Building bridges among chain pharmacy's allies

Drug Store News, June 7, 1999 by James Frederick

The pharmacy profession and the chain drug industry it supports have "a very bright future," asserted Kurt Proctor, senior vice president of pharmacy policy and operations for the National Association of Chain Drug Stores. But to get there, he said, pharmacy leaders will have to find new solutions to what he considers "the one overriding issue, and that is how we're going to deal with the tremendous demand for our services-both in prescription volume and new pharmacist services."

That explosion in demand is fueled by an aging population more dependent on prescription drug therapy, and by a concurrent rise in the development and marketing of new, breakthrough drugs that for the first time are being advertised directly to consumers. But the sweeping takeover of managed care and third party benefits plans, coupled with community pharmacy's ongoing effort to provide more in-depth care for the members of those plans and other patients, is also putting new demands on chain pharmacy, he said.

"There's a disconnect between parties and retail, in terms of what their policies are and how that impacts at the store level," Proctor said.

That disconnect, he said, is one of several that. currently impact chain pharmacy, and it is one of the most serious. Third party payers, he told Drug Store News, are presenting chain pharmacies with a growing list of demands, including managing their drug formularies, assuring their patients' compliance with their drug regimens and assisting them in managing their chronic diseases and lifestyles. Meanwhile, pharmacists must spend time on the phone verifying patients' plan membership or eligibility for a particular medication, often with a help desk that may or may not "answer the phone quickly," according to the NACDS executive.

"There's a whole litany of things [third party payers] do that contribute to the workload of the pharmacist, and yet, at the same time, they want us to get into more services and be doing things to serve their patients quickly and efficiently," Proctor said.

Compounding the problem, he added, is the disconnect between the managed care reimbursement system and community pharmacy. That reimbursement scheme, he noted, also doesn't reflect a realistic perception of pharmacy's contribution to both plan members' health care and the cost efficiencies realized by the plan.

Bridging managed care and pharmacy

As head of pharmacy policy and operations, Proctor is a key point person for NACDS's efforts to help its chain members connect more effectively with managed care payers and other groups that impact chain pharmacy, in a time of what he calls "exploding demand for our products and services.

"Just the numbers of prescriptions we're projecting are putting a lot of strain on the system, and we find ourselves in a situation of having a lot of disconnects in the system," Proctor asserted. "There's a disconnect between state board regulations and the current practice of pharmacies" because of "state board regulations that were largely written in a different era, many of which have not been updated and modernized like they need to be."

In addition, he said, "There's a disconnect between pharmacy education and practice in terms of the graduates and what their expectations are-a disconnect between their expectation and reality."

Proctor is well-positioned to help chain pharmacy bridge those "disconnects." The son of a pharmacist and holder of master's and doctoral degrees in pharmacy and pharmacy administration, he joined NACDS 10 years ago as head of research and information under then-newly hired organization president and chief executive Ron Ziegler. Proctor now oversees all aspects of pharmacy policy-making and support on behalf of NACDS members, as well as managed care operations, library and research functions, technician training and technology support and production of the monthly NACDS Chain Pharmacist Practice Memo.

As such, Proctor often works side-by-side with Larry Kocot, senior vice president of government affairs and general counsel for the organization. The result is a coordinated effort to support chain pharmacy's efforts to modernize and streamline its dispensing operations.

"We've got to deal with this issue of the [rising] volume of scripts, by changing the board regulations and working with the third parties and talking about other options," Proctor asserted. "We don't have a magic answer for this, but the key is getting the profession to recognize and talk about it, and to consider some out-of-the-box ideas. It can't just be business as usual for the profession."

Proctor and his team work with the state and federal affairs people under Kocot to remove outmoded regulatory barriers that hamper efficient drug delivery and patient-care initiatives. Much of that depends first on "just shaking people up [on state boards of pharmacy, in schools of pharmacy and elsewhere] and getting their attention ... to the reality of what's going on in the profession and what we need to be talking about and doing about it," said Proctor. "And we've been encouraged by the recognition of that from some of the state boards and some of the state pharmacy executives."