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Count on generics. Now more than ever.

Dr. Reddy’s generic medications have been making life more affordable for patients for over 40 years. Today, our commitment to providing access to high quality, more affordable medications that patients and their doctors can count on remains unchanged. Why? Just ask the more than 23,000 committed employees at Dr. Reddy’s who know that Good Health Can’t Wait.



Alternative brands are shaking up the feminine hygiene category

Page 56


Suddenly there are opportunities for action at both state and federal levels on issues important to retail pharmacy

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34 INSIDE BEAUTY 2023 Hair Care Trends

Here are what experts predict will keep hair care sales bouncy in the new year

38 BEAUTY TALK Mist Fits

With their Mist of Wonders spray, DevaCurl is cutting down on product usage


Generic Drugs –a Year in Review

There are some tough-love lessons from the events of the past year


Driving Innovation in Diabetes Care

Manufacturers are developing products and initiatives to make care easier and more accessible


Seeking More than Sleep

Consumers want side-effect-free sleep aids to help them relax, stay asleep and more


Feminine Hygiene

Gets a Makeover

Natural and alternative products are invigorating this long-staid category

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W. Bryn Mawr Ave, Suite 200, Chicago, IL 60631. Vol. 45 No 1, February 2023. Copyright © 2022 by EnsembleIQ. All rights reserved. Vol. 45 No. 2 DEPARTMENTS 8 EDITOR’S NOTE 10 INDUSTRY NEWS 14 PRODUCTS TO WATCH 18 ISSUE SUMMIT REPORT 22 WOMEN IN THE NEWS COLUMNS Facebook.com/DrugStoreNews Twitter.com/DrugStoreNews
16 GUEST COLUMN By Chirag Patel, PharmD, senior product manager, FDB (First Databank) 58 LAST WORD By Lynne Fruth, president and chairman, Fruth Pharmacy
Suddenly there are opportunities for action at the state and federal levels on issues important to retail pharmacy


When it’s crunch time, you want TEAM CAMBER on your side. From supply chain, to customer service, to distribution, Camber is dedicated to raisin g the bar on our support, with timely solutions that make your job easier.

Quality, value, and supply are the hallmarks of Camber’s commitment to excellence.



Legislative Limbo

The mood is optimistic at the prospect of congressional reform

I started my journalism career covering environmental regulations in the federal government and Congress. I have a lot of memories of that time, but the thing I remember most is the slow pace of progress. Bills were introduced, hearings were held, deals were made, but all that activity frequently resulted in stalemate.

That’s not to say bills didn’t make it to the Oval Office for signing. Clearly some did–the easier ones like infrastructure, farm bill reauthorization and others. Sometimes a bill to rename an obscure bridge made it through. Other policy issues were harder to bag.

It’s not necessarily a bad thing that the wheels of government grind slowly. The framers of the Constitution intended it. We should be mindful of that when we start thinking about the pace of congressional legislation on issues that are important to retail pharmacy, such as PBM reform and patient access.

As we report in our cover story this month (page 24), optimism is strong that there finally might be movement on legislation to help the industry. Chris Krese, senior VP of congressional relations and communications at the National Association of Chain Drug Stores, said it best:

“The pharmacy issues are extremely bipartisan. We find that these issues are broadly supported by Democrats, Republicans, and Independents alike, and we look forward to working with the Congress and with the administration to advance all these issues on a bipartisan basis.”

The industry is not just looking for leadership from Congress. Retail pharmacy executives and associations are hopeful that there will be continued progress on the state level as well. Some–such as Arkansas, Florida, California and New Jersey–have seen legislative movement, and there is hope that other states can build on that momentum.

Sure, the industry would prefer to see Congress take the lead and set policy that makes it easier to serve patients in every state, but short of bipartisanship and a cooperative mood overtaking both chambers, the industry may have to settle for continued progress on the state level. Until Congress acts, it’s the next best thing. dsn

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Heidi Snyder, Drug World Pharmacies


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Kristen Bell joins Hers as mental health ambassador

Actress Kristen Bell is teaming up with Hers to break down stigmas surrounding anxiety and depression and to raise awareness of trusted online resources.

Hims & Hers Health, a consumer-first platform focused on providing modern personalized health and wellness experiences, announced that actress Kristen Bell is joining Hers as its first mental health ambassador.

Sharing a common goal of helping people feel confident when it comes to taking care of their mental health, Bell and Hers are working to combat the stigma surrounding mental health and encourage conversation and exploration of treatment for people struggling with anxiety and depression.

“As a society, mental health has become an increasingly important topic over the last few years and the need for more understanding and reliable resources has been continuously voiced in conversations with our customer base,” said Hilary Coles, co-founder and senior vice president of Brand & Innovation at Hims & Hers. “Kristen’s genuine personality and openness about her mental health resonates with people in a really honest and authentic way. Harnessing her influence and community, we hope to support people looking for a better way to take care of their anxiety and depression. In working with Kristen, we want more people to understand that mental health care doesn’t have to be daunting, scary, or unattainable — trusted care is available right now.”

In her role as Mental Health Ambassador, Bell will share her personal mental health journey to drive meaningful conversations on the topic. She also will draw attention to the individualized care Hers provides for anxiety and depression, which includes virtual psychiatry and therapy services with licensed healthcare professionals, free support group sessions, on-demand treatment education, and more. Customers who have sought psychiatric treatment through the Hers platform and who were

prescribed medication by a licensed healthcare provider have reported improved PHQ and GAD scores about four weeks after first seeking treatment, the company said.

“It’s no secret that I’ve sought help for my own anxiety and depression. While it may sound intimidating, professional help can be lifesaving for some people struggling with mental illness,” the actress said. “I’ve been advocating against the stigma of mental health for a long time, and I feel immensely proud to be teaming up with Hers to help people understand that high-quality care for anxiety and depression is readily available.”

In an effort to engage new audiences as well as existing customers, Bell will work closely with the brand throughout the year to drive awareness of the safe and trusted mental health resources Hers provides access to.


Walmart expands Associateto-Driver pilot program

“After they complete the 12-week training course and earn their CDLs, they have a coveted Walmart driving job ready to step into,” Cortes said, noting that Walmart drivers can make up to $110,000 in their first year with the company, in addition to the suite of benefits the company offers.

“And that’s just a start – drivers who have been with Walmart longer can earn even more, based on factors like tenure and location,” Cortes said.

Cortes went on to say that the Associate-to-Driver program allows participants to learn driving “from the best of the best – our current Walmart driving instructors.

Through this expanded pilot, Walmart associates in stores, distribution centers, fulfillment centers and transportation offices within a 50-mile radius of a participating transportation office will be eligible to apply to the Associate-toDriver program.

Walmart is expanding its Associate-to-Driver pilot program for associates working in stores, distribution centers, fulfillment centers and transportation offices in participating locations so that they will be able to take advantage of its Fleet Development program.

In a post on Walmart’s website, Fernando Cortes, senior vice president of transportation said that Walmart associates know the crucial role its Private Fleet of more than 13,000 drivers play across the company in delivering items to customers.

Acknowledging that many Walmart associates have long been interested in stepping into these driver roles themselves but felt limited by the time and expense of the training required, Cortes said that’s why the launch of Walmart’s Fleet Development program last year was such a game changer.

“It gave supply chain associates in select parts of the country a path to earn their commercial driver’s license and became full-fledged Private Fleet Walmart drivers,” Cortes said.

Since the program was announced last year, Walmart has trained 56 associates from various roles. The retailer is now expanding the program to include store associates within a 50-mile radius of a hiring transportation office.

Noting that Walmart’s fleet is continually recognized for its commitment to safety, Cortes said that the American Trucking Association has awarded Walmart the Safest Fleet in the Over 250 Million Mile Division for six consecutive years.

“By training our new drivers in this program from day one, we can help guide them to approach all parts of the job focusing on the values of safety, courtesy and pride so that we will never disappoint our fleet, customers or families,” Cortes said.

Lastly, Cortes said the program is a win for associates, who can take the next step in their career journey without leaving the company.

Cortes added, “It’s a win for Walmart as we can continue to invest in our talented team of associates. And it is a win for customers and members, as our fleet continues to deliver every day. It’s exciting to be part of one of the world’s largest private fleets, and we plan to keep hiring and growing the best drivers in the industry to join our team.”


Walgreens removes purchase limits for OTC products

Walgreens has removed its online-only purchase of over the counter pediatric fever reducing products.

In late December, retailers instituted product limits as cases of COVID-19, flu and RSV ticked up, amid a scarcity of OTC children’s pain relief products at certain locations.

“Walgreens has worked diligently with our suppliers to ensure we have enough supply to meet customer demand nationwide,” the retailer said. “This was originally put in place to prevent excess purchasing behavior. For customers looking for items, our website updates with the latest available store inventory information frequently throughout the day.

Additionally, Walgreens Same Day Delivery and Pickup provide contactless options for receiving products.”

Walgreens noted that it previously only had online purchase limits of these products in place and has not had in-store purchase limits.

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New & Noteworthy

HRG’s five notable products from January 2023

Product introductions started the year relatively strong, holding on to some of the momentum from 2022 as inflation eased and hope for a soft economic landing returned. For the month of January, suppliers introduced 224 new products, which is 42 less than the 266 they introduced in December. Waukesha, Wis.-based HRG reviewed 21 products in the health category, 86 in the wellness sector and 117 items in the beauty aisle to see which ones stood out as Products to Watch. Here is what they found:

1. Icy Hot Kids Pain Relief Patches

Sanofi worked with pediatricians to create the Icy Hot Kids Pain Relief Patches for ages 5+ to relieve pain associated with sore muscles, bruises, as well as other pains and aches. The smaller patch size is designed to fit children’s back, legs, arms and shoulders and is formulated with naturally sourced menthol (5%). Patches can be worn for up to 8 hours and are free of alcohol, preservatives, fragrances, dyes, parabens and phthalates. It includes stickers so kids can decorate their patches.

2. Batiste Dry Shampoo Overnight Deep Cleanse

Batiste Dry Shampoo Overnight Deep Cleanse was developed by Church & Dwight to tackle oil buildup while users sleep. Made with charcoal and baking soda, the product formulation means users will wake up with fresher hair, with no rinsing required, the company said. It comes in a 3.8-oz. bottle.

3. Hyland’s Naturals Dry Ear Relief Oil

Hyland’s Naturals said its Dry Ear Relief Oil relieves dry, itchy, and irritated ears quickly. Designed for consumers who wear hearing aids, earbuds, or headphones regularly or who suffer from dry skin, the product features a blend of premium oils that is meant to moisturize and calm itchy skin. Hyland’s said the oil is safe for internal (ear canal) or external use as well as for use with auditory devices. It comes in a .5-oz. bottle.

4. Total Relief Shampoo

Dr. Marder Skincare’s Total Relief Shampoo is dermatologistformulated with maximum strength hydrocortisone to stop itching and relieve the symptoms associated with psoriasis, seborrheic dermatitis and eczema. The company claimed the solution works in 24-48 hours and is safe for everyday use on all hair types as well as treated hair. Available in 6-oz. bottles, the shampoo includes vitamins A, C & D and is sulfate- and paraben-free..

