Standing up: Retail pharmacy's crucial role in pandemic response

David Salazar
Managing Editor
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There could be no doubt about the importance of this meeting. 

On March 13, standing next to President Trump in the Rose Garden at the White House, were top executives from healthcare providers and major retailers, including CVS Health, Kroger, Target, Walgreens and Walmart. 

The president was declaring a national emergency and sharing the administration’s plan to combat the novel coronavirus. He needed to show strength and unity from the people in the trenches and, as we all soon found out, retail, including the pharmacy, quickly became the front line in the war on COVID-19.

In addition to remaining open for the necessities that customers and patients required, the retail pharmacy industry over the past seven months also has been tasked with increasing the services offered to nclude COVID-19 testing, more immunizations and, eventually, administering a COVID-19 vaccine. 

For these reasons, Drug Store News is honoring the significant contributions that the entire industry has made to responding to the pandemic and demonstrating to a watching nation just how essential it is. 

“The pandemic has been called the great accelerator in almost every aspect of our economy, healthcare system and really on our personal lives and how we use technology — and that’s particularly true as it relates to pharmacy,” said Steve Anderson, president and CEO of the National Association of Chain Drug Stores. 

We talk a lot about what our pharmacists are capable of doing, are educated to do, but this has given us the platform to show the country what the true value of a pharmacist is and how we can contribute to the whole healthcare system.
Jocelyn Konrad, Rite Aid chief pharmacy officer

From Anderson’s perspective, there is not a better industry to help combat the coronavirus, with 91% of the U.S. population living within five miles of an NACDS member pharmacy. On a wider scale, 95% of the population lives within five miles of any pharmacy. 

Executives said that the pandemic has laid bare the crucial role retail pharmacy plays in the nation’s healthcare system — particularly when it comes to the clinical services offered by retailers that operate pharmacies. 

“As an industry and a profession, we’ve been lifting this boulder up this hill for many years and getting quick wins here and there where we could,” said Jocelyn Konrad, Rite Aid executive vice president and chief pharmacy officer. “This has accelerated that. We talk a lot about what our pharmacists are capable of doing, are educated to do, but this has given us the platform to show the country what the true value of a pharmacist is and how we can contribute to the whole healthcare system.”

Throughout the pandemic there have bene key developments underscoring the value of pharmacy. 

“There were two really important inflection points for pharmacy in COVID, and they both related to the Public Readiness and Emergency Preparedness Act,” Anderson said, referring to two Department of Health and Human services declarations — the first allowing pharmacist testing and the more recent one allowing pharmacists to order and administer an eventual COVID-19 vaccine. “Both those items were huge game-changers for pharmacy, not only during the pandemic, but from our perspective if we can make some of these changes permanent, it will be excellent for patients moving forward.”

Processing tests at a Walgreens test site

The Testing Challenge
A critical component of the country’s response to the coronavirus has been its capacity for testing — an area where retailers have stepped up in a big way throughout the pandemic. 

On the regulatory side, getting clearance for pharmacists to order and administer tests was an important step, according to NACDS senior vice president of pharmacy care Kathleen Jaeger. “We worked at the federal level and state level to remove all the needless regulatory burdens and limitations out there so that our members could actually engage in COVID testing,” she said. “While we were doing it at the state level, one state at a time, it was fantastic to see HHS issue a guidance and legal advisory opinion. NACDS, working with our members, was instrumental in getting the barriers removed so that our members could go ahead and get the testing done in an efficient fashion.”

Getting the public tested was something many retailers knew they would be instrumental in providing to the public.

“As Health and Human Services was reaching out to different partners, given our enormous presence in our communities, we saw this as one of the things that we had to figure out how to participate in,” added Bill Shinton, vice president of health and wellness at Kroger Health. Kroger currently is testing at all more than 220 Little Clinic locations, and it provided testing in certain hotspots when cases were peaking. 

Besides Kroger, the nation’s leading pharmacy chains went all-in on building out their testing infrastructure. Alongside Kroger, Walmart and Health Mart partnered with eTrueNorth to provide lab-testing capabilities. Rite Aid has partnered with PNWHealth as it worked to scale its testing effort, which currently includes 303 sites in 15 states. Though it was a challenge, Rite Aid’s Konrad, said it was a process that allowed for collaboration and that enabled retailers to highlight their capabilities. 

