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Accelerated Pharmacy Programs

As chain pharmacies increase their collaborative efforts with pharmaceutical manufacturers and with managed care organizations to define a new model of integrated health care, the question of how to prove and measure the value of that model is being addressed aggressively.

Outcomes data continue to be released showing definitive patient benefits and bottom-line financial returns. In a year studded with success stories of pharmaceutical care initiatives--Project ImPACT, the Asheville Project, the Emergency Contraception Project in Washington state--along with the rise of stand-alone wellness centers and disease-management efforts throughout virtually every level of pharmacy, the remainder of 1999 promises even greater recognition. Pharmacy remains intent on increasing its value to the consumer, proving its value to managed care, and showing returns on that value to pharmaceutical manufacturers.

Chain pharmacies increasingly are aligning their services--and strategies--to match the pharmaceutical industry's, showing manufacturers that community pharmacy can reach consumers at each step of product lifecycle management and, in the process, improve patient outcomes and care.

Contingent on the depth and success of those efforts, pharmacy will play a critical role in a new integrated healthcare model-one that is more comprehensive, analytic and interdependent, say the experts. Gary Levine, senior vice president of Medicine Shoppe International, theorizes: "I really believe that as the Food and Drug Administration continues to move these drugs through quicker, with much faster approvals, that they may in fact go to something that looks like a Phase IV study that says, 'Look, we'll approve your product, but you, manufacturer, have to come back to us a year from now and provide us with outcomes data.'

"I feel that is a huge opportunity for a collaborative relationship between pharmacy and pharmaceutical manufacturers. In that scenario, you're going to need to duplicate a real-world environment in which the patient exists, and that's going to be the pharmacy--it's not a laboratory, it's not a closed-study," Levine said. "I just have to believe that's going to come about-and if it's not because the FDA comes up with it, it's because consumers are going to demand it. Consumers want those products to come to market, the manufacturers want them to come to market-but I think somebody's really got to continue to measure and monitor those outcomes."

This summer, for the first time in its history, pharmacy benefits manager Merck-Medco embarked on a disease-management program at the retail pharmacy level in a partnership with Medicine Shoppe. The new program is sponsored under an unrestricted grant from AstraZeneca and is being piloted in Ohio markets. Patients with GI disorders are identified for the program through an online clinical review of pharmacy data that indicate when a prescription for a GI-related medicine is filed through PAID Prescriptions L.L.C., the retail pharmacy program manager for Merck-Medco. Patient candidates are invited to enroll in the program by visiting a nearby participating Medicine Shoppe Pharmacy.

As PBMs, such as Merck-Medco and PCS, become actively involved in pilot programs in drug therapy management, pharmacists increasingly are making the point that they are uniquely well-positioned to improve patient care and definitively lower costs by aggressively collaborating with physicians and health plans.

There also has been a clear revision in the attitude of pharmaceutical manufacturers toward chain pharmacy. In the past two years branded manufacturers have accelerated their product launch model and focused on consumer initiatives and consumer-driven product. "If manufacturers are spending a lot of time relating that message and a lot of effort raising the awareness level for a product, clearly they see that one of the advantages is that we're 18 inches away from the patient," said Levine.

Pharmaceutical companies are offering a slew of continuing education and marketing programs to address what seems an inevitable realignment in healthcare delivery. From reimbursement for biotechnology products from Amgen to comprehensive initiatives in women's health from Wyeth-Ayerst and a definitive series on the dynamics of pharmaceutical care from Merck (with topics such as collaborative practice agreements between pharmacists and physicians, and submitting claims for patient care services), drug manufacturers are increasing their efforts to be, if not pioneers, at least on the record, in their support of pharmaceutical care initiatives.

Novartis has been one of the leaders in pharmaceutical care initiatives at the retail level, most visibly in its alliance with Eckerd on the Eckerd Patient Care Center, but also with a host of programs to position the pharmacist as an advisor--and an authority--on patient care and drug therapy management.

Pat Barbera, director of national trade marketing at Novartis, noted: "We're trying to provide our customers with business-building programs. My feeling is that unless pharmacy moves into pharmaceutical care as a major effort, it's going to be a lose-lose situation for everyone. What we've done is design a number of programs to support pharmaceutical care, and to help them gain the skills that are necessary.

"That includes coming out with education/compliance programs for each new product launch, and looking closely at e-commerce opportunities," Barbera added.

"What we're looking at are ways to utilize those opportunities to help get our message across to the consumer, but at the same time work through our customers," Barbera continued. "What we recognize is if that customer--be it Rite Aid or CVS or whoever--is successful, so will we be. We're trying to approach this by initiating pharmaceutical care."

