s Analysis: The Pharmacy Alliance & API Dispute | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

read more
open full screen

Recent Comments

Click here to read...

News Flash

Newsflash Updates for July 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
Access and click on the title links that are illustrated

Comments: 1

read more
open full screen

Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

It started with “tablet” computers deployed on shelves inside the retailer Coles, specifically to provide information to consumers relating to pain management and the sale of strong analgesics.
This development was reported in i2P under the title Coles Pharmacy Expansion and the Arid PGA Landscape”
In that article we reported that qualified information was a missing link that had come out of Coles market research as the reason to why it had not succeeded in dominating the pain market.
Of course, Woolworths was working on the same problem at the same time and had come up with a better solution - real people with good information.

Comments: 5

read more
open full screen

Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

Editor's Note: The understanding of a pharmacy's presentation through the research that goes into the design of fixtures and fittings that highlight displays, is a never-ending component of pharmacy marketing.
Over the past decade, Australian pharmacy shop presentations have fallen behind in standards of excellence.
It does not take rocket science - you just have to open your eyes.
Recently, our two major supermarkets, Woolworths and Coles, have entered into the field of drug and condition information provision - right into the heartland of Australian Pharmacy.

read more
open full screen

The sure way to drive business away

Gerald Quigley

I attended the Pregnancy, Baby and Children’s Expo in Brisbane recently.
What an eye and ear opening event that was!
Young Mums, mature Mums, partners of all ages, grandparents and friends……...many asking about health issues and seeking reassurances that they were doing the right thing.

Comments: 1

read more
open full screen

‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

It should be the scandal of the century.
It potentially affects the health of almost everyone.
Healthcare providers and consumers alike should be up in arms. But apart from coverage in a few credible news sources the problem of ‘Marketing Based Medicine,’ as psychiatrist Dr Peter Parry terms it, hasn’t as yet generated the kind of universal outrage one might expect.

read more
open full screen

Community Pharmacy Research - Are You Involved?

Mark Coleman

Government funding is always scarce and restricted.
If you are ever going to be a recipient of government funds you will need to fortify any application with evidence.
From a government perspective, this minimises risk.
I must admit that while I see evidence of research projects being managed by the PGA, I rarely see community pharmacists individually and actively engaged in the type of research that would further their own aims and objectives (and survival).

read more
open full screen

Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

Most of us leave a tremendous impact on pharmacies we work for (as proprietors, managers, contractors or employees)—in ways we’re not even aware of.
But organisational memories are often all too short, and without a central way to record that impact and capture the knowledge and individual contributions, they become lost to time.
It is ironic that technology has provided us with phenomenal tools for communication and connection, but much of it has also sped up our work lives and made knowledge and memory at work much more ephemeral.

read more
open full screen

Academics on the payroll: the advertising you don't see

Staff Writer

This article was first published in The Conversation and was written by Wendy Lipworth, University of Sydney and Ian Kerridge, University of Sydney
In the endless drive to get people’s attention, advertising is going ‘native’, creeping in to places formerly reserved for editorial content. In this Native Advertising series we find out what it looks like, if readers can tell the difference, and more importantly, whether they care.
i2P has republished the article as it supports our own independent and ongoing investigations on how drug companies are involved in marketing-based medicine rather than evidence-based medicine.

read more
open full screen

I’ve been thinking about admitting wrong.

Mark Neuenschwander

Editor's Note: This is an early article by Mark Neuenschwander we have republished after the soul-searching surrounding a recent Australian dispensing error involving methotrexate.
Hmm. There’s more than one way you could take that, huh? Like Someday when I get around to it (I’m not sure) I may admit that I was wrong about something. Actually, I’ve been thinking about the concept of admitting wrong. So don’t get your hopes up. No juicy confessions this month except that I wish it were easier for me to admit when I have been wrong or made a mistake.
Brian Goldman, an ER physician from Toronto, is host of the award-winning White Coat, Black Art on CBC Radio and slated to deliver the keynote at The unSUMMIT for Bedside Barcoding in Anaheim this May. His TED lecture, entitled, “Doctors make mistakes. Can we talk about it?” had already been viewed by 386,072 others before I watched it last week.