“We knew we had the skills to do it and we were willing, able and nimble enough to work with HHS alongside some of our peers and colleagues to learn from this, as it was something we hadn’t done before,” Konrad noted. “As that evolved, we had a seat at the table and we were able to continue to find ways — along with everyone else and HHS — to create a new and easier way to test patients.”

Rite Aid is not the only pharmacy chain making testing strides. Walgreens currently boasts more than 400 testing sites nationwide and in Puerto Rico. Rick Gates, Walgreens senior vice president of pharmacy, said that in addition to the drive-thru testing with fairly quick turnaround on results (within 24 hours), the retailer also offers polymerase chain reaction tests, which can typically offer results within 72 hours. 

“As we worked to expand testing capacity to allow for more than 500,000 COVID-19 tests per month, we maintained a focus on underserved communities, with more than 70 percent of our testing sites located in areas the CDC has identified as socially vulnerable."
Rick Gates, Walgreens senior vice president of pharmacy

“As we worked to expand testing capacity to allow for more than 500,000 COVID-19 tests per month, we maintained a focus on underserved communities, with more than 70 percent of our testing sites located in areas the CDC has identified as socially vulnerable,” Gates added. “The pandemic has underscored the significant trust Walgreens pharmacies have within the communities we serve.”

For its part, CVS Health is on track to have more than 4,000 testing sites operational by mid-October across 33 states and Washington, D.C. The chain opened 400 sites on one day in September. 

“Since opening our first test site in March, we’ve been able to quickly adapt to the changing landscape in order to make it easier for people in the communities we serve to access testing,” Jon Roberts, COO of CVS Health and acting CVS Pharmacy president, said when the company announced in mid-September that it would be doubling its testing footprint from 2,000 sites. “We recognize the critical role testing plays in helping to manage the spread of the virus and are incredibly proud of how our teams have responded to this need while continuing to take care of our customers,
clients and patients.”

Beyond directly testing the general population, Kroger made it a point to develop an easy to way ensure that its associates had access to tests in order to guarantee that its shoppers were healthy as well. The company work with the Food and Drug Administration to develop its own COVID-19 home collection test. “That was an easy decision for us and we had the support all the way up to our CEO to make sure that we could take care of our associates,” Shinton said. 

At Walgreens, it also has positioned itself as a resource for institutions looking to reopen safely. “We’ve also launched Walgreens Test & Protect program to aid businesses and universities in their COVID-19 work plans and strategies,” Gates said. “The program provides access to COVID-19 testing, as well as clinical guidance including ongoing preventative care services such as flu shots and other CDC-recommended immunizations."

Kroger began offering free telenutrition services at the onset of the pandemic

Filling in the Gaps
As various businesses closed, consumers began to take notice of the extent to which retailers served as more than just a place to stock up safely. Increasingly, retailers stepped in to fill in areas of need in terms of healthcare — from medication dispensing and management to nutrition services and even catch-up vaccines for children and adults. 

The obvious part of retailers’ response was continuing to keep pharmacies open and dispensing medication. Along with that, particularly given the importance of keeping patients as healthy as possible to prevent contracting the virus, 

“We’ve been more focused than ever on making sure that we’re there to provide services for people, whether that is preventive care, whether it’s vaccination services, whether it’s disease state coaching or medication management,” Kroger’s Shinton said, noting that the company would continue to focus on the service aspect of pharmacy. “We felt really good that we were able to stay open through the pandemic and be able to continue to provide those services, particularly as other parts of the healthcare system contracted a little bit.”

With many physician’s offices closed and hospitals largely were only being visited for emergencies or by patients with the coronavirus. “One of the healthcare destinations that has been open and that is convenient is the pharmacy,” said NACDS’ Jaeger. 

The industry has seen its importance grow in vaccinations, an area of clinical services that it has been working to expand. In August, HHS allowed pharmacists to offer and administer vaccines to anyone ages 3 to 18 years old, opening up several pediatric vaccination opportunities to pharmacists in response to lower rates of childhood vaccination rates throughout the pandemic.

“Especially in times of stress and illness, good nutrition is a big part of your arsenal, and while people are homebound, having something to focus on like maintaining good nutrition is important. So, we made the decision early on to make our dietitian services free during the pandemic.
Bill Shinton, Kroger Health vice president of health and wellness

“It’s exciting to see that trust and confidence in our pharmacists across the federal and state government to give us that ability to fill in the gaps,” Rite Aid’s Konrad said. “Any time we can get our pharmacists to practice at the top of their license, that’s what we want to do. 

