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Anthem CEO Joseph Swedish caused a bit of a stir at an otherwise tame JP Morgan Healthcare Conference this month when he essentially accused Express Scripts...of overcharging his managed care organisation by $3 billion per year...the public spat represents a serious headache for Express Scripts, and could result in an unexpected windfall for one of the company’s main competitors, but in a broader sense the episode highlights what one industry expert believes is an increasingly important market inefficiency that would – if exposed to and by payers – have massive implications for the PBM sector...Politicians (and plenty of others) have been raising hay lately about the need for...more transparency...this same thought process has not (yet) been extended into the PBM space, where companies’ primary role is that of a middleman...“I hope it erupts into more – this is serious and real. PBMs...make price transparency for pharmaceuticals impossible and it is the patient that suffers the most because of it,”...“The thing centres on the fact that the PBMs insist on large rebates from the manufacturers, and the amounts are ‘proprietary’ so they can conceal them from their clients. The discounts aren’t being passed along to their customer but the effect is to force list prices higher to maximise rebates,”...more transparency could be a big benefit for drugmakers, who are likely well aware of the situation but feel as though their hands are tied when it comes to fighting back. “I believe that the more this gets pushed, and the more others learn about it, they will have to have this extend further,”...“Pharma has to have this revealed by others – they can’t complain because the PBMs could retaliate” during the formulary negotiation process.

Community pharmacies focus on providing value through convenience, service, and price. Value, that is, for the customer and the customer alone...Traditionally, community pharmacists haven’t had to worry much about them beyond deciphering prescriptions and asking for reimbursement...a pharmacy is a pharmacy is a pharmacy, right? Not anymore...alert independent pharmacies realize that to survive, they’ll have to do more than dispense drugs...They’ll also have to show that they have more to offer than the competition does, and that comes down to serving as much more than sophisticated pill dispensers...The new mantra...“I’m an investment, not a cost center.” In other words, by helping patients get better, the independent pharmacist can offer value to a health plan or a provider. That means taking advantage of opportunities to improve patient health in areas such as chronic illness...New payment models are the big drivers of this revolution...as healthcare reform forces a massive rethinking of how doctors are paid...What happens outside pharmacy will affect pharmacy...This is where creativity and business savvy enter the picture. As billions of dollars move toward models that emphasize results, independent pharmacies will need to show health plans and physicians that they can save them money.

Manufacturers pay billions in rebates to pharmacy benefit managers (PBMs). How much of that money do PBMs share with their plan sponsor clients...As far as I know, the only public answer comes from the Pharmacy Benefit Management Institute’s new 2015-2016 Prescription Drug Benefit Cost and Plan Design Report (Free download with registration)...According to the PBMI’s survey data, only three-quarters of employers directly receive a piece of manufacturer rebates. Some employers get 100% of the rebates. Others get a portion, sometimes with a guaranteed minimum amount...I also highlight PBMI data about the prevalence of spread pricing (as opposed to pass-through pricing) as a means for employers to compensate PBMs. Despite what you may have heard, many employers still seem to prefer spread pricing models...

The traditional pharmacy business model is under siege as it faces challenges from healthcare reform and competition. As community pharmacies scramble to survive, the specialty pharmacy model offers a lucrative opportunity for growth...The key to success? You’ll need to understand and prepare for a wide variety of challenges on fronts ranging from accreditation to marketing. That’s the message from community pharmacists who are urging their colleagues to take advantage of the growth in specialty pharmacy.

• What is specialty pharmacy?....The definition is not clear cut...
• Here are common characteristics of specialty drugs: They’re pricey, sometimes even shockingly expensive...treat a rare and chronic illness...injectable or infused...Complex manufacturing is required...special requirements for storage and handling.
• Complex patient monitoring is required (eg, for compliance and side effects).
• Help available in specialty arena...a number of companies are working to give independent pharmacists a helping hand in the specialty pharmacy arena.
• Accreditation...It’s expensive, and it’s confusing...
• Marketing to physicians.
• Marketing to the public.
• Willingness to deal with issues like reimbursement rates and performance standards.

So why bother with all this? “There’s huge opportunity for growth,” Clark said, and a chance to provide high-quality care to patients who need it. “But we have growing pains,” he cautioned. “You’ve got to be patient.”

