January 13, 2021

Drug Topics®: Hi, I'm Gabrielle Ientile with Drug Topics®.

We’re asking our Editorial Advisory Board members what the biggest trends in pharmacy have been, and what 2021 will bring to the pharmacy space.

Up next is my interview with Perry Cohen, PharmD, FAMCP, and chief executive officer of The Pharmacy Group, about his list of key trends and changes in the pharmacy space.

On the topic of 2020 trends and looking toward 2021, I wanted to start out with COVID, of course, the pandemic has been a cornerstone of this past year. So what has the pandemic brought in relation to the pharmacy space, and what do you see it bringing to the year ahead?

Cohen: I think on the delivery of health care, meaning the actual functioning of pharmacies, it's been a blessing and a curse.

Based upon your site of practice. I think if you're a hospital pharmacist, it's been total hell. That from March 1 through today, it's just been like a warzone, and either it was really busy, and people were dying, or your hospital was empty because you anticipated coronavirus cases. And it was very frustrating for the practice of pharmacy because there was no off the shelf treatment for the coronavirus. You couldn't grab a bottle of a drug and give it to somebody that's going to work. There's nothing on the shelf. They tried dexamethasone and other things. But that's in the media: that's not going to pharmacy.

So for the hospital pharmacists going in every day to work, it's got to be very frustrating and stressful. That's that group.

Community pharmacy, I think, on some level, there was a drop off of prescription volume, because people weren't going to the doctor. You're not going to the doctor, you're not getting prescriptions. Now I can't speak to the foot traffic for over-the-counter (OTC) medications and overall revenue for community pharmacy, but I think they took a hit short term. And they're trying they're trying to figure out what to do.

And then you've got the role of information technology and telehealth, and how that's all working. So it's kind of like, a lot of physicians were hurt. A lot of pharmacists were hurt. So I think it was just overall a really tough year for a physician or pharmacist with this coronavirus. That's on the delivery side.

On the financing side, meaning like health insurance companies, pharmacy benefit managers (PBMs), it's a different business, right? That's the financing of healthcare and pharmacy benefit. Health insurers saw boondoggle because they got all these premiums every month, expecting a certain level of utilization of hospitals, doctors and pharmacies, and it was all depressed. So they made a lot of money in the second quarter and the third quarter. Now the question is, is it going to come back, but they've already gotten their premium revenue. So they got the revenue and have the expenses. Because a lot of elective procedures got delayed, all that kind of stuff.

Drug Topics®: And then moving into 2021. How do you see COVID informing pharmacy as well?

Cohen: From now until April 1, I still think it's kind of a warzone. Very stressful, very chaotic.

Coronavirus cases are going up, you know, it's out of control. So the nightmare that started basically in March of 2020 will go through March of 2021. So that's the bad news is not stopping anytime soon.

The good news is that these drug companies have these vaccines, they're going to get approved the next 30 days and start rolling out and getting distributed around the world. And theoretically, it'll still work and theoretically, the right people get them and they won't be diverted or black-marketed or a lot of things like that. So that's a new dynamic over the next 120 days.

And then April 1, going forward: Number 1, the winter will be over. Number 2, the vaccine’s out. Theoretically the search is over. And from April 1 going forward from a healthcare standpoint, I think we'll be headed towards a new normal, but more normal.

Drug Topics®: I also wanted to touch upon vaccine distribution within pharmacy real quick. A lot of concern is surrounding the uptake amid American people of the vaccine. Do you see uptake being a big issue? And what can pharmacy do to inform their customers effectively about a COVID vaccine?

Cohen: Well, pharmacist on the ground could be a trusted source.

A pharmacist is not part of the media; a pharmacist is not a politician. Pharmacists are on the ground scientists whose responsibility is to public health. And every day, if I was working in a pharmacy, I'd be having a sign, get vaccinated, get vaccinated, get vaccinated. I’d put the signs up. And I'd be telling every person to get it. If they have to go down the street to Walgreens to get it, so be it, because that's the right thing to do.

Drug Topics®: The pandemic has spurred a lot of changes in pharmacy, but also there have been large changes independent of the pandemic, so I wanted to touch on some of those. What changes has pharmacy faced in 2020? And then what trends do you expect to be some of the mainstays for pharmacy in 2021?


Cohen: Okay, we'll go back to hospital practice of pharmacy, and the community practice of pharmacy.

Hospital pharmacy is trying to reinvent itself to have some semblance and place at the table, whether it's managing drug shortages, getting new information to physicians on the latest treatments for the coronavirus - you can't be a passive practitioner in a hospital. You've got to be reading all the right sources, the CDC guidelines, those kinds of things. And being an advocate for the proper treatment of the coronavirus.

And number 2, the role of vaccines and making sure that happens. And number 3 is having your drug distribution system working, so you can supply the medications needed. That's the hospital one for the next year. It's still hospital pharmacy 101, it's just really in a crisis situation. It's very dysfunctional. So I think the poorly run hospital pharmacies are just a disaster. And the well-run ones, usually the large institutions, have adapted and changed and are going to do the right thing.

Community, as far as the practice going forward, it's a different world. You can't rest on your laurels that patients are coming to you. People aren't going out. If you didn't have delivery service, you better have delivery service. If you want to mail prescriptions, you could mail prescriptions, that type of thing.

