ABSECON, N.J. -- "Whose job is it to show the economic viability of pharmacy?" Is it pharmacy's alone? Or should the pharmaceutical industry play a part?
These questions were raised by two speakers at the 15th annual Northeast Pharmaceutical Conference held March 3 and 4 here, and attended by pharmacists from various practice settings, state association executives, third-party plan representatives and pharmaceutical company executives.
"Pharmacists can assist pharmaceutical manufacturers in improving patient outcomes with medications," said Ron Jordan, president of Drug Benefit Management Systems, West Greenwich, R.I., and a trustee of the American Pharmaceutical Association. "We can work together to change behaviors," he said.
"Help us get the message across that we are the catalytic ingredient" in the prescription, Jordan urged pharmaceutical company executives. He suggested that such help could include "direct compensation and facilitation of payment to pharmacists.
"Industry has to help us," said Jordan. "We can't rely just on managed care [to pay for pharmacist cognitive services]." He suggested that rebates now being paid to third-party plans could be used to compensate pharmacists for providing pharmaceutical care.
"Pharmaceutical products and pharmacists are inextricably tied together," said Jordan. "Pharmaceutical companies will have to support pharmacists unless they are headed to deliver products on a commodity basis."
Richard Levy, Ph.D., vice president of scientific affairs for the National Pharmaceutical Council, representing research-based pharmaceutical companies, was not encouraging on the point that industry would embrace such a role.
The pharmaceutical industry is feeling a lot of pressure itself, said Levy. "You have to be blind not to have noticed that many jobs have been lost. Marketing expenses are being cut."
In such an environment, said Levy, "any partnerships that evolve need equal valence and weight of possible contributions. It is conceivable that the industry will come forward, but only if pharmacy is willing to bring to the table real value," he said.
Levy suggested that the profession can do more to help itself by leveraging pharmacists' assets in providing "high-touch."
Poor compliance with medication regimens is a major cost driver for many diseases and an area where pharmacists can get more involved, said Levy. The compliance rate for patients taking beta blockers is less than 50%. Improving compliance may not even require all that much effort. Levy noted that a previous Schering report found that compliance is improved by 23% merely if the prescription is handed to the patient by the pharmacist, rather than a clerk.
Pharmacists might also mount a public relations effort to let people know what they do, suggested Levy. "The public perception of pharmacists is that they are trusted and valued. People know that pharmacists do more than take tablets out of big bottles and put them into little bottles. Some education about the added value of pharmacy in that process would be helpful."
The pharmaceutical industry, meanwhile, is moving aggressively on its own to position itself in the new managed care environment. "It may not be enough for pharmaceutical companies just to develop, manufacture and sell medicines, no matter how wonderful," said Levy. Companies are beginning to package their knowledge of diseases and of existing and potential treatments to add value, he said. They are providing "informational software wrapped around it, a package that enables patients to take the medicine properly."
Levy described a project being undertaken by Medco Containment Services, Montvale, N.J., and Lilly, Indianapolis, aimed at reducing overall costs in treating diabetics. Patients receive brochures, nutritional information, newsletters and refill reminders. They participate in surveys and can call a toll-free number staffed by pharmacists.
The way health care is delivered and managed is undergoing a "paradigm shift," said Levy, moving away from managing the individual components of health care, such as hospitalization, drugs and physician services.
Component management can sometimes increase overall costs, said Levy, because it ignores the relationship among component costs. Levy cited several published studies supporting his argument. In one study, discontinuation of the beta blocker nadolol increased the overall cost of managing a patient from $24 per patient per month to $26.
Systems management focuses on the disease and patient as units of control, taking into account the distinct patterns of cost elements for each of these, Levy explained.
For example, asthma has a total cost associated with it of $6 billion. But a closer look reveals that 5% of asthma cases account for 70% of costs. A study by the Boston Consulting Group that focused on early intervention and prevention reduced component costs by 25%. Patient education improved medication compliance.
