May
17
2012
I thought about back when I decided to apply to pharmacy school. I thought about the motivations and thoughts going through my head as I made my final decision. Some of those same thoughts have recently returned.
Back when I was debating my future, several things impacted my final decision. I wanted a stable career that would allow me to make a comfortable living. Helping people was also something that drew me to pharmacy. And a healthcare related job was always appealing to me.
But there was something else that drew me to pharmacy. I thought the profession of pharmacy gave me an opportunity to be a part of something bigger than myself. And that meant a lot to me.
It was that idea that stuck with me over the years. Being part of a huge profession of individuals whose mission was improving health was a big plus for me. It made being a pharmacist more than just a job. It was a profession.
Now I feel that same sense of opportunity in front of me. The profession of pharmacy is at a critical crossroads. The next couple of years may shape our profession for decades to come.
Pharmacists have a rare chance to fundamentally change and define our roles. Healthcare is an evolving field. This means pharmacists can adapt to any changes that come or risk being left behind.
We often discuss the dispensing function of pharmacists. It’s a point of concern for some pharmacists that our impact on healthcare is often limited by our involvement in the drug delivery process of medicine. Sure, there is more to pharmacy than dispensing. But many positions within the profession do seem to be self limiting.
What if there were ways for us to expand our roles in the healthcare system? What if patient care by pharmacists was defined in new terms like complete disease management or preventative care?
Just look at the recent consideration the Food and Drug Administration (FDA) is giving to a third class of medication? Not only could pharmacists control the distribution of those drugs directly, but we could also push for mid-level practitioner status. That would mean widespread prescribing authority for pharmacists.
How about looking at our roles in disease management? I’m under the belief that pharmacists are more than capable of doing limited blood testing with the proper facilities and testing equipment.
I’ve already been involved in functions like cholesterol screenings or blood glucose testing for patients in the community pharmacy setting. These kinds of pharmacist functions could easily be expanded without compromising safety or drastically altering practice models.
But to get where we want to go as a profession we have to engage and face our challenges. These are not good times to be an unorganized and inactive profession. It is critical to fight for our own interests instead of sitting back and hoping for the best.
And that brings me back to that idea I had before becoming a pharmacist. I wanted to be a part of something bigger than myself. And these crossroads we now face as a profession gives us another opportunity to do just that.
This is a rare chance for pharmacy to help secure a vital role in healthcare instead of being relegated to some volume based repetitive motion job. This is a chance to secure our futures and livelihood. This is a chance to be part of something bigger than ourselves.
The Redheaded Pharmacist
May
14
2012
One of the things about the profession of pharmacy that fascinates and confuses me is the fact that there are so many people outside our profession who simply don’t understand what we do for a living. They either don’t know or don’t care about the challenges and strains of being a pharmacist. I’m just wondering what could be done to change that.
I’ve been a pharmacist for over a decade now. And in that time working in the community pharmacy setting I’ve observed many patients and listened to their comments and questions. And one thing really strikes me about them- so many have no clue what we do as pharmacists!
Why is that? Why is the general public more often than not blind to the job description of a pharmacist? Why can’t patients realize that their prescription might be taking a little longer to fill because the pharmacist is checking on a potential drug interaction or other problem?
So often now the general public views pharmacists as mere drug dispensers. The simple act of handing a patient a prescription bottle seemingly defines our very existence and purpose for so many people now. In other words, no one understands us or more importantly what we do for them.
I think this aspect of perception is one of the biggest challenges the profession of pharmacy faces going forward. Patients need to be educated about what we do for them and why that work is important. But will they listen or even care to hear that kind of message?
One of the shortcomings of our great profession is our ineffectiveness at delivering a message of purpose. We don’t clearly describe our many functions including complete medication reviews, drug allergy screenings, compounding, counseling, and disease management and prevention functions just to name a few. Public perception pigeon holes our profession into simple dispensing functions and little more.
Is a major advertising campaign in order? I’ve always thought the major pharmacy organizations could be more effective at promoting our work to the public. An effective ad campaign highlighting our strengths could change public perception for the better. It’s worth a try.
What if patients simply don’t want to hear the message? They’ve been conditioned to think we are there only to give them pills and that is what they want from us. For everything else, there are doctors right? This is the mindset we’ve got to overcome as a profession to move forward and break out of this dispensing only perception.
Patients need to know that the IV bag hanging next to their hospital bed is helping them in part due to the work of a pharmacist. Retail pharmacy customers need to realize that they aren’t getting that bad reaction to a medication they are allergic to because somewhere a pharmacist thought to check for that problem and avoided it by calling the prescriber to have a medication changed.
