JAMA to Retail Pharmacies: Get Out of the Tobacco Biz. The DMCB Agrees & Has Additional Recommendations for Managed Care & Disease Mangement

Let's see.... time to pick up that 30 day supply of my prescription drugs for my diabetes and heart disease and while I'm here grab some razor blades, some shampoo and some.... smokes?

Not if Mitchell Katz of the Department of Public Health in San Francisco has his way. Writing in the Sept 24 issue of JAMA (issue is not up at the time of this writing), Dr. Katz says it's time to force pharmacies to get out of the tobacco product business. Not ask. Not encourage. Force.

Why you ask?

Pharmacies are Special: Pharmacies hold themselves out, unlike other retailers, as agents that promote well being. The passage of laws and regulations that hold them to that standard are reasonable, especially if the sale of tobacco products in health-oriented pharmacies undermine the message that tobacco is harmful. Customers with illness who need pills for their coronary artery disease or an inhaler for their emphysema are also relatively more vulnerable to tobacco. Last but not least, the sale of tobacco is a huge conflict of interest.

Pharmacies Will Not Be Hurt Economically: There are no data demonstrating that patients will not continue to patronize pharmacies. Similar bans in Canada did not drive any pharmacies out of business. Small private owned pharmacies will continue to be able to compete against the big boys. In fact, help in some States is available.

Government Intrusion is Warranted: Other attempts by the pharmacy industry to self-regulate themselves on this matter have not been very successful. In the meantime, the government has had a successful track record in similarly important areas such as the banning of vending machines and requiring motorcycle helmets. Dr. Katz recommends that local governments are probably in the best position to do this.

Why Stop at Tobacco? Maybe pharmacies should get out of the business of selling alcohol or calorie dense foods to combat the evils of alcoholism and obesity. However, unlike that pint of vodka or that candy bar, tobacco is a product for which there is no such thing as a safe level of consumption. Dr. Katz says it's OK to stop at tobacco.

Should stores with a pharmacy also be included? Maybe not, says Dr. Katz. Stores with a 'side' pharmacy aren't perceived to be in the business of health promotion.

The Disease Management Care Blog thinks this is an important issue with other implications for the managed care and disease management industry.

Suppose a retail pharmacy (example) or a store with a pharmacy offers additional care services in the form of health screening, advice, flu shots or a retail clinic? Should that be an added reason for local government to ban the simultaneous sale of tobacco products in the same setting? The DMCB thinks that may be a good idea.

Maybe managed care organizations that are willing to include retail clinics in their network should make credentialing locally or nationally contingent on not simultaneously selling tobacco products. Audit/site visit a small number of pharmacies to show you mean business and offer your enrollees a gift certificate if any of them 'catch' a retail pharmacy selling smokes. By the way, the docs will support you on this. Maybe it is self-serving of the physicians, but attacking tobacco at this level may buy some good will.

Maybe managed care organizations that offer a pharmacy benefit should declare that its participating pharmacies have one year to get out of the tobacco business. Pharmacies failing to meet that standard are out. Good bye. If some patients are unable to access their retail pharmacy as a result, offer terms on a mail order benefit and dare the Department of Insurance to tell you that's unfair.

Where is the leadership of the disease management industry here? They have access to millions of persons with chronic illness and undoubtedly can recommend against patronizing pharmacy settings that sell tobacco. They could even develop an on-line data base for use by their enrollees and their physicians. If there are emerging data-based/co-promotion/business venture partnerships with retail pharmacy chains that sell tobacco products, maybe they need to be re-examined.

Thanks Dr. Katz.