And you've got to realize that people need their medications. They can't physically go to the medications, so the medications have to come to them. That's the number 1. And then number 2, how do you stay connected to your patients to keep them informed? Telehealth. Telepharmacy. Calling patients, zooming with patients like we are right now. If I was at a pharmacy, I'd be zooming out my patients, hey, let's do a zoom call, Hey, how are you doing? You know, I would go through my drug database of prescriptions and find my top 20% of my customers who take a lot of drugs. And I've identified them I call them up and say hey, Mary, how you doing? Hey, well, you haven't given the pharmacy, but what can we do for you?

See what I'm saying? You got to do new things, put energy into the system and use technology. And that's just for the elderly people. For people your generation, social media, there’s other ways to advertise your pharmacy. And in the absence of that, Amazon wins.

So new models of pharmacy care. I think I give you the PowerPoint. And if you read through the PowerPoint, you get to the back of it, we're talking about new care models. 10% of the patients are driving like 80% of the health care costs. And a lot of those patients are now in the home and aren’t able to get out. We've got to bring the delivery system to them with technology, telepharmacy, Pillpack, stuff being delivered and all that so it's really more of a patient-centric world.

And pharmacy has got to fit into that patient-centric world more than it ever has been, has got to lead not follow. There are new companies that are out there: one's called Nurx and they're having a new model where you're the perfect person. It's women, ages 16 to 46 - so I know you're a woman, and I'm assuming you between ages 16 and 46. Okay, you have certain medical needs. One of them would be sexual health, contraception, sexually transmitted diseases, preventing aids all that they focus on that you can log on, register for $15. Get an office visit with a nurse practitioner or doctor without leaving your home. If that's right into your wheelhouse, you just do that. And if you have the doctor's prescription, they can just mail it to you. That's a new pharmacy care model and Nurx, that's going to be disruptive. It's going to take a few percentage points of the normal retail business to that website.

PBMs are going to have to reinvent themselves. They're going to struggle; they're going to try to reinvent themselves to be relevant. Right now they are the bad guys. But the other pharmacy care model is bringing more technology into the home of the elderly, and the people that are chronically ill. And putting everything around the patient versus around the institution.

Most pharmacists want the prescriptions to come to them, want the patients to come to them, want to do their work behind the counter. And that model is an old model. And if you looked at my slide deck, as you flip through it kind of criticizes the current model that's out there. That, if you just think of the bullets on that slide that explains the current model, and a couple slides later, it says with the new model is the benefit. And some of your generation will look at those 2 and say, Oh, I get it. It's just like if now if you had to drive to the shoe factory to buy shoes. You'd say like, why do I do that? I can just click click, and they'll show up right in front of me. Well, pharmacy makes you go to the pharmacy to get the drugs. So that's the care model, makes sense?

Drug Topics®: Absolutely. And then you also mentioned the role of the federal government and state government as well. Did you want to touch upon that?

Cohen: Sure. So the government is the biggest payer for healthcare. Right? There's commercial insurance that employers pay for. There's what individuals pay out-of-pocket, those are 2 sources of funding. And the third bucket is the government. And the government, because of Medicare, is bigger than the other ones, as far as dollars. And so the government spends a lot of money on health care through the VA system, etc. Medicare, Medicaid, they pay through those. Hospitals, doctors and pharmacies get reimbursed.

Well, the federal government is led by whoever the president is, and then the Senate and the House, and they create laws, they go back and forth. Well, for 4 years, we were on one trajectory with Obama. And then we had Trump and he was on a different trajectory - not a better or worse one, just a different one. And it was kind of just as it was against Obama, he did it.

Well, some of the stuff Obama put in was okay, and was kind of taking hold, and he just kicked the chair out from underneath it for 4 years. So now Biden's got to come in and look at what Trump did and what Obama did and say, okay, what things did Trump do that we should keep? And what things did Obama do that we should keep or reinvent?

So the federal government over the next 4 years, hopefully, we'll come up with a hybrid that makes sense. So that by 2024, we're in good shape with the federal government, and the financing of health care, and the programs that people get.

At the state level, it's going to be a disaster, because the states don't have enough money. And the state program to fund health care is called Medicaid. So Medicaid, traditional Medicaid fee for service Medicaid programs are really going to struggle the next 4 years, because of the economy in certain states, money, and they have to reinvent themselves.

So there's something called managed Medicaid, which is probably a better way to deal with Medicaid than fee for service Medicaid. And in certain states, California a few other ones, managed Medicaid is pretty advanced, in other states, not so much. So the states that actually want to do Medicaid should probably put in managed Medicaid to make it happen. And that's why I just think, because of Biden coming in, it's all going to get changed, hopefully, for the better.

Drug Topics®: Just closing out here as one of our Drug Topics® editorial advisory board members. What do you have to say to our audience of pharmacists as this year finally comes to a close and with 2021 on the horizon?

Cohen: Well I still think pharmacy is a noble profession, I think pharmacy has to reinvent itself.

Because I was at Costco a couple days ago talking to a pharmacy manager. And he told me that new grads in Los Angeles who come to work for Costco or any retail pharmacy, make between $50,000-$60,000 a year. Most of those graduates have hundreds of thousands of dollars in debt. And that math is very sad for me, that those people, I don't know what pharmacy techs are getting these days, but I can remember the days pharmacists made north of $100,000 a year. It seems like those days are over and it's just supply and demand. Pharmacy schools are kicking out a lot of students. There's not a lot of jobs, especially in certain parts of the country. And pharmacists’ compensation is not what it used to be. So pharmacists have to look for other ways to find decent jobs to practice the field. I graduated 40 years ago. It's just very sad, right now.

But it's also the same for the primary care physician. They've got to reinvent themselves as well. So healthcare really has to change over the next 10 years, and pharmacists need to be a part of that change, just like we always have.

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