Drugstores look to expand pharmacist consultations — and charge for them

Marc Levy

Friday, Oct. 1, 2004 | 9:37 a.m.

CAMP HILL, Pa. -- Jaime White helps her diabetes patients understand how to manage their blood sugar, checks their blood pressure and sometimes examines their feet for signs of nerve damage common to diabetes sufferers.

Her patients are West Virginia state employees participating in a program offered by Rite Aid Corp., the nation's third-largest drugstore chain. They meet with White at a drugstore, and their insurer pays the bills: $80 for initial visits, $20 for follow-ups.

Customers have long called on pharmacists like White to do more than fill prescriptions. But drugstores, from giants like Camp Hill-based Rite Aid to smaller regional chains, are looking to expand their counseling programs and boost revenue -- a trend that could be bolstered by the prescription drug benefit that will become available to Medicare enrollees in 2006.

"Many of (the chains) have started to look at how they can transform a pharmacy from a place where one can obtain drugs into a place where you deliver health care," said John M. Coster, vice president of policy and programs for the National Association of Chain Drug Stores.

The chains say regular patient consultations help patients stay healthier because many patients don't take their medication correctly. As a result, they say, both patients and insurers will save money.

But to provide pharmacists' time and private rooms for consultations, stores need to be reimbursed by insurers, as White's program is, the companies say. The hurdle is getting insurers to agree -- such reimbursement is common for pharmacists who work in nursing homes, but nowhere else, those in the industry say.

Under the law President Bush signed in December, insurers providing Medicare drug plans must provide a medication consulting service for patients whose illnesses and prescription use meet certain thresholds. The federal government has not finalized how the consulting programs will work, and there are conflicting ideas over the shape of final regulations.

Drugstores and pharmacist groups want retail pharmacies to play a significant role. Insurers generally support the idea of pharmacist checkups but want more flexibility.

For instance, some insurers already have in-house systems in which enrollees can consult by telephone with a pharmacist, which they would like the regulations to accommodate, said Mohit Ghose, a spokesman for America's Health Insurance Plans, a group that represents insurers.

People who have consulted with pharmacists say they like having an extra health care resource.

Bill Wilmer, 68, a retired city worker in Asheville, N.C., said his physician takes care of him when he has a problem, but his pharmacist is like a coach who works to keep him healthy. Wilmer, who takes medication for diabetes, high cholesterol and congestive heart failure, has seen a pharmacist at a Kerr Drug store a few times a year since the late 1990s, with his insurer picking up the tab.

"I think I am far better off in the program with the pharmacist than on my own, trying to learn, hit or miss," Wilmer said. "I wouldn't feel uncomfortable asking my doctor any question, but what I'm saying is that the coach is there."

And Daniel Stokley, 69, of Wendell, N.C., last week began a counseling program with a Kerr Drug pharmacist that is paid for by a pharmaceutical company grant. His physician recommended it, he said.

The pharmacist is "deeper into diabetes than my doctor and can explain a little bit more about what you shouldn't do," said Stokley, who was diagnosed 12 years ago.

The 102-store Kerr Drug chain, based in Raleigh, N.C., has installed consultation rooms in 10 stores, and its pharmacists take part in a dozen different counseling programs, said Rebecca Chater, Kerr Drug's group manager for clinical services.

Rite Aid has pilot programs for Washington state's Medicaid program and West Virginia's state employees. Walgreen Co., the nation's largest drugstore chain, has a handful of pilot programs in states including Wisconsin, New Mexico and Texas.

"We're looking at the potential there to expand services," Walgreen spokesman Michael Polzin said. "Certainly, the new Medicare program could help move these along. ... But a lot of that depends on how the final regulations look."

For the drugstores, the consulting revenue could help them compete with online pharmacies and restore some profit margins on prescriptions that HMOs and pharmacy benefits managers have squeezed in recent years.

However, Coster, of the drugstore industry group, said he doesn't expect consultation revenue to amount to a big windfall, and industry analysts said it's too early to tell how important this niche will be to the drugstores.

But, said Mark Miller, of the Chicago-based investment firm, William Blair & Co. LLC, he expects drugstores to continue looking for new ways that pharmacists can bring in revenue.

Drugstores and pharmacist groups say the goal is to make the consultation programs available to everyone who takes medication, at least as a companion to traditional, over-the-counter advice.

"There will always be some advice that's provided with the dispensing and then there's the in-depth medication review, like, 'We really need to sit down and talk about your diabetes,"' said Susan C. Winckler, staff counsel and vice president for policy and communications for the American Pharmacists Association.

Eager to expand the programs, drug chains are retrofitting stores with private consultation rooms and trying to persuade insurers, one by one, to reimburse them for the service -- even if on a trial basis.