January
26
2012
We’d be better off as a profession if more of us became more involved in the profession. But the big question I always get when I challenge everyone to get involved is “but what can we do?” Sometimes, sending a message to a politician might actually help precipitate positive change. And a story out of Washington State is a prime example of what can happen if we just make an effort.
I stumbled upon an article from The Arlington Times online today. The story is about Arlington Pharmacy in Arlington, WA. General manager Cory Duskin was actively voicing concerns about PBM practices like forced mail order policies and concerns over shipping refrigerated products to Rep. Kirk Pearson (R- 39th District).
The results of Duskin’s actions are HB 2303 and it’s companion bill- SB 6096 in the Washington State legislature now. And what are these bills about you might ask? The first line of HB 2303 says it all- “An act relating to protection against unfair prescription drug practices by pharmacy benefit managers …” which sounds good to me right from the start!
This legislation, which has bipartisan support in Washington State, addresses concerns over some of the pharmacy benefit manager (PBM) practices we’re all familiar with already. Things like preferred pharmacies, forced mail order filling of prescriptions, and stability concerns for shipped prescription products all helped urge lawmakers to act. Duskin simply wants the playing field to be level between mail order pharmacies and his own store. That seems like a reasonable request to me.
Duskin points out that his store is highly regulated by the state. He can be inspected for everything from the store’s temperature to name tag checks for employees. His refrigerators could be inspected by the board to make sure they are within the limits necessary for proper medication storage. And yet mail order pharmacies can ship something to a customer that can sit in a box for days or longer without proper refrigeration. The results could be a loss of expensive medications. And that always seemed like a waste of resouces for a healthcare system desperately trying to find ways to cut costs.
Duskin believes that the PBM preferred mail-order pharmacies should be regulated to the same extend as brick-and-mortar pharmacies in his state. He argues that a level playing field where every pharmacy is treated the same is better for patients. He also thinks patients should be able to choose where they want to shop for their prescription needs. And I agree with him 100%! Personal choice, not insurance mandates from PBMs, should drive patients to mail-order pharmacies or their local drugstore. But that isn’t how the system works right now.
I think Duskin has some critical points in his argument. He welcomes competition from other pharmacies including mail order facilities. But at the same time, he thinks the choice for where to fill prescriptions should be left to the individual patient, not their insurance company. He points out that a free market system only works if it is truly a free market. A level playing field would help to make community pharmacy more of a true free market.
The point I am trying to make by sharing this story isn’t to highlight some individual pharmacy-related legislation in one state in the United States. It’s to demonstrate what even one person can do if they make an effort for change. There is legislation in Washington State right now that could help bring positive changes to pharmacies all across that state. And it all started with one store manager and one state representative who asked some very specific questions about issues that impact pharmacies all over the state and beyond.
There is some signs of hope for the profession of pharmacy coming from efforts such as HB 2303 in Washington State. This example just demonstrates what is possible if we stop whining and complaining about all the issues affecting community pharmacy and instead attempt to bring positive change to the industry.
Patients already know PBMs are telling them what pharmacy they can use and what price they will pay for prescriptions. Pharmacies all across the country already know PBMs are cutting them out of the healthcare system by driving patients and prescriptions away from home town pharmacies. These facts aren’t new. Now it is time to stand up and fight for the ideas we believe in and the concept of patient choice.
So as you read this article about the changes that could be coming in Washington State because of the concerns of one person, ask yourself what is possible if you voice concerns about the influences of PBMs or pharmacy working conditions to your state’s representatives? Perhaps we aren’t that far away from seeing the profession change for the better? It just takes a little effort and the right person to listen.
Positive change can and does happen! The efforts right now in the State of Washington to address some of the questionable actions by PBMs is proof of that. There are signs of hope for the profession of pharmacy. You just have to know where to look.
The Redheaded Pharmacist
January
23
2012
Maybe it is the bad economy that is driving people into desperation? Or perhaps the drug abuse problem has reached an epidemic level and people are simply trying to feed their habit? Either way, pharmacy-related crime is on the rise and it is increasingly violent in nature.
It’s enough to scare the average pharmacy employee to read the latest news online or watch the evening news report on television. If you happen to see any pharmacy story, chances are it’s a report about an armed robbery of a pharmacy. People are desperate and they are boldly taking action. And your local pharmacy seems to be a magnet for criminals.
We all know we have the two things that criminals want: drugs and money. And we have them in one convenient location. Couple that with the fact that the average pharmacy is designed to be open and accessible for patients and customers and you have a recipe for trouble. Criminals have easy access to us just like patients and customers do.
