CVS Caremark pharmacies will phase out sales of cigarettes and other tobacco products this year, according to a Viewpoint published in JAMA today.
For the last several years, the American Pharmacists Association and other groups have argued that pharmacies should stop selling tobacco alongside prescription medications and other health care products. Most independent pharmacies have stopped selling tobacco products, and Target, a large retailer with a pharmacy, has never sold tobacco. But CVS will be the first major US pharmacy chain to end tobacco sales.
“As a company committed to health care, we thought we just couldn’t continue selling them,” said Troyen A. Brennan, MD, MPH, executive vice president and chief medical officer at CVS Caremark, who coauthored the Viewpoint, in an interview with JAMA.
CVS’ business strategy as well as public health considerations drove the decision, Brennan said. Although the company stands to lose about $1.5 billion in annual tobacco sales, he explained that in the long-term, there is more value in taking a larger role in health care. For example, the company would like to use electronic records to notify physicians when patients are not filling prescriptions for medications. In addition, the company is adding more retail clinics to help meet the growing demand for primary care that is expected to be driven in part by the Affordable Care Act.
CVS’ decision to cease sales of tobacco products “sends a clear signal that the major goal of a pharmacy, which is to improve people’s health, is incompatible with selling cigarettes,” said Steven A. Schroeder, MD, coauthor of the Viewpoint and director of the Smoking Cessation Leadership Center at the University of California, San Francisco.
Schroeder credited leaders in the academic pharmacy community for pushing for this change and said that most pharmacists are uncomfortable with selling cigarettes. “This move will bring smiles to the pharmacists at CVS,” he said.
Mitchell Katz, MD, director of the Los Angeles County Department of Health Services and deputy editor of JAMA Internal Medicine, described CVS’ plan as “good news” and said the company is taking a leadership role. Katz, who banned pharmacy sales of tobacco products in San Francisco while serving as director for the city’s department of public health, noted that large pharmacy chains have resisted calls to eliminate sales of these products.
“It’s a conflict of interest for pharmacies to simultaneously be selling a substance that causes health problems and the medication needed to treat those problems,” Katz said.
He said that selling tobacco products alongside health products sends mixed signals to children and nonsmokers, who may perceive a message that “tobacco isn’t such a harmful product.”
Whether the decision will help reduce smoking rates or smokers will simply go elsewhere to purchase cigarettes is unclear. Katz said he was unaware of any studies that measured the effect of banning pharmacy sales on smoking rates. But he said the cumulative effects of bans on tobacco use in public spaces and restrictions on sales have helped decrease smoking rates.
States could play a role in further reducing smoking rates by funneling cigarette tax revenue into helping smokers quit through quit hotlines or providing free nicotine replacement, Schroeder said. He also said clinicians should place more emphasis on helping patients quit smoking, particularly patients with mental illness, substance abuse, and cancer, who have higher smoking rates than the rest of the population.
Schroeder said he hopes other pharmacies will follow CVS’ example.
“It feels good to be getting out of this category,” Brennan said of his company’s decision. “I think it’s the best thing for our customers as well as our shareholders.”
Audio interview with Troyen A. Brennan, EVP and CMO of CVS Caremark Corporation: