Mothers just don’t get enough credit for everything they do.  Their influence on the lives of their children are immeasurable. 

      My mom deserves some sort of medal of honor for all she put up with between myself and my brother growing up.  Two boys full of energy are about as much as one mom can handle.  Yet she handled the task of raising us with grace and strength. 

      She definitely deserves credit for helping me become a pharmacist.  There were times I wanted to quit pharmacy school and just give up.  I’m sure a lot of us have gone through some moments like that as we met the challenges that pharmacy school throws our way.  

       But it was those times that my mother, among others, was there to encourage me to continue.  I’m just not sure I would have been able to finish on my own. 

      My mom would actually make a good pharmacist herself.  Her compassion, kindness, and ability to listen to others would serve her well in the profession.  Patients would appreciate her honesty and hard work.  She would treat everyone like family. 

       But today to me isn’t about my pharmacy career.  Today isn’t about the job of pharmacist that can frustrate me at times.  Today is about the woman who helped me to get to the point where I could find out what pharmacy was like first hand. 

      So thanks mom.  That is the simplest way I can articulate all that I’d like to say to you.  My mom has helped this pharmacists through lots of good times and bad.

       But today it is her day.  Happy Mother’s Day mom!  I hope all the mothers out there have a great day. 

The Redheaded Pharmacist

       The Supreme Court of the United States is hearing just such a case right now.  Just a couple of weeks ago oral arguments began for a very unusual court case.  And the resulting ruling by the Supreme Court could have an impact on the future of medicine.

       For the previous few decades the practice of patenting human genes has been legal in the United States.  In fact, according to this Fiscal Times article roughly 20% of all human genes already have existing patents.

       But now that practice is being challenged in court.  The case involves Myriad Genetics and their patented diagnostic test BRACAnalysis.  That diagnostic test checks for a pair of mutated genes that are excellent markers for predicting breast and ovarian cancers in women. 

       Myriad owns the patent on the two genes involved in that diagnostic test.  And this means no other company can develop and market products that would similarly screen for those mutated genes. 

       The problem is that the diagnostic test Myriad has available sells for thousands of dollars.  And some groups including the American Civil Liberties Union (ACLU) are not happy about that fact or the fact that Myriad has those exclusive rights. 

       The arguments for and against patenting genes are familiar to those of us who work in pharmacy.  They are very similar to the arguments for and against the patenting of prescription drugs. 

       On the one hand, patent protection encourages exploration and development because of the potential profits involved.  While on the other hand, restricting who can develop tests or manipulate a certain gene may result in higher costs for any and all resulting medical breakthroughs.

       I’ll refrain from trying to predict what the Supreme Court will do in this case.  But I will say that the reason the case made it to the highest court is the fact that a US Federal Court of Appeals ruled in favor of patenting genes late last year. 

       The potential impact of a court case such as this is quite large.  I fully believe that the future of medicine lies in gene therapy.  And removing patent protection on genes could slow down advancements in this area of medicine.

       On the other hand, cost effective care is the current buzz phrase of choice for the healthcare system.  And removing patent protection on genes could lead to lower cost treatments and diagnostic tests in the near future. 

       So what do you think?  Should the genetic makeup of a human be something that can be patented?  Should we only allow alterations of genes or other manipulations to be patentable?  What happens to all the existing patents if genes are ruled unable to be patented by the Supreme Court? 

       I don’t know the answers to any of those questions.  But what I do know is that one of the most promising area of medicine could be impacted by this ruling. 

       What will that mean for the future of medicine?  How will the outcome of this court case potentially impact what we see on the shelves of pharmacies years down the road?  Is this area of medicine too important to restrict with patents or is it too important not to have patent protections available?

        I don’t know.  But I do know that the big question right now seems like a simple one- to patent or not to patent.  But it is anything but a simple question to answer. 

The Redheaded Pharmacist

       It’s almost inconceivable to think that someone could be capable of the actions that occured at the end of the Boston Marathon on April 15th, 2013.  Two young men left home-made explosives that detonated and killed three people while injuring over one hundred others.  In the aftermath, a security officer was also shot and killed. 

       The media frenzy surrounding these events and the ensuing manhunt for the individuals responsible rivaled the 9/11 coverage in scope and intensity.  An entire major U.S. city was left practically at a standstill while these dangerous men were still at large. 

       For me, all of the expected human emotional responses were triggered.  I was fearful and scared.  I was angry and upset.  And I was confused asking myself how and why such a thing could happen.

       But then I took notice of something fairly obvious and yet so easily overlooked by the media: the response to the attack by many good people in the aftermath of this bombing.  There was a lot of good that happened.  It’s just not something we often notice. 

