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AN INDEPENDENT PUBLICATION NOT AFFILIATED WITH NACDS Kimberly Oser Publisher Jules Denton-Card Senior Associate Publisher Lorrie Baumann Editorial Director Anthony Socci Associate Publisher JoEllen Lowry • Jeanie Catron • Karrie Welborn Associate Editors Yasmine Brown Art Director Jonathan Schieffer Graphic Designer Caitlyn McGrath • Susan Stein Customer Service Managers Marcos Morhaim Senior Account Manager Adrian Chacon • Paul Harris • Andy Hartnett Account Managers Tara Neal Director of Operations Jay Watson • Hannah Stefanovich • Margaret Oser Show Logistics & Distribution Enrico Cecchi European Sales Chain Drugstore Daily is published by Oser Communications Group ©2019 All rights reserved. Executive and editorial offices at: 1877 N. Kolb Road, Tucson, AZ 85715 520.721.1300/Fax: 520.721.6300 European offices located at Lungarno Benvenuto Cellini, 11, 50125 Florence, Italy www.osercommunicationsgroup.com Lee M. Oser Founder Chain Drugstore Daily Saturday, April 27, 2019 4 Prasco Continues a Tradition of Outreach at NACDS Events Prasco Laboratories is a privately held healthcare company founded in 2002 and located in Mason, Ohio. The company's core business model focuses on market- ing and distributing authorized generic prescription drugs. From the beginning, Prasco has had a strong culture of service – to God, fam- ily, customers, partners, fellow employ- ees and the global community. The com- pany's outreach programs are essential to Prasco's identity and activities. Employees give time, talents and resources to make an impact in local, regional and international communities. Beyond numerous outreach activities in the Cincinnati area, Prasco employees have traveled on mission trips around the United States, Mexico, Belize and other parts of the world. At the 2010 NACDS Total Store Expo in San Diego, Prasco saw an oppor- tunity to serve the community around the host city. Employees created an event to raise funds for local pediatric cancer patients and the Friends of Scott Foundation. The event took place at the Padres stadium, Petco Park, and was a great success. This began an annual tradi- tion of Prasco serving the host communi- ty by raising funds for local charities. In 2015, the Prasco team expanded the event to include a service project. Prasco employees and a small group of business partners spent a day volun- teering at a warehouse that supports Denver children. Since then, Prasco events hosted at the NACDS TSE have grown into fully coordinated volunteer efforts, involving more and more industry participants each year. These events have included service projects such as: planting trees at inner city schools, constructing toddler beds for families transitioning from homeless shelters, and packing backpack kits for children in need. Last year's event was the biggest ever, including over 80 NACDS participants from dozens of compa- nies assembling bikes for children living in lower income neighborhoods. In total, Prasco's outreach events have provided more than $150,000 in support to char- itable organizations in the NACDS TSE host cities of Boston, San Diego and Denver. For 2019, Prasco is excited to announce it has "Teamed Up to Clean Up" the Patrick J. Kennedy Elementary School playground and indoor facility. This effort to restore and revive the school will be conducted in partnership with Boston Cares on Friday, August 23, 2019. Prasco welcomes NACDS atten- dees to join the fun. If you are interested, contact kc.donovan@prasco.com. For more information, go to www .prasco.com or stop by booth #224. DIR – A Three-letter, Four-letter Word By Lari Harding, Vice President, Strategy & Marketing for Inmar Direct and Indirect Remuneration (DIR) is a component of Medicare Part D pro- grams today. It is very complicated and has been implemented in a variety of dif- ferent, and often confusing, ways. The lack of clarity, fairness and transparency to all parties has created business chal- lenges for pharmacies. The good news is that NACDS is working on behalf of pharmacies to elim- inate post point-of-sale price conces- sions; include quality-based incentives for pharmacies; and require claim-level data be provided to pharmacies. While patients choose their doctors and their pharmacies/pharmacists, they do not, in many cases, choose their insur- ance plans, their PBMs or even the drugs they are taking. Pharmacists engage with patients many more times a year than doctors. With the ultimate goal to improve access to healthcare, while low- ering healthcare costs, and improving patient outcomes, pharmacists are in the best position to work directly with patients to achieve this goal. Pharmacies operate on very thin margins – the lowest of all entities in the