Everything Old Is New Again?

On Madison Avenue, there’s a well-worn way to grab attention for a product: Tell everyone it’s new. It seems old hat, and it is, but over on Wall Street, it works. The market often rewards companies for trying something new.

Even when it’s not new at all.

Community pharmacists noticed this recently. We do business in a way that may be so old-fashioned that it seems new. In an era of impersonal, corporatized bigness, we still interact with patients face-to-face (and often know their ailments as well as we do our own).

Recently, we watched the much-ballyhooed announcement that Walgreens will partner with FedEx to offer next-day delivery service by mail order. The move comes six months after CVS announced the same service. Both charge $4.99 for this “new” benefit.

That sound you hear is the collective yawn of community pharmacists across the nation. A new service? Hardly. According to an October 2018 report, 71 percent of community pharmacies offer same-day delivery — in-person — and most of them have been doing so for years for free. It goes hand-in-hand with personal, patient-centered service.

One of our National Community Pharmacists Association members owns a pharmacy in California’s rural Central Valley. Most of her patients are low-income seniors. They have a hard time getting to the pharmacy, so she takes the pharmacy to them.

On her way to and from work each day, she stops at patients’ homes to deliver medications, do wellness checks and give immunizations — and she does it without charging a delivery fee. While she’s there, she answers questions and promotes medication adherence.

That’s the kind of personal service independent community pharmacists offer.

If we continue to go down the path of mega-mergers and mail order, face-to-face interaction between patients and pharmacists will be on the way to being lost forever. More and more, after mergers, patients are moved to mail order for maintenance medications (and that mail order pharmacy is likely owned by one of the big corporate pharmacy benefit managers and located out-of-state).

Yes, the medications are delivered to their doorstep (eventually — unless the mail is not delivered on time, or weather prevents mail delivery, or a “porch pirate” swipes it), but who answers their questions? Who knows if they’re actually taking their medications correctly and consistently? Mergers are systematically removing the human element from pharmacy patient care, a health care setting where personal service is sorely needed to assure patients are taking the right meds in the right way on the right schedule.

Not long ago, another of our member pharmacists visited a new patient’s home to deliver medication. He spotted a table piled high with boxes of insulin pens costing hundreds, if not thousands, of dollars.

He asked about the pens, and the patient said she’d received them by mail order, wasn’t really sure how to use the device, and didn’t know whom to ask. The unopened boxes meant the patient hadn’t been treating her diabetes for months — a serious red flag that hadn’t been caught by automatic mail order delivery but was easily caught in that at-home consultation with the pharmacist.

But by mandating or steering patients to mail order, pharmacy benefit managers are cutting off that option for many.

For some patients, mail order may be the right choice. But it is just that — a choice. It’s not for everyone, and patients, plans and employers shouldn’t be forced to use it.

It’s easy to be distracted by a shiny object and bamboozled by fancy marketing. You may be led to think that mail order delivery of meds is somehow new and better for patients. But choice, delivery and personal service — none of those are new. Those are the foundations of community pharmacy.

The challenges of health care — and health costs — in America today won’t be solved by clever marketing or evermore impersonal service. Instead of focusing on what’s supposedly new and improved, let’s not lose the basics of interacting with and listening to patients, advising them and empowering them to make decisions on what works best for them.

That’s an idea so bold and effective that community pharmacies have been doing it for decades.


Douglas Hoey, MBA, a pharmacist, is CEO of the National Community Pharmacists Association, which represents 22,000 independent pharmacies across America.

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