Shinton said that though there was a lull in vaccinations offered early in the pandemic, interest in remaining health has driven more visits to the pharmacy. “Vaccines are definitely starting to pick back up and they have for a little while,” he said. “We’re seeing people really re-engaging with preventive care again.”

Beyond the pharmacy, in May, Kroger Health began offering free telenutrition services as part of its “Food as Medicine” platform. Using data from the retailer’s analytics arm, 84.51° that found more Americans cooking and baking, as well as an uptick in consumption of comfort food, packaged foods and snacking, the offering included a complimentary virtual consultation with a registered dietitian and personalized support plans for individuals and families. 

“We have a strong belief at Kroger that food is medicine,” Shinton said. “Especially in times of stress and illness, good nutrition is a big part of your arsenal, and while people are homebound, having something to focus on like maintaining good nutrition is important. So, we made the decision early on to make our dietitian services free during the pandemic.”

Walgreens has added safety procedures to its flu shot services.

Flu Season and Beyond
Even with expanded vaccinating powers, this year much focus has been placed on patients stopping by the pharmacy for a longtime mainstay — the flu shot. In 2020, the saying that an ounce of prevention is worth a pound of cure is being taken to heart. 

Jaeger noted that in the most recent flu season, 67,000 people died and more than half a million were hospitalized. She said that if that trend repeats itself, those numbers, combined with COVID-19 cases, could easily overload the healthcare system. 

As a result, NACDS has been highlighting flu preparedness with an ad campaign, and retailers have been publicizing flu shot availability, while also making adjustments to the experience to ensure safety during the pandemic. 

“With flu, every action that we take is ultimately going to help the health care system because it will alleviate some of the patients who might be hospitalized if they don’t get their flu shots and the system won’t be able to handle it,” Konrad said, noting that pharmacists have contributed to a 30%  rise in overall administered flu shots than were delivered before pharmacists could immunize. 

Because the pandemic is still going on, retailers are making necessary changes to the process. 

“The patient experience for flu vaccines may look and feel a little different this year,” Walgreens’ Gates said. “Among other precautions we’ve taken in our pharmacies, prior to administering an immunization, pharmacy team members will take patients’ temperature and screen for presence of symptoms or illness. If a patient has a fever or other symptoms associated with illness, they will be referred to their healthcare provider and immunizations will be deferred. Pharmacy team members also wear face shields in addition to facemasks required by both pharmacy team members and patients while administering vaccinations.”

In addition to precautions, at Kroger, Shinton said the need for a contactless experience drove the adoption of a paperless fly shot experience. 

“We’re happy that we were able to make this completely digitized,” he said, adding that from appointment scheduling to insurance information completion, the entire process is done without paper. “Even if somebody doesn’t schedule an appointment or do their form prior to showing up, they can scan a QR code onsite and it takes them to the form, which transmits directly into our pharmacy system for our staff to start working on it right away.” 

In another occurrence that is underscoring pharmacy’s role in healthcare delivery, HHS in September issued a guidance allowing pharmacists to order and administer an eventual COVID-19 vaccine that passes regulatory muster. The move made clear that the administration sees the advantages to distributing the COVID-19 vaccines via the existing infrastructure of retail pharmacy. 

“They realize that the existing pharmacy infrastructure across the United States is reliable, so why not utilize what’s you already have and what’s already very effective,” Jaeger said. 

Konrad concurred: “I  believe that in order to get the vaccine to the masses, you will not be able to do it without pharmacists — I don’t know how you can immunize the number of people who will need to be immunized without pharmacists in the mix.”

Ultimately, though the pandemic is far from being over, industry players agree that it has raised pharmacy’s profile and forced retailers to adjust on the fly to best serve customer needs — two trends that are expected to continue. 

“Something like this really makes us look at how to take it to the next level,” Shinton said. “Our digital capabilities are where we’ve started to lean in and ask how we make the overall healthcare experience simpler for people.”

Rite Aid’s Konrad said, “This has probably been the most exciting time in my career because it’s all actually happening, and we’re here and making it happen. And we’re going to continue to show the world that pharmacy really can be supportive — not only in times of need, but always. 

To put it very simply, as NACDS’ Anderson did, “This is a time where pharmacy has shined more than it ever has, and I think it will speak very well for the future of pharmacy moving forward.”