5. AMB Foot Powder

New to the AMB product line, the AMB Foot Powder from Bridges Consumer Healthcare is designed for friction and blister defense. It also absorbs sweat and controls odor. The powder is formulated with unique ingredients including vitamin A and C to help soften the skin and restore dry, chapped feet. Bridges Consumer Healthcare said the powder also does not “cake” on, even with heavy use. It comes in an 8-oz. bottle. dsn


Making Workflows Smarter

How pharmacists can find ways to increase efficiency and streamline essential duties

parts of the pharmacy puzzle,” said one of the retail pharmacists surveyed. “However, [the technology] can be very time-consuming and take focus away from thorough clinical review, timely completion of orders, and collaboration with doctors, nurses, and other pharmacists on important clinical issues.”

Solving the Puzzle

The retail pharmacist’s role has changed more than anyone could have imagined in recent years. For example, they deliver an ever-growing list of vaccines, conduct medical tests, counsel patients, perform health screening and review and complete orders for an increasing volume of prescriptions.

Despite this changing and expanding workload, pharmacists still have the same number of hours in the day to accomplish everything. Adding to this challenge is the struggle to hire and retain pharmacy technicians. So, it is no wonder a 2021 survey of pharmacists found that three-quarters of pharmacists think they do not have enough time to perform clinical and nonclinical duties safely.

At the same time, pharmacists are embracing the changes that enable them to practice at the top of their license. According to the previously cited survey, 75% of retail chain pharmacists and 53% of independent retail pharmacists state that they would like to spend more time devoted to patient counseling and medication therapy management.

Working Smarter

Without adding more hours to an already long workday, one strategy for extending patient-facing time is to automate or better streamline essential duties in the pharmacist workflow.

Consider Drug Utilization Reviews (DURs). While they are critically important, they can be time-consuming—especially when a patient takes multiple maintenance medications for chronic conditions and needs to expand an already complex regimen. Traditionally, retail pharmacists need to consider major clinical domains—drug interactions, allergies, precautions and dosing information—in a siloed approach and repetitively dismiss non-actionable alerts for the same patient.

Managing irrelevant notifications leaves inadequate time to consider relevant guidance and contributes to the distractions and stress pharmacists already endure during the day, according to results of a 2021 survey of Ohio pharmacists conducted by the state board of pharmacy. “Delivery of completed medication orders and the technology that helps with dispensing them are very important

Technology can drain a retail pharmacist’s time, but improvements in data analytics and artificial intelligence are helping to eliminate manual or unneeded repetitive tasks within pharmacy management software. For example, actionable guidance to the pharmacist can be focused on the most important risks to the patient as reflected in the clinical record in the pharmacy system.

A more patient-centered view consolidated from pharmacy data, as well as information from prescribers and insurers, offers pharmacists greater context to determine the most effective clinical course more efficiently, whether that is to fill the prescription, provide additional guidance to the patient, or follow up with the patient’s physician.

For instance, guidance could include guideline-recommended therapeutic alternatives, when available, based on the patient’s risk or equipping the pharmacist with a scripted narrative for counseling the patient or discussing interventions with the physician. These innovations can help standardize pharmacist actions across all pharmacies.

DURs are only one area of a pharmacist’s workflow in need of streamlining, but it speaks to the larger goal of improving pharmacists’ experience through the elimination of time-wasting inefficiencies. In doing so, we can reduce the cognitive burden for busy pharmacists so they can spend more time on the most rewarding aspects of their job—patient care and counseling— that also enable them to practice at the top of their license, protect patient safety and help deliver optimal outcomes. dsn

Chirag Patel, PharmD, is senior product manager
for FDB (First Databank)
“Drug Utilization Reviews are only one area of a pharmacist’s workflow in need of streamlining, but it speaks to the larger goal of improving pharmacists’ experience through the elimination of time-wasting inefficiencies.“

DSN Industry Issues Summit: Why shoppers need pharmacy now more than ever

The second panel at the 24th annual event highlighted what shoppers are demanding and how retailers and technology companies are responding

The panel, “The Price of Staying Healthy,” moderated by Nimesh Jhaveri, president of community pharmacy and health at McKesson, featured top executives from retailers and technology companies sharing how they are responding to customers’ needs.

Panelists included Kevin Host, senior vice president of pharmacy at Walmart; Dain Rusk, vice president of pharmacy at Publix Pharmacy; Leon Nevers, business development, procurement, supply chain director at H-E-B; Brad Ulrich, group vice president at Walgreens; Jeff Key, president of PioneerRx; Alecia Lashier, chief automation officer at iA; and Valerie Mondelli, executive vice president, healthcare and chief commercial officer at RevSpring.

Jhaveri opened the discussion asking, “How can retail pharmacy improve the patient experience going forward?”

Host said that pharmacy has been on the forefront implementing technologies for many years, including doing simple things like real time claims adjudication. “Fast forward to today. We have an omnichannel connection with patients, through apps and texts,” Host said. “Ninety percent of America is within 10 miles of a Walmart and 140 million people shop at a Walmart every week. Those folks are not just there for TVs and groceries, but for health care as well.”

As Walmart builds out clinics, Host said, it is placing trained community health workers into those sites, to act as navigators. This enables Walmart to address social determinants of health, such as food insecurity, transportation and housing. “They know where resources are and can help our patients get connected to them,” Host said.

Walmart also provides affordable options, such as ReliOn insulin, and its $4 generics program. “Walmart has been founded on the mission to help people stretch dollars and to help them live more affordably. Pharmacy is another example of that for Walmart,” Host said.

Rusk noted that retail pharmacy has evolved. “It’s about creating a single integrated experience, a health and wellness destination and creating convenience. When people have to wait to be seen, it becomes out of sight, out of mind. With employers passing costs on to employees, value-based care is the best outcome at the cheapest cost. At Publix we want to help the consumer get what they want, where they want it and when they want it.”

On the topic of software platforms that enable pharmacy personnel to be more efficient, Lashier said, “Do pharmacists

Moderated by Mckesson’s Nimesh Jhaveri, the panel featured top executives from retailers like Publix, Walmart, Walgreens and H-E-B and companies such as PioneerRx, iA and RevSpring.

have the time to provide these additional services? Pharmacies are looking at how to get prescription fulfillment moved centrally to give the time back to the pharmacist, allowing patients to have choices as to how they get their prescriptions filled, where they get them filled, what types of additional care and when those different types of care can be given to a person. It’s important to make sure we develop the tools that allow for patient choice and allow the initiatives we are putting in place to be scaled in the future.”

On the subject of helping vulnerable patients, Host cited Walmart’s partnership with United Health Group, which involves sharing of resources, information, tools and people. “Sharing the best of both organizations and sharing in the risk and reward will improve the overall access, connectivity and outcomes for those particular patients. We’re focused on seniors first through Medicare Advantage plans. The intent is that [the] model expands to all patient populations, including Medicaid and commercial,” he said.

Rusk addressed how Publix caters to seniors, noting that the retailer is trying to be in as many preferred networks as possible. Publix also has invested a lot of resources into technology “so we can pull production out of stores so that it gives our pharmacists and techs more patient-facing time to do preventive care, immunizations and test and treat,” Rusk said.

Key took the discussion to how PioneerRx is helping retailers around messaging. “There are a lot of retailers that only have one way messaging. We need to embrace synchronous messaging and the ability of a patient to reach out electronically and ask a question. We are working with synchronous messaging and how to do that in a pharmacy,” Key said.

How can retail pharmacy and suppliers help shoppers understand the need to manage their health care proactively?

Nevers noted that over the last 20 years, H-E-B has changed the way it interacts with customers and their understanding of what pharmacies can do for them, including offering free health screenings.

Nevers praised wholesalers and suppliers

for working with H-E-B to drive down the cost of the components of health screenings and to produce information and incentives to try different things that incentivize a healthy lifestyle for customers. “When you bundle price in a way that you are interacting with a customer, for example, we get out and talk to customers and touch them, when we’re doing a health screening or an immunization, those are the times when we impact patients’ lives,” Nevers said.

As the panel progressed, Ulrich addressed how Walgreens integrates the front and back of the store experience. “When you think about gaps in care, nutrition, for example, as baby formula became unavailable we did line limits on items so everyone could get their share, and we worked with suppliers and manufacturers to increase our own brand supplies at Walgreens,” Ulrich said.

Additionally, when the FDA allowed baby formula from Europe and approved the sale of OTC hearing aids, Walgreens was first to market with both products. “It’s another opportunity for pharmacy and front of store offerings to come together to provide needs,” Ulrich said.

Next, Key addressed the challenge of the overwhelming amount of information coming into pharmacies. “We’re all excited about sharing e-care plans and wearables and we haven’t thought about what happens when we have all of this data and

can’t do anything with it. Is there a legal responsibility? There’s a huge effort in technology about bringing this information together and presenting it in a workflow where you can do something about it. We have to simplify how the information gets to the pharmacy and staff,” he said.

Mondelli discussed how RevSpring enables the flow of information. “Now pharmacists are under the medical benefit structure. They will be doing more medical services, which creates a unique need for technology,” Mondelli said. “We have enabled patients to pay their self-pay portion through Apple pay, text to pay and creating grab and go cues before they even get to the pharmacy. We’re offering ease of use, accessibility and the experience that the consumer expects and demands today but also created a relationship with them after the transaction, engaging them clinically through digital means.”

Lastly, Lashier said, “How do we put affordable automation in stores to allow pharmacists to be able to focus on their patients? Analytics is a big piece of what we’re doing. As we move to more digital and virtual offerings, how do we share those services across each other so we can specialize in things like nutrition in the pharmacy and continue to do inoculations and screenings?” dsn

There are a lot of retailers that only have one way messaging. We need to embrace synchronous messaging and the ability of a patient to reach out electronically and ask a question. We are working with synchronous messaging and how to do that in a pharmacy.
It’s about creating a single integrated experience, a health and wellness destination and creating convenience. When people have to wait to be seen, it becomes out of sight, out of mind.
— Dain Rusk, vice president of pharmacy at Publix Pharmacy
iARx.com (317) 664-7592

Elizabeth “Busy” Burr Named interim CEO of Rite Aid

Heyward Donigan is departing from the company as president and CEO

Rite Aid has announced that its board of directors has appointed Elizabeth “Busy” Burr, a member of the company’s board, as interim CEO, effective immediately. Burr’s appointment follows Heyward Donigan’s departure from the company as president and CEO, and as a member of the board. Rite Aid said it has initiated a search to identify a permanent CEO and has retained an executive search firm.

Burr has extensive experience in the health industry, and proven expertise in innovation, business strategy, retail and brand management. She previously served as vice president, head of health ventures and chief innovation officer at Humana, a $70 billion for-profit U.S. health insurance company.

Most recently, at Carrot, named a “Most Innovative Company” by Fast Company magazine in 2020, Burr served as president and chief commercial officer, leading the team focused on bringing the company’s digital health solutions to market.