read more
open full screen

Dispensing errors – a ripple effect of damage

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

Most readers will be aware of recent publicity relating to dispensing errors and in particular to deaths caused by methotrexate being incorrectly packed in dose administration aids.
The Pharmacy Board of Australia (PBA), in its Communique of 13 June 2014, described a methotrexate packing error leading to the death of a patient and noted “extra vigilance is required to be exercised by pharmacists with these drugs”.
This same case was reported by A Current Affair (ACA) in its program on Friday 20 June
http://aca.ninemsn.com.au/article/8863098/prescription-drug-warning

read more
open full screen

Take a vacation from your vocation

Harvey Mackay

Have you ever had one of those days when all you could think was, “Gosh, do I need a vacation.”
Of course you have – because all work and no play aren’t good for anyone.
A vacation doesn’t have to be two weeks on a tropical island, or even a long weekend at the beach. 
A vacation just means taking a break from your everyday activities. 
A change of pace. 
It doesn’t matter where.
Everyone needs a vacation to rejuvenate mentally and physically. 
But did you also know that you can help boost our economy by taking some days off? 
Call it your personal stimulus package.

read more
open full screen

Explainer: what is peer review?

Staff Writer

This article was first published in the Conversation. It caught our eye because "peer review" it is one of the standards for evidence-based medicines that has also been corrupted by global pharma.
The article is republished by i2P as part of its ongoing investigation into scientific fraud and was writtenby Andre Spicer, City University London and Thomas Roulet, University of Oxford
We’ve all heard the phrase “peer review” as giving credence to research and scholarly papers, but what does it actually mean?
How does it work?
Peer review is one of the gold standards of science. It’s a process where scientists (“peers”) evaluate the quality of other scientists' work. By doing this, they aim to ensure the work is rigorous, coherent, uses past research and adds to what we already knew.
Most scientific journals, conferences and grant applications have some sort of peer review system. In most cases it is “double blind” peer review. This means evaluators do not know the author(s), and the author(s) do not know the identity of the evaluators.
The intention behind this system is to ensure evaluation is not biased.
The more prestigious the journal, conference, or grant, the more demanding will be the review process, and the more likely the rejection. This prestige is why these papers tend to be more read and more cited.

read more
open full screen

Dentists from the dark side?

Loretta Marron OAM BSc

While dining out with an elderly friend, I noticed that he kept his false tooth plate in his shirt pocket. He had recently had seven amalgam-filled teeth removed, because he believed that their toxins were making him sick; but his new plate was uncomfortable. He had been treated by an 'holistic dentist'. Claiming to offer a "safe and healthier alternative" to conventional dentistry, are they committed to our overall health and wellbeing or are they promoting unjustified fear, unnecessarily extracting teeth and wasting our money?

read more
open full screen

Planning for Profit in 2015 – Your key to Business Success

Chris Foster

We are now entering a new financial year and it’s a great time to reflect on last year and highlight those things that went well and those that may have impacted negatively in the pursuit of your goals.
It's also a great to spend some time re-evaluating your personal and business short, medium and long term goals in the light of events over the last year.
The achievement of your goals will in many cases be dependent on setting and aspiring to specific financial targets. It's important that recognise that many of your personal goals will require you to generate sufficient business profits to fund those aspirations

read more
open full screen

ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

read more
open full screen

Attracting and Retaining Great People

Barry Urquhart

Welcome to the new financial year in Australia.
For many in business the past year has been described as a challenging period.
Adjectives are a key feature of the English language.  In the business lexicon their use can be, and often is evocative and stimulate creative images.  But they can also contribute to inexact, emotional perceptions.
Throughout the financial pages of newspapers and business magazines adjectives abound.
References to “hot” money draw attention and comment.  The recent wave of funds from Chinese investors, keen to remove their wealth from the jurisdiction and control of government regulations is creating a potential property bubble in Australia.

