NACDS Total Store Expo: What’s Old Is New Again

Monday, September 9, 2019

Marsha K. Millonig, MBA, BPharm

The National Association of Chain Drug Stores (NACDS) Total Store Expo (TSE) is one of the year’s best attended events in the commercial healthcare industry, with a focus on categories throughout the retail store environment, from front-end to pharmacy. This year’s event, held August 24-28 in Boston, was no exception.  While I have been to TSE many times, this was my first trek to the seaport area of Boston in a decade. The changes in the city, the state, and even TSE itself reflected the old and the new.

Back in Boston

Let’s start with the city and its waterfront. What consisted of a new convention center and one adjacent hotel a decade ago has since blossomed into a bustling waterfront full of shops, restaurants, hotels, and living spaces that is among the hottest neighborhoods in the Boston. Part of my trek included a tour of Fenway Park—the oldest ballpark in America, which opened in 1912, five days before the sinking of the Titanic. I was impressed with how the original structures have been maintained, while the stadium has been improved through four major renovations. An innovative rooftop garden supplies a significant percentage of the food served at the venue. The “Green Monster” left field wall is one of the best-known features in a major league baseball park. Coca Cola’s sponsorship and presence for 107 years is evident throughout. Decades of fans have embraced this baseball institution and protected it. The ballpark is one of only nine major league stadiums that have not been rebuilt since 1990. The mix of old and new is a hallmark of this historic city, and one that I appreciate.

Inside the Conference: Old Meets New

That mix of old and new was also evident at NACDS TSE. Sessions ran the gamut, but they all addressed the consumer’s shopping experience, opportunities to provide better patient care, and the trends impacting store operations from the front to back end.

My week started by facilitating a workshop among retailers on the forthcoming track-and-trace requirements as part of the Drug Supply Chain Security Act (DSCSA). While the Act is relatively new (passed in 2013), efforts to protect the integrity of the nation’s supply chain have been ongoing throughout my professional career, most notably starting with the 1987 generic drug crisis and progressing through the patchwork of state pedigree laws that had been designed to address the growing problem of counterfeit drugs highlighted in Katherine Eban’s book, Dangerous Doses.

What’s new is the industry’s focus on return-on-investment operational opportunities that could result from efforts to comply with the DSCSA track-and-trace requirements. Such opportunities include:

  • More efficient recall management
  • Product expiry and return
  • Receiving
  • Financial processes

These operational improvements may allow the current streamlined staffing in the pharmacy to focus on providing more patient care services.

Trend Talk

Trends that are impacting pharmacy operations were explored in sessions about marketplace and legislative issues. These trends are resulting in continued cost-consciousness and streamlined staffing. They include the impact of retroactive direct and indirect remuneration fees (DIR) and the specialty drug market.

A mere 12 hours after leaving his post, former Senior Advisor to the HHS Secretary for Drug Pricing Reform, John Michael O’Brien, provided an insider’s insight into ways that the pharmacy profession may consider adjusting its strategies to get the DIR fix implemented. IQVIA’s Doug Long shed light on the growing specialty drug market, while another session provided insights into building specialty pharmacy services.

Again, the old and new: Reimbursement pressures have been felt in pharmacy since claims processors came on the scene in the 1980s and the market shifted from a majority cash pay to third-party pay. Innovative products from the biotechnology pipeline that began coming to market in the 1990s have continued to grow and been “captured” by the specialty pharmacy segment – an industry class of trade still yet to be truly defined, except for the Medicare Part D legislation’s note that it is any drug costing $600 or more.

The Cannabis/CBD Conversation

Another striking debate of old and new was marijuana, medical and otherwise, and its component cannabidiol (CBD). 

The first medical marijuana law was passed in 1996 in California. The first recreational marijuana laws passed in 2012 in Colorado and Washington. Flash forward and now 32 states, the District of Columbia, Guam, Puerto Rico and U.S. Virgin Islands have enacted similar medical marijuana laws, while 14 states and the District of Columbia have recreational marijuana laws.

As I walked to the meeting venue, the large electronic sign outside the Boston Convention Center boasted an advertisement by the Massachusetts Department of Transportation and Cannabis Control Commission stating, “Marijuana is legal. Know the laws.” The electronic sign then flashed to NACDS TSE session information and sponsors, including the evening reception sponsored by Harmony Hemp. The theme continued at the registration desk when the lanyard holding my name badge was sponsored by Mile High Labs.

CBD references were everywhere, and a session on “CBD: What’s Next?” highlighted key elements retailers should consider as they continue down the CBD path. No fewer than 20 exhibit booth vendors were featuring CBD products.

In my view, the CBD environment is like the wild, wild west. There is growing recognition that regulation is needed, evidenced by an FDA hearing on the issue held in June 2019. Such regulation could address the lack of quality and consistency in CBD products highlighted in a 2017 study. Manufacturing standardization and compliance with good manufacturing practice are among areas to be addressed. Some suggest that the CBD category should become part of the rules that currently regulate dietary supplements, foods, and cosmetics.

Many of these issues were included in remarks by NACDS CEO Steve Anderson and NACDS Chairman of the Board Chris Lane, executive vice president of Wakefern Food Corp./ShopRite, during the opening business session. Both men described the association’s work on DIR fee relief and on opioid-abuse prevention. These two issues, combined with pharmacy reimbursement and expanding pharmacy’s scope of practice, comprise the four campaigns on which NACDS is focused. And while many of these issues are “old yet new again,” what is not is the urgency with which they need to be addressed. As Lane noted, “This is a pivotal time … A healthy pharmacy profession and industry is essential for the unified work of stores and suppliers to meet the health and wellness needs of consumers. The stakes are so high on these issues – we have to get them right for the good of the American people.”

Marsha K. Millonig, MBA, BPharm, is president and CEO of Catalyst Enterprises, LLC, and an Associate Fellow at the University of Minnesota College of Pharmacy’s Center for Leading Healthcare Change.

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