Burr previously served as managing director of Citi Ventures and global head of business incubation of Citigroup as well as Entrepreneur-in-Residence at eBay. She also has held various senior leadership roles at Credit Suisse Group AG (formerly Credit Suisse First Boston) and Gap, where she served as vice president of Global Brand Management.

“As the company continues its efforts to enhance its competitive position in this dynamic environment, the board determined and Heyward agreed that now is the right time to identify the next leader of the business,” Bruce Bodaken, Rite Aid chairman, said.

“With a deep understanding of the industry and our strategy,” Bodaken continued, “the board was unanimous in its

belief that Busy is highly qualified to serve as interim CEO while the board conducts a search for a permanent successor. We are fortunate to have someone of her caliber to step into the role and are confident

in Busy’s ability to lead the company forward during this transition period.”

“Having served as a director since 2019, I have great respect for the important role Rite Aid plays as a fullservice pharmacy improving health outcomes for millions of Americans,” Burr said. “I will work with the board and management team to realize our vast potential while supporting our thousands of pharmacists and team members who are focused every day on meeting the needs of our communities and customers. With Rite Aid’s well-established brand and its committed and talented team, I look forward to delivering on our business strategy and driving value for all our stakeholders.”

Bodaken continued, “On behalf of the entire board, I want to thank Heyward for her contributions and service to Rite Aid, particularly her efforts in helping to lead Rite Aid throughout the COVID-19 pandemic. We wish her all the best in her future endeavors.”

Donigan said, “It has been a privilege to lead Rite Aid and its exceptional team. I am proud of all that we have achieved together, and I believe that the company is well positioned for the future.”

Rite Aid reaffirmed its fiscal year 2023 guidance for total revenues between $23.7 billion and $24.0 billion, net loss between $584 million and $551 million, adjusted EBITDA between $410 million and $440 million and capital expenditures of approximately $225 million.

The company said it continues to expect to generate positive free cash flow in fiscal 2023 and will provide additional detail on its financials and operational progress when it reports its full fourth quarter and fiscal year 2023 results. dsn

“With Rite Aid’s wellestablished brand and its committed and talented team, I look forward to delivering on our business strategy and driving value for all our stakeholders.”
— Elizabeth “Busy” Burr


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Suddenly there are opportunities for action at the state and federal levels on issues important to retail pharmacy

Momentum appears to be growing around several legislative and regulatory issues that are important to retail pharmacy, including pharmacy benefit management (PBM) reform at both the state and federal levels and preserving some of the functions that pharmacies added during the pandemic.

Even with a divided Congress presiding over the legislative branch in 2023, the industry is optimistic that the recent

progress that has been made in these areas can continue this year and beyond.

“The pharmacy issues are extremely bipartisan,” said Chris Krese, senior VP of congressional relations and communications at the National Association of Chain Drug Stores. “We find that these issues are broadly supported by Democrats, Republicans, and Independents alike, and we look forward to working with the Congress and with the administration to advance all these issues on a bipartisan basis.”


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It’s Not About
It’s About How Technology Can Help Your Pharmacy and Its Customers.

NACDS Highlights Outsized Role of Pharmacies

The NACDS 2023 Initiative, which the association launched last year, seeks to emphasize the role that pharmacies and retail stores play in health and wellness.

The focus is on health and wellness solutions throughout the store and through partnerships with other health care providers and community organizations. It was demonstrated last September at the White House Conference on Hunger, Nutrition, and Health, where NACDS held an event to call attention to the industry’s interest in these issues, said Chris Krese, senior VP of congressional relations and communications, NACDS.

“We’re really taking an aggressive position, and you’re going to be seeing more and more of this in 2023.”

PBM reform remains high on the agenda for pharmacy associations, as retailers seek to preserve the ability for patients to patronize their local retail pharmacy and to have greater visibility into the pricing practices of these entities.

NACDS describes the legislative and regulatory issues it is tackling as the “access agenda,” which Krese defines as patients’ “ability to get the convenient and equitable access to pharmacies that they expect.”

“There are a host of policy issues that affect that,” he said. “Certainly, an issue that tops the list is pharmacy benefit manager reform.”

The industry in the last few years has seen significant progress on PBM reform but is continuing to press for more reforms, particularly around transparency and pricing practices, Krese said, while the current political climate favors this type of legislative and regulatory action.

“Right now, there is significant interest at the federal and state level to address the issue, and that really flows from the recognition of how important it is to patients,” Krese continued. “There’s a real sense at this point that the PBM middlemen and those who hire them have gotten to the point that they’re manipulating the pharmaceutical benefit market to a degree that it’s impacting patients.”

He cited the unanimous U.S. Supreme Court decision of 2020, Rutledge v. Pharmaceutical Care Management Association, which paved the way for states to begin legislating on the issue of PBM reform themselves. Since then, there have been more than 100 new laws enacted at the state level around PBM reform, he said, and more efforts are in the works.

That decision was itself based on a state-level case in Arkansas in which the Pharmaceutical Care Management Association, which represents PBMs, had sued to prevent the state from forcing PBMs to reimburse pharmacies for prescription drugs at rate “equal to or higher than the pharmacy’s wholesale cost,” according to one description of the law.

There’s a real sense at this point that the PBM middlemen and those who hire them have gotten to the point that they’re manipulating the pharmaceutical benefit market to a degree that it’s impacting patients.
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That ruling, and another, PCMA v. Wehbi, created the opportunity for allowing states to exercise greater control over PBM practices, and several states have since followed suit, often in the interest of better managing their own Medicaid programs by increasing transparency.

Pennsylvania, for example, late last year expanded the ability for the state to audit PBMs that service the state’s Medicaid managed-care organizations.

These state actions often also serve retail pharmacies not only by increasing the transparency of PBM pricing practices but also by helping ensure that patients can continue to patronize their local pharmacist to receive their prescriptions.

New Jersey in October introduced S.B. 3199, which seeks to prohibit PBMs from steering patients to pharmacies that the PBM owns and prohibiting PBMs from charging a pharmacy a fee for network enrollment or collecting point-ofsale or retroactive fees from pharmacies. That bill has been referred to the state’s Senate Commerce Committee, according to law firm Mintz.

“We expect states to continue engaging in efforts to increase oversight of PBMs,” Mintz said in a recent blog post. “We will continue to monitor and report on relevant legislative activity.”

Independent Pharmacy’s Agenda

Retail pharmacy access also is a key focus of the National Community Pharmacists Association, said Anne Cassity, VP, federal and state government

affairs at the association. “You saw how important patient access was, especially during COVID and the rollout of the vaccines,” she said.

PBMs have disrupted patient access to independent community pharmacies in particular, Cassity said. NCPA’s focus is to bring about changes in the pharmacy payment model that make it both more transparent and reflective of a drug’s actual acquisition cost. “You can’t operate any business if you’re getting paid below what you even acquired the product for — in this case, prescription medications,” she said.

One goal of the NCPA, Cassity said, is to reintroduce a bill called the Medicaid Managed Care Transparency Act, which was introduced in 2021 by Reps. Earl L. “Buddy” Carter (R-Ga.) and Vicente Gonzalez (D-Texas). The bill aims to prohibit “spread” pricing in all state Medicaid managed care programs and require that pharmacies be reimbursed at specific rate, such as the national average drug acquisition cost (NADAC), plus the state’s current fee-for-service dispensing fee.

“Prescription drug prices are way too high,” said Carter, a pharmacist himself, when he introduced the legislation. “With this bill, we can radically decrease drug prices and put power back into the hands of the patients.”

While NCPA would like to see PBM reform take place at the national level, the association has been working with individual state governments on the issue during the past several years. Cassity said there could be more activity in California this year around PBMs.

“They’ve done some really great reforms in Medicaid, but they struggled a little bit with PBM reforms,” she said.


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A bill seeking to prevent PBMs from steering patients to their own pharmacies was passed by large margins in both state chambers last year, but Gov. Gavin Newsom vetoed the legislation, SB 524, saying it “lacked clarity.”

“I know that there’s going to be another push there,” said Cassity.

Cassity said she expects activity around PBM reform in several other states as well in 2023, including, potentially, Florida, which has been stubbornly resistant to PBM reform. She noted that Gov. Ron DeSantis signed an executive order last year that includes more oversight of PBMs.

In a statement on the Florida state government website, Katie Scanlon, senior director of pharmacy administration at Publix Super Markets, was among those who spoke out in favor of the initiative.

“We appreciate Gov. DeSantis’ leadership in championing the initiative for lower prescription drug costs for Floridians,” Scanlon said. “It is a critical step in the right direction to ensure our residents and customers have access to their medications at the lowest price available to all, dispensed from their community pharmacist of choice.”

Much of DeSantis’ proposal reads like a wish list for retail pharmacy, calling for an end to steering of patients by PBMs to their own affiliated pharmacies, prohibiting mandatory mail-order prescription fulfillment, prohibiting “clawbacks,” or direct and indirect renumeration (DIR) fees on pharmacies for a variety of reasons and calling for greater transparency on the part of PBMs.

Federal Action On PBM Reform

The U.S. Congress has also expressed bipartisan interest in addressing PBM reform, Krese pointed out. “Legislators realize that they’re going to be held accountable as to whether they could do things to improve their constituents’ way of life, and certainly their healthcare and their finances all figure into that,” said Krese. “PBM reform is a great way to get those things done.”

Last year Reps. Bruce Westerman (R-Ark.) and Anthony Gonzalez (R-Ohio) introduced the Fair Care Act of 2022, which included several provisions that would have addressed PBM pricing practices, including charging retroactive fees to pharmacies and requiring the U.S. Comptroller General to conduct a study on the role of PBMs in the pharmaceutical supply chain.

Sen. Chuck Grassley (R-Iowa), who has long advocated for PBM pricing transparency, last year joined with Sen. Maria Cantwell (D-Wash.) to introduce S.4293, the Pharmacy Benefit Manager Transparency Act of 2022, which the two said “sought to ban deceptive unfair pricing schemes, prohibit arbitrary claw backs of payments made to pharmacies, and require PBMs to report to the Federal Trade Commission how much money they make through spread pricing and pharmacy fees.”

The legislation won the support of the numerous industry trade groups, including NCPA, the American Pharmacists Association, the American Pharmacy Cooperative and the Iowa Pharmacy Association, plus some retail pharmacy operators, including Hy-Vee and Hartig Drug.

“That bill did gain a lot of traction, and we’re hoping to get it reintroduced, or something very similar reintroduced,” said Cassity. “Anything that brings transparency, whether it’s in the commercial market or in the public market, is extraordinarily important.”

While the Grassley-Cantwell bill focused on transparency for commercial insurers, NCPA is also hoping to see more action this year around Medicare Part D reforms as well. In 2022, the Centers for Medicare and Medicaid Services (CMS) issued a final rule related to Medicare Part D for contract year 2024, which requires Part D plans to include all DIR fees at the point of sale.

Cassity said more reforms around Part D need to be introduced.

“We’re going to be focusing on a bigger Part D reform package, including additional DIR reforms, but also addressing things like patient steering,” she said.

Cassity said there’s also industry concern that some PBMs are reimbursing their own or affiliate pharmacies at higher rates, which NCPA would like to see addressed in Part D reform.