read more
open full screen

Updating Your Values - Extending Your Culture

Neil Johnston

Pharmacy culture is dormant.
Being comprised of values, unless each value is continually addressed, updated or deleted, entire organisations can stagnate (or entire professions such as the pharmacy profession).
Good values offer a strong sense of security, knowing that if you operate within the boundaries of your values, you will succeed in your endeavours.

read more
open full screen

Evidence-based medicine is broken. Why we need data and technology to fix it

Staff Writer

The following article is reprinted from The Conversation and forms up part of our library collection on evidence-based medicines.
At i2P we also believe that the current model of evidence is so fractured it will never be able to be repaired.
All that can happen is that health professionals should independently test and verify through their own investigations what evidence exists to prescribe a medicine of any potency.
Health professionals that have patients (such as pharmacists) are ideally placed to observe and record the efficacy for medicines.
All else should confine their criticisms to their evidence of the actual evidence published.
If there are holes in it then share that evidence with the rest of the world.
Otherwise, do not be in such a hurry to criticise professions that have good experience and judgement to make a good choice on behalf of their patients, simply because good evidence has not caught up with reality.

read more
open full screen

Laropiprant is the Bad One; Niacin is/was/will always be the Good One

Staff Writer

Orthomolecular Medicine News Service, July 25, 2014
Laropiprant is the Bad One; Niacin is/was/will always be the Good One
by W. Todd Penberthy, PhD

(OMNS July 25, 2014) Niacin has been used for over 60 years in tens of thousands of patients with tremendously favorable therapeutic benefit (Carlson 2005).
In the first-person NY Times best seller, "8 Weeks to a Cure for Cholesterol," the author describes his journey from being a walking heart attack time bomb to a becoming a healthy individual.
He hails high-dose niacin as the one treatment that did more to correct his poor lipid profile than any other (Kowalski 2001).

read more
open full screen

Culture Drive & Pharmacy Renewal

Neil Johnston

Deep within all of us we have a core set of values and beliefs that create the standards of behaviour that we align with when we set a particular direction in life.
Directions may change many times over a lifetime, but with life experiences and maturity values may increase in number or gain greater depth.
All of this is embraced under one word – “culture”.
When a business is born it will only develop if it has a sound culture, and the values that comprise that culture are initially inherent in the business founder.
A sound business culture equates to a successful business and that success is often expressed in the term “goodwill” which can be eventually translated to a dollar value.

read more
open full screen

ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

read more
open full screen

Pharmacy 2014 - Pharmacy Management Conference

Neil Johnston

The brave new world of health and wellness is not the enemy of Pharmacy, it is its champion.
Australian futurist, Morris Miselowski, one of the world's leading business visionaries, will present the Opening Keynote address on Pharmacy's Future in the new Health and Wellness Landscape at 2.00pm on Wednesday July 30.
Morris believes the key to better health care could already be in your pocket, with doctors soon set to prescribe iPhone apps, instead of pills.
Technology will revolutionise the health industry - a paradigm shift from healthcare to personal wellness.
Health and wellness applications on smartphones are already big news, and are dramatically changing the way we manage our personal health and everyday wellness.

read more
open full screen

Generation and Application of Community Pharmacy Research

Neil Johnston

Editor’s Note: We have had a number of articles in this issue relating to pharmacy research.
The PGA has conducted a number of research initiatives over the years, including one recently reported in Pharmacy News that resulted from an analysis of the QCPP Patient Questionnaire.
Pharmacy Guild president, George Tambassis, appears to have authored the article following, and there also appears to be a disconnect between the survey report and its target audience illustrated by one of the respondent comments published.
I have asked Mark Coleman to follow through, elaborate and comment:

read more
open full screen

Analysis: The Pharmacy Alliance & API Dispute

Neil Johnston

articles by this author...

Neil Johnston is a pharmacist who trained as a management consultant. He was the first consultant to service the pharmacy profession and commenced practice as a full time consultant in 1972, specialising in community pharmacy management, pharmacy systems, preventive medicine and the marketing of professional services. He has owned, or part-owned a total of six pharmacies during his career, and for a decade spent time both as a clinical pharmacist and Chief Pharmacist in the public hospital system. He has been editor of i2P since 2000.

