. "Mail order was going to save all this money," said Wilson. She said some employers still like mail because it allows them to set standards, but added, "There is nothing worse than bad mail."
In evaluating pharmacy benefit management companies, corporations are looking for companies that have the ability to capture data, are investing to improve protocols and can communicate with physicians, said Wilson. "Employers don't want an adversarial relationship [with providers]." She added that companies "are nervous" about the mergers taking place in the industry.
Closed pharmacy networks apparently have lost much of their appeal. "The discounts [on reimbursement] are not sufficient to limit where patients can go," said Wilson. Employees tend to define quality in terms of how much choice they have, she said. "Some pharmacy benefit management companies are banking on restrictive networks, but I think they are wrong."
Lowell Sterler, vice president of operations at Pharmacy Direct Network, agreed. "I don't think restricted networks will be around long. Pricing has been driven down so much."
Sterler said he expects pharmacy benefit management companies to work more closely with pharmacies on such areas as improving patient compliance and helping to manage disease. "There is an opportunity to gain information about the side effects of particular products so that formulary development can be individualized," he said.
Jerry Edwards, a pharmacist and vice president of Managed Health Care for Thrifty PayLess, Wilsonville, Ore., said capitation methods of reimbursement might lead to pharmacists being the "gatekeepers of care." He noted third-party plan contracts increasingly include performance standards, such as increasing generic utilization and enforcing formularies.
Sullivan, however, challenged this view. Pharmacists should not see themselves as "gatekeepers, but as facilitators," said Sullivan. "If the pharmacist's new role is as a health care provider, then I have a new place to go and I will pay for that."
Sullivan was also not enthusiastic about programs that pay pharmacists to call physicians to switch patients' drugs. "I don't know whether I should follow the money or the care," he said. "If it gets down to follow the money, I'll go to mail order," he said.
Patients "want to be informed and be able to trust the information we receive," said Sullivan. "I'm not looking for service but for health care. The physician regards me as a patient. Pharmacists regard me as a customer. Our relationship has to change."