“Reforms in public, taxpayer-funded programs are extraordinarily important, to make sure they’re fair, to make sure they’re transparent, and to make sure that beneficiaries get the access that they need and deserve,” said Cassity.

CMS has limitations on how much it can do with PBM reform, she said, which means that the kinds of reforms sought by NCPA may need to come from Congress.

Another issue on NCPA’s agenda for 2023 is a recent contract for TRICARE, the government health insurance program for uniformed service members, their families, National Guard and Reserve members and their families, retirees and

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their families, survivors and certain former spouses.

Thousands of pharmacies were excluded from the network because of the extraordinarily low reimbursements that were offered by Express Scripts, which is administering the pharmacy program for the Department of Defense, Cassity said. “There’s been a lot of interest in this in Congress, and some concerns,” she said. “We’re hoping potentially for some oversight hearings.”

The incoming chairman of the House Armed Services Committee, Rep. Mike Rogers (R-Ala.), has been very vocal about the contract, Cassity said. “That’s not a bad person to have on your side when you’re addressing this issue.”

She also said the industry also has other pharmacy champions who have assumed more important roles in the House, including Cathy McMorris Rodgers, the new chair of the Energy and Commerce Committee. “She’s been a huge proponent of pharmacies, and not just pharmacies, but patient access to pharmacies,” said Cassity.

In addition, Rep. James Comer (R-Ky.) is the new chairman of the House Oversight Committee, who Cassity said has been “really engaged” in pharmacy issues. As the ranking member last year, he held a roundtable to discuss PBM reforms, she said.

Senate Finance Committee Chair Ron Wyden (D-Ore.) has also been a leading advocate for retail pharmacy, she said. In January of this year, he praised CMS for outlining the timeline and mechanisms for Medicare drug price negotiation policies.

“I think we’re teed up pretty well,” said Cassity. “It just depends on what Congress decides to do [in 2023] and what they can get done.”

Consumers Support PREP Act Extension

Nearly two thirds of Americans — 64% — support keeping the additional pharmacy services allowed by the Public Readiness and Emergency Preparedness Act (PREP Act) in place, according to a December poll by Morning Consult commissioned by NACDS.

Among seniors, that figure rises to 77%, and the agreement spans political ideologies, said Chris Krese, senior VP of congressional relations and communications, NACDS.

“Americans have gotten used to the access that they rely on at their pharmacies, and they want it to stay,” he said.

NACDS is calling for the PREP Act to be extended through October 2024, which would allow more states to replicate it, Krese said.

Extension of the PREP Act

Another key focus of NACDS in the year ahead is to push for the Public Readiness and Emergency Preparedness Act (PREP Act) to be extended for pharmacy services. The PREP Act allows pharmacy technicians and interns to administer certain vaccines.

Krese said NACDS is pushing for the Pres. Biden administration to extend these pharmacy services until October of 2024.

“This is really important, because we are hearing more and more about the imminence of the public health emergency ending, and the move to commercialization for vaccines, and testing, and antivirals,” he said. “When those two things happen — the end of the public health emergency and the commercialization of these countermeasures — the PREP Act is going to end for pharmacy services. That’s going to impact patients, and it’s going to impact pharmacies.”

For example, the PREP Act allows pharmacy technicians to provide flu vaccinations to adults. which most states otherwise do not allow. If pharmacy technicians are no longer allowed to give flu shots to adults that would be the equivalent of removing about 40% of the nation’s vaccination capacity, Krese said.

That will result in longer lines and longer wait times for patients seeking vaccines, and potentially the loss of access to vaccines for some patients in some locations.

“Plus, it’s just very difficult to plan a pharmacy workforce when you don’t know a few months down the road what certain professionals in your pharmacies are going to be able to do or not do,” said Krese.

NACDS would like to see states replicate the PREP Act at the state level during the extended time that the PREP Act remains in effect, he said.

The recent confluence of flu, COVID and another virus, RSV, reinforce the need for these expanded services, Krese said. “I think a lot of policy makers unfortunately forget that you can’t just turn these services on and off.”

In addition, NACDS is also advocating for legislation at the federal level that would set up a reliable payment mechanism in Medicare for pandemic-related services.

“We had tremendous success in 2021 and 2022 in building support for this legislation,” said Krese. “What we need to do in this next Congress is get this over the goal line so we can make it a reality.” dsn

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2023 Hair Care Trends

Here are what experts predict will keep hair care sales bouncy in the new year

Whether driven by TikTok trends or a desire to soothe itchy scalps, people are buying more hair care products.

Mass market retailer dollar sales in hair care rose 5% in the final month of 2022, capping off a year where growth never dipped into the red, as per NielsenIQ data. Prestige hair care is also booming, according to The NPD Group, which said the category expanded 23% in the third quarter of 2022.

During the past year, retailers such as Walmart, Target, Walgreens, CVS and Ulta Beauty expanded selections of products for textured hair, added new solutions for healthier scalps and stocked up on hair growth remedies. Here are a few trends industry experts believe will keep the momentum in 2023.

Acquisitions: Founders, especially BIPOC creators, worked hard to solve specific hair care needs by formulating products, often in kitchens, before securing distribution. Multinational powerhouses, seeing the traction these brands are gaining, look to leverage that power by joining forces.

Procter & Gamble’s acquisition of Mielle Organics, a brand founded by Monique and

Source: The Mayo Clinic

Melvin Rodriguez in 2014, is a case in point. Monique, who has a nursing degree, gained fame on social media after she shared her hair care regimen for her tailbone-length tresses. Most recently, her Organics Rosemary Mint Scalp & Hair Strengthening Oil went viral.

Monique launched the company with one product, the Advanced Hair Formula that included a blend of herbs, amino acids and minerals. Today her brand is sold at CVS, Walmart, Target and Walmart, among others. For Mielle, P&G will help expand the availability of the brand; for P&G, Mielle brings to its portfolio a broader assortment

HiBAR’s shampoo bar uses African dates and B5 to help thin, fine or lifeless hair.

34 February 2023 DRUGSTORENEWS.COM
of men and about half of women experience some form of hair loss in their life.
34 February 2023 DRUGSTORENEWS.COM

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ECRM S ssions off r customiz d m ting solutions for buy rs and suppli rs in th r tail and consum r packag d industry to m t, n twork, and shap th ir industry.

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of products for people of color. “Within this partnership, our role as P&G Beauty will be to support the Mielle Organics team with what they need to achieve their vision—including product expansion in Black and brown communities and investing in research and innovation,” said Alex Keith, CEO of P&G. What is important for the brand’s future is that Monique and Melvin Rodriguez will continue at the helm as CEO and chief operating officer, respectively, and will operate as an independent subsidiary.

This is the latest in a string of purchases of brands built by Black founders including Carol’s Daughter (L’Oréal), The Mane Choice (MAV Brands) and Shea Moisture (Unilever).

With demand for products for people with textured hair, multinational companies are on the prowl for acquisition opportunities in 2023.

Ingestible Hair Health: The hair supplements market is projected to cross $2.8 billion by 2031, according to Transparency Market Research. Several brands are capitalizing on the demand for beauty from inside to outside.

Reserveage just launched Keratin Hair Booster Gummies, providing a combination of biotin and keratin, two of the most important ingredients for hair health. This product is formulated to support healthy hair and nails, according to Yamit Sadok, vice president of marketing for Twinlab, the maker of Reserveage.

“Among several symptoms of biotin deficiency is hair loss. Researchers investigated the serum biotin level in women complaining of hair shedding and found that low biotin levels were found in 38% of them,” said Sadok. “In addition, research has shown that biotin supplementation helped improve brittle nails, making them firmer and harder. Considering that the primary protein in hair is keratin, it would seem to make sense that supplementation with keratin would help support the structure of keratin in human hair— and indeed that is the case as demonstrated in clinical studies.” Gummies, she added, are the format consumers say they prefer.

“Besides benefits to hair, consumers are also interested in fun and convenient delivery forms for their supplements—including hair supplements. Gummies fit the bill. In fact,

when consumers were asked which format they prefer, 27% said gummy. That’s ahead of tablets at 25%, capsules at 20% and SoftGels at 13%. The gummy supplements market size was valued at about $9.5 billion in 2021 and is projected to grow to $16.5 billion by 2028, with a compound annual growth rate of 8.3% from 2021 to 2028,” Sadok said, citing a report from The Insight Partners.

Celebrity Tie-Ups: Famous faces are getting their hands into the hair business. Taraji P. Henson, Priyanka Chopra, Jennifer Aniston, Youtuber Mindy McKnight and Tracee Ellis Ross are among the stars with their own hair care brands. Ross just announced the extension of Pattern brand into tools with a blow dryer for curls, coils and tight textures.

Firstline, a textured hair accessories company, continues its mission to innovate high-quality hair care and fashion items.

The company’s brand portfolio includes Evolve, WavEnforcer, DriSweat, Sleek, and Camryn’s BFF for girls and tweens. New from Camryn’s BFF is an assortment of satin bonnets and pillowcases under a licensing agreement with Karma’s World, an animated Netflix series produced by Chris Bridges (also known as rapperturned-actor Ludacris). Made with nonabrasive, high-quality satin, the Satin Bonnet helps retain hair’s natural moisture while keeping it secure and intact during nighttime wear. The Satin-lined Bonnet offers the same benefits as the Satin Bonnet and is reversible, with a fun print on one side and a bold solid on the other to provide two styling options. The nonabrasive fabric of the Satin Pillowcase minimizes hair breakage, reduces frizz, and maintains natural moisture to protect hair during sleep. The Karma’s World collection will officially launch on Amazon.com and specialty stores in February 2023, offering three fun, vibrant, and coordinated prints that inspire sweet dreams.

Cantu Beauty inked a deal with singer Jordin Sparks to be the brand’s

36 February 2023 DRUGSTORENEWS.COM
Pura D’Or and OKAY Pure Naturals offer products to promote hair health and growth.

ambassador. The brand’s global vice president of marketing Dametria Kinsley met Sparks at a music festival, and they had an instant connection. The brand, Sparks added, resonates with her textured hair needs.

Retailers expect more famous faces to enter the fray, especially with the ease of reaching fans via social sites.

Wellness Meets Scalp/Hair Care:

The “skinification” of hair care is nothing new, but 2023 will take scalp and hair health to new heights, according to Clyde Haygood, the celebrity hairstylist partner with Pura D’Or.

“Bed head is dead and has been replaced with hair that has a glass like finish,” Haygood said. “There is a strong trend for healthy, shiny hair. Gone are the days of messy, unwashed hair. Pura

D’Or has always been and will always be about the foundations of hair. A healthy scalp is a conduit to healthy hair. We treat the issues at the core, and we are concerned about the hair shaft and cuticle. Pura D’Or’s mission is to home in and treat problems at the core so healthy, shiny, hair is what the customer is left to deal with, and they can try out any of the hottest hairstylist trends.”

One of his go-to products is Pura D’Or Argan Oil Heat Shield Spray for its protecting, hydrating, defrizzing and shine capabilities.