I’ve talked about this issue of safety in the pharmacy workplace before. High profile violent crimes are happening all across the United States with a frequency that’s alarming. The pharmacy crime wave has brought the issue of safety to the minds of pharmacy employees, owners, and even state board members. It’s time we all recognize what is at stake now and take the necessary steps to protect ourselves while behind the counter at work.
Some states are passing stricter safety requirements for pharmacies. New York is looking into safety issues related to pharmacy operations after a string of recent violent crimes. Pharmacies are adding elaborate security camera systems and devoting extra time training employees how to handle robberies. Many stores now have silent alarms in place that can contact the authorities in the event of an emergency. But are these measures enough?
I’ve read stories of individual pharmacies that have taken extreme measures such as keeping the main doors locked and buzzing in patients and customers or installing bulletproof glass for protection. Do we need these kinds of safety precautions in this day and age? Has it come to the point where pharmacy employees should be separated physically from the customers for our safety?
I’d like to think that my personal safety is not in question while on the job. I don’t spend my day at work worrying too much about being robbed. There are thousands of other issues, problems, and duties that keep me busy enough so I’m not focused on safety issues. Maybe that’s the problem? Shouldn’t we all make more of an effort to be aware of the potential dangers at work?
And then there is the question of what else can be done to protect pharmacy employees. Should we be allowed to carry firearms at work? Is it really necessary to have a store with a pharmacy open all hours where there is access to the pharmacy 24 hours a day? Should state boards step in and demand certain safety or security standards for pharmacies or is that the sole responsibility of the employer or owner of the pharmacy?
We seem to focus on lots of other issues impacting the profession of pharmacy such as PBMs or accuracy. Those issues are important but we tend to overlook employee safety. I see a general lack of concern over the safety of pharmacy employees regardless of practice setting. Sure, there are things in place specifically to address workplace safety. But are we really doing all we can?
Maybe I’m just a bit paranoid after the robbery experience I went through years ago? Once you live through a robbery situation as an employee, the issue of safety becomes a lot more real to you personally. And while that day I experienced ended with no one getting hurt, other instances of robberies did not end so favorably for some pharmacy employees. It’s not like we can deny there are safety concerns with our profession. Things do happen.
Personally, I’d like to see the major pharmacy organizations take a more active role in developing and suggesting safety standards for pharmacies. I’d like for employers to spend more time focusing on security issues and maintaining employee safety. We should all feel safe and secure while on the job. We should also recognize that pharmacies are at risk. That is the reality now.
This struggling economy coupled with an epidemic of drug abuse has created a very volatile environment for pharmacies. And the desperation that sometimes drives criminals to act has been bringing them to pharmacies more often in recent memory. We’re a target whether we like it or not.
But how far should we go with safety measures? Is it now necessary to enclose retail pharmacies completely from the general public? Do pharmacies need extensive security camera systems now? What about time-delayed safes or panic buttons? How about an armed security guard on duty at night? There are so many questions related to this issue.
I don’t see the trend of increased crime at pharmacies reversing anytime soon. And because of that, we’ve got to do everything we can to make sure we are all safe while on the job. Safety is important. But what does that statement mean for all of us? What should we all be doing to protect ourselves? What do you think?
The Redheaded Pharmacist
January
19
2012
At work recently I was talking with another pharmacist about immunizations. She asked me the question “do you think we should be immunizing children?” I had to think about my answer and what childhood immunizations in the community pharmacy setting really involved.
That question by the other pharmacist wasn’t exactly random. Efforts are being made in my state by some to expand the immunization role of pharmacists. That expanded role could include being legally able to administer a larger variety of vaccines to patients. But it could also include authorizing pharmacists to give vaccines to children.
Currently, pharmacists can legally immunize patients in all 50 states. But age restrictions and even what vaccines we’re allowed to administer varies from state to state. And if you live in my state, you know there is a big effort to get the laws changed to allow pharmacists to offer more immunizations and make them available to much younger patients.
Now before I tell you how I feel about this idea of immunizing children, let me say I’m well aware of the positives. Pharmacists do make vaccines more convenient for patients. Vaccine administration is an expanding role for pharmacists that can’t be cannibalized by mail-order pharmacies. And pharmacists have shown they are capable of administering vaccines safely and effectively to patients. It also increases revenues and profits for a community pharmacy business that works on very small profit margins.
I’m not about to try and deny all the positives. But having said all of that I think vaccinating children involves a whole new set of challenges. Children are more unpredictable than adults. I’d be nervous about spending the extra time needed to ensure a pediatric patient is comfortable and ready to receive a vaccine. Also, I would worry about reactions to vaccines and the emergency protocols for handling a child who is having a severe allergic reaction.