I have been following the recent relationship breakdown between the Pharmacy Alliance Group and national wholesaler, API Ltd.
The breakdown is seen by i2P as having been inevitable and is really a side-effect of the Pfizer initiative of taking back the supply chain in respect of its own products.
The triad of manufacturer (represented by Pfizer), the wholesaler (represented by API) and the pharmacy (represented by the Pharmacy Alliance Group) is a contemporary model, illustrating the general state of the tension between the respective parties, and is reflective of the entire Pharmaceutical Industry.

open this article full screen

This tension traditionally existed in the past, but each party had learned to live with, and accommodate, the expectations of one to the other.
That traditional model is now totally disrupted and new boundaries have to be formed up, with the activities conducted within those boundaries altered, upgraded or eliminated, but definitely re-defined to reflect pharmacy in the twenty-first century.
The issues that have been building up between pharmacy owners and non-pharmacy owners also need to be addressed.
It is possible that this new industry-driven disruption will create momentum that will generate a life of its own that may compel each side to have a fresh look at each other, and generate the opportunity to develop new pharmacy designs and services.

From their website, the Pharmacy Alliance Group is “a member-based network with 424 member pharmacies providing independent pharmacies the retail tools and expertise to improve their profitability and streamline their in-store operations.”
In 2008 the Pharmacy Alliance Group initiated a generic tender system, believed to be the first in pharmacy. The tender was done by molecule on volumes of $80 million p.a. and currently has 350 molecules on the best available discount.

Pharmacy Alliance appears to have provided an excellent service for its members having in 2009 strengthened its offering by amalgamating with the NSW pharmacy group (IPAG) to provide an efficient bulk buying service.
So when the next step was taken to strengthen purchasing power and reduce prices by floating a tender for wholesalers to quote on, the management of Pharmacy Alliance was simply doing its job.
Building on a tendering process that had started with generic drugs, was simply a logical next step.

However, API was not in the mood to see, in its view, 16 percent of a market moving out of its control, having already lost 20 percent of a market in directly diverted Pfizer product sales.
As can be readily seen, control of the supply chain means control of sell-in prices and their margins.
Pfizer seriously understood this when it went with direct supply to squeeze every dollar that was available within the supply chain, to offset losses about to be endured through loss of patent protection on some of its original molecules e.g. Lipitor.

Predictably, API erupted and developed a separate offer for each member of the Pharmacy Alliance Group as a strategy to immobilise their control.
API was simply doing its job as well, but was too heavy-handed, leaving itself in a situation with little negotiating advantage.
However, the Pfizer experience had reinforced the feeling of unity that is understood by all pharmacists, irrespective of their existing liaisons.
API only recruited a small percentage of Pharmacy Alliance members who capitulated to a process that was deemed to be “bullying” by Pharmacy Alliance.
Threats have been thrown up by both sides but this is seen as mostly hot air.
Neither side appears to have breached the Trade Practices Act even though tempers have frayed.

That API took such a stance is understandable, given its Pfizer losses documented above.
That forced a complete change within the API business model with the upshot that the loss of gross profit, occasioned by the Pfizer experience, was adjusted on the price of all other products.
This immediately disadvantaged two of the players –pharmacists, who had to pay higher prices for all their wholesaler products with no offset, and manufacturers (other than Pfizer) whose sell-in prices were now comparatively higher across the board, creating a market disadvantage.
It is now inevitable that other manufacturers will follow suit and supply on an independent basis, utilising the Pfizer model.

It is also an imperative that pharmacists must come out fighting, king-hitting any opposition that impedes the goal of supply chain protection and decent profit margins.
Noticable also is that the Pharmacy Guild of Australia (PGA) is almost invisible at a time that is critical to the survival of its members.
PGA members must be wondering who their executive really represents given their passive response to Pfizer, API activity and the so-called "reforms" of the PBS that are stripping the economic life out of pharmacy in rigid out-of-step actions, incompatible with these free enterprise movements.

