Rina Shah has been working at Walgreens her entire career—close to 25 years—but this year she got a shiny new title: vice president of pharmacy of the future.

The role was created as part of what CEO Rosalind Brewer said in Walgreens’ latest earnings call is the company’s top priority: creating a consumer-centric healthcare company. The retail pharmacy giant essentially wants to free up its pharmacists’ time so they can go from filling prescriptions all day to engaging more directly with patients.

Shah is heading up these efforts, and she sat down with Healthcare Brew to talk about what Walgreens sees when it pictures the pharmacy of the future.

What does “the pharmacy of the future” mean? When we talk about the future of pharmacy, it’s to leverage our pharmacists in a much more data-driven, effective way to lower costs in the system. For example, in certain states where there’s higher pollen counts and pollution, we’re seeing higher emergency room visits because of asthma. We can educate people on the difference between a rescue inhaler and a maintenance inhaler—and how they can understand triggers—and ultimately impact lower emergency room visits because of that.

What problems are you trying to solve in this role? Prior to the pandemic hitting, we had been asked by providers and payers and other organizations for our pharmacists to do more. We were being asked to provide testing services and in-depth consultations with patients. However, our operating model didn’t really account for that. Our pharmacists were busy doing many more administrative tasks. We made the decision that we needed to transform the model, which meant really freeing up the capacity of our pharmacists so they could spend time with patients delivering care, as it’s always intended to be. Keep reading here.—MA

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In the bewildering world of how the heck drug prices get set in the US, perhaps the most confusing players are called pharmacy benefit managers, or PBMs. They’re often called “middlemen” because they operate between insurers and pharmacies. We’re going to try to explain PBMs in the simplest way possible, but be warned: Your brain might be sore at the end of this.

PBMs were created in the 1960s, and they work on behalf of insurers. They negotiate with drug manufacturers to create formularies, which are lists of drugs that insurers cover. Those lists are divided into different tiers. The top tier includes mostly generics, which are cheaper than brand-name drugs because they’re required to have identical chemical makeup and therefore don’t have to repeat the same testing process. Insurers cover a larger portion of drugs in the top tier, so manufacturers want their drugs to be listed there.

The US health system saves money when generics, which cost less, are prescribed over brand-name drugs. Some states even have generic substitute laws that require a pharmacist to dispense the generic version of a brand drug.

PBMs negotiate with manufacturers over rebates, or the sum of money the producer pays for each drug to be included in the formularies. The amount is calculated as a percentage of the price of the drug, which is divvied up between the PBM and the insurer. Rebates are used by manufacturers to incentivize PBMs to include their drugs in formularies over their competitors’s, said Ronna Hauser, SVP of policy and pharmacy affairs at the National Community Pharmacists Association.

For example, if a manufacturer wants a PBM to put Drug A, which costs $20, at the top of a formulary, it might give the PBM a rebate of 20% of that price ($4) to incentivize them to do so. It’s important to note that we don’t know how much PBMs charge in rebates—they’re considered trade secrets. Keep reading here.—MA

It’s looking more than likely that we’ll see a recession in the next year, and Americans are preparing themselves by taking steps like delaying major purchases, allocating more of their income to savings, and staying in jobs they don’t love. Another thing they’re not doing? Getting Botox. And that’s bad news for AbbVie.

AbbVie, one of the biggest drug manufacturers in the US, brought Botox into its medical aesthetics portfolio—which also includes the popular dermal filler Juvederm—in 2020, when it bought rival drugmaker Allergan for $63 billion.

AbbVie CEO Richard Gonzalez said during the company’s Oct. 28 earnings call that the company expects the aesthetics business to take a hard hit in 2023 as recession fears cause consumers to be more cautious with their spending.

“Based on all the data we’ve been observing, especially in the US, with both the consumer-confidence index and real personal consumption expenditures trending down and continued high inflation, these factors are putting pressure on consumers’s discretionary spending,” Gonzalez said.

AbbVie lowered its 2022 full-year forecast for its aesthetics business by $600 million, down to $5.3 billion. After the earnings call, AbbVie’s stock fell 4.3%.

Through the third quarter of 2022, Botox has brought in $1.97 billion for the aesthetics business. The third quarter saw $637 million in cosmetic Botox sales, down from an expected $640 million. Gonzalez said he doesn’t think the hit on sales will last long, though.

“As consumer confidence improves, we would once again expect the market growth to accelerate. Our aesthetics portfolio experienced a rapid and sustained recovery following the 2008, 2009 recession,” Gonzalez said.

But Botox also faces a new competitor, called Daxxify, which just got FDA approval in September. Made by Revance Therapeutics, the drug may last longer: In clinical trials, Daxxify injections lasted six to nine months, while Botox injections typically last three months.—MA

Today’s top healthcare reads.

Stat: Three in five psychologists said that they are so booked they can’t take on new patients, according to an American Psychological Association survey. (the Washington Post)

Quote: “Why weren’t we informed that there was an issue? I might be standing right beside Joleen instead of mourning her loss.”—Doug Shiffler, a retiree who is suing CPAP manufacturer Philips over a device defect that he believes caused his late wife’s cancer (the New York Times)

Read: Patients are increasingly being offered financial assistance through payment plans, but some of those options come with high APRs or higher-than-anticipated interest-rate hikes. (Kaiser Health News)

Catch up on the top Healthcare Brew stories you may have missed:

• Where digital health investors are aiming their money in 2023
• Hospitals are competing with Big Tech and Big Retail to hire new workers
• How AI can lower the costs of clinical trials