healthcare system. The top three PBMs and plans manage 70 percent of the pre- scription volume; the top seven manage 92 percent of the volume. This makes it difficult for pharmacies to negotiate equitable business practices because these PBMs and plans have more com- mercial market power due to their size and scale. The PBMs and plans deduct a cer- tain amount from each prescription with the possibility that pharmacies can miti- gate the amount of the clawback depend- ing on their performance. Despite what form the DIR takes, the result is loss of revenue by pharmacies. Here are the Top 10 Things you need to know about DIR: 1. DIR fees averaged 1.42 percent of total pharmacy sales in Q4 2018. DIR fees averaged more than 6 percent of Medicare Part D sales. 2. Over the last 16 quarters, reim- bursement rates have declined. 3. The criteria for DIR calculations are medication adherence, generic dis- pense rates (GDR), medication therapy management (MTM), generic effective rates (GER)/network variable rates and formulary compliance. 4. Formulary compliance and GDR are examples of largely unattainable met- rics that a pharmacy must meet in order to qualify for the lowest DIR fee. Pharmacists are ultimately subject to the prescriber-patient treatment decision. GDR goals range from 84-95 percent, with average performance of 85.79 per- cent. Thirty-two percent of pharmacies fall below 85 percent GDR. 5. GER (also known as Network Variable Rate) further contributes to the ambiguity inherent in DIR as different PBMs and plans use varying brand/generic definitions and set differ- ent targets that pharmacies must reach – resulting in clawbacks. 6. Medication adherence is compli- cated due to patient attribution; that is, "who counts" for "which pharmacy" as a result of patients' polypharmacy behav- iors. 7. Even pharmacies with very strong performance have high DIR takebacks as there is no clear definition of peer groups or contract participants. 8. The complexity of managing DIR fees is compounded by the fact that phar- macies are expected to manage as many as seven different accrual calendars. 9. In most instances, pharmacies struggle to perform a reconciliation between DIR fees and claims. Only 25 percent of PBMs and plans provide claim-level detail in the 835 remittance. Most DIR is collected via a lump sum, making it impossible for pharmacies to determine what money is being taken back for which claim and why. 10. Inmar can help. Inmar Analytics helps pharmacies understand DIR, fore- cast and accrue properly for DIR, and develop approaches to address DIR. Call us. For more information, go to www.inmar.com or stop by booth #430. Consumers Review New Remedy Dermatology Series Lotion When it comes to skincare, it's important to have scientific support and expertise to produce the highest quality products. In fact, those factors are important to get consumers to try a new brand. New Remedy Dermatology Series Moisturizing Lotion is a unique, propri- etary botanical formula that provides a wide range of benefits. It contains pro- teins, vitamins and carbohydrates for skin nutrition; natural oils and other moisturization support; plus a high level of skin soothing antioxidants. While the science behind the product may pique customer interest, the proof comes when they actually try it. That's why Remedy monitored reviews from customers to see how this new product performs for them. Among the many 5- star reviews the product received, a high percentage came from people who con- sidered their skin highly sensitive or extremely dry and irritated. Other popu- lar comments referred to the smooth tex- ture, the way it absorbs quickly and the gentle formulation. Here are a few excerpts: "My skin is really dry due to medical reasons, especially my elbows. I've been using this product for four days and can already see a huge improvement." "You don't have to put a huge amount on. It rubs into your skin easily and is not greasy." "I've not seen a product that is free of the ingredients found on the North American 80 Comprehensive Series (NAC 80) list of possible allergens before." "I love it is free of paraben and sul- fates." It shouldn't be surprising that Remedy Dermatology Series Lotion has elicited such positive responses. It's made by Medline Remedy ® , the No. 1 brand of skincare in the medical field, with a history of cre- ating high level skin- care for all types of skin issues. Remedy Dermatology Series Moisturizing Lotion was introduced into retail in March of 2019. Packaging is designed to stand out from other thera- peutic lotions on shelf, highlighting the effectiveness and gentle, botanical for- mula. Available sizes include 3-ounce, 8- ounce and 12-ounce bottles. For more information, go to booth #532 or visit www.medline.com.