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Clinical Laboratories and Pathology Groups

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Clinical Laboratories and Pathology Groups

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Bankruptcies and Store Closings Are Signs of Tough Times Ahead for US Retail Pharmacy Chains

Plans by several national retail pharmacy chains to expand primary care services and even some clinical laboratory test offerings may be delayed because of financial woes

Times are tough for the nation’s retail pharmacy chains. Rite Aid Corporation, headquartered in Philadelphia, closed 25 stores this year and has now filed for bankruptcy. In a press release, the retail pharmacy company announced it has “initiated a voluntary-court supervised process under Chapter 11 of the US Bankruptcy Code,” and that it plans to “significantly reduce the company’s debt” and “resolve litigation claims in an equitable manner.”

Rite Aid may eventually close 400 to 500 of its 2,100 stores, Forbes reported.

Meanwhile, other retail pharmacy chains are struggling as well. CVS Health, headquartered in Woonsocket, Rhode Island, and Walgreens Boots Alliance of Deerfield, Illinois, are each closing hundreds of stores, according to the Daily Mail.

They are each experiencing problems with labor costs, theft, being disintermediated for prescriptions by pharmacy benefit managers (PBMs), and probably building too many stores in most markets.

This is a significant development, in the sense that Walgreens, CVS, and Walmart are each working to open and operate primary care clinics in their stores. This is a way to offset the loss of filling prescriptions, which has migrated to PBMs. Primary care clinics are important to the revenue of local clinical laboratories, but retail pharmacy chains do not yet operate enough primary care clinics in their retail pharmacies to be a major influence on the lab testing marketplace.

Jeffrey Stein

“With the support of our lenders, we look forward to strengthening our financial foundation, advancing our transformation initiatives, and accelerating the execution of our turnaround strategy,” said Jeffrey Stein (above), Rite Aid’s CEO/Chief Restructuring Officer, in a press release. Clinical laboratory leaders may want to closely monitor the activities of the retail pharmacies in their areas. (Photo copyright: Rite Aid.)

Multiple Pharmacy Companies at Financial Risk

Rite Aid Corporation (NYSE: RAD) confirmed it continues to operate its retail and online platforms and has received from lenders $3.45 billion in financing to support the company through the bankruptcy process. 

However, according to the Associated Press (AP), Rite Aid has experienced “annual losses for several years” and “faces financial risk from lawsuits over opioid prescriptions,” adding that the company reported total debts of $8.6 billion.

Additionally, the US Department of Justice (DOJ) filed a complaint “alleging that Rite Aid knowingly filled unlawful prescriptions for controlled substances,” explained a DOJ press release.

Rite Aid is not the only retail pharmacy brand dealing with unwelcome developments. Fortune reported last year that Walgreens and CVS paid a combined $10 billion to 12 states for “involvement in the opioid epidemic.”

Walgreens intends to close 150 US and 300 United Kingdom locations, its former Chief Financial Officer James Kehoe shared in a third quarter 2023 earnings call transcribed by Motley Fool.

And in a news release, CVS announced plans to close 900 stores between 2022 and 2024.

Pharmacy Companies’ Investment in Primary Care 

Though they are experiencing difficulties on the retail side, Walgreens and CVS have significantly invested in primary care.

In “Walgreens Continues Expansion into Primary Care as VillageMD Acquires Starling Physicians Group with 30 Locations in Connecticut,” we covered how Walgreens’ VillageMD primary care clinics business was expanding its footprint by acquiring Starling Physicians, a multi-specialty physicians group with 30 locations in Connecticut.

In that same ebrief, we reported on CVS’ acquisition of Oak Street Health, a Chicago-based primary care company, for $10.6 billion. CVS plans to have more than 300 healthcare centers by 2026.

“We looked at our business, and we said, ‘We’re seeing an aging population.’ We know people don’t have access to primary care. We know that value-based care is where it’s going. We know that there’s been a renaissance in home (care). So that’s kind of how we approached our acquisitions,” Karen Lynch, CVS Chief Executive Officer told Fortune.

Other Challenges to Retail Pharmacies

It could be that these major pharmacy chains are hoping entry into primary care will offset the loss of sales from prescriptions that have migrated to PBM organizations.