Under the wellness umbrella are new products designed to lessen hair loss. “Hair loss continues to be a hot topic,” Haygood added, noting that everything from Pura D’Or is one of the top selling brands to address hair loss on many levels. The brand is clinically proven, clean and has proven results to treat hair loss. The pandemic is also blamed for perpetuating hair loss. Eighty percent of men and about half of women experience some form of hair loss in their life, according to data from The Mayo Clinic.

Mass retailers are clearing more space for hair growth products beyond Rogaine. CVS stocks BosleyMD products, which was created with the input of physicians and endorsed by professional stylists. “We find consumers are really looking for clinically supported products,” Andrea Harrison, CVS’ vice president of beauty and personal care said in regard to brands like BosleyMD.

Other popular hair growth lines include Vital Proteins, Viviscal, Love Beauty Planet, Olly, Mielle, Function of Beauty and Keranique.

Simple, Safe and Sustainable: Hair trends often mimic skin care preferences. Recently shoppers started moving away from complicated 10-step skin care regimens. Christ Lopez, marketing director for Okay Pure Naturals sees the same in hair. Consumers are shopping with a less-is-more mentality, he suggested. Lopez backs that up with reports from retailers that shoppers are paring back on things they don’t need but buying more daily use items. “A lot of those consumers are looking for affordable products that satisfy their needs,” he said.

Shoppers are also researching ingredients in products, looking for lines that are not merely green washed. “Consumers now have the option to purchase natural and vegan and eco-friendly beauty products, and many of them are now available at affordable prices,” he said. “This has expanded the growing demand for consumers seeking out natural and pure products. Why buy an expensive synthetic shampoo when you can now easily purchase a natural one that works even better than the synthetic one at a more affordable price. Okay has a full pipeline of innovations slated for the year including hair growth serums, Kosher and Halal gummy vitamins and fragrance-free hair and skin debuts.

Experts believe ingredients will be put under the microscope this year. Recently an organization called Color of Change called on retailers to pull and audit their Black hair product assortments following an October study by The National Institutes of Health that found the use of chemical straighteners or relaxers (used especially by Black women) is associated with an increased risk of uterine cancer. The study found that women who reported frequent use of hair straightening products (defined as over four times in the previous year), were more than twice as likely to develop uterine cancer than their counterparts.

Consumers are clamoring for sustainable packages. In fact, Spate registered more than a 23% surge in online searches for refillable hair care. The industry produces more than 120 billion units of plastic packaging each year, according to Zero Waste Week—about 95% of that is discarded after use. Hair care is one of the worst offenders, especially since people don’t tend to have recycling bins in bathrooms. Products made without water and “naked” packaging are gaining attention. One example is HiBar, now stocked at Target and other chains. Dove also gets high marks from retailers for its Dove refillable products. Many expect 2023 to be the year of more sustainable hair care debuts. dsn

DRUGSTORENEWS.COM February 2023 37

Mist Fits

With their Mist of Wonders spray, DevaCurl is cutting down on product usage

DevaCurl is continuing to innovate the way consumers care for their curly tresses. Fresh off the heels of its latest launch — the Mist of Wonders Leave-In Multi-Benefit Curl Spray — Drug Store News spoke to Alexis Ansley-Benjamin, director of communications at DevaCurl, about the new product’s origins.

Drug Store News: What was the inspiration behind the Mist of Wonders Leave-In Multi-Benefit Curl Spray?

Alexis Ansley-Benjamin: Our new Mist Of Wonders Leave-In is such an exciting launch for us because it was inspired directly by the curl community, 70% of which use a Leave-In in their hair care routines. Mist of Wonders has 12 instant curl-specific benefits that help to cut down on the number of products people with curly hair will need when prepping, styling or protecting their strands.

DSN: How long was this new product in development?

AAB: Mist of Wonders has been in development for over two years! As with any product we produce at DevaCurl, we take a generous amount of time to ensure we are developing top-notch innovations that the curly consumers truly need. Once developed, all of our products are rigorously tested for efficacy and safety to meet our dermatologist co-developed and stylist-approved standards.

DSN: How important was it to create a product that caters to hair care needs of those with all curl types but also sustainable?

AAB: We know our curly consumers care about sustainable product options just as much as we do. Our motto at DevaCurl is ‘Live Your Curls,’ which encompasses our commitment to ensuring all coils, curls and waves can find a home in our product family. That also means that we are always looking for ways for consumers to live their curls sustainably by way of refillable product options. Mist of Wonders Leave-In offers product refill pouches that allow consumers to lower their overall plastic waste.

DSN: Does the brand have future plans to expand its sustainability efforts with new or existing products?

AAB: Sustainability is a top consideration for DevaCurl as we continue to bring best-in-class, professional curl-care products to the curl community. Our new Mist of Wonders Leave-In refill pouches are an example of our commitment to sustainability, and we look forward to sharing more with future innovations. dsn

developed Mist of Wonders Leave-In curl spray with product refill pouches that allow consumers to lower their overall plastic waste.

38 February 2023 DRUGSTORENEWS.COM
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Generic Drugs –a Year in Review

There are some tough-love lessons to be learned from the events of the past year

An aging population combined with increasing numbers of people diagnosed with chronic diseases are among the top factors set to influence innovation in the generics drug market in 2023. To position themselves to capitalize on this opportunity, generics drug companies have been quietly expanding their reach into untapped markets, beefing up R&D and acquiring competitors.

This collective result has enabled companies to start off the year with several new drugs. Generics companies, such as Aurobindo, Fresenius Kabi, ANI, Camber and Alembic, generated industry buzz when they announced the approval of several key medicines by FDA early this year.

But while most indicators point to generics sales rising this year, experts say the economic and logistics problems the industry experienced in 2022, if not resolved, potentially stand to eclipse this growth potential.

A look back

John Dillaway, executive vice president for Parsippany, N.J.-based Ascend Labs, is among those who believe many of the issues that came into play last year will influence growth opportunities in 2023. “Without a doubt, 2022 was an interesting year,” said Dillaway. Several factors, including the turbulent economy, he noted, pushed many businesses, including generics, into uncharted waters.

“After unprecedented deflation in 2020 and 2021 many believed the rates of deflation would revert to more historical norms but that didn’t happen,” Dillaway said. “Each time it appeared that things were starting to stabilize, they would begin to drop again.”

Dillaway continued, “What’s surprising is that given all the traditional costs generic manufacturers face and considering the new costs from Track & Trace, Stewardship Programs and DEA and Opioid fees this rate of deflation is not

“The industry needs to recognize the value generic drugs bring and work together to solve these issues or risk living with a much weaker generic alternative to high prices.”
— John Dillaway, executive vice president, Ascend Labs
Talk™ Jason Callori, Host Sr. Advisor, Marketing Operations Cardinal Health Join us for engaging conversations with pharmacists, industry experts and Cardinal Health leaders, hosted by Jason Callori, a 22-year veteran working with independent pharmacies. Episode topics include pharmacist burnout and mental health, pharmacy ownership and legislative updates — plus innovative services and solutions from the independent pharmacy experts at Cardinal Health. Inside talk for independent pharmacists Cardinal Health™ Counter © 2023 Cardinal Health. All Rights Reserved. CARDINAL HEALTH, the Cardinal Health LOGO and COUNTER TALK are trademarks of Cardinal Health and may be registered in the US and or in other countries. Patent cardinalhealth.com/patents. Lit. No. 1PD23-2244908 (01/2023) Podcast Scan here to listen and subscribe to the Cardinal Health™ Counter Talk™ Podcast cardinalhealth.com

sustainable and yet it keeps occurring.”

Dillaway said at times it has been upsetting to see the amount of investment made in gaining a new approval for what many times is a lifesaving or life prolonging medicine being sold for well underneath its value and often at loss. He also pointed out that companies have already started to see the fallout from this, including lower revenue and earnings results, lower stock prices and a market flooded with short-dated product sales. “The industry handled these challenges poorly and my guess is that we will begin to see companies either fail or be acquired by stronger, smarter ones,” said Dillaway. “The bottom line is that the current model we face is not a healthy one.”

The impact that government policies have had on the industry during the past several years cannot be underestimated, said Marc Kikuchi, chief executive officer, Dr. Reddy’s Laboratories North America Generics located in Princeton, N.J. The effects of the 2022 Inflation Reduction Act, which allows Medicare to negotiate drug prices and how costs are allocated, are already being seen, he noted.

Likewise, Kikuchi said, the Affordable Care Act also has left a mark on the industry. “It has been nearly 10 years since its passage and its impact on the industry has been complex to say the least, with the uninsured rate falling nearly eight percent, while at the same time, we have seen an acceleration in the use of deductibles for pharmacy benefits which reduced margins.”

Supply chain challenges

In addition to concerns over deflation, generics companies worry about the continued fallout from the global supply chain crisis witnessed last year.

Paul McMahon, president, APUSA Oral Solids Division of Aurobindo Pharma USA, East Windsor, N.J., said the shortages affecting every industry have forced companies to consider new strategies for alternative materials procurement and transportation methods.

“After three years of Covid, the industry has been severely impacted, and demand dislocation has been difficult to predict, most recently resulting in the antibiotics shortage due to the higher than anticipated cough/cold/flu season,” said McMahon.

Stepped up facility inspections by the FDA have created further supply disruption, he noted.

Dr. Ram Chakroborty, president of Bajaj Medical in Chicago, said if there is one thing the pandemic validated it is the strength of the pharmaceutical industry to rapidly provide quality drugs and treatments to protect and help prevent the spread of Covid. “Generic Rx companies offered lower cost drugs to the marketplace during periods of major shortages in the supply chain,” said Chakroborty.

At the same time, Chakroborty and others pointed to the long-term repercussions from out-of-stock issues experienced in 2022. “Like many, we were surprised that the industry was unable to keep the shelves stocked. Respiratory illnesses were

“I would like to see the industry recognize the critical work we do in collectively producing nearly 90% of the nation’s drug supply, saving, sustaining, and improving lives of tens of millions of Americans, and more often than not for just pennies per pill”
— Paul McMahon, president, APUSA Oral Solids Division of Aurobindo Pharma USA

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extremely prevalent last year – between new strains of COVID-19, Influenza, RSV, and the common cold, and we witnessed other makers of antiseptics, cough and cold medicines not able to keep up with demand.” Many consumers, he noted, lost faith in drug companies as a result.

Bajaj Medical’s products are made in the U.S., a factor the company said helped them to fill all orders on time and in full. Other companies, he noted, were not as capable and experienced significant fulfillment issues. “The key lesson of 2022 was supply chain hardening. This year, companies will need to work hard to gain back consumer trust,” Chakroborty said.

Kikuchi pointed out that many important supply chain lessons were learned during this period but said the most important is that even though we can learn from the past, we still cannot predict the future. “We have implemented many new processes to protect ourselves against the uncertain supply chain issues, and yet our industry still had to manage through drug shortages due to a stronger than expected flu season,” he said.

Adjustments are needed

The metrics of the current business model remain a top concern for generics companies, many of whom say changes are a must for them to remain in business. “Three groups dominate the buy side but it is not uncommon to have 10, 12 and even 15 competitors on the sell side,” Dillaway said. If this model is allowed to remain, generics companies will continue to struggle, he added.