       Boston is a literal hotbed of top quality medical facilities.  The immediate area surrounding the route of the Boston Marathon has some of the best hospitals in the world.  And they more than proved it this past week. 

       There were many people that stepped up in this time of crisis.  The Boston police, fire, and emergency services performed excellent under immeasurable pressure.  Many federal and state organizations coordinated efforts to focus on a greater good. 

       Medical centers in the area received waves of patients with seriously injuries as if they were in a war zone.  But the healthcare system in place stepped up and met the challenges it faced.  Disaster drill training kicked in and healthcare workers were forced into overdrive. 

       I’m here to remind everyone that the profession of pharmacy was a small but important part of that effort.  How many pharmacists and pharmacy technicians worked hard to help those bombing victims?  I’m positive it would be a large number if it could be calculated.

       Think of all the victims of this attack who needed medications for some relief from their pain or to prevent some further harm such as an infection.   Think of all the third-shift pharmacy employees who assisted with the treatment of patients who were in surgery until late into the nights after the bombing. 

       Our healthcare system is often criticized for it’s shortcomings and it’s failings.  But we do still have top quality healthcare in the United States.  And one of the areas where our system shines is emergency medicine.  And pharmacy plays an important role in that effort. 

       It makes me proud to think that I am a small part of a profession that was critical in helping the victims of the Boston Marathon bombing.  And think of all the hard work area pharmacists and technicians will do in the next few days to help patients.  Pharmacy is a vital public service that will help Boston residents in the recovery process going forward. 

        I hope our profession takes time to recognize those individuals involved in the response and recovery efforts in Boston.  Credit is deserved for a job well done.  Maybe one of the larger pharmacy organizations could find a few individual pharmacy stories and highlight them?

       I’ve always complained that the profession of pharmacy is the victim of negative press.  We’re rarely spoken of unless something bad happens. 

       But in Boston this past week, we were able to see a shining example of everything that is right in the world of pharmacy.  Will the world see or hear about those efforts?  I sure hope so!

       A terrible terrorist act happened in Boston, MA on April 15th, 2013.  But in the aftermath of the bombing there were many places to look to for that hope and comfort we all desperately needed.  And pharmacy, along with all of healthcare, was one source for that hope.  

The Redheaded Pharmacist

   The second question is an easy answer of no for me.  My response to the first question is a bit more complicated. 

    Back in the day, I grew up with aspirations of becoming a medical doctor.  My interest in science and medicine with a healthy fascination of just how the human body worked steered me towards medicine.

     But as I entered college, something happened.  I volunteered at a local hospital in their emergency department.  And while I was there I talked with practicing physicians, interns, and medical students about my career interests. 

      Guess what happened?  Not one of those doctors or medical students recommended medicine as a career. In fact, they were more likely to advise me to avoid the career completely.

     Just think about that for a moment.  The career you always thought you wanted for yourself was suddenly shunned by everyone you could find that was actually working within that field. 

     Naturally, I became worried that medicine really wasn’t for me.  And then I talked to a couple of pharmacists.  The rest, as they say, is history. 

     I then spoke with a couple of pharmacists about a career in pharmacy.  They recommended pharmacy without hesitation.  These pharmacists loved what they did and enjoyed their interactions with patients.

     Pharmacy seemed to offer the work/home balance I was interested in maintaining.  I didn’t want to be “married to the hospital” as a couple of the interns warned. 

     Pharmacy also seemed like a better fit for my personality.  It was more laid back.  People were comfortable talking with pharmacists.  Doctors just seem to be more intimidating to the average patient. 

    Now fast forward several years after my career plans were in place.  Could I still say the same positive things about pharmacy today as I heard from others back then?  Would I recommend the profession to a young student who came to me now? 

    Pharmacy has become more challenging since my days in pharmacy school.  A whole host of changes have been ushered in that impact my work and my profession.

    But I honestly still think pharmacy is a good profession.  I’d still consider becoming a pharmacist to be a smart career path.  Pharmacy has been good to me. 

    But I qualify the above statements with words of caution.  Pharmacy is at a critical crossroads.  More changes are coming.  More challenges must be faced. 

    And we do now live in a “fast food pharmacy” era.  The insurance industry and the pharmacy benefit manager (PBM) world negatively impacts our professional lives.

    But all is not lost.  I refuse to believe that a group of highly educated professionals will be reduced to nothing by organizations driven by greed and power.  We are better than that aren’t we?

