Independent pharmacies don’t need to ask whether there’s a market for diabetes products and services. The market is there. The Centers for Disease Control and Prevention recently estimated that more than 114 million adults in the U.S. had diabetes or were pre-diabetic in 2015.¹
The question pharmacies should be asking themselves is how they can best serve the market and the patients who suffer from diabetes, a prevalent chronic medical illness that can lead to heart disease, stroke, kidney disease, circulatory problems, blindness and more.
I believe the answer extends beyond filling prescriptions for diabetes medications. The answer is a comprehensive approach that includes offering non-prescription diabetes and related health products, as well as education and resources that help patients manage their condition and avoid additional medical problems. Independent pharmacies are uniquely qualified to serve the diabetes patient market, and they can most effectively do that by expanding their disease management capabilities.
Types of diabetes products independent pharmacies should offer to patients
The diabetes products that independent pharmacies should offer fall into three categories:
- Medication - both injectible and oral - as well as the products to deliver injectible medications such as pen needles and insulin syringes
- Self-monitoring blood glucose supplies so patients and care givers can test and monitor blood glucose levels. Those items include devices like blood glucose meters, test strips lancets and lancing devices.
- Other over-the-counter, non-prescription items related to lifestyle. These may include fast acting glucose, skin and foot care products, wound-care products, sugar-free OTC medications like cough and cold remedies, nutritional products, and related durable medical equipment.
The specific brands of each item in each category largely are dictated by six factors:
1. Clinical need. The first and most obvious factor is the clinical need of the pharmacy’s patients. Pharmacies should stock a full range of products to meet all the prescription and OTC needs of their patients with diabetes.
2. Sales data. Like any retailer, a pharmacy should look at its own sales data and available national sales data, or utilize a planogram and retail pricing program, to know what patients with diabetes are purchasing. Those data-driven insights will help pharmacies decide the correct assortment of products to carry on their shelves and the price points that are in range for their local competitive market.
3. Patient preference. Beyond sales data, product features and attributes may appeal to different individual patients. For example, older patients with dexterity issues may prefer glucose meters with large screens and test strips that are easier to handle. Younger, tech-savvy patients may prefer glucose meters with health apps that send readings to their smartphone and provide colorful graphs and charts. It’s important that the pharmacist takes time to understand their patient’s lifestyle needs so they can assist with recommending the right product for them.
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4. Physician preference. Physicians may recommend that their patients use specific brands of products, just as they may recommend a specific brand-name medication. Some doctors are very particular about the brands they want their patients to use and this may be related to practices that use a single platform for ease of collecting and analyzing outcome data. If a physician has a product recommendation, a pharmacist should always balance that with the patient’s needs including insurance coverage and lifestyle to ensure there are no barriers for the patient to be compliant to the recommended treatment.
5. Profit margin. An independent pharmacy has financial needs like any other business. It may choose to offer value or private-label brands of OTC diabetes products in addition to the national brands. Pharmacies can often purchase private label items at lower, more competitive prices. If they’re reimbursed by health plans at the same level as higher-priced national brands, they may realize a better margin.
6. Insurance coverage. By far the most important factor is insurance coverage. What drives patient choice—and ultimately, what pharmacies sell—is which products are covered by insurance. Every payer, whether it’s Medicare, Medicaid or a commercial health plan, uses financial incentives to direct enrollees to the preferred products for that plan. Payers may limit patient choice of diabetes products so it’s important that the pharmacist understands which products and brands will be covered on a patient’s plan.
Independent pharmacies need to know the payer mix of their patient base and carry the diabetes products approved by those insurers. In practice, that means pharmacies should offer several national brands in addition to one or more value or private-label brands. A variety of products at different price points ensures that patients with diabetes will be able to find the right products based on their insurance coverage, lifestyle needs, and physician recommendation.
Why patient education is central to the pharmacy’s role in diabetes management
In theory—and unfortunately, sometimes in practice—patients with diabetes can walk out of pharmacies with the right medications and OTC diabetes products and not improve their health status. What’s missing is patient education and engagement. That’s the disease management function that pharmacies and pharmacists should embrace. It’s also one for which they’re uniquely qualified: they’re the healthcare provider that often has the most regular contact with patients.
The patient educator role can play out in five initial areas:
- Medication reconciliation. Pharmacies can verify that patients are taking the correct medications to manage their diabetes. They can counsel patients and prescribers about other medications that may be indicated based on their comorbidities or contraindicated based on what they’re currently taking.
- Medication use. Many patients with diabetes require injectable insulin. Pharmacies can teach patients how to store the insulin, how to draw the insulin into the syringe, how to inject the insulin, how to change needles and how to rotate injection sites.
- Product selection. Pharmacists should have conversations with patients and possibly family members about their OTC diabetes product needs. They should ask patients regularly if they are experiencing any issues so they can direct patients to the right products they need to manage their condition and ensure a minor issue doesn’t evolve into a severe complication.
- Product use. Pharmacists should teach patients and possibly family members how to use their diabetes products. Monitoring blood sugar levels is an essential part of health maintenance for patients with diabetes. Knowing how to use a lancet and glucose meter is critical.
- Education and Awareness. More importantly, a pharmacist can help guide the patient to understand their blood glucose results. This can include noticing patterns in their readings and helping a patient make adjustments, and understanding how their food choices, exercise, stress or illness may affect their glucose levels.
The role of patient educator can play out in a number of ongoing areas, too. For example, the risk factors associated with diabetes, according to the CDC, include smoking, obesity, physical inactivity, high blood pressure and high cholesterol. Pharmacies can support their patients with diabetes with clinical services like nutritional counseling and smoking cessation classes that can mitigate those risk factors and offering flu and other key immunizations to their patients and family members
Pharmacies can also support patients with diabetes with prescription and non-prescription products directed at the same risk factors. Dietary supplements and home blood pressure monitors are just two examples. Patients with diabetes should be comfortable going into a pharmacy not just for their medications and their testing supplies but for anything related to their chronic medical condition.
Outreach to physicians and health plans is key
As mentioned, patients with diabetes require a variety of products to manage and control their blood glucose levels and it’s important to stay connected with their physician. Consequently, a pharmacy’s comprehensive approach to disease management should include reaching out to both doctors and insurers.
Doctors want their patients with diabetes to be as healthy as possible, and they would welcome a pharmacy partner that helps them achieve that goal. The immediate and ongoing patient education and personal service that the pharmacy provides to patients with diabetes can help the pharmacist be viewed as an attractive clinical partner.
To be as healthy as possible, patients should have the right ancillary diabetes supplies. A pharmacy can support patients by helping them understand what their health plans cover. A pharmacy also can work with a patient’s plan to resolve any coverage disputes. And it can work with patients to obtain financial assistance for prescription and non-prescription diabetes products from manufacturers.
Independent pharmacies that offer comprehensive disease management programs for patients with diabetes will become the pharmacies of choice in their service area, with the net result being better health for patients and better business health for themselves.