Implications for Stakeholders
As pharmacies carve out new and expanded roles in the health-care delivery system, four key stakeholders — regulators, pharmaceutical companies, providers, and payors — should seek to accelerate the process and create new opportunities through collaboration.
For regulators, increasing coverage for the uninsured is a laudable goal, but increasing access is more difficult. As newly covered individuals flood into the already strained system, it will take all hands on deck to meet the increasing demand. This will require a relaxation of some of the constraints currently placed on pharmacists and pharmacy-based retail clinics. Regulators should create the optimal conditions to allow innovations in pharmacy cost and access to flourish.
For pharmaceutical companies, pharmacies represent an important potential ally. As pharmacy chains deploy compliance programs and more complex disease management protocols, pharmaceutical companies stand to gain a great deal. Noncompliance reduces the effectiveness of medication regimens and can lead to acute episodes and complications. Achieving greater compliance could be a genuine win for pharmaceutical companies, pharmacies, payors, and of course patients.
Pharmaceutical companies also stand to benefit as pharmacies offer more diagnostic services. For example, there are more than 6 million undiagnosed diabetics in the United States, and pharmaceutical companies have launched massive efforts to promote testing. Pharmacies could aid both parties, gaining valuable clients and helping patients avoid complications thanks to early detection. Pharmacies and retail clinics will likely become essential alternatives for making specialty drugs part of a broader disease management effort. Both CVS and Walgreens are moving in this direction. This would give pharmaceutical companies a new channel and would provide consumers with a more convenient way to access care.
For health-care providers, offering better quality of care, greater cost-effectiveness, and more successful outcomes will be increasingly important, and of increasing concern to the regulators that oversee them. For example, after a New England Journal of Medicine report revealed that 20 percent of Medicare patients are re-hospitalized within 30 days of discharge, the government announced it would evaluate hospitals based on re-admission rates. Because noncompliance plays a large role in avoidable re-admissions, pharmacists, with their high level of engagement with patients, may be able to play a role in lowering re-admissions. As noted earlier, the pharmacy could also become a diagnostic and triage facility, referring patients to providers as well as handling after-hours needs and low-acuity emergency room overflow.
For health-care payors, reducing the cost of care will remain a challenge, and pharmacies are well positioned to play an important role. A recent Medco Health Solutions study showed that every $1 spent on improving compliance returned $7.10 for diabetes drugs, $5.10 for cholesterol drugs, and $4 for blood pressure medication. Payors are already partnering with pharmacies on pilot programs aimed at improving compliance. Payors are also beginning to recognize and leverage the credibility of the pharmacist with patients and are starting to use the pharmacy as an engaging channel for delivering health and wellness messages, coaching, interventions, and other services.
In a reform debate full of hard decisions, whether to empower the pharmacy should not be a difficult choice. The pharmacy of the future could take the current assets of trust, access, skill, and cost to the next level. Regulators, pharmaceutical companies, providers, and payors should be prepared to help this evolution and benefit from it.
Reprint No. 10103
- Gary Ahlquist is a Chicago-based senior partner who leads Booz & Company’s work for healthcare clients worldwide. He specializes in strategy and organization development for health plans, insurance companies, and providers.
- Minoo Javanmardian is a Booz & Company partner who works with global health-care clients. Based in Chicago, she focuses on strategy, strategy-based transformation, and innovation in health-care services.
- Ashish Kaura is a Booz & Company principal based in Chicago. He specializes in the development of growth strategies and new business models in response to market
discontinuities, for health-care and health-services companies.
- Also contributing to this article was Booz & Company Senior Associate Ihor Bilokrynytskyy.