“In the meantime, Ascend will continue to take a logical, ethical approach to the business. We will not follow the crowd off the bridge, and we will not make

decisions that may benefit the short term but harm the long term,” Dillaway said. “In my experience being an honest partner is the best way to add value to both your company and your customers.”

For generics to excel in 2023, the industry needs to find a healthy balance of meeting the increasing needs of the nation’s drug supply with a reasonable and sustainable approach from wholesaler and retailer partners that ultimately control if and how that product makes its way to patients, Dillaway added.

One of the biggest disappointments of this past year, noted Kikuchi, was the continued perception that the problem with our healthcare system is generic drug pricing. “The truth is that generics continue to be one of the most affordable, and arguably, the best value, in our healthcare system,” Kikuchi said. “I get frustrated when I see claims and commentary that lump generics manufacturers in with big pharma companies and drug originators.”

Also, he added, there continues to be misperceptions about drug quality, especially with foreign-based companies. “Hopefully, that will change in the coming years,” he said.

Feeling seen

Another issue brought to light from the events of the past year is that generics companies are often underappreciated for the critical work they collectively do.

“The industry needs to recognize the value generic drugs bring and work together to solve these issues or risk living with a much weaker generic alternative to high prices,” said Dillaway. “We need to shore up the supply chain on components and API so that we can do what we do best -- make quality medicines that help people stay or get healthy and save them money in the process,” said Dillaway.

McMahon believes generics companies should be heralded for what they do and looked to as part of the solution for our nation’s health care system. “I would like to see the industry recognize the critical work we do in collectively producing nearly 90% of the nation’s drug supply, saving, sustaining, and improving lives of tens of millions of Americans, and more often than not for just pennies per pill.” dsn


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Driving Innovation in Diabetes Care

Manufacturers are developing products and initiatives to make care easier and more accessible

Affordability, supply chain constraints and access to healthcare are on everyone’s mind these days, but for people with diabetes, these are ongoing issues. Costs are high for everything from medications and testing products to hospital inpatient care, and some items are becoming hard to find. Manufacturers are working on solutions.

In an often-cited figure, the Centers for Disease Control and Prevention, in its National Diabetes Statistics Report 2022, indicates that 14.7% of U.S. adults have diabetes, which includes diagnosed (11.3%) and undiagnosed (3.4%). What’s more, the CDC also said certain racial and ethnic groups are at a higher risk of developing diabetes. And the numbers prove it: 17.4% of Black Non-Hispanic adults and 15.5% of Hispanic adults have diabetes, diagnosed and undiagnosed.

Manufacturers say they are developing products that can make diabetes care more accessible. “Until recently, technology in insulin delivery was limited to insulin pumps,” said Janice MacLeod, director of clinical advocacy, global professional

affairs and clinical education at Medtronic. “With the commercialization of smart insulin pens, a much larger population of people with diabetes now have access to intelligent insulin dosing support for those who choose injection therapy over pumps.”

Medtronic makes the InPen system, which can be used to deliver insulin, calculate insulin doses and estimate carbohydrates for meals.

MacLeod said technology that helps record, share, and interpret diabetes-related data can help the person with diabetes and their care team develop a care plan. “Connected devices support evolving care models that are moving to asynchronous, continuous care with remote data monitoring,” she said. “Recognizing the disparities that exist in diabetes technology access and ongoing use, extending technology options to a broader population is critical.”

Retailers can help

The pharmacist, often the care team member

“People living with diabetes are facing supply challenges like we’ve never seen before. You are seeing patients forced to search multiple pharmacy locations for their injectables and supplies.”
— Casey Pflieger, director of retail sales for Owen Mumford

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The unique features of BD Nano™ 2nd Gen 4mm Pen Needles offer a number of potential benefits, including:

• Reduction in injection pain6†

• Less force required to deliver the full dose4‡

• Greater confidence that the full dose has been delivered compared to other pen needles studied4§||

Compatible with widely used pen injection devices7 Covered

completed 6 pairs of abdominal injections of 0.3 mL sterile saline in random order and utilized a Likert Scale where ratings range from -2 to 2; positive scores reflect less thumb force for BD Nano and negative scores reflect less thumb force for the comparator pen needle. Scores of 0 indicate no difference. BD Nano™ 2nd Gen 32Gx4mm contoured hub 5-bevel extra thin wall demonstrated superiority vs each comparator group for less injection force. [(P <0.01) (Artsana 33Gx4mm mean +0.80, 95% CI, +0.62 to +0.98); (Artsana 34Gx3.5mm mean +0.98, 95% CI, +0.80 to +1.16); (Comfort EZ 33Gx4mm mean +0.31, 95% CI, +0.13 to +0.49); (Terumo 34Gx4mm mean +0.21, 95% CI, +0.07 to +0.35)]. §198 patients with diabetes were included in this prospective, multicenter, randomized, open-label, 2-period, crossover study to evaluate differences in confidence that the full dose of insulin was delivered between the participants’ usual pen needle (PN) and the corresponding extra-thin wall (XTW) PN. Confidence in delivering the full dose of insulin was assessed with the use of a visual analog scale (VAS). Confidence results would be considered statistically significant if the 95% CI for the mean VAS score was either positive (XTW preferred) or negative (current PN preferred). XTW PNs had statistically significantly increased confidence that the full dose was delivered by 24.4mm ([95% CI, 19.7-29.1] [P<0.001]). ||Single-blind, randomized, control trial of 154 patients with diabetes where each completed 6 pairs of abdominal injections of 0.3 mL sterile saline. Leakage was measured with a calibrated analytical scale. The occurrence of leakage from the needle tip and the injection site (measurements combined) was defined as wet weight equivalent to ≥5% of the injection volume, [equivalent to ≥0.015 g (0.015 mL)]. Leakage frequency for BD Nano™ 2nd Gen 32Gx4mm contoured hub 5-bevel extra thin wall was 0.4% vs 3-bevel posted hub (Artsana 33Gx4mm, 6.2%; P<0.001); (Artsana 34Gx3.5mm, 18.8%; P 0.026); (No significant difference vs Comfort EZ 33Gx4mm). ¶Fingertip Formulary, as of 1/27/2022.

1. IQVIA XPT Device Retail TRx Data. United States, Nov 2020- Oct 2021. 2. Whooley S, Briskin T, Gibney MA, et al. Evaluating the User Performance and Experience with a Re-Engineered 4 mm x 32G Pen Needle: A Randomized Trial with Similar Length/Gauge Needles. Diabetes Ther. 2019;10(2):697-712

3. Rini CR, Roberts BC, Morel D, Klug R, Selvage B, Pettis RJ. Evaluating the Impact of Human Factors and Pen Needle Design on Insulin Pen Injection. J Diabetes Sci Technol. 2019; doi: 10.1177/1932296819836987.

4. Aronson R, Gibney M, Oza K, Berube J, Kassler-Taub K, Hirsch L. Insulin pen needles: effects of extra-thin wall needle technology. Clin Ther. 2013;35(7):923-933

5. Hirsch L, Gibney M, Berube J, Manocchio J. Impact of a modified needle tip geometry on penetration force as well as acceptability, preference, and perceived pain in subjects with diabetes. J Diabetes Sci Technol. 2012;6(2):328-335. 6. Gibney M., Fitz-Patrick D., Klonoff D., Whooley S., Lu B., Yue W., Glezer S. User experiences with second-generation 32-gauge × 4 mm vs. thinner comparator pen needles: A Prospective Randomized Trial. Current Medical Research and Opinion, DOI: 0.1080/03007995.2020.1803248, 2020. 7. BD Compatibility Confirmation for Pen Needles and Pen Injector Manufacturers, Document Number: 149OTH-0004-20, Ver S, Dated 3 February 2021.


embecta, formerly part of BD. BD is the manufacturer of the advertised products. embecta and the embecta logo are trademarks of Embecta Corp. BD and the BD Logo are trademarks of Becton, Dickinson and Company. All other trademarks are the property of their respective owners. © 2022 Embecta Corp. All rights reserved. U.S. Patent Nos. D787054, D825749, D804023 and other patents pending. 2203772033N1SADDSN

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embecta, formerly part of BD *226 patients with diabetes on insulin treatment were studied with a 150 mm visual analog scale (mean scores of >0 mm; clinically significant difference of ≥5 mm). BD Nano™ 2nd Gen demonstrated superiority vs. BD Nano™ for overall preference.†Single-blind, randomized, control trial of 209 patients with diabetes where each completed 6 pairs of abdominal injections of 0.3 mL sterile saline in random order and utilized a 150mm visual analog scale (mean scores of >0mm; clinically significant difference of ≥5mm). BD Nano™ 2nd Gen 32Gx4mm demonstrated superiority vs each comparator group for less injection pain. [(P <0.01) (Artsana 33Gx4mm mean +17.4 mm, 95% CI, +11.3 to +23.5mm); (Artsana 34Gx3.5mm mean +17.6mm, 95% CI, +11.4 to +23.7mm); (Comfort EZ 33Gx4mm mean +9.1mm, 95% CI, +3.1 to +15.3mm); (Terumo 34Gx4mm mean +7.3mm, 95% CI, +2.2 to +12.4mm)]. ‡Single-blind, randomized, control trial of 209 patients with diabetes where each
by most health plans across

that healthcare consumers see most frequently, is ideally suited to support people with diabetes selfmanagement, helping them finetune their medication or insulin treatment plan. They can also help identify the best tools for patients based on their technology skills, health literacy and numeracy skills. “The pharmacist can help people get off to a strong start with their chosen technology tools, then using the resulting data with them to optimize care,” MacLeod said.

These professionals can help with instructing patients, too. There is increased focus on educating people with diabetes about injection technique, injection site rotation and lifestyle management, according to Tom Blount, president of North America for Embecta.

“Pharmacists are an important partner in these efforts,” he said.

As the incidence of diabetes increases, poorly managed diabetes creates a cost burden for patients and the healthcare system. “By making it easier for people with diabetes to manage their care consistently, using effective tools and proper techniques, we can help them maintain their long-term health and decrease the risk of other health issues that are related to poorly managed diabetes care,” Blount said.

Formerly part of BD, Embecta introduced pen needles in 1991. Over the years the design innovations have focused on enhanced comfort and safety, with smaller and thinner cannulas. The company’s BD Nano 2nd Gen Pen Needles feature ergonomic enhancements to make the needle shield easy to grip and remove, and a contoured needle base for more reliable injection depth and comfort.

The brand is in the process of developing a patch pump product

for Type 2 diabetes under the FDA’s Breakthrough Device designation. “People with Type 2 diabetes make up 90 percent of the population of people living with diabetes,” Blount said. “They have different needs than those with Type 1 diabetes, so we’re developing a tubeless pump designed with their needs in mind.”

People with both types of diabetes are seeking innovative devices, so manufacturers are developing more advanced CGMs. Dexcom recently launched the G7 CGM system, a low-profile, all-in-one wearable system that is 60% smaller than its predecessor. “The desire for simple and easy-to-use technology is especially true for the millions of people living with diabetes who rely on medical devices like CGM to manage their chronic condition 24/7,” said Dexcom CEO Kevin Sayer.

