Tobacco sales in pharmacies: What will it take to quit for good?

 B. Joseph Guglielmo

Craig SvenssonOn February 5, 2014, CVS Caremark announced its commitment to remove all tobacco products from its more than 7,600 pharmacies across the United States. The company’s CEO stated that it is “the right thing for us to do for our customers and our company to help people on their path to better health. Put simply, the sale of tobacco products is inconsistent with our purpose.” This decision is an element of the corporation’s long-term plan to position CVS Caremark for “future growth and the opportunity to play a bigger role in our evolving healthcare system.”

Analysts who expect the need for primary care to continue to grow also anticipate that community pharmacies and clinics located within retail pharmacies will play an enhanced role in the care of patients with chronic health conditions, many of which are affected by tobacco use.

The leading known cause of preventable disease and death

How can members of the pharmacy profession credibly advance their efforts to serve as healthcare providers in a reformed U.S. healthcare system if the most visible and frequented area in community pharmacies, the area behind the checkout counter, prominently displays tobacco, the leading known cause of preventable disease and death?

By virtue of the company’s size and the historical volume of its tobacco sales, the CVS Caremark announcement represents a landmark decision. With a few notable exceptions (e.g., Wegmans, Target), to date retail chain pharmacies have turned a blind eye and a deaf ear to the strong opposition to tobacco sales in pharmacies voiced by virtually every facet of our profession.

Over the past four decades, numerous resolutions and formal position statements have been set forth by state and national pharmacy organizations, including the American Pharmacists Association, the American Society of Health-System Pharmacists, and the American Association of Colleges of Pharmacy. Ample research demonstrating that fewer than 2% of pharmacists are in favor of tobacco sales in pharmacies further supports this stance.

Regional legislative initiatives have achieved success in removing tobacco from pharmacy shelves in several cities, including San Francisco and Boston, but these municipalities are outliers in the U.S. pharmacy landscape. Retail chains have frequently cited economic hardship and the need for a “level playing field” as their reasons for continued sales of tobacco products, stating a need to balance customer choices with health needs.

A new playing field

A note to all community pharmacies that choose to sell tobacco: There is now a “new” playing field. Payers, including self-insured employers and carriers, also have choices. They can choose which pharmacies to favor when designing their health benefits. In Indiana, initiatives are already underway to encourage these groups to designate all pharmacies that sell tobacco products as out-of-network.

Surely other states will follow suit, now that the second largest pharmacy chain has made it possible - for the first time - for payers to fully align with tobacco-free pharmacies. Perhaps this potential for financial disincentives will provide the necessary impetus for other chains with a self-reported interest in promoting health and wellness to reevaluate their position on tobacco sales.

Call to action

As deans of schools of pharmacy, we are highly invested in the future of the pharmacy profession. We applaud CVS Caremark for its bold step, its commitment to the advancement of pharmacy practice, and most important, for its commitment to the patients that our pharmacy graduates have the privilege of serving.

We encourage others to follow the lead of Wegmans, Target, and CVS Caremark, and end the profession’s connection to the sale of tobacco products, which contradicts our calling as healthcare providers.

B. Joseph Guglielmois dean of the School of Pharmacy, University of California, San Francisco.Craig K. Svenssonis dean of the College of Pharmacy, Purdue University.