I also have concerns about follow-up vaccines for children. If the vaccine regulations are really going to expand for pharmacists in my state, that expanded role could inevitably include vaccinating children for all kinds of normal childhood vaccinations. The problem is that several childhood vaccines involve a series of shots where proper timing of the vaccine series is important. I could see a potential nightmare trying to get parents to bring a child back in for a follow up so the child could meet some deadline for their next shot of a particular series. It could be done with proper planning but ensuring children are getting a vaccine series in the appropriate time intervals is another challenge we as pharmacists would have to face.
I know there are lots of pharmacists who believe in expanding the immunization role of pharmacists. But personally, I think that it’s a mistake for pharmacists in the community setting to vaccinate children. I don’t think the average retail pharmacy is capable of handling the special circumstances and needs of the pediatric population. Personally, I wouldn’t want to administer vaccines to younger children. I just think some things are best left for a child’s pediatrician in a doctor’s office.
I am curious though to hear from other pharmacists, pediatricians, and even parents on this issue. As a parent, would you feel comfortable taking your child into a pharmacy for a vaccine? Would pediatricians support pharmacists vaccinating children in the community setting? If you are a pharmacist, do you think we are capable of administering vaccines to children safely and effectively?
Maybe I’m just nervous about the unpredictable nature of children? Maybe I’m worried this will become one more duty for already over-worked retail pharmacists? Or maybe I am just overlooking the potential opportunity pharmacists have to provide a valuable service to younger patients? Whatever it is, I don’t like the idea of vaccinating children and I plan to voice my concerns about the issue to my state’s pharmacists association telling them I think it’s a bad idea.
But what do you think? Is it a good idea for pharmacists to immunize children? Are we capable of providing this valuable service? Is it safe to administer vaccines to children in pharmacies? Let me know what you think!
The Redheaded Pharmacist
January
16
2012
“Is that transfer coupon promotion back on this week?” I asked as I held the phone up to my ear. I was already getting one transfer from another pharmacy and a patient just requested three more. We checked the paper and sure enough, transfer coupons were back. I couldn’t help but think to myself “who makes these decisions?”
I knew the answer. Just like so many other poor decisions, there was one source of my frustrations with my employer. The decision makers don’t know the first thing about filling a prescription. Yet they still make all the important day to day decisions related to how several pharmacies operate. And there lies the problem.
It isn’t an original thought. I’ve talked about this fact before along with others. Many pharmacists and technicians have struggled to grasp the idea that most of the people that hold the power positions in community pharmacy are no more a pharmacist than I am a lawyer. They’ve never spent one shift behind the counter at an actual pharmacy. They don’t know the stresses and challenges of doing retail pharmacy work. They don’t see the consequences of their decisions. Either they don’t understand, or they don’t care.
Community pharmacy is now dominated by a handful of large chains and general merchandise retailers who will throw a pharmacy into their stores simply to attract customers. We’ve become an afterthought now or a loss-leader instead of a legitimate profession. We’ve lost our identity as a healthcare service provider completely.
Pharmacists have lost control of community pharmacy. We are blowing through a rough ocean and the winds on our little sails come from regulations, insurance companies, and employers who don’t work at the store level. Patient care has been replaced with prescription metrics as the primary focus for many pharmacies. It’s all about the numbers now.
And pharmacists, afraid of losing the carrot that is always dangled in front of us (our jobs), have become ineffective champions for our own best interests. Community pharmacies have often been reduced to simply providing a commodity (prescriptions) instead of a valuable service (patient oriented medication therapy). We’re no different now from a big box electronics retailer other than the obvious point about lives being at stake everyday in a pharmacy.
But what has frustrated me personally over the years is that decisions are being made at pharmacies by people who has never filled a prescription. If you treat a community pharmacy like a grocery store or even a fast food restaurant then you miss the point completely about why we are important. Pharmacies are often the only place people have easy access to healthcare advice from a real professional without spending a fortune or having to make an appointment weeks in advance. Consider us the urgent care for the masses.
The fact that a $4 generic list, drive-thru window, or prescription transfer coupons even exist should tell you something is wrong. Encouraging patients to hop from store to store, giving away products for free or even paying customers to take them, or short-staffing to the point of being dangerous are all things that most pharmacists would never allow, IF they were in control. But that is the problem, we’re not in control.
Someone asked me what happened to retail pharmacy the other day at work. I told them we allowed outside forces to take over our profession and our business. It’s true and once that control is lost it is very difficult to regain. We are a profession of mostly passive work-a-holics who simply want the paycheck and the piece of mind that comes with our jobs instead of wanting to question the status quo. After all, there are bills to pay and we have families. We can’t afford to risk losing our jobs right?