In addition to reimbursement challenges, retail pharmacies are reportedly experiencing:

  • High labor costs,
  • Competition from online, bricks-and-mortar, and grocery businesses, and
  • Effects from the work-at-home trend, among other struggles.

“I think there’s a number of challenges which are coming to a head. One, you have ongoing reimbursement pressure. The reimbursement level for drugs continues to decrease, so profit margin on the core part of the business is under pressure,” Rodey Wing, a partner in the health and retail practices of global strategy and management consulting firm Kearney, told Drug Store News.

Additionally, the pharmacy’s drug sales need to be high enough to retain pharmacists, who are difficult to recruit in a post-pandemic market, Drug Store News explained.

And in the retail space where products are displayed, some pharmacies struggle to compete with Amazon on convenience and with “dollar” stores on price. And with more people working from home, retail pharmacies are seeing less foot traffic, Drug Store News noted. 

Retail pharmacy companies also have competition from pharmacies conveniently situated in grocery and big-box stores, Forbes reported. These include: 

Walmart, for its part, reduced operating hours of pharmacies at more than 4,500 sites, Daily Mail reported.

Thus, medical laboratory leaders would be wise to keep an eye on market changes in their local retail pharmacies. Some locations are equipped with clinical laboratory services and a closure could give local labs an opportunity to reach out to patients and physicians who need access to a new testing provider.

—Donna Marie Pocius

Related Information:

Rite Aid Takes Steps to Accelerate Transformation and Position Company for Long-Term Success    

Drugstore Downsizing: CVS, Walgreens, and Rite Aid to Close Nearly 1,500 Stores

Pharmacy Chain Rite Aid Files for Bankruptcy Amid Declining Sales and Opioid Lawsuits

US Files Complaint Alleging Rite Aid Dispensed Controlled Substances in Violation of the False Claim Act and the Controlled Substances Act

Rite Aid Files for Bankruptcy in the Face of Massive Debts and ‘Potentially Significant’ Claims for Role in the Opioid Epidemic

Walgreens Boots Alliance Q3 2023 Earnings Call

CVS Health Announces Steps to Accelerate Omnichannel Health Strategy

CVS CEO Sees Changes Coming ‘Faster than a Freight Train’ for Medicare. She’s Betting Billions She Can Build a New American Healthcare System

Threats and Opportunities Facing Retail Pharmacy

As CVS Says It Will Close 900 Stores, Here Are Three More Big Pharmacy Chains Which Are Shutting Locations and Cutting Hours

Walgreens Continues Expansion into Primary Care as VillageMD Acquires Starling Physicians Group with 30 Locations in Connecticut

Walmart to Open 4,000 Healthcare ‘Supercenters’ by 2029 That Include ‘Comprehensive’ Clinical Laboratory Services

With the majority of Americans living just a few miles from a Walmart, how might independent clinical laboratories compete?

Retail giant Walmart (NYSE:WMT) plans to install 4,000 primary care “supercenters” in stores by 2029 that will include clinical laboratory testing services. This is on top of the dozens of Walmart Health locations already in operation in Georgia, Florida, Arkansas, Illinois, and Texas.

Clinical laboratories already have growing competition in the healthcare marketplace from pharmacy chains CVS (NYSE:CVS), Walgreens (NASDAQ:WBA), and Rite Aid (NYSE:RAD) which have installed in-store healthcare clinics in their retail locations—many of which offer limited, but common, medical laboratory services—as well as from existing Walmart Health locations.

Now, Walmart is poised to become a much bigger healthcare player. According to MedCity News, Walmart is “looking beyond traditional retail clinics as it seeks to create ‘supercenters’ with comprehensive healthcare services.”

Presumably, this includes an expanded menu of clinical laboratory testing services—along with the EKGs, vision care, dental care, and more—that Walmart Health locations currently provide for children and adults.

And though Becker’s Hospital Review reported in March that Walmart’s “plan is in flux,” the major national retailer continues to disrupt healthcare in significant ways.

Not the Average Retail Health Clinic

In “Walmart Health Opens Two Primary Care Clinics at Retail Supercenters in Chicago with Plans to Open Seven Florida Locations in 2021,” Dark Daily covered CNBC’s question, “Is Walmart the future of healthcare?” from its article, “How Walmart Plans to Take Over Health Care.”