It doesn’t help that we live in an era of mass media that not only is easily accessible to everyone via a myriad of formats but also tends to sensationalize and highlight the negative. Disasters, criminal behavior, and gross negligence do in fact help media companies increase ratings. But in the case of pharmacists, only highlighting instances where something goes wrong ignores all the good work we do everyday for patients.
And part of the importance of telling patients about what we do is to educate them on what they don’t know or understand. People who aren’t pharmacists don’t understand the stresses and difficulties of the job. They can’t imagine the feeling a pharmacist has deep in their stomach when they even suspect they’ve made an error that could potentially hurt a patient in any way. That stress alone can be too much for some people to handle.
In a perfect world patients would realize how important our work is and give us plenty of uninterrupted time to properly complete the tasks at hand. But we all know that doesn’t always happen. More often than not, we are overworked and under severe time restraints to fill prescriptions and get the rest of our work done.
I’m just wondering if there is anything we can do at this point to try and help people understand our work. Are there ways to help patients care about our duties and realize we are doing important functions that help to protect them from harm? I can only hope there is an answer to that question.
We face many challenges as a profession these days. But to me, one of the biggest hurdles we now face is a question of perception verses reality. Many members of the general public simply don’t understand about the work we do as pharmacists. And finding ways to change that reality will be one of our biggest challenges going forward. Are we ready to meet this challenge? Can we help people to understand us? I sure hope so!
The Redheaded Pharmacist
May
10
2012
Well, we all now know about the combination of the retail pharmacy chain CVS with the pharmacy benefit manager (PBM) and mail-order service provider Caremark. Now it seems Walgreens is expanding their mail-order and specialty pharmacy services presence with an acquisition of their own. And I can’t help but wonder if there is more of these kinds of deals in the works.
What I am talking about is the recent announcement by the retail pharmacy giant Walgreens that they are acquiring certain assets from BioScript Inc. according to this Yahoo! Finance article. Basically, Walgreens is acquiring specialty pharmacy, mail-order pharmacy, and centralized pharmacy businesses from BioScript for about $225 million. So what does this all mean?
Basically, Walgreens will be able to expand their mail-order services business, specialty pharmacy business, and build on their central fill prescription refill business model all at the same time with this purchase. But is this a big deal or just a minor purchase from a large retail chain?
Admittedly, this is not an acquisition of the scope and scale of say a CVS and Caremark merger. BioScript is not some huge PBM Walgreens is buying. The value of this deal is addmittedly peanuts by comparison.
But I do find it interesting that all of the larger retail pharmacy chains seem to be interested in expanding their own mail-order pharmacy capabilities. I think they realize that mail-order pharmacies are here to stay and rather than fighting them for the business they are losing, they would rather replicate that business model for themselves.
This of course leaves the question as to what Rite Aid will now do themselves to try and position their company to win in this new mail-order maintenance fill world of community pharmacy. And rest assured, some deal will come involving the third largest retail pharmacy chain. In fact, yours truly has on more than one occasion at work speculated that the newly merged Express Scripts and Medco combined PBM might be interested in making a bid for Rite Aid.
Rite Aid themselves might even be primping their results and making their company look like a better acquisition target. Every chance they get, Rite Aid is bragging about improvements in their results as part of their leaner and meaner business strategy. Sure, they still have a long string of negative earnings quarters, but Rite Aid still could be a relatively cheap purchase for the likes of the new Express Scripts Inc.
And lets face it, what better way could there be to turn around the pharmacy results at a struggling but slowly improving large retail chain than to have it merge with a PBM and then have that arm of the combined company force plan participants into using either mail-order pharmacies or Rite Aid stores for their prescription needs? And if you think this could never happen, just ask patients with Caremark insurance about where they go for their prescriptions and why.
What I’m trying to say is that the inevitable mergers that will now happen thanks to a Medco and Express Scripts merger goes way beyond simple consolidation of the PBM industry. What I would expect to see going forward is that there will be more alliances and even mergers between retail pharmacy chains and either mail-order pharmacies and/or PBMs. Competition and margin pressures will drive this trend because none of the larger retail pharmacy chains will be able to make any money without some sort of alliance or affiliation with either a mail-order pharmacy or PBM (or both).
And that prediction of further consolidation and merging has me worried that more and more patients will have some sort of insurance plan that will force their hand and make them use certain retail pharmacy chains for their prescription needs or even worse forcing them to use only mail-order pharmacies. This is already happening to millions of plan participants all over the country but I’m worried the trend is only going to increase.
