After years of adding everything from groceries to grills to their inventory, drugstore chains are once again emphasizing their pharmacies.
Pharmacists are being asked -- and paid by insurance companies -- to monitor their customers' health. That could include counseling them on chronic diseases, making sure they're taking their medications, and screening for maladies from diabetes to high cholesterol.
While many pharmacists have long done more than dispense pills, this is the first time many have been able to offer such a wide range of medical services -- partially because of changes in the way pharmacists are educated, and partially because of legislative changes that have cleared the way for an expanded role.
For pharmaceutical chains, it's an opportunity to develop new revenue sources in a highly competitive industry.
For customers, it's a health care option that may take less time or money than a trip to the emergency room or an urgent care clinic.
"I think it's a mixture of everything that's going on," said David Catalano, a Raleigh, N.C., pharmacist who works for Walgreens. Customers "are trying to get some advice as quick as they can from someone they can trust."
The emphasis on pharmacists makes economic sense for health insurers. Pharmacists have expertise and often have a customer's entire medical picture, so they can catch prescription overlaps or possible drug interactions. Nor do they command the same fees that a physician does from an insurer.
The push toward enlisting pharmacists to do more comes as the nation is trying to lower health care costs. A 2007 study from the New England Healthcare Institute estimated that 13 percent of total health care expenditures -- more than $290 billion a year - arise because people don't take medications as prescribed. They have a higher likelihood of complications and emergency-room visits.
Not everyone is happy with pharmacists treading on turf once exclusive to doctor's offices and urgent care clinics.
"Store-based health clinics can offer patients an option for episodic care but cannot replace the patient-physician relationship," said Rebecca Patchin, a California doctor and American Medical Association board member. "... Convenience should never compromise safety."
James Evans has come to rely on Prasanna Bafna, a Rite Aid pharmacist near his home in Durham, N.C., for much of his medical advice. Bafna recently counseled Evans for an hour, reviewing medications for diabetes, high blood pressure and poor circulation.
The opportunity for a lengthy talk with a medical professional is invaluable, said Evans, 76. "When it's time for my medicine, it's right on time. ... (Bafna) is closer than my doctor. My doctor is eight or nine miles from here."
In general, pharmacists are not reimbursed as much money as doctors are for immunizations and the like, said Dan Mendelson, CEO of Avalere Health, a health care advisory company in Washington, D.C., and a Duke University adjunct professor.
Most pharmacies are "allowed to bill for a vaccine," Mendelson said, "but there's no routine office visit into the pharmacy that gets paid for by the insurance."
As of this year, laws in all 50 states allow pharmacists to administer immunizations, clearing the way for expanded services.
Edith Rosato, a senior vice president for the National Association of Chain Drug Stores, credits federal plans that began paying pharmacists to counsel Medicare and Medicaid patients in hopes of improving health results.
She also noted an important academic change: Students earning a pharmacy degree must now get a year of training on counseling and interacting with patients. That set the foundation for the industry to focus more on patient care services.
Pharmacies say they work closely with area doctors to refer patients who do not have a primary care physician or need further medical expertise.
Still, some physicians say there are risks to having health care administered by pharmacists.
Linwood Watson, a family medicine doctor with an urgent care clinic in Knightdale, N.C., said he thinks patients like the new options because they are transparent. Each service has a set fee; there are no secrets about cost. But with so many options and such a fragmented system, Watson said patients have to take more responsibility to ensure continuity of care.
"If you want to go buy a car and you want a good deal, you're going to have to do some research, keep some records and be prepared," he said. "Are you prepared to do that for your health care?"
What services do pharmacies provide?
While pharmacists offer a wider range of services, some patients still should go to a doctor instead.
Patients who are in a high-risk group or may be at high risk for complications because of medications may want to consult a doctor as well as a pharmacist before deciding where to seek treatment.
Here's a list of services pharmacies are providing:
- Immunizations, especially the flu shot
- Health screenings for diseases such as diabetes
- One-on-one counseling sessions
- Diagnosis of minor ailments like the flu or colds in on-site clinics
- Skin exams
Doctors' offices and urgent care clinics offer most of those services. They're still the primary resources for more complicated procedures, including:
- Setting broken bones
- Chiropractic issues, including neck and back pain
- Mental health concerns
- Illness involving reproductive, respiratory or urinary problems
CVS has found success with its Minute Clinics, in-store health clinics for diagnosing illnesses like colds and the flu. So far there are 500 in CVS stores. This fall, Target announced it would add similar health clinics in five Chicago-area stores, bringing its total number to 36 nationally.
Earlier this year, Rite Aid launched a new loyalty program called Wellness Plus that rewards shoppers with financial incentives and free screenings for problems like high cholesterol and diabetes.