There has been a lot written about codeine-combination products and the 1 February 2018 changes. What is missing, in my opinion, is education and guidance on consumer behaviour, and tailoring solutions to the needs — and medical history — of those specific codeine-combination consumers.
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Consumers Suspicious of Pharmacist ‘Switches’

Consumers are suspicious of pharmacists, and pharmacy assistants, switching patients from their preferred current medication to other products, or switching to a broader ‘pain management’ approach.

The latter is the direction some government-endorsed educational material is taking. That approach might be suitable for new pain ‘symptom-based’ presentation, but can alienate existing patients who are presented with a direct product request.

The best example I can give that indicates pharmacy staff are focusing too much on process rather than focusing on patients, is the number of consumers who report that their pharmacy has attempted to switch them away from their existing codeine-combination product, even if the product is still available.

One of those ‘consumers’ that spoke to me is the CEO of a large pharmaceutical company and was quite dismayed regarding the strong push from a pharmacy assistant to switch him away from his preferred codeine-combination product even though the change was many months away.

As he cynically put it to me, ‘Are pharmacy staff on a financial incentive to switch people early?’

Of course, there are no such incentives in place, but if that is the opinion of a senior pharmaceutical industry representative, I am concerned what an ‘average consumer’ might be thinking.

The executive I refer to walked out of the pharmacy and made no purchase — he went to another pharmacy!
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Segmenting the Consumer

If pharmacy is to take a consumer-centric approach regarding codeine-combination pharmacy presentations, the following should be considered. As we get closer to 1 February 2018, the approach for the same patient will also change.

First Level Segmentation for Direct Product Requests:

1. The direct product requested item is still available.

2. The direct product requested item is NOT available.

We are beginning to see that many ‘home brands/generic versions’ are running out of stock and this scenario will increase, especially for those manufacturers that are discontinuing supply of their product, and not making that same product available as a prescription only medicine from 1 February 2018.

It is key that out-of-stock shelf tickets in the pain category are kept up to date and that the pharmacy has a printed summary of products that are unavailable. Showing consumers such a list will stop them from leaving the pharmacy thinking it was just your pharmacy that was in short supply.

If the products are unavailable now, it likely means stock will NOT return to shelf, so the advice given to consumers is important.

I would recommend a product with the same ingredients at this stage rather than switch to an ibuprofen and paracetamol product.

I recommend providing a sample or selling, as a second sale of an ibuprofen and paracetamol product with the advice of, ‘I have provided you a product with the same ingredients as your requested brand; however, please try this product next time you have pain because this product will be available at the pharmacy without prescription post Feb 2018’.

To explain this approach, if the only product provided is a ‘switched’ ibuprofen and paracetamol product, and it does not work for pain relief for the patient, there is every chance the consumer will blame the pharmacist for their recommendation. This is already occurring in pharmacies.

There is every likelihood the codeine-combination product may not have provided relief either but the consumer ‘owns’ that decision.

If the product is still available, it is my firm recommendation that the product be provided to the consumer together with advice regarding what will occur with that product after 1 February 2018.

A recommendation from the pharmacist regarding the approach to take post February 2018 is suitable at this time.

Second Level Segmentation for Direct Product Request:

1. Product available and a Prescription Only version will be on the market 1 Feb 2018.

2. Product available now but the product will be discontinued 1 Feb 2018.

Depending on the research quoted, some 30–50% of doctors have stated they would be happy to write a prescription for a codeine-combination product post 1 Feb 2018, as long as they know the patient.

In my view, that figure will be significantly higher because the politically correct answer is to state that the doctor won’t supply codeine-combination products, even if requested.

If we are consumer-centric, as pharmacists we need to be aware of those doctors that are happy to continue to write prescriptions for codeine-combination products, and receive referrals from the pharmacy.

At the very least, for local medical practices, a discussion needs to be held with the doctor as to their position on codeine-combination products.

Many pharmacies already have a patient referral process in place with local doctors and this process can be tweaked to accommodate codeine-combination products. Some manufacturers will also be producing collateral which can facilitate this process.

A tricky situation for pharmacy staff is when they know the product is available as a Prescription Only medicine but the local doctor will not write a prescription for the codeine-combination prescription only products.

In this circumstance, the pharmacist may adopt a broader ‘pain management’ approach and find a suitable pharmacy-based solution for the patient. This approach may indeed still require a referral to the doctor depending on consumer response to questions.
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A New Strong Pain Category in Pharmacy

Consumers will continue to present at the pharmacy, as first port of call, for what they deem is stronger pain. Pharmacy therefore needs to review products at their disposal to support consumers and create a category to facilitate this process.

There has been a great deal invested by manufacturers in advertising ibuprofen and paracetamol combination products.

Some pharmacists have said they will reduce the size of their pharmacy pain category given the number of lines that are discontinued. This would be a mistake.

The overall space allocated should remain the same so that consumers will continue to see pharmacy as a strong pain destination.

This scheduling change is an opportunity to review other products in the revamped category, including non-drug therapy, that may need to move into this category to support those scheduled products that will remain available via a pharmacist recommendation.

Staff training is key and training on a consumer-focused approach is just as important as any product training.

The pain category in the pharmacy is changing rapidly with new ‘short supply’ occurring on a weekly basis. It must be reviewed constantly.

The pain OTC codeine-combination market was a $120M annual market. Give it the attention it deserves in your pharmacy.


Kos Sclavos AM, Industry Consultant