We reported that Walmart Health’s list of services included:

  • Primary care,
  • Dental,
  • Counseling,
  • Clinical laboratory testing,
  • X-rays,
  • Health screening,
  • Optometry,
  • Hearing,
  • Fitness and nutrition, and
  • Health insurance education and enrollment.

However, the new Walmart Healthcare supercenters differ from Walmart Health clinics and the clinics operated by Walmart’s retail competitors Target, CVS, Walgreens, and Rite Aid.

Those clinics are designed to draw customers into existing retail setting. Walmart has a different goal with its healthcare supercenter concept.

“There’s a big difference between offering healthcare services to drive more people to your store and offering healthcare services because you’re in the healthcare business,” said former President of Health and Wellness for Walmart, Sean Slovenski, during a panel hosted by the American Telemedicine Association. “We’re in healthcare,” he continued, “We’re not in retail healthcare. We’re recruiting physicians in all of these areas and bringing them in.”

Providing Transparency with Clear, Consistent Pricing

In response to consumer demand for transparency, Walmart is taking a different approach to charging patients for healthcare services. The cost of an appointment for primary care is $40 for an adult and $20 for a child. The patient can choose to bill insurance or not, and people without insurance can pay out-of-pocket.

Prices for individual services are equally transparent. Explaining why Walmart is becoming a player in the healthcare industry, Marcus Osborne, Senior Vice President Walmart Health, told Fierce Healthcare, “It’s issues of affordability. That people can’t afford the care they need for themselves and their families. It’s issues of access … That really is the business that we’ve been in. Walmart’s business has been about helping people afford the things they need, getting them in a more accessible, convenient way, and doing it in ways that are simple. Healthcare’s no different in that regard.”

According to STAT, some 35 million Americans were uninsured in 2020. Thus, the idea of transparent pricing and walk-in affordable care should appeal to a sizable market. Walmart is banking on that. Considering that 90% of Americans live within 10 miles of a Walmart, the potential success of the healthcare supercenters becomes clear, Becker’s Hospital Review noted.

Walmart’s Other Healthcare Moves

In addition to opening 20 Walmart Health Centers, and its plans for 4,000 healthcare supercenters, Walmart has made other moves that indicate its intention to disrupt the healthcare industry.

Walmart Insurance Services, for example, partnered with eight payers during the open enrollment period in 2020 to sell its Medicare products. Through a partnership with Clover Health, a Preferred Provider Organization (PPO), and a Health Maintenance Organization (HMO) with a Medicare contract, Walmart made its insurance plans available to 500,000 people in Georgia, Becker’s Hospital Review reported.

“We’re going to have a consumer revolution in retail for point of care,” John Sculley, former Apple CEO and current chairman at RxAdvance (now called nirvanaHealth), told CNBC. “Why? Because if the Walmart tests are successful, and I suspect they will be, people will be able to go in and get these kinds of health services at a lower cost than if they had health insurance.”

“A lot of the opportunity is just about bringing what we’re doing to more people. I think about Walmart Health and what we launched a little over a year ago in Georgia and the impact we’ve seen in the communities where it launched. I think one of the biggest things to do is how do we continue to find ways to make that model work so we can reach more people with it in more communities,” Marcus Osborne (above), Senior Vice President Walmart Health, told Fierce Healthcare. Walmart certainly has experience in disruption. The retailer upended the grocery industry from the moment it entered the market, and it was the first to offer $4 prescriptions, which disrupted long-standing retail relationships consumers had with their pharmacies. Clinical laboratories should realize that Walmart
will likely make similar waves in the healthcare sector. (Photo copyright: Consumer Goods Forum.)

How Will Clinical Laboratories Compete?

Change is constant. Clinical laboratories that cannot adapt to changing market forces are ill-equipped to withstand the coming “consumer revolution.” However, labs that have already begun to plan for more direct-to-consumer interactions will be better positioned to adjust as changes come.

“My goal is that we have done the work on Walmart Health as a model, to really get it to work from a consumer perspective and get it to work in a way that it scales effectively, that we are able to reach more people,” Osborne told Fierce Healthcare.

Clinical laboratory leaders should understand that this trend is being driven by consumer demand for convenience, lower costs, and price transparency. Labs that don’t prepare to address those forces will be left behind as Walmart provides what consumers want.

