CHICAGO — As the Walgreen Company pushes its army of pharmacists into the role of medical care provider, it is bringing them out from their decades-old post behind the pharmacy counter and onto the sales floor.
The pharmacy chain, based in Deerfield, Ill., and the nation's largest, has renovated 20 stores in the Chicago area and is converting more than 40 in Indianapolis to get the pharmacist closer to patients. Pharmacists in the revamped stores are being kept away from the telephone, where dealing with insurance coverage questions and other administrative tasks occupy 25 percent of their time, Walgreen says.
"What we are seeing now is pharmacists should be using their knowledge to help consumers manage their medications appropriately," said Nimesh Jhaveri, executive director of pharmacy and health care experience at Walgreen. "It's not about the product but the care we give."
The reinvention of the pharmacist's role comes at a critical time for Walgreen, as it vies to keep its customer base. The company has so far been unable to reach a new contract with the pharmacy benefit giant, Express Scripts. At the same time, Greg Wasson, the chief executive, is trying to remake the company into a national provider of health care services.
This last summer, Walgreen sold its own pharmacy benefit management company for more than $500 million to a Maryland firm in a deal that Mr. Wasson said would help the company focus on becoming the consumer's "most convenient choice for health and daily living needs."
Walgreen braced investors last month for the potential loss next year of more than $3 billion in sales in 2012 if it lost the customers whose prescription coverage was managed by Express Scripts. In the most recent fiscal year for the company, it filled about 90 million prescriptions managed by Express Scripts. The two are parting ways effective Jan. 1 over payment issues, leaving Walgreen scrambling to contract with major employers directly in hopes that they will want to opt out of Express Scripts' pharmacy network. Walgreen's new model resembles the type of service that CVS and other major drugstore chains are trying to achieve by developing deeper relationships with customers and their doctors. Big pharmacy companies are hoping to increase reimbursements from insurers and employers as they become more integral in managing customers' medical care.
At the newly converted Walgreen stores, one of the ways pharmacists hope to develop longstanding relationships with customers is through private or semi-private consulting areas away from the busy pharmacy counter.
On Chicago's North Side, Walgreen has a pharmacy in the Andersonville neighborhood on North Clark Street that dispenses a substantial amount of medications to patients with the AIDS virus, so privacy for patients was critical and figured in the overall idea behind the new store model, company executives said.
Behind the pharmacy counter, the familiar bags of medications are tagged and labeled alphabetically in plastic containers, but they cannot be seen from in front of the pharmacy counter. "Customers want privacy," Mr. Jhaveri said.
The Andersonville neighborhood store includes a 50-square-foot room behind sliding doors where a pharmacist, James Wu, can sit and counsel patients, who sit on a padded bench that has enough room for the patient and a family member or two. Mr. Wu's desk is steps to the right of the private room.
Mr. Wu said he could now spend more time talking to patients or out in the store aisles, and rarely is distracted now by the orders being placed for prescriptions.
"I would take calls, asking 'Is it ready?' 'Is it covered?' " Mr. Wu said. "The phone doesn't ring anymore."
Walgreen said it would route routine questions about insurance coverage and co-payment issues to a call center in Orlando, Fla., that is staffed around the clock by pharmacists and pharmacy technicians. Another new feature is a "health guide," a concierge of sorts who answers questions, markets new services and triages patients who may need other health care services, like treatment at a Walgreen Take Care retail clinic. At 354 of the chain's more than 7,700 stores, nurse practitioners at such clinics are available to handle routine maladies.
There are financial incentives for the more personal approach; some private and government insurers have programs that reward health care providers if they can prove that their services improve the quality of care and save money.
Moreover, insurance companies and the federal government are moving to models that encourage better coordination of medical care service, putting all providers on the same page.
Federal Medicare drug laws allow for payment to pharmacists for "medication therapy management," when patients have multiple chronic diseases like hypertension, diabetes and asthma and are taking multiple medications. In recent years, Walgreen and other pharmacy chains have lobbied aggressively for reimbursement and changes to rules that allow pharmacists to do more and to get paid for these additional services.
Walgreen already has aggressive lobbying efforts under way to get pharmacists the ability under state rules to administer more vaccines in the pharmacy. And the company is working with doctors and hospitals to develop relationships that include having a pharmacist involved in patient consultations and management of their diseases.
"As we start to prove better outcomes, our reimbursement is going to be more based on how we do that," Mr. Jhaveri said.
Employers are open to Walgreen's idea, citing national studies showing large numbers of Americans, particularly among the elderly, who do not adhere to their treatment regimens or forget to take their medicines.
For example, 2009 research from the New England Healthcare Institute showed that patients who did not take medications as prescribed cost the health system $290 billion in "avoidable medical spending every year."
"There are a variety of reasons why the current medical system is failing to help people stay on their medications," said Larry Boress, president and chief executive of the Midwest Business Group on Health, a coalition of large employers that purchases more than $3 billion in medical care services annually. Among the members are Boeing, Ford Motor and Kraft Foods.
"On filling the script, the pharmacist or pharmacy tech doesn't do much more than ask: 'Do you have any questions?' And then they give you the bag," Mr. Boress said.
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