Novartis' PEAK program (Pharmacists Encouraging Awareness and Knowledge), introduced to national chains in March, consists of slide lecture kits addressing migraine, cardiovascular disease, osteoporosis, lipids and general compliance. Once pharmacists complete the CE lesson, they are sent the package of disease state information to set up the educational program, to provide pharmaceutical care and to maintain and attract new customers.

Manufacturers, in addition to their total-immersion product sites (i.e., Enbrel.com), are increasingly using the Web to offer integrated, add-on services. This fall, for example, AstraZeneca will be launching a free CE Web site for pharmacists, which should be up and running within the next one month to two months.

"This is meant to add to our pharmacist education and CE pieces," said AstraZeneca's Rachel Bloom. "We have a number of CE home study courses for pharmacists in various disease areas." Through AstraZeneca-sponsored symposia, the company also sponsors continuing education to pharmacists at national and state meetings.

The company will be launching a new program, Strategies to Improve Patient Compliance, which is an educational piece on effective patient counseling, in addition to several other new pharmacy initiatives. "We have a lot of things brewing in this area," said Bloom.

"I think more manufacturers are really understanding that their role in the whole healthcare practice possibly extends beyond getting their product past the FDA and into the market," said Medicine Shoppe's Levine. "It extends to ensuring patients receive positive health outcomes. I think more and more there is an interest--and clearly expressed--in wanting to play a more active role beyond the fact that the product gets prescribed by the physician."

All of Novartis' new products will have a CE program, as well as a PEAK program, Barbera noted. The program for Exelon, for example, Novartis' new drug for Alzheimer's disease, which recently received priority review status from the FDA, would be designed with a primary focus on counseling the caregiver.

"When we came up with Exelon, I thought, 'Wouldn't this be a great thing for the pharmacist to be that healthcare consultant for the questions that happen every day, especially something as devastating and confusing as Alzheimer's disease, something to help caregivers through the stages of the disease?' And it could be done with just the initial lecture, so at least people understand the basics of the disease. And we could extend that to any Web site, as well," said Barbera.

Manufacturers also are playing far greater attention to the pharmacy's role as they launch their new products. Searle, for example, with Celebrex, gathered key players from the major chains together and hammered out not only questions of logistics, distribution and tracking, but also pharmacist education on the product and consumer education.

With the Xenical launch, Roche set a similar kind of benchmark with the breadth of its consumer/pharmacy support programs, including XeniCare, an extensive personalized patient management program and other educational and informational tools to get the product out, make sure it is used correctly and ensure the drug regimen is adhered to.

Levine agrees that the pharmacist plays possibly the most critical role--not only in launch mechanics, but in the final healthcare delivery model. A service plus a product is a much better offering than either one of them alone. "The pharmaceutical industry is really one of the few industries that offers a product that doesn't necessarily have a service associated with it. In other words, you sell a product, and then is there a service sales force out there subsequently--like a repair force, so to speak--and I'm simply saying I believe that pharmacy can play an instrumental role in assuring positive health outcomes," Levine commented.

"We keep talking about our availability in the community and I do think that is an asset we have," Levine added, "an asset that's specifically advantageous to us over a lot of the other forms of pharmacy, be it mail service, Internet and so forth."

Drug manufacturers already are eyeing the Internet pharmacies as a vehicle for DTP efforts. Less than a month after its launch PlanetRx announced Warner-Lambert would be sponsoring a series of consumer disease state management programs, beginning with a program on its recently acquired diabetes.com site, which PlanetRx said currently attracts some 1 million visitors a month. Rx.com has 13 disease state management modules it plans to launch this fall.

The importance of bringing in managed care cannot be overstated in terms of proving the value of pharmaceutical care, said Levine, who has noted that what made a difference in Medicine Shoppe's program with Cigna in Kansas City was that the 25 percent reduction in costs was validated by data from a third party plan.

He sees these programs as enormous opportunities for both managed care and pharmaceutical manufacturers to move forward to a more integrated healthcare model, as the managed care plan clearly has a relationship with the physician, with the pharmacy network and with the PBM, and is in a unique position within its plan environment to make this plan come along a lot more quickly.

The managed care perspective is evolving to view cost-containment as more than just reducing the price of services. "They're really going to need to get into managing care and outcomes similar to what we did with Cigna in Kansas City," said Levine. "You're not going to take 25 percent of any of the drug cost out through contracting scenarios or MAC lists--they're already past all of that stuff. Managed care has thrived on the financial equation to this date. Now they seem to be suffering a little bit because they haven't necessarily taken some of those more patient-oriented steps. And I think those steps may bring us all together."

COPYRIGHT 1999 Lebhar-Friedman, Inc.
COPYRIGHT 2000 Gale Group