    Pharmacy still attracts highly qualified bright students.  We have future leaders in the wings sitting in pharmacy classes all over the world right now.  That fact gives me hope. 

    But bright people joining the profession isn’t enough.  We need to be active pharmacists.  We need to be involved pharmacists.  We need to put on our boxing gloves and swing for the fences. 

    I’m not sure if I’d get the same glowing recommendations from other retail pharmacists today as I did all those years ago.  And to me, that doubt is a shame. 

     But that change in sentiment demonstrates the battles that the profession now faces.  And it highlights the urgency with which we should treat them. 

     So yes, if a student asks me about the profession of pharmacy I will give my enthusiastic recommendation.  But it will be tempered with cautions and doubts.  I simply want to be honest with anyone that asks me. 

     I just hope as our profession continues to evolve there is less doubt and fear among us.  The future can be a scary proposition.  But the profession of pharmacy doesn’t have to be feared or spoken of in the past tense.  It’s still our profession.

The Redheaded Pharmacist

      I was reading an interesting article in the paper over the weekend.  The subject was the U.S. corporate tax code and how it influences corporate profits. 

     The main focal point of the article was the trend of U.S. corporations moving money overseas to avoid increased tax burdens.  The author basically argued that an overhaul  of the corporate tax code was well overdue. 

     Within that article, there was an interview with a business consultant.  He was advising his business clients on the potential changes that could be on the horizon. 

     He basically told his clients that “if you don’t have a seat at the table, you’re on the menu.”  This meant that companies needed to be involved in the process of change to ensure their own best interests. 

     The profession of pharmacy and all it’s member pharmacists aren’t that different from a corporation awaiting these tax law changes.  We too face uncertainty and change.  Politicians influence our lives just like they impact corporate profits through policies and regulations. 

     Pharmacists need to become more involved in the power positions within our profession.  We need to voice our concerns to those people in positions of power. 

     What does that mean exactly?  It could mean that pharmacists need to become more politically active.  We also need a greater influence over the corporate boards that dictate so much of what we do. 

     We can also become more visible to our state boards and even reach out to the press to help show what our problems are and what needs changing.  These things can help show the world that what we do is important and what can go wrong is dangerous. 

     I’ve spoken before about the idea that pharmacists are too passive and/or reactionary.  We need to learn to be proactively involved in our profession.  There are dozens of issues of critical importance to our future that need to be addressed.

     But if we sit back and rely on politicians or corporate executives to look out for our needs, we will be sorely disappointed.  It’s our responsibility to voice concerns to the people in power.

     Pick an issue and run with it.  It could be something as simple as mandatory lunch breaks or as complicated as enhanced prescribing authority for pharmacists.  Whatever your cause, make it your responsibility to strive for improvement. 

     The bottom line is that we are on the verge of major change.  And if we don’t have a seat at the table to influence that change, I’m afraid we are what’s on the menu! 

The Redheaded Pharmacist

       In case you haven’t heard by now, CVS just announced they will implement a “voluntary” Wellness Program for it’s employees.  The program will require employees to either fill out a health screening questionnaire including a disclosure of their weight or pay a $50 surcharge per month. 

       Normally my knee-jerk reaction would be that CVS is being, well CVS.  I’d consider them utterly reprehensible and complain about their unfair treatment towards their employees. 

       But unfortunately for workers in the United States, this move by CVS is a growing trend.  Companies are now treating obesity like smoking.  And they’re making patients pay for it.  Fair or not, this is our new reality.

        Company providing health insurance are realizing that obesity is a high risk group just like smokers.  This means that an employer like CVS wants to know what percentage of it’s employees are in these high risk groups. 

       The trend now is that employees may have to answer questions or even undergo some sort of health screening requirement to get the best health insurance rates.  And what if something is wrong?  Well, that might just cost you. 

      The entire concept of insurance is based on pooled risk theory.  And employers are realizing that it’s perfectly legal to separate employees based on risk factors such as obesity or smoking and charge those patients accordingly. 

       So what do I think about CVS’s policy?  I don’t like the idea of employees having to jump through hoops to get a preferred health insurance rate.  And I definitely don’t like the idea of being penalized $600/year for not participating in a “voluntary” program.

       It reminds me of the mail-order refill policies that are “voluntary” but come with a significant co-pay reduction versus filling those same maintenance drugs through traditional retail pharmacies.  I’d hardly consider that to be voluntary. 

        The bottom line is that companies are really starting to concern themselves with the health of their employees.  Healthier employees use less healthcare services and miss less work.  And employees that use more healthcare services due to a risk factor such as obesity may have to pay higher rates or a penalty going forward. 