Wholesalers have always been the traditional power brokers within the Pharmaceutical Industry, but this role is now being taken from them by the manufacturers, and to a lesser extent, pharmacies.

Pharmacies will need to fight to maintain their share of power by utilising a number of strategies:

* Use their professional power to break up the generic market away from Pfizer.

* Make the PGA executive fight on their behalf.

* Develop their own logistics system to control the flow of goods into store. This will need to extend to a nationally networked system of regional bulk-buying groups.

* Extend that logistics system to control the flow of goods and services from the pharmacy to the home and to back a “pharmacy-in-the-home” service.

A pharmacy-in-the-home service represents a value-adding to the drugs supplied by a pharmacy.
It can mean a number of things (Dose Administration Aid systems, Information Systems, Patient Drug Analysis Systems or primary health care services of all descriptions).
Manufacturers will value any supply chain system that beats a direct pathway to a patient, particularly one that can demonstrate an increase in compliance.
This will most likely become the interface boundary where manufacturers will support pharmacy endeavours to give advantage to their specific products.

Manufacturers will tend to buy their way in.
Pfizer is reported to be currently withholding about 5 percent of each pharmacy account to be returned in rebates on their future product sales.
In particular, it will be applied to Lipitor when it comes off patent.

So just analyse that for a moment.
You have immediately paid (up front) a higher price for Pfizer products through their new direct business model. That also represents a considerable cost and a loss of market power by pharmacists.
The virtual 5 percent discount, when applied back to products like Lipitor, will be a temptation for cash-strapped pharmacists. US financial analysts have already predicted that Lipitor will remain in Pfizer’s Top Five Products over the next 5 years because they are betting that pharmacists will  break ranks and not recommend alternate Lipitor generics, to simply regain money that was theirs in the first place.
Pfizer gets to keep its original margins and a higher than anticipated market share for Lipitor (and other products), still maintaining market share and control.
To me, this is an unconscionable action that represents abuse of market power that inflates drug prices and disadvantages the ultimate consumers. It is something that should involve the ACCC.

This type of market control continually beats pharmacists over the head, causing financial damage over time, and may even translate into manufacturers owning their own chains of pharmacies as the ultimate control of the supply chain.
And you thought Coles and Woolworths (and possibly some wholesalers) were the demons in pharmacy ownership!

i2P predictions regarding inevitable supply chain battles were documented over 12 months ago. They seemed improbable then, just as manufacturer owned pharmacies may seem now. You be the judge.

Twelve months ago we also predicted that wholesalers would begin to move in on their client pharmacy traditional service business.
Where else can they go?
Financially they need to recover to become a competitive force and pharmacy services will be a logical process.
Don’t let them achieve this goal!

Mechanisms exist now for pharmacies to become larger scale corporate structures, also to exist as multiple chains. This will only work if the professional side of pharmacy can be kept to a smaller personal scale i.e. an arms-length clinical pharmacy practice that is a contracted entity within that corporate structure.
This is a potential model that could universally satisfy most pharmacist aspirations (including pharmacist prescribing).

Pharmacy Alliance also has another initiative within some of its member pharmacies and that is the nurse practitioner clinic. It only needs to add the pharmacist practitioner clinic to be complete.
Pharmacy Alliance should be supported and congratulated for its efforts in demonstrating leadership in pharmacy and i2P wishes them well in the coming industry battles – and there will be quite a few!

Return to home

Post new comment

The content of this field is kept private and will not be shown publicly.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Allowed HTML tags: <a> <em> <strong> <cite> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Lines and paragraphs break automatically.

More information about formatting options

health news headlines provided courtesy of Medical News Today.

Click here to read more...

If any difficulty is found in subscribing, please use the "Contact Us" panel found in the navigation bar with the message "subscribe" and your email address.

Subscribe to our mailing list

Email Format
 

 

  • Copyright (C) 2000-2020 Computachem Services, All Rights Reserved.

Website by Ablecode