Well, it is that pacifism that’s led our profession away from holding all the power. We are now at the mercy of regulators, politicians, and business majors who control our livelihood and make all the important decisions for us. It is their decisions, no matter how detrimental they might be, that are the final say at the pharmacy.
So there I was on the phone that day, knowing that all of my frustrations with work were due to things out of my control. The decision had already be made by someone else to offer prescription transfer coupons. It didn’t matter that patients could forget where their prescriptions were located or that pharmacists could potentially miss a critical drug interaction because of that poor decision. The company had spoken! And as I sat there on hold with another pharmacy, I couldn’t help but think this is what’s wrong with community pharmacy.
I just wish there was a way for the profession to regain even a little of that control back. What if some pharmacists stood up for the profession and created some positive changes? What if we demanded a minimum set of working conditions including mandatory lunch breaks (real ones) and proper support staffing? Imagine how much better things could be for all of us? But the frustrations that drove me to write this post also makes me realize that regaining control probably isn’t going happen.
There are so many decisions made each day that are critical for the operations of the average community pharmacy. I’m simply wondering why so many of those decisions are made by people who aren’t pharmacists or have never worked in a pharmacy? When did pharmacists lose all the power to make our own decisions? And more importantly, how do we get that decision-making power back? Is that even possible anymore? That’s something to ponder the next time you’re on hold for a transfer at work!
The Redheaded Pharmacist
January
12
2012
I came across an interesting article the other night about a chain of urgent care centers. But what caught my attention was the efforts being made by this company to gain the right to dispense prescriptions directly to patients. And I can’t help but wonder what everyone thinks about a non-pharmacist practitioner dispensing prescriptions directly to patients.
First a little background for you. The company in question is called ZoomCare and they are based out of Portland, OR. Their clinics are urgent care style facilities available for patients for quick treatment and same-day appointments. They have some unique features like a scheduling function on their website (or by phone) and they promote same day appointments.
According to an article here in The Lund Report, ZoomCare has also been involved in efforts to become authorized to dispense prescription medications directly to patients in their clinics. There was an effort by pharmacy organizations in the State of Oregon to block previous legislation that would have allowed practitioners such as physicians assistants at these ZoomCare clinics to dispense non-narcotic bottled prescriptions directly to patients.
And while the original draft of legislation addressing the dispensing of prescriptions failed, there is now a second effort to bring a bill to the legislature. And with some revisions, the Oregon State Pharmacy Association has now supported the new bill. The revised bill is expected to be heard in the state’s legislature next month.
But what changes were made to the proposed law and how does that affect patients and practitioners in the State of Oregon? There are two main revisions of the original failed bill that will make it possible for urgent cares like ZoomCare to dispense medications. First, a ”drug outlets” category would be created allowing urgent cares like Zoomcare to do dispensing functions under supervision of the Oregon Board of Pharmacy. The second change was that any ZoomCare clinic would be required to contract with a licensed pharmacist who will be in charge of following all rules and regulations related to medication dispensing.
If the bill passes in the Oregon legislature, there would be limits to what a “drug outlet” facility could dispense to patients. Basic emergency medications for things like infections or pain would be covered under the revised bill. But, ZoomCares would not be able to dispense any narcotic prescriptions to patients. Other things like basic preventative medicine would also be allowed to be dispensed by the clinics. So while these urgent care locations wouldn’t be operating full pharmacies, they would have a variety of medications on hand at their clinics available for direct dispensing to patients.
So what do you think about the proposed law in Oregon? Should facilities such as an urgent care clinics be allowed to dispense medications directly to patients? Is the requirement of being contracted with a pharmacist enough to ensure patient safety? Should non-pharmacist prescribers be allowed to dispense medications directly to patients?
I think that the revisions to this bill at least address the need for a pharmacist to be involved in dispensing. Patients should have access to a licensed pharmacist anytime they are given prescription medications. They need to know all the details of the prescribed medications they are receiving. And who better to do that education on therapy other than a licensed pharmacist?
I’m curious to find out if the pharmacist must be on location at these urgent care centers to meet the new requirements in this bill or can they be off site. I think patients should have access to a pharmacist at the clinic or urgent care facility if they have questions or concerns related to their medication therapy.
In general, I think it is a bad idea for non-pharmacist providers to directly dispense prescriptions to patients without a pharmacist involved in the dispensing and counseling process. I just feel that pharmacists are the most qualified to dispense directly to patients. There could be safety concerns with dispensing medications without directly receiving counseling from a pharmacist.
It will be interesting to see if Oregon passes this bill and how will it affect pharmacies. Is this idea just putting patients in danger or do providers like physician assistants have the necessary skills to effectively educate patients regarding their prescriptions? What do you think?
The Redheaded Pharmacist
