How a Beer Pong Table Gave Me Clarity on the Future of Pharmacy

MY 40TH BIRTHDAY PARTY

I have never played beer pong before. As a year-round athlete in college, I had precious few opportunities to let off steam at house parties. So, when I started thinking about what I needed for my 40th birthday party, I did what any reasonable person going through a midlife crisis would do: searched online for a beer pong table. I mean, you can’t just find one of those down at the local mercantile, right?

My search was illuminating, both figuratively and literally. My product of choice was a table that could fold up (so we could hide it from the kids), with LED lights (because the party was at night), with holders for the cups so playing wouldn’t get messy (I am too old to live in a dirty fraternity house with drying beer causing my shoes to adhere to the hardwood).

DIRECT TO CONSUMER WITHOUT PASSING ‘GO’(leaving out wholesalers and retailers and other intermediaries)

Apparently, there is a bit of a cottage industry out there for cheeky party games. An online search produced many prospect products with a surprising number of manufacturers and variety of tables. However, the only way to access or purchase these products was through a limited number of online retailers. At that moment, all the hullabaloo around Amazon, eBay, Jet, and other online retailers and exchanges as a business model became crystal clear for me: retailing is no longer retailing as we knew it. It is less storefront and more Match.com, where a person manufacturing a product is matched with a person wanting to use the product with nothing but a website in between.

I received my package in 2 days from a logistics and delivery company not affiliated with the online retailer in any way. I opened it, and at the top was an envelope with the following handwritten note:

Turns out we don’t need to hide the table from the kids, because beer pong tables have gone mainstream and are now party pong tables that don’t need to be associated with drinking alcohol. The note struck me as a conflation of 2 warring business models. On the one hand, mass production with impersonal delivery, a delivery driver pushing the door bell and leaving without even a “Hi, nice to meet you,”—a model dependent on blockbuster mass marketing and uniformity, without any personalization whatsoever (think Bud Lite or Miller Lite). Yet, here was this handwritten note (perhaps authentic, perhaps not) from a small company that, quite literally, could be in a garage with a seminiche product giving the transaction character (think farmers market or craft beer).

PULLING PERMITS(we are no longer in an exclusive bubble)

This dynamic is coming to a pharmacy neighborhood near you. The online pharmacy industry started out as a means by which to circumvent the US market and procure drugs from countries such as Canada, which to date hasn’t really hit its prime. But that is likely about to change soon with a wholesale shift to central fill, online ordering, and retailing that doesn’t require intermediary handlers and steps, perhaps disintermediating the community pharmacy itself. It is notable that Amazon pulled a permit in at least 12 states in recent months to become a wholesaler.¹

IS THIS MOVEMENT GOOD OR BAD FOR PHARMACISTS?(are we dispensing pharmacists or health care providers who happen to dispense?)

Pharmacists and pharmacies have claimed to be health care services providers for many decades, so why wouldn’t we welcome the removal of all dispensing-related activities and pass them along to machines and technicians, who, by the way, have shown in some instances to be more accurate? Would that allow us to spend more time with the patient? Allow for more delivery of care? Yes, but the operative question is, do pharmacists need more time available so that they can bill for services or do they need to be able to bill for services in order to find time?

THE FUTURE IS SERVICES(but will telepharmacy take that opportunity away as well?)

My party table, from manufacture to doorstep, required that fewer services be involved. Yet, we know that not to be the case with medications. More than 4 out of every prescription fills in the United States are for patients with 2 or more chronic illnesses, with most of those patients having clinical markers outside the ideal range. The market is there, but the traditional pharmacy marketplace simply hasn’t seen the need or imperative to act on it, since most pharmacies have been profitable for the past half century.

That is all about to change. Several movements are afoot to fill the services gap. High-performing pharmacy networks are emerging to separate themselves from the dispenser typecast and reclaim the need to have a community presence.^2,3,4 These include chain pharmacies, independent pharmacies, and boutique pharmacies (compounding, pharmacogenomics, chronic care management providers, and other services and care orientations). But the fastest- growing movement is the medication therapy management (MTM) call center industry, which has grown dramatically year over year and now represents the majority of the MTM service provision for Medicare Part D.

So, the question is, if squeezing out the middlemen so there are fewer costly steps between manufacture and consumer is the prevailing retail mega-trend, are pharmacists and community-based pharmacies middlemen in the distribution chain, or indispensable service providers (pun intended) that need be linked to the dispensing of the product*

*In the spirit of full disclosure, I have a strongly held conviction that community-based pharmacies are part of the lifeblood of many communities and an essential part of the local health care ecosystem. It would be a tragedy to cut down that redwood forest to make way for a freeway full of mail order trucks, as it would take a long time to grow it back once we all realize that we need more than dispensing machines and phone call coaches from afar to solve so many of our community’s health care and wellness needs. I hope that as pharmacists and pharmacy technicians invested in your communities, you share my sentiments.

Troy Trygstad, PharmD, PhD, MBA, is vice president of pharmacy programs for Community Care of North Carolina, which works collaboratively with more than 1800 medical practices to serve more than 1.6 million Medicaid, Medicare, commercially insured, and uninsured patients. He received his PharmD and MBA degrees from Drake University and a PhD in pharmaceutical outcomes and policy from the University of North Carolina. He also serves on the board of directors for the American Pharmacists Association Foundation and the Pharmacy Quality Alliance.

References

• Ramsey L. We just got another hint that Amazon could be getting into the prescription drug business. http://www.businessinsider.com/amazon-cvs-walgreens-stock-price-wholesale-pharmacy-licenses-2017-10. Accessed October 27, 2017.