So where does that leave the rest of us? How do retail pharmacy chains or independents without some PBM as part of their name compete? What can the rest of us do to attract and more importantly maintain a customer base when their insurance companies are literally telling them where to shop? Those are valid questions but they are hardly easy ones to answer.
I just wish there could be some way to return the purchasing power to the consumer. If the playing field was level and patients truly had a choice, retail pharmacy would be in great shape. Patients usually appreciate and value their local community pharmacies and the relationships they develop with the pharmacy staffs at those locations. But if they are forced to shop elsewhere by insurance edicts, what recourse do we have as an industry to respond?
That Walgreens acquisition story I mentioned above is really a small business story related to community pharmacy. But it might also be a window into a much bigger trend that will impact all of us down the road. This little acquisition by the biggest of the big might be a hint as to what the future holds for community pharmacy.
For the big retail pharmacy chains, it has become a situation where they can’t beat mail-order pharmacies at their preferred provider game so they are instead joining forces with them. And I can’t help but wonder what this means for community pharmacies going forward? I guess the old saying is true- if you can’t beat them, you might as well join them!
The Redheaded Pharmacist
May
7
2012
The United States Food and Drug Administration (FDA) has been making the news recently. They are considering a proposal to make some prescription medications over the counter with the restriction that they must be obtained from a licensed pharmacist. So what does this proposal mean and how will it affect the profession of pharmacy?
This isn’t really a new concept. The debate over a potential third behind the counter (BTC) class of medications has been discussed for a while now. But it seems that the FDA is now seriously considering the proposal according to this Washington Times article.
But why now? Why is the FDA suddenly more motivated to look at the idea of a third class of medications? It’s all about money. And to me, that is one area of concern.
You see, the FDA is actually getting a lot of political pressure to look for ways to save the healthcare system money. Medicare is an increasing financial burden on the federal government. This means government officials are looking for any means possible to contain healthcare costs. And prescription drug prices is an easy target for anyone looking for ways to cut healthcare costs.
One of the ideas to help contain costs is this third class of medications. The idea is that patients won’t have to go to their primary care physician for certain drugs that are now prescription only. Pharmacists could dispense those medications directly to patients thus saving the healthcare system the added cost of the doctor’s office visits. But are things really that simple?
Medications will only qualify for this new BTC status if they meet the FDA’s condition of “safe use” without a prescription. All of the proposed BTC medications will be evaluated on an individual basis for this “safe use” classification and each drug could have it’s own set of rules and conditional restrictions for being dispensed without a prescription. But can this idea work and what will our role be as pharmacists?
First, lets look at that cost issue. I’m afraid consumers may notice an increase in healthcare expenditures if a third class of medication is added. While it’s true patients will forgo the expense of seeing their prescriber in the office, these medications might not be covered by their health insurance plan anymore. This means any cost savings from eliminating an office visit will likely be offset by the increased out of pocket expense of the medications.
This proposal from the FDA is also dividing doctors and pharmacists on opposite sides of the argument. According to this Medscape Medical News article, doctors seem to feel there are safety concerns with eliminating primary care providers from the drug selection process. “In our view, lack of oversight from a practitioner could be a serious concern” said Dr. Sandra Fryhofer, chair-elect of the AMA Council on Science and Public Health according to the article.
And some physician groups feel certain chronic diseases are simply too complicated for dispensing medications by a pharmacist without a prescriber first evaluating the patient. The Endocrine Society told the FDA to exclude diabetes medications altogether from the proposed list of drugs placed in the new BTC class. Why? Because they believe that “diabetes is an extraordinarily complex disease.” They add that prescribing medications for diabetes ” should rest with the primary care physician or endocrinologist.”
For pharmacists, the FDA proposal seems like a natural extension of our professional duties. We are the drug experts of the medical community after all. Why not have us more involved with the direct dispensing of medications? It could increase medication access to patients and lower costs to the system.
Well, I do have a couple of concerns. First, there is the idea of a “safe use” requirement for any drug that will be included in the new BTC class. While this is a good idea to ensure safe dispensing of what used to be prescription only medications, it may complicate the BTC class for pharmacists. We will have a whole new class of medications to dispense, each with their own individual set of rules and regulations required before legal dispensing. That complicates the job of pharmacist immensely.
Also, pharmacists should push for a way to be compensated for the professional judgement and counseling involved in dispensing these medications without a prescription. I worry that there won’t be any kind of counseling or dispensing fee involved in administering these BTC medications. We will effectively be giving away professional services for free.
