Plotting a course to navigate pharmacy's changing role

Drug Store News, August 18, 1997 by James Frederick

In advance of the NACDS Pharmacy Conference and Managed Care Forum, Drug Store News Chain Pharmacy spoke at length with Laura Cranston, the organization's vice president of pharmacy affairs. Cranston has been a key force in shaping this year's conference, which has been broadened in scope to include decision-makers from the whole spectrum of pharmacy and prescription benefits management.

Cranston, a pharmacy graduate of St. John's University College of Pharmacy and Allied Health professions, served as the first executive resident for the American Society of Consultant Pharmacists in Arlington, Va., before joining NACDS in 1988. As head of pharmacy affairs, she is responsible for monitoring the development of pharmacy-related initiatives and operational issues. She also helps develop training programs, CE programs and technician education efforts, works with many national professional organizations and helps NACDS members comply with counseling requirements of OBRA '90 and state regulations.

Chain Pharmacy: Where do you hope this year's conference will take the industry?

Cranston: We think it will help us further integrate community pharmacy providers into managed care systems and into larger integrated healthcare systems in the future. And it will provide under one roof an opportunity for the players to explore future relationships.

We have seen an outstanding increase in the number of chain community retail providers at this meeting. In the face of a consolidating industry, we are at a record level of attendance on the retail side of the business, and the associate members are bringing their managed care teams. So we think this conference is in a controlled-growth stage. We think this year has been outstanding, and that the integration of pharmacy and managed care will continue to make this pharmacy conference and managed care forum a very valuable meeting for our members, for suppliers and PBMs we're doing business with. We have a number of chain-owned PBMs at this meeting and a number of new, strong PBMs on the outside that are also here for the first time.

Chain Pharmacy: Framing the issues addressed by the upcoming conference in a broad sense, can managed care and retail pharmacy truly coexist? And what avenues do we have to take to get there?

Cranston: We feel that absolutely managed care and retail pharmacy must coexist. We have to get beyond managed costs. We also believe that community pharmacy is the segment of pharmacy that can control basically two major factors, and that is access for patients and the ability to interact with patients on a face-to-face basis. And, we are turning that into a point of leverage with managed care.

Chain Pharmacy: That's a good point, because the access issue probably has not been fully driven home to managed care companies.

Cranston: And, you talk about disease-state management and cognitive services. How do you deliver that on the phone? So as pharmacy demonstrates they can save money on other line items within the healthcare system beyond prescription drugs--that's community pharmacy, that's what we can do best.

We're seeing our members get very creative in the disease-state management area. And, we're seeing them pilot different things with specific managed care organizations. They're hiring different types of clinical services directors to look at the high-risk populations of certain plans, and developing strategies that are a win-win combination for the managed care organization and the pharmacy provider.

Chain Pharmacy: Part of the difficulty has been getting the comparative data on a patient population. It's a question of getting a benchmark on hospitalization rates or clinical visits patients have without active pharmacist intervention, disease management efforts or compliance programs.

Cranston: Yes, but a lot of companies are doing it one-on-one with a specific plan, where a specific plan comes in and they know what their cost has been on this population of, for example, 500 at-risk people. The payer can strike some sort of arrangement with the chain, where they're asking, `Can you bring down this total cost? and how will you do it?' Or, a chain says, 'Here are people exceeding their per-month capitation plan, so these are the ones we'll look at.'

Also moving the trend along is that retail pharmacy chains are beginning to realize that they need their own aggregate data from their own prescription files to find out where the highrisk populations are, or where drugs aren't being used properly.

There's been a great deal of dollars put by the chains toward the development of aggregate prescription data, which is not violating patient confidentiality. The question is, how can we use that aggregate data that we've captured in our central systems, analyze it and better position ourselves?

Chain Pharmacy: What role can NACDS play to help move the relationship between retail pharmacy and managed care beyond cost-per-script reimbursements and lines in the sand?

Cranston: I think the best role NACDS can play is to bring market insight and analysis to our member companies, so that individually they can make independent decisions as to the strategic direction that they need to take. I think the strength of our organization is looking at market trends, analyzing them and communicating that information to our members.