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TAKING CONTROL

The future of community pharmacy will depend on the industry's ability to prove its continuing value, according to the far-reaching initiative, Project Destiny. Consumers, government regulators and legislators, and payers such as insurance entities all will be watching to see if retail pharmacies can do more than dispense medications, and do it cost effectively. Health services and drug consultations

The future of community pharmacy will depend on the industry's ability to prove its continuing value, according to the far-reaching initiative, Project Destiny.

Consumers, government regulators and legislators, and payers such as insurance entities all will be watching to see if retail pharmacies can do more than dispense medications, and do it cost effectively. Health services and drug consultations done in concert with the rest of medical community will be part of this future and will contribute new revenue streams.

“The dispensing model has worked well over the last 150 years or so, but that model has got to adapt because of so many changes in the industry,” said Doug Hoey, senior vice president and chief operating officer, National Community Pharmacists Association, Alexandria, Va.

Project Destiny is a joint effort by NCPA, the National Association of Chain Drug Stores, Alexandria, and the American Pharmacists Association, Washington. Developed by the BearingPoint consultancy in McLean, Va., it started last year and is now moving from the first phase of identifying its vision, mission and goals to a second phase of collaboration and retail pilots.

“We are in a bridge period between phase one and phase two,” which should launch within two months, said Edith Rosato, senior vice president, pharmacy affairs, NACDS.

While the initiative has been reported on at industry meetings, no major announcements have been made after its unveiling last summer. An executive summary and update on phase one are expected to be released soon. The time line, or “strategic journey,” extends for 10 years, although intermediate steps should yield profitable results for retailers.

The initiative is scalable, so it is adaptable to all sizes of retail entities involved in the pharmacy business: supermarkets, chain drug stores, independent drug stores, mass merchandisers and warehouse clubs.

“Yes, we are all competitors, but to change the tide, we all have to have a similar message in that we are valuable, and we can do different things other than count and pour and hand out medicines,” said John Fegan, senior vice president of pharmacy, Ahold USA, Quincy, Mass.

Project Destiny was getting started as the Food Marketing Institute, Arlington, Va., was launching its pharmacy advocacy program, so it is not as deeply involved as it might have been. However, Cathy Polley, now FMI's vice president, pharmacy services, was a top executive at APhA at the time.

“FMI strongly supports the vision of Project Destiny, whose goal is to position the community pharmacist as the leader in medication management,” she said. FMI is in communication with the team managing Project Destiny, she added. “As program elements are implemented, I see supermarket pharmacy being involved.”


Many prominent supermarket pharmacy executives like Fegan, with ties to both FMI and NACDS, already are.

“The program means that pharmacists have to control their destiny. We have to take the bull by the horns. We can talk a good game, but we have to implement, we have to show,” Fegan said.

“Health care is changing and with change comes opportunity,” said John Beckner, director, pharmacy and health services, Ukrop's Super Markets, Richmond, Va. “We've got to be in position to capitalize on that, and leverage the things that we do well, and that's helping people manage their medication therapy.”

In the big picture, pharmacists are a vital part of the health care team, providing value to patients and payers, he said. “Project Destiny increases the awareness about the role of pharmacy in health care today. But it is really up to pharmacists to walk the walk and talk the talk.

“We can raise the awareness and educate the public, our patients and payers about what we do, but now is the time to just step up to the plate and do what we say we can do. It's a great vision. We just need to execute the vision,” Beckner said.

While something like Project Destiny should have been undertaken 15 years ago, it's still a very good instrument for pharmacy, said Curtis Hartin, senior director of pharmacy, Bi-Lo, Mauldin, S.C. “For our business, it's a way to justify our existence as a player in the whole health care landscape. That's important for every facet of health care. If you don't justify your existence, and show value, you go away,” he said.

“Project Destiny gives us the opportunity to showcase not only what we are doing now, and the value we bring to the health care equation, but also it gives us a chance to show what we can bring to the table that perhaps we are not doing,” Hartin said. “It gives us the opportunity to further enhance our ability to positively impact health care, to show that we can make a positive financial difference to the payers in the equation.

“It will give a lot of pharmacists more opportunity to utilize their knowledge in a more practical manner than they've ever had the opportunity to do.”

“Initiatives such as this will help prove to people outside of the industry what we have always known inside the industry,” said Chris Duffy, vice president, pharmacy, Marsh Supermarkets, Indianapolis. “The message is simply that the local pharmacist has the knowledge, skills and access to the patient that, if utilized, will reduce the total health care expenditure of the patient as well as improving the patient's quality of life and medical outcomes.

“This will drive emphasis on the supermarket, or community pharmacy, as a resource center for healthy living,” he said. “Furthermore, it will open a new revenue stream that will allow pharmacy to be reimbursed for the service that we provide as well as the product that we provide. I believe that this project is one step towards reimbursement for cognitive services and it will improve profitability in the long run.”


