Mail-order Pharmacy Threatens the Role of Pharmacists as Health Professionals

An issue for our entire profession

Pharmacy's political strength (or lack thereof)

Additional strategies

1. We must determine the number of prescriptions that residents in a particular state are receiving from a mail-order pharmacy in another state, and the estimated dollar value of those prescriptions. The largest mail-order pharmacies are located in a small number of states with the result that prescriptions with a total value of many millions of dollars are being sent out of most states each year. In addition to this data, the loss of tax and other revenues that a state experiences when pharmacies close, as well as the reduction or lack of growth in the number of employees in pharmacies because of the extent to which prescriptions are sent out of state, must be included in the financial analysis of the impact of mail-order pharmacy programs on a state's economy.
   
   
2. We must strive to determine (to the extent possible in what are typically highly confidential transactions) the terms under which PBMs and mail-order pharmacies have established agreements for prescription programs with employers, unions, and government agencies. Rumors of kickbacks or other inappropriate payments or incentives must be investigated by the appropriate authorities. Individuals who are aware of illegal or other inappropriate actions should consider being a whistleblower if the situation enables participation in that capacity.
   
   
3. Engage others in the community in developing and promoting programs that encourage "buying local." I recently read the book, Switch - How to Change Things when Change is Hard (Chip Heath and Dan Heath; Broadway Books, 2010). It was very thought-stimulating and enjoyable, and I highly recommend it. One of the experiences that the authors described was especially intriguing. It involved a small town and surrounding county in South Dakota in the mid-1990s. The population was declining; many of the residents were elderly and, when the young people were old enough, they left and didn't return. A high school teacher and his business class decided to analyze the situation. They constructed a survey to which members of the community responded and one of the findings was particularly noteworthy - one-half of the residents were doing significant shopping outside the county, driving for as long as an hour to go to larger stores. The class developed a plan around the theme of buying local that they presented to community leaders and residents. They estimated that if residents would spend 10% more of their disposable income at home, they would increase the local economy by $7 million. The community was energized and enthusiastically participated in various phases of the program. After one year, the amount of money spent in the county had increased by $15.6 million. The improved economy provided more tax revenue that the community could commit to support other needs and programs.
   
   Thousands of communities throughout the country are experiencing similar situations. Pharmacists are well positioned to provide leadership in developing initiatives such as this one that will be of benefit for the entire community and, of course, will also keep prescriptions local.
   
   
4. The national pharmacy organizations should provide a prescription drug benefit program for their employees that will serve as such a positive model that other organizations will want to consider a similar program for their employees. The program should include medication therapy management (MTM) and the full range of other professional services that pharmacists are in a position to provide. If such a prescription benefit program is not presently available in the communities in which the employees of our professional organizations reside, our organizations should provide the financial support and leadership to establish such programs. It is imperative that this be done. If our organizations that are the primary advocates for the provision of comprehensive services by pharmacists are not assuring such services for their own employees, how will we convince other organizations/employers that they should do this for their employees?
   
   
5. The profession of pharmacy must establish our own prescription benefit program that will compete with the programs of the PBMs and insurance companies. We have the expertise and motivation to establish the best program that will provide the greatest benefit for patients in assuring optimum therapeutic outcomes and avoiding drug-related problems. I also believe that this program can be financially competitive with other programs and, very possibly, be even more cost effective because of the extent to which drug-related problems and associated costs will be substantially reduced. This action is very important for our entire profession and all of our national organizations that have a commitment to increase the role of pharmacists in providing services and care for patients should be participants. It will be a major step in recapturing control of our destiny.

Dimethyl fumarate
(Tecfidera - Biogen Idec)
Agent for Multiple Sclerosis

• Has a unique mechanism of action (activates the nuclear factor [erythroid-derived 2]-like 2 pathway);
• Less risk of cardiac adverse events (compared with fingolimod);
• Less risk of hepatotoxicity and teratogenicity (compared with teriflunomide);
• Is rapidly metabolized and excreted (compared with teriflunomide).
  

• Is administered more frequently (twice a day, compared with once a day with fingolimod and teriflunomide);
• Many patients experience flushing.