Barriers and solutions

Supply chain constraints are affecting every industry, including diabetes care. “People living with diabetes are facing supply challenges like we’ve never seen before,” said Casey Pflieger, director of retail sales for Owen Mumford, which makes Unifine pen needles. “You are seeing patients forced to search multiple pharmacy locations for their injectables and supplies.”

One unusual challenge is that there is an unanticipated surge in demand for certain medications. People with diabetes and people without diabetes are both seeking GLP-1 agonists, such as liraglutide and semaglutide. “When drugs like Wegovy were hailed as miracle weight loss treatments, manufacturing couldn’t keep up with heightened demand and the offlabel use of Ozempic exploded,” Pflieger said. “Suddenly the drugs many T2D’s relied on to manage their condition became scarce.”

Even CGMs are in demand among people who do not have diabetes, because they are using the

A wide variety of products is now available to make diabetes care more accessible to consumers dealing with the disease.

Source: Centers for Disease Control and Prevention, National Diabetes Statistics Report 2022

systems for weight loss or to analyze and improve athletic performance. “Movement of these devices from prescription-only to OTC should also significantly improve access, assuming the demand doesn’t outpace forecasting,” Pflieger said.

Another phenomenon, Pflieger said, is that pharmaceutical and device manufacturers are engaging in aggressive contracting with payors that promise massive rebates for exclusivity arrangements. Pflieger noted that while Owen Mumford is successfully planning to and bringing in safety stock to help ensure continuity of supply for customers and patients, payors and buyers should be mindful of and avoid the pitfalls of sole-sourced supply. “Otherwise access to therapy and medication adherence suffers.”

Convenience can help boost adherence, and automatic blood glucose testing can help. Intuity Medical introduced POGO Automatic Monitor and Cartridges, the first and only FDA-cleared blood glucose monitoring system with 10-test cartridge technology, eliminating the need for separate lancets and glucose strips. Patients click the cartridge door open, pop the multitest cartridge into the monitor and close the cartridge door. They press the power button, place their finger on the test port,

and hold it there until the image on the screen tells them to lift their finger. Then, POGO Automatic analyzes the sample and displays the reading.

Connectivity is another feature that can help people with diabetes adhere to their treatment plans. “Diabetes care management can be a demanding task,” said Badia Boudaiffa, divisional vice president of U.S. commercial operations for Abbott’s diabetes care business. “Connected technology allows people living with diabetes to have a more seamless experience.” The company is working with partners to collaborate on new advancements in connectivity, such as smartphone app integration, remote monitoring smart insulin pens and automated insulin delivery systems that connect with CGMs.

Abbott makes the FreeStyle Libre portfolio, which Boudaiffa said is the most affordable CGM in pharmacies today. The company is working with partners, including sponsoring the American Diabetes Association’s Health Equity Now platform, to tackle barriers so all people living with diabetes can access the latest medical technologies, no matter their income level, race or background.

Meeting other needs

Comfort is another consideration. Last year, HTL-Strefa, which makes medical sharps, introduced the Droplet Micron 34-gauge pen needle, which is 3.5 mm long and is the shortest, thinnest available. “It’s all about comfort and reducing the anxiety associated with having to deliver an injection,” said Chris Woeste, vice president of sales North America. “It improves the injection experience.”

The bigger trend, Woeste said, is that more companies are entering the diabetes products category, a change from the old pattern of having only a few big players in certain segments. “The increased competition in the space benefits retailers and patients alike by driving down costs and improving efficiency,” he said.

Innovations are also appearing from companies that offer other products. Simply Good Foods Company makes Atkins and Quest products, including new Atkins Nacho Cheese Flavor Protein Chips with 13 grams of protein and 4 grams of net carbs and Quest Cheese Crackers with 10g of protein and 5g of net carbs. “Fresh, low sugar and high protein are the most common perceptions of what’s considered healthy,” said Colette Heimowitz, vice president of nutrition and education for Simply Good Foods. “When you remove carbs, you have room for protein and fiber and that’s satiating.”

The brands’ recipe pages are the most often visited on the website, Heimowitz said, and the recipes were prepared by the company’s nutrition department and based on recommendations from the American Diabetes Association. While she agrees that pharmacists can play an important role in diabetes education, retailers should also build wellness sections featuring these nutrition-related products and reinforce the message that a low carb, high protein diet can help people with diabetes maintain their health.

Wound care is another important segment, and the need for these products is increasing as healthcare costs rise. “Unaffordable healthcare is leading people living with diabetes towards more self-care wound care treatments,” said Geolyn Gonzalez, vice president of sales and marketing for Total Resources International.

Another trend, Gonzalez said, is a preference for the convenience of pre-organized kits and bundled products or services. TRI recently launched the Be Smart Get Prepared diabetic wound care line, designed to enable people living with diabetes to rapidly and successfully care for and treat their wounds at home or while traveling. Retailers can engage with these consumers by setting up an Infection Prevention section, and by providing information and making the products easy to find on shelves.

“With diabetes being such a complex and demanding disease, encouraging and educating people living with diabetes to be more proactive instead of reactive is key in helping them get ahead of their wound care management,” Gonzalez said. dsn

The total cost of excess medical costs associated with diabetes was per person in 2017. $9,601

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Seeking More than Sleep

Consumers want side-effect-free sleep aids to help them relax, stay asleep and more

A good night’s sleep is critical to mental and physical performance. Many people, however, have difficulty getting enough slumber.

According to the American Sleep Apnea Association, sleep-related problems affect between 50 million to 70 million people in the United States alone. Those sleep-deprived people fall across all ages and socioeconomic classes.

Moreover, many of them are actively seeking help in falling — and staying — asleep. In 2021, the global sleeping aid market was worth $83.6 billion, a November report from New York-based P&S Intelligence states. And the company projected the market will continue to see strong growth, reaching $157.5 billion by 2030.

Pandemic spurred growth

Although the sleep aid category was growing by double digits in all retail channels prior to the COVID-19, it really took off during the height of the pandemic, said Barbara Apps, product manager for Newtown Square, Pa.-based Boiron USA. The main push behind the surge? Pandemic-related stress.

Steven Springer, senior brand manager for West Hills, Calif.-based Pharmavite, agreed, saying that his company has seen younger consumers, including

millennials and Generation Z, admit to more sleep issues coming out of the pandemic.

The worst of the pandemic might be over, but today’s economic situation also threatens to come between consumers and a good night’s sleep, said Michelle Yoon, senior brand manager for San Francisco-based OLLY.

“Whether it’s worrying about the economy or raising children during a global pandemic, consumers have a lot on their plate and are finding it hard to turn off their thoughts at night, which affects their sleep quality,” Yoon said. “As such, we’re seeing a rise in sleep aids that help consumers relax and keep calm.”

A melatonin-free push

But the sleep aid segment’s growth within the mass market has decelerated somewhat recently, Apps noted. Potential reasons for the slowdown? The past two years saw a growth rate that was unsustainable. Plus, there also is an excess of melatonin-based SKUs and continuing negative press surrounding melatonin’s side effects. “In the natural channel, which offers a wider variety of non-melatonin natural sleep options, growth continues to be strong,” she said.

“Whether it’s worrying about the economy or raising children during a global pandemic, consumers have a lot on their plate and are finding it hard to turn off their thoughts at night, which affects their sleep quality.”
— Michelle Yoon, senior brand manager, OLLY
Good Sleep Guarantee GMP Certified Gluten Free All Natural Clinically Proven Ingredients Made in the USA

For its part, Boiron offers melatonin-free and hormonefee homeopathic OTC sleep aids that are not associated with any known drug interactions, Apps said. For example, the company’s SleepCalm meltaway tablet represents a plantpowered homeopathic alternative for consumers aged 12 and up who suffer from occasional sleepiness.

“Melatonin, which is a synthetic hormone, may interact with birth control and diabetes and blood pressure medications, and it is not recommended for pregnant or breastfeeding women,” Apps continued. “The Mayo Clinic has also weighed in on melatonin for children and teens, citing a lack of research and potential side effects, including daytime drowsiness or grogginess, headaches, dizziness, nausea, nightmares and bedwetting, among others.”

Pete Petersen, head of sales for Sandland Sleep, El Segundo, Calif., agreed that more consumers are looking for melatoninfree alternatives. “They hope to find something that works with their body to restore a healthy sleep pattern and reteach the body to sleep soundly, naturally,” he said.

And many consumers still want products containing melatonin. Sandland offers sleep supplements with and without melatonin, Petersen noted. Consumers may take them daily without any negative side effects.

“Our goal, though, is more than just one or two good nights of sleep,” Petersen said. “We want to help our customers longterm by providing safe, natural sleep solutions that restore the body’s healthy sleep rhythm, essentially retraining the body to sleep the way it’s meant to.”

These Aren’t 2020’s Shelves

Consumers looking for relief from pandemic-related stress managed to influence changes in the makeup of the sleep aid category overall, Apps said.

“The sleep category was typically dominated by OTC brands, but now growth is being driven by dietary supplement brands with melatonin or herbal-based formulas in a variety of delivery forms and line extensions,” she said, “and traditional OTC sleep aids launching melatonin-based supplement lines.”

The pandemic also attracted new buyers to the vitamin, mineral and supplement space as consumers homed in on their overall health, Springer noted. What’s more, the gummy format continues to grow in popularity. He said Pharmavite’s Nature Made brand recently launched Wellblends, which target specific sleep, stress and immune health needs. They are available in a variety of formulations, including gummies. “For sleep, we have products such as Sleep Longer, Sleep and Recover, Back To Sleep and Fall Asleep Faster,” he said.

Yoon also is seeing a trend toward sleep aids that go beyond inducing drowsiness. Value is an important consumer driver here. “Many are feeling economic strain and want their dollars to stretch further by selecting products that offer extra value,

MelatoninMax sleep supplement

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Natrol said MelatoninMax sleep supplement is the only sleep supplement on the market that provides the maximum recommended amount of 10 milligrams of melatonin in a single gummy. The 100% drug-free product is formulated with clean ingredients. Non-GMO, gelatin-free and vegetarian, it is free from artificial flavors, sweeteners, preservatives and synthetic dyes. It retails in a natural blueberry flavor in 50- and 80-count packages.

Pascoflair Night sleep aid

SRP: CA$13.95 (15-count)

Pascoe Canada expanded its sleep products category with the addition of Pascoflair Night. Each tablet contains 80 milligrams of passionflower, 125 milligrams of valerian and 112 milligrams of lemon balm to help consumers fall asleep and stay asleep, the company said. The sedative properties come without side effects such as hormonal disruptions or hangover effects. Suitable for ages 18 and older, the product features non-habitforming ingredients and can be used as needed or on a regular basis. It comes in 15-, 30- and 90-count packages.

like sleep aids that offer two-in-one benefits,” she said.