        This new CVS policy is more a sign of the times rather than a reflection of them specifically.  But if this CVS policy becomes the norm at other companies and not the exception, that doesn’t bode well for the rest of us. 

The Redheaded Pharmacist

      Drug prices have always been a bit of a mystery for consumers.  And the recent spike in the cost of the antibiotic doxycycline have only further confused the average consumer. 

       Add in the fact that most patients pay for prescription medications using some sort of complicated third party insurance and you have a recipe for further confusion.  Patients simply don’t understand drug prices. 

       Recently the antibiotic doxycycline became more difficult to obtain.  The result was a shortage and a massive increase in cost.  Patients who were able to buy this medication for less than $10 a few months ago may now find that the exact same medication will cost them well over $100. 

      That quick availability status change and subsequent price increase understandably confuses and concerns the average consumer.  Patients don’t understand how those kinds of drug price increases could happen in a relatively short period of time.  Even worse, they may assume that pharmacies are guilty of price gouging. 

      The reality is that prescription drug prices are a function of a complicated relationship between supply, demand, and other forces including third party insurance plans and company pricing policies.   For the average consumer, the best advice is to trust but verify. 

      Consumers need to realize that drug shortages are a reality that is all too common in modern medicine.  They also need to realize that shortages can lead to back-orders or significant increases in drug prices if the medication in question is still available. 

      But patients also need to understand that drug prices are complicated and constantly changing.   We always recommend price matching and using other means of discounts such as rebate cards or discount cards available from your doctor or pharmacy.

      What consumers need to realize is that pharmacies aren’t trying to pull a fast one on them when they charge more for a medication.  That price is a reflection of what the medication costs the pharmacy and how much is covered by your insurance. 

      Doxycycline is a recent and extreme example of just how quickly a medication can increase in cost.  But it does highlight industry-wide questions related to price transparency and consumer confusion. 

      Consumers need to arm themselves with as much information as possible.  My advice to patients?  Ask for a price quote and see if your pharmacy, like many, will price-match.  Look for other discounts as a means to lower costs.  And ask your pharmacist about lower cost alternative therapies. 

      Contrary to popular belief, pharmacists are actually interested in saving patients money.  We are a resource for consumers to use if they are confused about drug prices and availability. 

      When in doubt, just ask.  We’ll tell you all about the latest availability and pricing issues with doxycycline or any other medication.  Just keep one thing in mind- our answers might not be what you want to hear!

The Redheaded Pharmacist

     I was working one day recently and a customer dropped off a new prescription.  I checked first to see if we had the medication in stock.  Bad news, we didn’t have any of the drug.

     I told the patient we could order the medication and that it would be in on Wednesday.  He responded with this question “So can you guarantee that this drug will be here this Wednesday?”  The answer I’m afraid is no. 

     Not too much later in the same shift an elderly lady dropped off a prescription. It was brand only and she handed me a new insurance card.  As she handed me the new ID card, she says “can you guarantee me that my insurance will cover this?”  Again, the answer is no. 

     There is this need by people to have all kinds of absolutes in life.  So many of us want guaranteed happiness.  Unfortunately, life isn’t that simple or accommodating.  Things happen and guarantees are rare. 

     So when a customer asks me if I can guarantee that we will still have flu shots available in a month I respectfully decline.  Or when someone asks me to guarantee that a particular drug will work for them I’m forced to disagree. 

     Life is never simple enough to rely on uncertainties as if they were set in stone.  And life behind the counter at my local pharmacy isn’t any different. 

     Of course, this lack of absolutes does work against me as well.  There is no guarantee that I will have a job the next day.  Though I may dismiss the thought of anything major happening to my employment status, it’s always a possibility. 

     People need to learn that guarantees are not handed out that often in life.  And when they are, they’re usually negatives.  Death and taxes are two glaring examples of the dark side to life’s guarantees.   

     I wish my customers and patients weren’t so demanding.  I think that certain expectations by patients are unwarranted.  Yet they still ask for them.  And I still have to decline. 

     So please everyone don’t expect too many guarantees out of life.  And if you do come across one, don’t be surprised if it is something you don’t want anyway. 

     We all have things we want to count on in life.  But few things in life are true guarantees.   This is true at the pharmacy just as it is everywhere else. 

The Redheaded Pharmacist

       According to this Yahoo article, there is a new study released by Visante that looks to compare prescription waste.  The study, commissioned by the Pharmaceutical Care Management Association (PCMA), found that waste was lower for mail-order prescriptions compared to prescriptions filled at traditional retail pharmacies. 

