The Irony of it all

This morning we learned that Walgreens will be replacing GE on the Dow. Yesterday CVS announced they have partnered with the U S Postal Service for home delivery of medications. And naturally everyone continues to speculate as to when Amazon will move into the pharmacy business. While it may not seem that any of these moves are related to our wacky world the fact is they all are.

With the diabetes world about to make their pilgrimage to steamy Orlando it would be wise to play close attention to what these moves could mean going forward. Although Walgreens being added to the Dow is not diabetes related it does signal that reports of the death of brick and mortar retail pharmacies is a bit premature.

The diabetes patient is very important to retail pharmacies for several reasons;

1. Diabetes is a chronic disease therefore these patients are constantly refilling prescriptions.

2. Even with the increasing popularity of home delivery the majority of patients still pick up their meds at their local pharmacy. This translates into big bucks for the pharmacy from the sale of additional items. Hey there’s a good reason why the pharmacy is located in the back of the store.

3. The role of the pharmacist is changing. The Asheville Protocol is proof of this.

4. CVS, Walgreens and Amazon are all getting into the diabetes coaching business.

5. In store clinics are becoming an important revenue source for CVS and Walgreens and patients with diabetes use many of the tests offered by these clinics.

How this all will play out is anyone’s guess. Will patients prefer coaching from a human or will they respond more favorably to snarky Alexa? In an attempt to differentiate themselves will these players move more aggressively into interconnected diabetes management (IDM)? Do patients really want Alexa telling them their glucose levels are too high?

One area which could be a major positive is in an attempt to curry favor with patients these companies can incentivize good behavior. Both CVS and Walgreens already have loyalty programs while Amazon has Prime memberships. It is not inconceivable using IDM they could reward patients who regularly refill prescriptions, achieve better outcomes, come in for regular HbA1c tests, etc. The opportunity also exists to supplement IDM with a human touch using the pharmacist to fill this role.

Such move into IDM would obviously be a positive for companies like Livongo, OneDrop or WellDoc. It would also be a positive for Dexcom (NASDAQ: DXCM), Abbott (NYSE: ABT) and Medtronic (NYSE: MDT) as CGM will replace BGM for measuring glucose.
The real question for us is and always has been just how much help the patient wants. Just how much medical information do they want to share. Do they really want another reminder they have diabetes? Do they really want Alexa reminding them to take their meds?

As everyone who’s making they’re to Orlando seems to forget is that for the majority of patient’s diabetes is one thing they’d rather not deal with. That it’s excuse the expression one big pain the ass. That these people have lives to live and that don’t want diabetes running their lives. They crave simple solutions not complex clinical explanations. What most everyone seems to forget most is they are human not computers.

It’s understandable that a conference like the one coming up everyone is laser focused on diabetes. The majority of the attendees get it. However, this is a not a representative sample of the real world of diabetes management. Far too much attention is placed on toys. Far too much attention is placed on the clinical aspects of diabetes. Far too little is placed on the patient, the person who must do all this stuff. This by far is the biggest mistake most companies make.

As we state consistently it doesn’t matter how way cool whiz bang the toy is if the patient doesn’t play with the damn thing. It does not matter how well a drug works if the patients doesn’t take the med as prescribed. Patients could care less about clinical studies, dosing algorithms or artificial intelligence. What patients want most is to not have diabetes in lieu of that they want their diabetes management to be easy, something that is part of their life but does not dominate their life.

The reality, nothing that will come out of the conference will change that. Sure, there will be lots of way cool and whiz bang. There will be lots of pontificating about which drugs are the best. There will be debates over data sets. What there won’t be unfortunately is any discussion about the folks who are supposed to use these toys and take these drugs. About how they see their diabetes, how they feel about being a patient with diabetes.

The sad part is the patient is almost viewed as an after-thought and this my friends must change.