A New Pharmacy Model

I had a chance to ride on a plane today with a man who sits on the board of a pharma company. He has worked in pharma for 30 years, and we had a good discussion. One of the things we talked about was the “arms race” in pharma to build up their number of detail representatives. Obviously this changed over the past few years especially with some of the limitations which have been placed on how pharma reps can incent physicians. We went on to talk about the challenge of physicians keeping up with all the drugs on the market and even understanding all the basic pharmacology. With over 10,000 different drugs, this is a challenge for pharmacists much more so for physicians who have other information to manage.

In discussing the topic, it reminded me of a law which exists in a few states that allows physicians and pharmacists to have a legally binding agreement around therapeutic substitution (i.e., allowing the pharmacist to change drugs or chemical entities for the patient without getting a new prescription). I can’t remember what these are called, but I threw out a new model to him that would seem very logical.

Could physicians simply write a prescription for a lipid lowering drug (aka cholesterol medication) and put the relevant diagnosis code and lab values on the prescription? The pharmacist would then be responsible for determining the right drug for the patient based on their prescription history and their benefit plan. It seems like a simple model which focuses every constituent on their primary role – the physician owns the diagnosis and care plan while the pharmacist owns the prescription selection.

It would eliminate the need for pharma reps in many ways because the conversation would be with pharmacies who use online information and have a corporate infrastructure that could have models for selection of drugs based on DUR (Drug Utilization Review – e.g., drug-drug interactions), copayments, UM (Utilization Management – e.g., step therapy, prior authorization, quantity level limits), and perhaps profit.