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PALM BEACH, Fla. — The National Association of Chain Drug Stores will move from strength to strength when Kevin Host succeeds Mike Wysong as the organization’s chairman during the NACDS Annual Meeting here this week. As senior vice president of pharmacy at Walmart, Host brings to the task considerable expertise in pharmacy reimbursements, a critical asset at a time when fundamentals of the business model are ripe for change; specialty pharmacy, which already accounts for roughly half of prescription drug revenues and continues to boom; and the development of new approaches to health care delivery.
CEO Steve Anderson and incoming NACDS chair Kevin Host.
“Pharmacists have been trained extensively, and historically our job has been to fill prescriptions and provide good pharmacy care,” Host said earlier this year. “But going forward, we’re trying to really provide good holistic care.”
With nearly 4,600 pharmacies in the United States, Walmart is one of the companies in the vanguard of that movement. In recent months, it has implemented Testing and Treatment protocols for such common conditions as strep throat at many locations across the country, as well as engaged in pilot programs to provide free HIV tests and administer injectable medications for mental health disorders. In addition, Walmart, like many other NACDS members, is exploring such emerging trends as food as medicine.
“The NACDS Foundation is now sponsoring Nourish My Health, which is exploring where pharmacists fit into the conversation around good nutrition,” noted Host. “We expect to see more activity on that front in the future, and that’s something we’re very interested in, as Walmart is the leading food retailer in the country. We have the ability to combine our hard assets — grocery and fresh food with our clinical assets and pharmacies — in a way no one else can match.”
Host will draw on his varied experience as NACDS and its members work to capitalize on those opportunities to expand patient access to health care, improve outcomes, and build a secure financial foundation for retail pharmacy. Before joining Walmart, Host was president and chief operating officer of Avita, which focuses on providing 340B pharmacy services to patients and providers in the HIV community; led Pharmaceutical Strategies Group’s pharmacy benefit consulting and 340B divisions; served as senior vice president of specialty pharmacy at OptumRx for over a decade; and was responsible for UnitedHealth Group’s OptumRx Specialty Pharmacy programs, which included specialty drug distribution, clinical program development, and benefits and outcomes strategy designs.
Since moving to Walmart almost three years ago, Host has been a key contributor to the progression of the retailer’s ambitious health care strategy. In addition to its nationwide network of pharmacies, the company is methodically building out a series of Walmart Health Centers — which offer a wide variety of services including physician-delivered primary care, diagnostic testing and dentistry — and virtual care options.
In working to foster what he characterized as “a paradigm shift for patients and pharmacies” (not to mention payers), Host will amplify Wysong’s efforts as NACDS chairman. Convinced of the importance of showing up, CARE Pharmacies’ CEO has been unusually active as the association’s leader, fostering collaboration with other health care stakeholders, both inside and outside of the association. During his tenure, Wysong has visited 20 states and 30 cities, connecting with government officials, consumer groups and health care stakeholders, as well as other chain pharmacies.
“One of the things that I learned on my visits was that there is really an interdependence between the patients and the providers and the communities and the retailers, and it was really quite a gift to the spirit to see that,” said Wysong. “The other thing that I learned was that our association has a very strong identity and is really grounded in the responsibility to represent its members. There’s a faithfulness from the bottom of the association to the top about trying to make sure that it carries out the initiatives that it thinks are important in terms of moving forward a lot of these priorities on behalf of the member companies, and the other companies that are participants and parties to the association.”
Mike Wysong
The outreach by Wysong during the past year occurred at a critical juncture for drug stores and other retail pharmacy operators. As reimbursement pressures continue to mount and approach a breaking point, the need for a new paradigm is evident.
“The models are clearly transitioning from the traditional dispensing model to value-based care,” he explained. “The new model hasn’t arrived yet. And while there is that tendency to be uncertain about it, there was a degree of hope and a degree of excitement about the fact that, even though it’s a moment of uncertainty, it is also a moment of great opportunity.”
The degree to which NACDS members can seize that opportunity will largely depend on winning fair compensation for the products and services they provide. The issue extends across the public and private sectors, but is perhaps most acute in the Medicare program, where direct and indirect remuneration has taken a heavy toll on pharmacies, in some instances — especially among independent drug stores — threatening their ability to keep their doors open. Although industry advocates have won some notable victories related to DIR (direct and indirect remuneration) fees and other PBM practices in the states, action at the federal level remains elusive.
“I would certainly have liked to see that happen faster than it has,” Wysong noted, “but sometimes things don’t move as quickly as you’d like them to move, especially given some of the challenges that we’re experiencing today within the halls of Congress. NACDS has done everything it can in terms of the lobbying and legislating, having an all-hands-on-deck approach. You saw that with some of the commercials and letters that have been sent out, about the necessity for reform now in both Medicare and Medicaid.
“My hope is that the people who will follow me, Kevin and Rick [Gates, senior vice president and chief pharmacy officer at Walgreens, who is slated to become NACDS chairman a year from now], are in a better position than I was because of some of the work that we’ve done here over the last 12 months.”
Once DIR and other reimbursement challenges are overcome, a new era in retail pharmacy will unfold, according to Wysong.
“As you look at where the models are today and where they’re likely going to go, it’s going to be an expansion of pharmacy-based services,” he said. “You look at point-of-care testing, you look at some of these services that extend past dispensing at the pharmacy counter — pharmacy is best positioned to do all of those things.
“As I was out talking about the next phase of pharmacy, with some of the pharmacy schools and pharmacy associations that are bringing in the next care providers, there was really a focus on trying to build that piece of it out. I am optimistic that you will see that.
We learned a lot of that from COVID. I don’t think anybody is better positioned to take on those types of patients, especially in areas of high need or underserved communities. So there is a sense of optimism, that these new models will play into the strength of pharmacy in general.”
To realize that vision, NACDS and its members need the support of a broad range of stakeholders. When the time comes, the industry will reap the benefits of the seeds planted by Wysong during his year as chairman.
“When you look at the new models, they’re not going to be less complex, they’re going to be more complex,” he said. “When you look at the emerging technologies, the innovation and the importance of presiding over the patient-provider relationship, everything is really intertwined and interdependent. I tell people all the time — I tell my kids this too — anything that you’re going to do is likely going to be done in groups. When you bring those groups of people together, they all have different gifts to contribute. And when you’re going to work together in good faith, that usually results in an opportunity for the next model for how things are going to be to take shape.”
As Wysong’s term as NACDS chairman comes to a close, he can be confident that Host will carry on the work under way at the association and help bring about the conditions for the emergence of a pharmacy paradigm appropriate for the 21st century.
