The move is clearly a reaction to Caremark’s no-tobacco preferred pharmacy network. Express Scripts however has gone further with its concept for a “no sin” network.
Below, I ask whether payers really want pharmacies to be goody two shoes. Instead of writing your thoughts on a pound note, let me know what you think by posting a comment below.
DON’T DRINK, DON’T SMOKE
In Thoughts on Caremark’s No-Tobacco Preferred Pharmacy Network, I review key managed care and pharmacy industry issues associated with Caremark’s proposal. My comments apply to the notional Express Scripts network, too.
The Caremark no-tobacco network has at least one small plan sponsor, with about 5,400 nonunion employees covered by the City of Philadelphia. By contrast, Express Scripts is merely researching the concept, per the WSJ:
“Some clients have inquired about creating networks that include pharmacies that do not sell tobacco or alcohol,” the Express Scripts spokesman tells us. “We regularly survey our retail pharmacy partners on many topics and we are doing so now. At this point, we are gathering information.” He adds that Express Scripts is looking to provide “better clinical outcomes in the most cost-effective way possible.”I'm still skeptical that payers will readily adopt "no sin" networks. A few questions:
- Why should people who don’t smoke or drink pay higher co-pays simply because their pharmacy sells tobacco or alcohol to someone else?
- Unlike tobacco, moderate alcohol consumption has been shown to have some beneficial health effects. What is the health rationale for a co-pay penalty?
- It will be harder to form a no-alcohol network, since the large chains sell alcohol in some states. In 2011, Walgreens even launched Big Flats 1901, its own private label beer. See Walgreens Rx for Growth: Beer! (Stephen Colbert has a great analysis of Big Flats. Start watching this video at 2:13.)
WHAT DO YOU DO?
Regular readers probably already guessed that this video would make an appearance today. No subtle innuendos here on Drug Channels!
Has anyone done a study to determine how many smokers and/or drinkers actually buy their tobacco products and alcohol in a store with a pharmacy? I would propose that the majority would purchase these daily items at a grocery store or a gas station that they frequent a lot more often than the pharmacy.
ReplyDeleteThis move to tobacco free or sin free networks is all marketing and not going to make one bit of difference in choices people make about alcohol and tobacco. It penalizes through cost and inconvenience those who do not smoke or drink. I would be complaining to my HR department if my employer chose one of these.
I would also suggest that this type of network might decrease the adherence of the masses for a poor attempt at messaging to the few. Convenience helps drive adherence and any time you decrease convenience you compromise adherence.
Good point, Beth. Convenience does indeed drive adherence! And so does choice.
ReplyDeleteAdam, wanna take a stab at how "Any Willing Provider" plays into this adherence and education piece?
What about people who don't garden or don't do oil changes? Garden hoses and motor oil could offend some people.! CVS is out of line and so are the other PBM'S. STICK TO QUICKLY AND ACCURATELY PROCESSING CLAIMS!
ReplyDeleteA no-sin network wouldn't be so bad for urban/surburban members. They often have multiple pharmacy choices within a few blocks/miles. But for rural folks with fewer options, that might dramatically change access and require them to travel much farther. For that reason, its a bad idea to impose such morality on the rural folks,
ReplyDeleteA while back where I lived, the Walgreens was as good and convenient as any local liquor store, so plenty of people purchased beer/liquor there.
If I'm not mistaken, the "study" done by CVS Health said 9% of smokers buy cigarettes at an outlet with a pharmacy. So, the City of Philly folks can buy their cigarettes at maybe 10 different places, on their way to CVS. There are convenience stores in the buildings housing City workers, that sell cigs. And, has the City gone no smoking on premises? How about smokers aren't eligible for benefits? Those strategies work, however draconian.
ReplyDeleteGood luck to ESI re: their legacy Medco labor groups, lead balloon material. Are they going to ditch clients like Altria or Reynolds, or tobacco farmers?
Has anyone done a study to determine how many smokers and/or drinkers actually buy their tobacco products and alcohol in a store with a pharmacy? I would propose that the majority would purchase these daily items at a grocery store or a gas station that they frequent a lot more often than the pharmacy.
ReplyDeleteThis move to tobacco free or sin free networks is all marketing and not going to make one bit of difference in choices people make about alcohol and tobacco. It penalizes through cost and inconvenience those who do not smoke or drink. I would be complaining to my HR department if my employer chose one of these.
I would also suggest that this type of network might decrease the adherence of the masses for a poor attempt at messaging to the few. Convenience helps drive adherence and any time you decrease convenience you compromise adherence.
Good point, Beth. Convenience does indeed drive adherence! And so does choice.
ReplyDeleteAdam, wanna take a stab at how "Any Willing Provider" plays into this adherence and education piece?
To those who have emailed me: The photo at the top of the article is *not* really me. It's Adam Ant, the very 80s singer in the video.
ReplyDeleteWhat complete nonsense. First of all, inconveniencing patients does not improve their health. Second, penalizing people who do not smoke or drink for patronizing the pharmacy of their choice is breathtakingly unfair. Third, some of the best pharmacists I know practice within organizations that sell tobacco and/or alcohol - as well as high salt, fat and sugar foods, and various health remedies that amount to nothing more than health fraud (e.g., Homeopathy).
ReplyDeleteThis entire movement demonstrates to me that the major PBMs have reached a point of complete intellectual bankruptcy in attempting to create new value for their clients. Instead of creating true performance-based networks of community pharmacies that provide a higher level of safety and quality to patients they have elected to use cynical gimmicks. Pathetic.
This entire premise of health based only sales is ridiculous CVS did it for publicity and to promote their own services ...they didn't stop selling obesity causing snack foods...Get rid of all health risk items or the cause for better health is not believable
ReplyDeleteThis is an interesting move on the part of Express Scripts. Although, if this is what their clients have asked for, it seems reasonable that they would want to test it out. If this progresses, I think it would be a step up for retail/community pharmacists, who constantly fight for recognition as a "valued healthcare professional" and fight the battle to be recognized by healthcare plans as a "provider" for billing clinical services.
ReplyDeleteI also don't actually think it is too much to ask for the removal of tobacco and alcohol. Remember that Walgreens had exited selling alcohol in the mid-1990s and did not reintroduce it until late 2010 after the acquisition of Duane Reade. During that time period of "no alcohol", their pharmacy business and overall top line continued to grow, they expanded their healthcare services and entered into vaccines and Specialty pharmacy. It didn't really hurt them all.
While these items add numbers for most retailers top line, the truth is that it adds very little, if anything, to their bottom line.
Instead of looking at this proposal as "being told how to live your life" look at it from the angle of positive branding for community pharmacists as healthcare professionals and encouragement to retire certain aspects of their business and forge into new areas of business to better position their overall value and build margins.
I would suggest that they (Express scripts) mandate people ride bikes to the pharmacies while at it ( in their Ho Chi Min approved pajamas )
ReplyDeleteWas really interested when CVS originally came out with this proposal since, by its own inference, they'd have to exclude their own pharmacies from a "no sin" network. After all, they've been fined by the feds for a variety of practice "indiscretions" in the past few years (many related to abuses of the Controlled Substance Act). Perhaps ExpressScripts will take notice?????
ReplyDelete