To meet needs here, OLLY recently introduced a line of Sleep fastdissolve tablets offering dual benefits such as a relaxing sleep or an immunity sleep, Yoon noted. The sugar-free tablets dissolve in the mouth — no water required — and come in Apple Berry, Soothing Citrus and other palate-pleasing flavors. dsn

“Our goal, though, is more than just one or two good nights of sleep,” Petersen said. “We want to help our customers long-term by providing safe, natural sleep solutions that restore the body’s healthy sleep rhythm, essentially retraining the body to sleep the way it’s meant to.”
— Pete Petersen, head of sales, Sandland Sleep

Feminine Hygiene Gets a Makeover

Natural and alternative products are invigorating this long-staid category

For decades, feminine protection was dominated by pads and tampons. While products have improved, there has been a dearth of new items–until now.

Driven by social media, health concerns and more open conversations about anything vaginal, feminine hygiene is experiencing significant growth in “alternative” items.

According to Mintel, total U.S. period care sales totaled $4.2 billion in 2022. While still a small part of the market, alternatives are outpacing category growth, with sales increasing 32% in 2022, Nielsen said; total category growth was 8.8%.

In addition to health aspects, alternatives can be more effective, convenient and economical. Many are from small, innovative companies that have emerged in recent years. Others are from big brands that want a piece of the action.

“Feminine care is night and day compared to 10 years ago,” said Beatrice Dixon, CEO, co-founder and chief innovation officer at The Honey Pot Co. “There hasn’t been innovation for 50, 60 years.”

Alternatives give shoppers a cavalcade of brands and solutions. “Choices are amazing,” said Clare Morgan, CEO of New Zealand-based Organic Initiative Corp. “Before, there weren’t many choices. Women would buy the same products. Now, they’re even mixing and matching, using tampons or pads during the day and period underwear at night.”

Teaching consumers about alternatives’ benefits via social media has been crucial to success. In addition to explaining products’ use, women can communicate about a traditionally uncomfortable subject. “The topic of vaginas is normal conversation now,” said Dixon. “A few years ago, it wasn’t. We were part of making this easy conversation, helping to de-mystify things. Social media plays a huge part.”

Social media also lets brands and consumers interact. “It’s today’s word of mouth,” said Concepcion Itchon, head of marketing, U.S. feminine care, Edgewell Personal Care. “Consumers have direct access to provide opinions visible to everyone.”

Some women discovered alternatives online during the pandemic. “People didn’t go out and start experimenting more,” said Morgan. “Many other products weren’t available.” Alternatives also benefited from shortages of traditional items.

Newer players

Black-owned Honey Pot is among the most successful “alternatives” companies. Launched in 2014 with vaginal washes and wipes incorporating cruelty-free, plant-derived ingredients, it now offers about 80 washes, wipes, panty liners, menstrual cups, tampons, supplements, antiitch cream and more, said Dixon. Its new vaginal care probiotic supplement with urinary tract support contains four lacto strains, cranberry and pomegranate to manage unwanted bacteria.

Debby Garbato
“Feminine care is night and day compared to 10 years ago. There hasn’t been innovation for 50, 60 years.”
— Beatrice Dixon, CEO and co-founder, The Honey Pot Co. Products such as the Flex Co.’s disposable soft Discs and Cups are shaking up the feminine hygiene sector and forcing established brands to play catchup.

Last year, it introduced an anti-itch formulation containing aloe, Calendula and Pramoxine.

Another pioneer, Flex Fits Co., started in 2016. Its disposable Soft Disc disposable discs create 50% less waste than traditional protection, said Lauren Schulte Wong, founder/ CEO. On average, women use eight per period versus 18 to 21 tampons. On the convenience end, discs can be worn for up to 12 hours, even during intercourse. Flex also makes reusable discs as well as cups.

Wong also believes education drives success. “When we launched, most people had never heard of a menstrual disc,” said Schulte Wong. “Awareness is our biggest issue. We do lots of online advertising, which increases traffic among younger consumers.” Flex also uses social media influencers.

Last year, Flex added a disposable, plant-based disc that is “more environmentally sustainable,” said Schulte Wong. Suggested retail price is $15.99 for a 12-pack versus $11.99 for Flex’s regular discs.

Saalt launched five years ago. Its reusable cups and discs (SRP $29) last 10 years, diverting 3,000 disposable tampons from landfills. Its period underwear (SRP about $32) employ post-consumer recycled water bottles and cotton. Benefits do not end there. “They’re more comfortable and there’s less cramping,” said Brendan Leach, sales director and a former P&G executive. “Nine out of 10 people who switch don’t go back to tampons.”

Discs were introduced in 2022. Cups and discs are made from medical grade silicone, leaving no residue. Tampons are made from rayon and cotton and can leave “little bits inside the body,” said Cherie Hoeger, co-founder and CEO. “The macro trend of clean beauty is hitting more `taboo’ areas like menstruation and incontinence. But it’s a bit of a learning curve.”

Organic Initiative offers reusable cups as well as organic tampons and pads. Retailing for $30 to $40, the cups “pay for themselves” in five or six months. The company plans to add reusable, organic cotton menstrual underwear soon.

Heavy hitters go natural

Looking to reap the benefits of a growing subcategory with higher price points, most traditional feminine hygiene companies have either acquired alternative brands or launched new products.

• Edgewell Personal Care, supplier of Playtex, o.b. and Stayfree, introduced Playtex Clean Comfort in 2022. Tampons are made from organic cotton and free from chlorine, dyes and fragrances.

• In 2018, Procter & Gamble unveiled the reusable Tampax cup. In 2019, it acquired L, maker of organic cotton tampons, pads, liners and wipes. That year, it also introduced Tampax PURE and Always PURE.

• In 2016, Unilever acquired Seventh Generation. The Vermontbased, all-natural brand offers cleaning products plus organic cotton tampons and chlorine-free, unscented pads and pantiliners.

• In March 2022, Kimberly-Clark Corp. purchased Thinx, supplier of reusable period and incontinence underwear. K-C also markets disposable Dreamwear Period Underwear under its U by Kotex brand.

Unscented itch relief

Established companies’ interest in natural ingredients goes beyond menstrual protection. Combe’s 50-year-old Vagisil brand recently unveiled Vagisil Itch Protect+ Wash. It contains Hyaluronic acid, a clear, gooey substance naturally produced by the body that promotes skin health and wound healing. The Ph-balanced wash also utilizes Lactoprebiotic, which helps beneficial vulval bacteria thrive, said Stacey Feldman, SVP of marketing.

While young women reject many brands their mothers used, Feldman said 50-year-old Vagisal enjoys cross- generational popularity. “Vagisil’s double-digit growth across Gen Y, Millennials and Gen X is a testament to its continuing ability to deliver relevant, effective products.”

Experts expect alternatives to continue growing. But there are challenges: not all consumers understand the subcategory and some are deterred by its higher price tags. “More people have heard of menstrual cups,” said Schulte Wong. “It’s still a fraction of the market. And price sensitivity remains a concern. We’re in the very early days.” dsn

Thriftier, more sustainable periods

• In the U.S., 20 billion menstrual products are disposed of annually.

• One woman uses more than 11,000 single-use, disposable menstrual protection products during her reproductive years.

• It takes a tampon longer to disintegrate than the lifespan of the woman who wears it.

• Using a reusable menstrual cup or disc for 10 years can divert 3,000 disposable tampons from landfills.

• Women use an average of eight discs per period vs. 18 to 21 tampons.

• Menstrual cups can pay for themselves within five to six months.

Source: Flex Fit Co., Saalt

DRUGSTORENEWS.COM February 2023 57
Organic Initiative’s Oi cup is a zero-waste and all-day protection product that stays in place for 6 to 12 hours and holds up to 30ml of fluid.

Access for All

Lynne Fruth says patients deserve access to safe, affordable pharmacy services

On October 31, 2022, a judge blocked the proposed merger of Penguin Random House and Simon & Schuster. The decision was based on concern for authors’ compensation and the possible decrease in the diversity of stories that would be published.

Weeks later, another huge company was thrust into the media spotlight after Taylor Swift fans were crying foul over the Ticket Master fiasco. The House Energy and Commerce Committee sent a letter to Live Nation’s CEO Michael Rapino asking the executive to clarify Live Nation’s ticketing process for the upcoming Swift tour and provide a list of actions the company will take to ensure consumers will have better access to live entertainment. Live Nation is the parent company of Ticketmaster.

I love music and good books, and I support the notion that readers and concertgoers should have equal access to the products and services they want. But I can’t get past the idea that overseeing the publishing or the event ticket-selling industry should be more important than providing patients with access to safe, affordable pharmacy services.

Over the years, patients and pharmacies have seen prices go up, while many pharmacies receive reimbursement so low that their businesses are no longer viable. Retail pharmacies are seeing shrinking payments while pharmacy benefit managers and health companies such as CVS/Caremark/Aetna, Cigna/Express Scripts and United Healthare/Optom are experiencing record profits.

When will the FTC, the public and our federal lawmakers realize that we are on a pathway to disaster? In the past three years, many pharmacies have closed. Bartell Drug, a family owned chain, sold out in 2020. Rite Aid announced plans to close 145 stores. Walgreens has closed 200 stores since 2019, and CVS announced plans to close 900 stores over the next three years.

Kroger also announced that it was ending negotiations with ESI and was dropped from ESI Networks. Kroger Health President Colleen Lindholz said the ESI proposal being offered to them was “far out of line with comparable terms Kroger has with all other pharmacy providers, and far outside the industry

standard.” This decision will displace thousands of patients who have relied on their local grocer to meet their medication needs, but is it fair to ask a retail pharmacy to provide services below their cost?

As the president of a family owned regional chain that operates 28 stores in Appalachia, I see firsthand the impact of these closures. I receive calls every month from smaller communities asking if Fruth Pharmacy can come into their town. The story is always the same: either an independent pharmacy can no longer survive and has sold the files to a large chain or the CVS/Walgreens/ RiteAid store closed because it no longer fits their business model.

The fact is, profitable stores in affluent America will not be the ones closing. I believe the pharmacy closures will impact two distinct areas: the urban poor and the rural communities, disproportionately impacting black, brown and poor communities.

If you think healthcare is expensive now, just wait until our oldest and poorest patients no longer have access to care. PBMs and vertically integrated healthcare companies claim they exist for the purpose of lowering healthcare and prescription costs. If that is true, then why are pharmacy costs to patients, employers and health plans going up sharply while the net cost of medications have gone down?

So what is the value in ensuring that local pharmacies survive? In West Virginia, you can see the results of what local pharmacies accomplished during Covid. We were the first state to vaccinate all nursing home and assisted living patients, and led the way in vaccinating the elderly.

Even after all this, retail pharmacies find themselves begging for a level of reimbursement that will allow our stores to stay in business. Many pharmacies believe that their stores will not survive even two years without relief.

Now is the time for state and federal government to consider what America will look like without the local pharmacy. It’s time to act while the trend can still be altered. Healthcare belongs in every community, even if the large PBMs and vertically integrated healthcare companies don’t agree. dsn

Lynne Fruth, president and chairman of Fruth Pharmacy
“Over the past years, patients and pharmacies have seen prices go up for consumers, while many pharmacies receive reimbursement so low that their businesses are no longer viable.”

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