America's big drugstore chains are facing long lines, burned-out pharmacy staff and massive cutbacks, including the closure of hundreds of stores.

• At the same time, they're determined to right the ship by transforming themselves into hubs for care that draw in customers by going far beyond their traditional role of dispensing drugs, Tina writes.

Why it matters: The retail pharmacies are making huge investments in providing more and more health care services, all while contending with growing competition from other retail giants and digital upstarts like Mark Cuban's drug company

• But it's not clear when these efforts to "transform" how health services are provided will pay off for the companies, or if they will meaningfully lower costs for consumers or make it less frustrating to access care. And the companies have even scaled back some efforts amid financial pressure.

The big picture: Companies like CVS Health, Walgreens, Rite Aid and Walmart are pitching themselves as a more convenient option for patients than traditional providers, having spent billions to build out their offerings.

• That includes more types of care, better digital scheduling tools and leaning more into mail-order drugs.
• CVS last week announced a rebrand of its health offerings as "CVS Healthspire" — an indication of the company's ambitions to tie those services together.

It's been an especially challenging year for the pharmacy chains.

• Evolving consumer preferences, more competition from online players and the decline in COVID-related business are contributing to their troubles.
• Part of the pharmacy chains' big bet on health care is tied to an "existential" question about their future, said Peter Bonis, chief medical officer at consulting firm Wolters Kluwer Health.

What's next: A big question is how these legacy brands not typically known as health care providers can differentiate themselves in the eyes of consumers.

• Experts say they expect the pharmacy chains to keep adding on services, such as programs to manage popular new anti-obesity medications.

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More Medicare beneficiaries are benefiting from the program's relatively new coverage of doctor's visits to get a cognitive assessment and develop a care plan to help manage any impairments.

• However, a new congressional watchdog report indicates very few beneficiaries with Alzheimer's or similar diseases are likely receiving the services, meaning many seniors may be missing out on a chance at detecting and tackling cognitive impairments early on.

Driving the news: Medicare beneficiaries' use of "cognitive assessment and care plan services" tripled between 2018 and 2022, when it accounted for almost 100,000 visits, according to the Government Accountability Office.

• However, at most about 2.4% of traditional Medicare beneficiaries diagnosed with Alzheimer's received the service in 2021, GAO estimated.
• Medicare added the service in 2017, as the toll of cognitive impairment is expected to grow in a country that's aging. An estimated 10 million Americans 65 and older have a cognitive impairment.

What they found: The limited time providers have to see patients could be affecting broader takeup of the service.

• Doctors usually see patients in 15-20 minute blocks, but they typically need over an hour to conduct a cognitive test and then develop a written care plan that includes strategies for managing an impairment and helps connect patients and caregivers with other resources and supports.
• Providers GAO interviewed also noted that primary care doctors have limited training on how to conduct these services, and they also said billing policies limit the use of team-based care that could help manage cognitive impairments.
• Some provider groups said that specialists like neurologists and geriatricians are better positioned to provide these services, but the report noted a shortage of such specialists could mean long wait times for an appointment.

For eight of the top 10 drugs with substantial net price increases last year, there was no clinical evidence to justify a price hike, according to a new analysis from the Institute for Clinical and Economic Review.

The big picture: The increases for these eight drugs, after accounting for rebates and discounts, amounted to almost $1.3 billion in additional spending, according to ICER, a nonprofit that assesses the value of medicines.

Details: In its last year of market exclusivity, AbbVie's blockbuster drug Humira was in the top spot on ICER's list. The wholesale price was raised by 7.1%, while the net price increased by 2% — leading to $386 million in additional costs, ICER found.

• That was followed by Johnson & Johnson's multiple myeloma drug Darzalex, whose 6.2% net price increase added $248 million in costs, and Pfizer's breast cancer therapy Ibrance, with a 4.5% net price increase that added $151 million in costs.

What they're saying: "We continue to see list price increases above inflation for many of the most costly drugs," said ICER chief medical officer David Rind.

• The latest report was the fifth time ICER identified "unsupported" price increases. Drugmakers have taken issue with how ICER makes its assessments.
• "The arbitrary methodology supports misleading conclusions about biopharmaceutical value and evidence, which should give anyone pause before making patient access or other policy-related decisions based on the report," the National Pharmaceutical Council said in a statement.

Health care was one of three sectors, along with government and leisure/ hospitality, that accounted for nearly all of November's job growth, Axios Markets' Emily Peck writes.

• Those three sectors, plus private education employment, account for 81% of new jobs this year, wrote James Knightley, ING's chief international economist.

Flashback: Health care employment recovered from its COVID-driven labor shortage earlier this year, according to Altarum. And as of this summer it was 3.2% above pre-pandemic levels, though employment at nursing and residential facilities still lagged.

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