Dava Stewart

Related Information:

Walmart Opens Second Health Center Offering Clinical Laboratory Tests and Primary Care Services

9 Numbers That Show How Big Walmart’s Role in Healthcare Is

Walmart Divulges Plans for ‘Healthcare Supercenters’

Why Does Walmart Think It Has a Right to Play in Healthcare? Top Health Exec Osborne Explains

The Number of Americans Without Health Insurance Has Been Trending Up. Let’s Turn It Down Again

Former Apple CEO: Walmart’s Healthcare Services Will Cause ‘a Consumer Revolution’

Walgreens Joins Competitors Offering Telemedical Virtual Doctor Visits: Adds Mental Health Specialists to the Roster of Providers

Consumers can access a physician anytime, anywhere on a computer or mobile device using a downloadable Walgreens app

As the national pharmacy chains take progressive steps to add more health services inside their retail stores, the day draws ever closer when they may want to add medical laboratory testing services to their menu of in-store clinical services.

At the moment, telemedicine physician consults is one healthcare service finding favor with several of the nation’s largest pharmacy chain companies. Recently, Walgreens (NYSE:WBA) of Deerfield, IL, signed an agreement with telemedicine vendor MDLIVE of Sunrise, Florida, to provide virtual doctor visits.

With this agreement, Walmart becomes the latest national pharmacy chain to offer telemedicine services within its retail stores. However, unlike competitors Rite Aid (NYSE:RAD), CVS (NYSE:CVS), and Walmart (NYSE:WMT), which are currently implementing in-store telemedicine services, Walgreens is providing this service via a downloadable app. Walgreens says this allows customers to access board-certified physicians and mental health specialists anytime and anywhere from a computer or mobile device—not just from within a Walgreens pharmacy.  (more…)

Mayo Clinic Pilots Use of Telemedicine Kiosks for Its Employees, but Will Pathologists Be Included to Provide Medical Consultations?

New generation of private telemedicine kiosks are popping up at Kaiser Permanente, Rite Aid pharmacies, giving pathology groups opportunities to do consultations

Coming soon to a pharmacy, school, retail store, or employer near you is a new generation of walk-in telemedicine kiosks. These kiosks are specifically designed to allow consumers to have private medical consultations with physicians. For that reason, pathologists and their medical specialty associations may find it timely to engage the company offering these kiosks with the goal of incorporating pathology consultations in the service mix offered by this new generation of telemedicine kiosks.

No less than the famous Mayo Clinic has become the latest healthcare provider to partner with HealthSpot, the company that designed this new telemedicine kiosk. This pilot program will be called the Mayo Clinical Health Connection and Mayo Clinic is placing these kiosks in its facilities in Austin and Albert Lea, Minnesota, specifically for use by employees of the Mayo Clinical Health System. Mayo officials hope that the use of these kiosks will contribute to reduced healthcare costs and improved access to medical services.

In a parallel pilot project, Mayo Clinic is placing its Mayo Clinic Health Connection kiosks in public schools in Austin, Minnesota. Plans are to eventually offer the service at university, employer, and retailer locations. (more…)

Rite Aid’s New Telemedicine Kiosks in Select Ohio Pharmacies Allow Customers to Consult with Physicians for a Nominal Fee

Pathologists may want to explore the opportunity to be tele-consultants and be paid for helping consumers understand their lab test results and other clinical findings

First it was rapid medical clinics in retail pharmacies. Next came health kiosks with information for consumers in pharmacies. Now a national pharmacy chain is upping the ante by installing enclosed health kiosks in their stores that deliver telemedicine services, thus allowing customers to speak with physicians and other medical providers in private from within the pharmacy.

For pathologists and clinical laboratory managers watching as national pharmacy chains introduce ever more medical services in their retail stories, the telemedicine kiosks is one more piece of evidence that, at some future point, pharmacies will want to provide medical laboratory testing services. In fact, lab testing is the basis for an existing agreement between Walgreens and Theranos, a lab testing company with ambitious plans to be disruptive.

It is Rite Aid Corporation (NYSE:RAD), that plans to take the health kiosk idea to a new level. Its telehealth concept allows pharmacy shoppers to consult directly with physicians via a kiosk. HealthSpot, a Columbus, Ohio-based telemedicine provider, recently launched a pilot involving the telehealth kiosks at Rite Aid stores in Ohio. It is also developing a network of board-certified physician consultants to expand this service nationwide. (more…)

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