Wal-Mart Supercenter customers expressed shock, frustration and dismay Sunday night in the final hours before closure of the Nellis Boulevard store, one of the few grocery shopping venues for Nellis Air Force Base families and others who live nearby...Shock that the store was closing so suddenly — just two days after...Wal-Mart Stores Inc., announced that the store at 4350 N. Nellis Blvd. was one of the 269 stores slated for closure globally and the only one in the Las Vegas Valley...Frustration that they now would have to travel farther to buy groceries, fill prescriptions and pick up other goods.

To realise new ways of working means moving away from traditional professional boundaries and enabling the pharmacy workforce to take on different roles if it benefits patients...the demand for pharmacists’ clinical skills as medicines experts continues to grow. Medicines optimisation spans all pharmacy services....In order to deliver this, maximising the skills, knowledge and experience of the rest of the pharmacy team is an absolute necessity...As pharmacists’ clinician role continues to evolve and become embedded in new areas...pharmacy technician, can help to support them.

• Education and training...realigning functional tasks and providing confidence in delegating duties is to ensure there is a defined education and training pathway that assures the public and the profession of a competent practitioner at every level.
• Expanding roles...Pharmacy technicians, as registered and accountable professionals working across the same pharmacy environments as pharmacists, can be used to release pharmacists’ time to undertake additional clinical responsibilities.
• Blurred roles...The expanding responsibilities of pharmacy technicians may help give clarity to the role...However, there is no clear distinction between a newly registered pharmacy technician and a dispensing assistant...requires greater clarity around the role of the dispensing assistant...This must be resolved if pharmacy technicians are to further their practice and help release pharmacists to conduct more clinical work.
• Working together...Pharmacy technicians will not be substitutes for pharmacists but, as foundation practitioners, they can work closely together, exercising autonomy and judgement within limited parameters...Working together for the benefit of patients will allow pharmacy to embrace the changes that are needed to relieve pressure on the UK healthcare system.

Ron Lanton – with True North Political Solutions brings another Health Policy Check-Up Segment with State Rep. Heidi Brooks with the state of Maine House of Representatives. They discuss MAC Drug Pricing Transparency and other pressing issues to our pharmacy industry.    (podcast 23:19 minutes)

Community pharmacy negotiators are refusing to negotiate with the government over its planned 6% cut in community pharmacy funding in England until it has seen details of the government’s long-term plans and the evidence behind them...The move comes as the Pharmaceutical Services Negotiating Committee voiced its fears that the government is deliberately keeping it in the dark about deeper cuts to come...We cannot agree to commence negotiations before we have had an opportunity to understand fully your plans and the analysis underpinning them…We believe we are entitled to this material but it has not been forthcoming. The government appears to have a settled intention to proceed on a course of action that will run counter to its stated ambition to develop a clinically focused pharmacy service, and be damaging to patient care...the 6% cut will force pharmacies to cut staff and damage patient confidence in the profession; the PSNC is also suspicious of government plans to create more online pharmacy services.

Walmart said it will close 269 stores worldwide this year, including many of its smallest stores, in an unprecedented move CEO Doug McMillon characterized as being more disciplined about growth...Plans call for the company to close 154 locations in the U.S., including the company’s 102 smallest format stores, Walmart Express, which had been in pilot since 2011. Walmart said it will focus on strengthening its large format supercenters, optimizing Neighborhood Markets which average about 40,000-sq.-ft., growing the e-commerce business and expanding pickup services for customers. In terms of closures by format type, the company said the 154 U.S. locations consist of 23 Neighborhood Markets, 12 supercenters, seven stores in Puerto Rico, six discount centers and four Sam’s Clubs...Walmart did not disclose how many of stores slated for closure contain a pharmacy. However the figure is expected to be less than the total because many of the affected stores are small formats that did not contain pharmacies...(Nevada - Supercenter at 4350 N Nellis Blvd. in Las Vegas closed, today 1/17/16) 

The drugstore arms race on the Strip is ratcheting up another notch...Workers are building a roughly 20,190-square-foot CVS store near the southeast corner of Las Vegas Boulevard and Flamingo Road, in front of Bally’s. The two-story property will have a pharmacy and is scheduled to open in May…It’s the latest Walgreens or CVS to land in the famed tourist-packed casino corridor, where the drugstores make big money — and pay big rents — selling medicine, food, alcohol and such Vegas-themed souvenirs as shot glasses, margarita cups, ash trays and gallon-sized flasks...This lucrative slice of commerce on the boulevard is only growing...CVS opened a store last year in the new three-story mall at Treasure Island and now has four outposts in the resort corridor, including the one at Bally’s.