Published Online: May 15, 2014
Troyen A. Brennan, MD, MPH, Chief Medical Officer, CVS Caremark
The statistics related to the negative health and financial impacts of tobacco use have been cited numerous times, but they remain staggering each time you see them:
• 42 million people in the United States continue to smoke and 16 million current and former smokers have smoking-related illnesses1;
• More than 480,000 deaths occur each year in the United States as a result of smoking1;
• Tobacco use costs $132 billion in direct medical costs and $157 billion in lost productivity.1
What these numbers make abundantly clear is that, despite 4 decades of concerted tobacco control efforts, finding ways to reduce the morbidity and mortality associated with tobacco use is
one of the most important public health challenges we face as a nation.
On February 5, 2014, CVS Caremark announced that our company will stop selling cigarettes and other tobacco products at all CVS/pharmacy stores across the country—that’s more than
7600 stores—by October of this year.
As the first national pharmacy chain to make such a commitment, we came to this decision because we believe the sale of tobacco products in our stores poses a paradox that is at odds with our role as a healthcare company and contradicts our purpose of helping people on their path to better health.
Over the past 40 years, a variety of policies have helped reduce the prevalence of cigarette smoking, including increases in tobacco taxation, legislation to create smoke-free public areas, and
growing support for smoking cessation.
In 1965, 43% of US adults smoked cigarettes, compared with 18% of US adults today.2 Despite this progress, in the past decade the rate of reduction in smoking prevalence has stalled, suggesting that new approaches and interventions are needed.
Recently, public health advocates have been turning toward programs designed to make smoking less socially acceptable. The rationale for this approach is that increasing the stigma of tobacco use and reducing the social acceptability associated with smoking could result in fewer people smoking and an increase in the number of smokers who attempt to quit. One example of this approach includes the launch of 3 large-scale, national, mass media campaigns in 2014 by the CDC, the FDA, and the Legacy Foundation for Health. Another example is the ban on smoking in outdoor public spaces in New York City.
Studies have also demonstrated a clear relationship between tobacco use and the geographic density of stores that sell cigarettes.3 This research supports the concept that access to cigarettes can play a role in reducing tobacco use. At CVS Caremark we believe that combining reduced access to cigarettes with policy changes at the state and federal level, and efforts to make tobacco use less socially acceptable, could help further reduce tobacco use and its resulting negative health and financial consequences.
For CVS Caremark, removing cigarettes and other tobacco products from our CVS/pharmacy locations is a concrete way we can help reduce access and make these products less readily
available. As a company of 26,000 pharmacists, nurse practitioners, and physician assistants who provide trusted advice to 5 million customers each day, selling tobacco products contradicts our core commitment to healthcare and our growing role as an integral part of the healthcare system.
As pharmacies are becoming more and more involved in chronic disease management and counseling, we find ourselves faced with a conundrum. How can we provide support and counseling to patients who have high blood pressure, high cholesterol, and diabetes—all conditions that are exacerbated by smoking—and then turn around and sell them cigarettes?
Clearly, tobacco products have no place in a setting where healthcare is delivered. When we think about where we expect to be in the future as a healthcare company, it is clear that removing
tobacco products from our stores is the right thing to do.
CVS Caremark is not alone in recognizing the paradox of selling cigarettes and tobacco products at pharmacies that are supposed to be focused on healthcare. Back in 2010, the American
Pharmacists Association urged pharmacies to discontinue the sale of tobacco products and urged state pharmacy boards to stop issuing and renewing licenses for pharmacies that sell these
products.4 The American Medical Association has passed a resolution opposing the sale of tobacco products in pharmacies, and calls to ban tobacco sales in pharmacies have also
come from the American Heart Association, the American Cancer Society, and the American Lung Association (ALA). Even cities in California and Massachusetts, particularly San Francisco and
Boston, have banned the sale of tobacco products in pharmacies,5 and efforts to institute statewide prohibitions are on.
Our decision to stop selling tobacco products at CVS pharmacy locations may not cause the majority of people to stop smoking; smokers will most likely simply go somewhere else to buy their cigarettes. But if other retailers that are focused on healthcare recognize this paradox and follow our lead, tobacco products will become much more difficult to obtain. And, perhaps this will reinforce the social unacceptability of tobacco use, as people begin to realize that pharmacies no longer sell tobacco products because it is not conducive to the promotion of health and well-being that these institutions stand for.
We think this concept is catching on. Shortly after we made our announcement, 8 senators—led by Senate Health, Education, Labor and Pensions Committee Chairman Tom Harkin (D-IA)—sent a letter to the CEOs of Rite-Aid, Walgreens, and the National Association of Chain Drug Stores (NACDS) urging them to follow our example. In the letter, the senators said, “By reducing the availability of cigarettes and other tobacco products and increasing access to tobacco cessation products, [you, as a company,] have the power to further foster the health
and wellness of [your] customers and send a critical message to all Americans—and especially children—about the dangers of tobacco use.”
In addition, a few weeks later, 26 of the nation’s leading public health and medical organizations—ranging from the American Academy of Pediatrics to the American Public Health Association—issued an open letter citing our decision and calling on other drugstores and retailers to also end the sale of tobacco products. These actions reinforce the odd juxtaposition inherent in selling tobacco products in a retail location that promotes health and wellness, and recognize the potential impact of reducing easy access to tobacco products.
Although surveys show that 7 out of 10 smokers say they want to quit, we do recognize that quitting smoking is not an easy task. As a result, in tandem with our decision to stop selling tobacco
products, CVS Caremark is also making a pledge to actively help Americans quit smoking. This spring we will launch a robust national smoking cessation program that will encompass the assets of our full enterprise as a retail pharmacy, retail clinic provider, and pharmacy benefit manager, because research shows that quitting smoking has proven health benefits.
According to the ALA, as soon as 12 hours after quitting smoking, carbon monoxide level in the bloodstream returns to normal; 2 to 3 months after quitting, the risk of heart attack begins to drop and lung function begins to improve; 1 year after quitting, the added risk of coronary heart disease is half that of a smoker; and 5 to 15 years after quitting, the risk of stroke is reduced to that of a nonsmoker.6 Our goal is to reduce easy access to cigarettes, help those people who want to quit smoking do so, and help people along their path to better health.
1. The Health Consequences of Smoking: 50 Years of Progress. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014.
2. Frieden TR. Tobacco control progress and potential. JAMA. 2014;311(2):133-134.
3. Pearce J, Hiscock R, Moon G, Barnett R. The neighourhood effects of geographical access to tobacco retailers on individual smoking behaviour. J Epidemiol Community Health. 2009;63(1):69-77.
4. American Pharmacists Association. Report of the 2010 APhA House of Delegates: discontinuation of the sale of tobacco products in pharmacies and facilities that include pharmacies. J Am Pharm Assoc. 2010;50(4):471.
5. Katz MH. Banning tobacco sales in pharmacies: the right prescription. JAMA. 2008;300(12):1451-1453.
6. American Lung Association. Benefits of Quitting. http://www.lung.org/stop-smoking/how-toquit/why-quit/benefits-of-quitting/.