Project Destiny frequently refers to “stakeholders.” These are entities and individuals that have an interest in community pharmacy, said Mitch Rothholz, chief of staff at APhA. These include pharmacists, pharmacy operators, physicians, people in government, payers and academicians.

A very clear sense of urgency was received from the stakeholders, said Hoey of NCPA. “Many of them said, ‘Pharmacy is in an ideal position to be a leader in medication management, but if they don't take advantage of that opportunity, we are going to do it.’”

Another unambiguous message was that the community pharmacy industry has to work together, he said. “If you don't, you're going to perish. I know that sounds draconian, but that was essentially what the report said. If pharmacy doesn't get together, operate collaboratively — not necessarily uniformly — but have some uniformity to the services that they provide, they will be beaten in the marketplace,” Hoey said.

Hoey, Rothholz and Rosato are the project management team leaders. There are five sponsors: Sanofi-Aventis, Paris, France, and Bridgewater, N.J.; Glaxo-SmithKline, London; Boehringer-Ingelheim Pharmaceuticals, Ridgefield, Conn.; Pfizer, New York; and Wyeth, Madison, N.J.

In phase one, BearingPoint contacted stakeholders, “and we were able to identify and reaffirm community pharmacy's assets that need to be preserved and leveraged as we move forward into this new health care model of the community pharmacy and its role within the changing health care system,” Rothholz said.

In preparation for phase two, “there have been a laborious set of plans and strategies put together,” said Rosato. This will begin to transform pharmacy “from a dispensing profession into more of a relationship-building, professional services profession.”

One area that will get attention is medication adherence, or making sure patients take the drugs that are prescribed to them as the physician directed, she said.

Another step will be demonstration or pilot programs that will prove the value that pharmacy should be reimbursed for. “For us to prove our value, we have to be able to have the data that proves we can enhance our patients' health outcomes, but also lower the overall cost of health care,” Rosato said.

Phase two will start to explore “interoperability” with other health care providers. “How do we connect pharmacists with physicians with other caregivers with the hospital data, and even with the consumers through personal health records? How do we do that through electronic means?”


But as Project Destiny unfolds, “time is of the essence,” Rosato said. “Community pharmacy has an opportunity to establish a leadership position in medication management. If they don't seize that opportunity now, Project Destiny identifies the fact that it would really be detrimental to our future practice,” she said.

“This is a real call to action to pharmacy to work together, and if we don't work together, we'll lose the franchise,” Hoey said. “Owners and operators and staff pharmacists have to take on almost a personal responsibility to decide how they can change within their practice. It is up to Project Destiny and other initiatives that are taking place to help give them the marketplace solutions to be able to make those changes.”

“It is clear that if pharmacists do not step up to be the medication experts, others in the health care team will,” said Larry Wagenknecht, chief executive officer, Michigan Pharmacists Association, Lansing. “Pharmacists are ideally positioned to be key providers of patient-centered primary care services.

“As more and more pharmacists embrace and implement the concepts outlined in Project Destiny, I believe there will be greater opportunities to realign the pharmacy reimbursement system to reward pharmacists for providing the level of care that will result in improved patient care,” Wagenknecht said.

More thought needs to be given to the economic foundation of community pharmacy, said Michael Rupp, professor of pharmacy administration, Midwestern University-Glendale, Glendale, Ariz. “Given that the business model is still developing for many of the future roles we envision for pharmacists, we must have a solid plan for the transitional period, and that means that we cannot ignore the importance of establishing equitable and sustainable payment models for the provision of prescription drugs to patients under third-party benefit plans,” he said.

“Project Destiny has great potential, but not without significant effort on behalf of participating pharmacies and pharmacists,” said Karla Anderson, managing director, Life Sciences, BearingPoint. “There must be a commitment to changing the way the community pharmacies and pharmacists interact both with the consumers, and with the rest of the health care delivery and financing system in order to realize this potential.”

In Project Destiny, “we are putting together a plan to talk about changing the paradigm in pharmacy,” said Steve Giroux, president of NCPA, and owner of eight independent pharmacies, based in Middleport, N.Y. “We have been over-commoditized in pharmacy — seen only for our cost to the system, rather than our value in terms of saving costs. But pharmacy and pharmacists are very cost-effective.

“The beauty of the partnership in Project Destiny is that we are all talking the same talk across the various practice spectrums.”

With the three major pharmacy associations working together on this project, “I hope they will reach out to people and organizations that need to be made aware of the value of pharmacy, and provide them with the documentation they need to sell it internally in their companies,” said Bruce Kneeland, founder and principal consultant, PharmacyConnections, Royersford, Pa.
Additional reporting by Wendy Toth