Finding something in nothing

Nothin' from nothin' leaves nothin'
You gotta have somethin'
If you wanna be with me
Nothin' from nothin' leaves nothin'
You gotta have somethin'
If you wanna be with me

A few (well, maybe more than a few) years ago, Billy Preston sang the above song. The lyrics came to mind during a staff discussion yesterday where APhA staff was discussing blogs, comments, and a article about a program at a major food chain that provides at no cost a small number of antidiabetic drugs.

Contrary to the "nothin" this deal implies, I believe we pharmacists “have somethin” that can make patients "wanna be with us."

Comments and blogs are raising concerns about the “devaluing” of pharmacists when prescription medications are given away. In recent years, we have seen more and more stores instituting discount programs with the stated goal of improving patient access to medications. The intent—and I’m sure often the impact—of these efforts can be laudable when persons who cannot otherwise afford their medications get the right medicine to meet their needs. But the real value arises when patients get the full benefit of their pharmacists’ counsel and the best information and advice available about how to use these medicines.

The other expressed concern I’ve read in the blogs and comments is that these programs devalue the role of the pharmacists and affect patient safety by encouraging “pharmacy shopping.”

As members of the pharmacy profession, we know that access is a component of appropriate medication therapy and that every day, thousands of patients are served by dedicated pharmacists working to ensure that all patients have the medications they need and know how to use them.

Pharmacists not only dispense the right medication, but very often, we help patients navigate the health care system, serve as referral sources when problems arise, and provide essential information and advice without which many would not do nearly as well with their therapy. We also know that equally important to access is making sure that the patient is taking the best medication to meet their individual health care needs. When a medication is free, but isn’t the right medication, then the price is too high. The drug product may be free, but the opportunity is lost to control the patient's diabetes, and that will almost certainly lead to other unnecessary health care costs and a shorter, less healthy life.

Making a determination of whether a medication will best meet the needs of a patient requires a comprehensive review of a patient’s entire medication regimen whenever a new medication is added or changed. The effectiveness of a medication review becomes more challenging anytime patients use more than one source to obtain medications. It’s a fact that many patients move from pharmacy to pharmacy on their own. As economic pressures grow, this dynamic also grows and we see more patients “shopping.” So the challenge we face is managing this growing dynamic.

This is not a new conversation for APhA. We have several policies that to one degree or another touch upon these challenges, the most recent of which was debated and approved in our 2010 House of Delegates. That policy states, “APhA advocates the elimination of coupons, rebates, discounts, and other incentives provided to patients that promote the transfer of prescriptions between competitors.”

In this hypercompetitive world, where market share is so important, I can’t put APhA in the position of criticizing business decisions. I don’t “make stuff up” about why a company promotes one way or another. We have members on all sides of this equation. Rather, our challenge as a membership organization with a public mission to Improve Medication Use and Advance Patient Care is to inform, educate, and advocate so that pharmacists will practice in a world that values their services and where patient safety is the absolute top priority.

A study published last year in Circulation showed veterans were more adherent to their lipid-lowering medications when copayments were lower. So, yes, economics 101 works for medications. But even when the medications were free, a substantial number of patients were still not adherent. Cost is not the only factor.

We must be vigilant in our message to patients: Wherever they obtain their medications, they must talk to their pharmacist. And finally, we must be vigilant with ourselves: We must talk with the patients whom we serve.

APhA works every day to promote the value of pharmacists’ services to whomever will listen—legislators on Capitol Hill, consumers groups and staff in government agencies, payers, PBMs, and others. We support efforts to expand patient access to medications. Medications play an important role in managing and preventing disease. The value of those medications (regardless of the cost to the consumer) increases when patients take advantage of the dispensing and clinical services of their pharmacist and benefits from the medication expertise this health professional provides.

The part about this issue that I like most is that the chain involved, Giant Eagle, is one that is ensuring patient access to a pharmacist trained in diabetes at every one of its pharmacies. This is a great step toward improving the care provided to patients with diabetes. Giant Eagle is on to something with this valuable MTM program. But giving the drugs away for nothing could well send the wrong message about medication therapy and those pharmacists who work hard every day to manage it.

Footnote – APhA is working with 9 other pharmacy organizations to lead the development and approval of a standard data set that will allow pharmacists to play an even more relevant role by receiving and writing into electronic health records across enterprises (hospital, lab, medical offices, chain, independent, mail) so even when patients shop multiple pharmacies, pharmacists can do their best to manage patient care with full knowledge of a patient’s record. More on that later….