       According to their results, mail-order pharmacies attributed for only 1/3 of the wasted prescriptions dispensed to Medicare patients.  The other 2/3 was attributed to traditional drugstore prescriptions. 

      They also found that less than 1% of total prescriptions filled for Medicare patients were wasted (meaning filled but never taken by the patient).  Visante found that overall prescription waste was rare and it was attributed to factors such as auto-refill programs or patient death. 

      It’s easy to get lost in the numbers if you look through the actual report.  But the overall goal of this study was simple, make community pharmacies look bad and make mail-order pharmacies look good.  Keep looking if you hope to find a true waste comparison report. 

      This study was commissioned by the organization that represents pharmacy benefit managers (PBMs).  They have a vested interest in making community pharmacies look bad when compared to mail-order pharmacies.   The PBM industry fuels the mail-order pharmacy business because they usually have an ownership stake.

      An independent study would carry a lot more weight.  Furthermore, clarification on the exact methods of data collection used to compile the results would also help anyone seeking to find useful comparison information. 

      This study is merely a promotional product for the mail-order pharmacy industry.  Mail-order pharmacies want to be seen as the model of efficiency.  Their goal is to shift more business away from retail pharmacies.

      Their focus on waste related to a patient’s death is curious.  By the study’s own admission, only a small percentage of prescription waste is associated with the death of a patient.   I never saw anything related to prescriptions being lost in the mail or sent to the wrong patient.  Those numbers are left unreported. 

      The PCMA is trying to convince our government that mail-order pharmacies are a better choice for Medicare prescriptions.  They want to prove that mail-order is less expensive. 

       I have always challenged the idea that mail-order pharmacies are less expensive.  A true cost-comparison analysis would show that mail-order pharmacies only gain pricing advantages through artificial means such as discounts.  And an honest look at waste would evaluate it from all sources.

       Community pharmacy has been under assault by the PBM industry for quite some time.  Mail-order pharmacies only compete with traditional pharmacies because patients are forced into using them. 

       If mail-order pharmacies were really the clear choice over traditional community pharmacies, there would be no need for discounted co-pays or mandatory mail-order plans.  Patients nd insurance plans would shift their business to mail-order pharmacies on their own. 

       You don’t have to subsidize a good idea.   You don’t need to mandate the most sensible choice to consumers.  This is simply a way to push the government further towards mail-order. 

       This is the battleground retail pharmacy now finds itself.  How do we fight an industry so rich and powerful it can create it’s own truths?  How do we combat a study designed specifically to make us look bad?  We need to answer these questions soon before the PBMs of the world answer them for us.

The Redheaded Pharmacist

       An awkward ritual for many employees; the performance evaluation is chalked up as a necessary evil for so many us.   Unfortunately, pharmacists aren’t immune from such a process. 

       The general justification for a performance evaluation is to assign merit and to quantify performance.  Those job scores are usually used for the purpose of calculating employee raises.  So why do I dread my performance evaluations so much? 

       It’s not that I think I’ve done a poor job.  It’s just that my real performance is often ignored or over-looked. 

       Modern day performance evaluations for many community pharmacists have turned into another game of metrics.  We aren’t evaluated on what we do anymore.  We’re judged on business metrics and corporate focal points. 

       I have no problem with the concept of an evaluation.  I know my boss and my employer want to see that I’m doing my work in a competent and efficient manner.

       But for once, I’d love for one of my employee evaluations to be just that- an evaluation of MY work.  I don’t think numbers like generic percentage calculations for my region or store is a valid metric to judge my work as a pharmacist. 

       So much of community pharmacy has been reduced to business analysis.  We’re all so focused on minimizing lost revenue and maximizing profits that the thought of patient care or helping people becomes a secondary goal at least on paper. 

       I watched some college basketball games the other weekend.  One of the announcers said this about a player who was just taken out of a game- “he does so many things that don’t end up in the stat sheet.” 

       That’s the way I feel sometimes as a retail pharmacist.  I do a lot of things that will never end up on one of those business reports.  Patient care just isn’t as easy to quantify as inventory levels or generic percentages.   

       I guess this is one more example of how community pharmacy pushes pharmacists away from our instinctive patient-care thought processes.  We simply aren’t judged by our work as much as we’re held accountable for the performance of a store or geographical area. 

       So yes, I will sit through another employee evaluation soon.  But the talk that will flow from that meeting will have little to do with how well I’ve done. 

        I just hope that we haven’t ordered too many expensive drugs lately.  After all, that’s the true measure of a good pharmacist isn’t it?  Not really, but it sure seems that way.

The Redheaded Pharmacist