Unless you can incorporate a professional services fee into the cost, we will be offering these medications without compensation. No other medical professional would give away expert advice without getting paid to do so. Why should pharmacists offer up these services and advice for free?
And finally, some of the medications under consideration for this new class of drugs require blood work and test results to accurately dispense. Will pharmacists be allowed to expand our roles further to offer the needed screenings or will patients have to get that done before going to the pharmacy? Monitoring parameters complicate the ability to simply dispense a medication without a prescription.
So what do I think of the FDA’s proposed third class of medications? While I freely admit this proposal is a huge opportunity for the expansion of the duties of pharmacist, that extended role does come with some logistical issues and safety concerns. Pharmacists have an opportunity here to secure and define our future role in the healthcare system. But this idea must be implemented correctly for it to work.
I also worry that the FDA is considering this proposal not based on their faith in the profession of pharmacy, but instead as a direct result of political pressure to rein in healthcare costs. While you may consider the motivation behind their proposal as irrelevant, I fear they are rushing to a decision based on political pressure instead of sound public health policy.
Despite opposition from medical groups, pharmacists are in fact capable of this expanded role in drug delivery. But any BTC class of medications must be created with patient safety in mind. And patients must realize that they personally may not realize the cost savings that could result from the creation of a third class of medications. What do you think?
The Redheaded Pharmacist
May
3
2012
The car ride felt like it took forever. It was actually only a couple of hours long. But when you are a young boy desperately trying to get to the beach and leave school behind you, that amount of time seemed like an eternity.
My parents would take my brother and I to the beach on a regular basis growing up. We liked to swim and we liked not having to think about school and homework. There were no tests to take at the beach or projects to finish. It was 100% fun.
I can remember taking walks with my brother down the street from where we stayed to the closest convenience store. We’d buy baseball card packs, candy, and drinks. There was nothing better than a cold drink on a hot summer’s day.
Those beach trips as a family growing up were great. But it wasn’t just the fact that there was an ocean and my family was together that made those trips fun. It was the fact that they were great escapes from the stresses and responsibilities of life.
On vacation, my biggest worries would usually involve what we were going to eat for dinner or how to avoid a sun burn. Mom would yell at us to come in and take a break from being out in the sun. Sometimes though, we’d still get a little sunburn despite our best efforts to avoid it.
As I thought about those trips, I realized how important it was for all of us to just get away from it all. Even if it was just for a weekend, we were all mentally decompressing and simply slowing down and having fun.
I didn’t have to worry about fitting in at school or finishing some project that was due in science class on Tuesday. I was at the beach! Nothing else mattered to me.
Now fast forward more years than I care to admit. I’m now an adult and working for a living instead of going to school. I still get sunburn easily. Somethings really never change.
But as I think about work and the stress involved with what pharmacists do for a living I realized that I still need those great escapes every once in a while. It is important to get away from it all occasionally. After all, you work hard and owe it to yourself to forget pharmacy for a while and have fun.
I’m going on a trip to the mountains with my fiancee in just a couple of weeks. It isn’t a big trip, just a few days away from the stresses of the job. But it still means a lot to me that I am able to take some time to get away and to spend with my future wife. We don’t get enough of that magical “quality time” I hear is a good thing in any relationship.
We are happy to spend hours in the car to get away from work and everything that comes along with a stressful job. It is important for us to take time together and escape away and simply relax and have fun. Work will always be waiting for us when we get back. The pharmacy will open without me as I used to say.
I guess what I am trying to say is that I’ve learned over my lifetime that a body needs some time to mentally and physically recover from the stresses of life. And that recovery period usually involves getting away from where you call home even if it’s just for a couple of days. Sometimes, even a little time away is enough.
It is important to find your own great escapes from the third party claims, angry customers, prescription back-orders, and all the other things that make our jobs hectic and stressful. I’ve learned that every once in a while I need to just get away from it all. Even as a kid, it was important.
So do yourself a favor and find a place to go simply to get away from it all. Find that feeling of bliss that I remember from being a little redheaded boy spending time at the beach. Find that avenue to escape everything that makes your job difficult. It will be worth it in the end.
I still have most of those baseball cards I bought all those years ago. I might take them out one day soon just to look through them. They are a reminder that it’s healthy to get away sometimes just to put work behind you. Somehow those little pieces of cardboard represent just how important a great escape can really be. I can almost hear the ocean waves in my mind just thinking about it.
The Redheaded Pharmacist
