CVS Caremark announced this morning it will stop selling cigarettes and tobacco products at its more than 7,600 stores by Oct. 1. The company is the first national pharmacy retail chain to end tobacco sales at its stores. (Target announced it would stop selling tobacco in 1996.)
“Ending the sale of cigarettes and tobacco products at CVS/pharmacy is the right thing for us to do for our customers and our company to help people on their path to better health,” CVS CEO Larry Merlo said in the press release. “Put simply, the sale of tobacco products is inconsistent with our purpose.
“As the delivery of health care evolves with an emphasis on better health outcomes, reducing chronic disease and controlling costs, CVS Caremark is playing an expanded role in providing care through our pharmacists and nurse practitioners,” Merlo said. “The significant action we’re taking today by removing tobacco products from our retail shelves further distinguishes us in how we are serving our patients, clients and health care providers and better positions us for continued growth in the evolving health care marketplace.”
In a video posted on the company’s website, Merlo said, “Tobacco products have no place in a setting where healthcare is delivered.”
The company has 50 stores in West Virginia. All will have to pull tobacco products by Oct. 1.
The Journal of the American Medical Association published an online article this morning highlighting the paradox of pharmacies that sell tobacco products. Excerpts from that article:
There is little doubt that reducing the morbidity and mortality from tobacco use remains one of the most important public health challenges of the 21st century. More than 480 000 deaths occur annually in the United States as a result of smoking. There is essentially no such thing as moderate use of tobacco, which fuels addiction and illness, with enormous costs to society: $132 billion in direct medical costs and $157 billion in lost productivity, according to recent estimates.
Studies have demonstrated a relationship between tobacco use and geographic density of stores that sell cigarettes. More important, reducing the density of tobacco outlets probably reduces smoking among young people—a key intervention, given the number of smokers who start before 21 years of age.
Advocates have long questioned the juxtaposition of the distribution of medications for promoting health with the sale of the single most deadly consumer product. Making cigarettes available in pharmacies in essence “renormalizes” the product by sending the subtle message that it cannot be all that unhealthy if it is available for purchase where medicines are sold. The argument that pharmacies also sell tobacco-cessation products only heightens the paradox. This is primarily a US problem: pharmacies in other developed countries do not sell cigarettes.
The paradox of cigarette sales in pharmacies has become even more relevant recently, in large part because of changes in the pharmacy industry. Responding to the overall shortage of primary care practitioners in the United States and to recent legislation that expands access to health care coverage, most pharmacy chains are retooling themselves as an integral part of the health care system. They are offering more counseling by pharmacists, an array of wellness products, and outreach to clinicians and health care centers. For example, Rite Aid has developed a new wellness-store format, and Walgreens is testing a “health and daily living” design. In this context, the sale of tobacco products seems contradictory, especially because pharmacists can provide nicotine-replacement distribution and counseling. Moreover, the usual excuses for selling tobacco products in pharmacies, such as avoiding sales to minors and keeping cigarettes behind the counter, become much less convincing as pharmacies expand their role in health care.
Perhaps more important, pharmacies are moving into the treatment arena with the advent of retail health clinics. More than 1600 such clinics are operated by Walgreens, CVS Caremark, Rite Aid, Target (which does not sell cigarettes), Walmart, and many chain grocery stores. The clinics are designed to offer an alternative to routine care by office-based physicians. Yet nowhere else in health care are tobacco products available in the same setting where diseases are being diagnosed and treated. These retail clinics, originally designed to address common acute infections, are gearing up to work with primary care clinicians to assist in treating hypertension, hyperlipidemia, and diabetes—all conditions exacerbated by smoking.
This action may not lead many people to stop smoking; smokers will probably simply go elsewhere to buy cigarettes. But if other retailers follow this lead, tobacco products will become much more difficult to obtain. Moreover, if people understand that retail outlets that plan to promote health, provide pharmacy services, and house retail clinics are no longer going to sell tobacco products, the social unacceptability of tobacco use will be substantially reinforced—indeed, the continued sale would appear to sanction the most unhealthy habit a person can maintain. If pharmacies do not make this effort voluntarily, federal or state regulatory action would be appropriate.
The Affordable Care Act increases health care coverage, but that coverage comes with a price. Any and all efforts to promote public health and reduce the burden of disease are greatly needed. Reducing smoking rates would have those effects, and removing cigarettes from retail pharmacies and grocery or other stores that contain pharmacies can only help in that regard; it would certainly contribute to the denormalization required to further reduce smoking rates. In lieu of regulation, pharmacies, grocery chains, and mass retailers that wish to promote the goal of better health should recognize the fact that selling tobacco products contradicts the commitment to health care.
President Barack Obama released a statement on Twitter this morning praising the CVS move:
— The White House (@WhiteHouse) February 5, 2014