Chains... What Are They Good For?
Published Online: Wednesday, July 13th, 2011
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I'm a huge fan of the social media. It gives me a chance to throw ideas out and see the response of others who are active in the social media. I try to share my thoughts at least once a week on my blog, but life gets hectic and sometimes I have trouble sitting down to put together a post.
As a result, I have become a huge fan of Twitter. I can share quick thoughts and get feedback almost instantaneously. Recently I made a comment about chain pharmacy ruining the profession of pharmacy. A fellow Tweep asked me to explain. I was going to send him an email, but then it struck me that the topic could be something I could use for a blog post, so here it is.
Let me start out by saying that chain pharmacy has put a lot of food on my table and made a lot of house payments for me. I have worked in the chain environment for the first 16 years of my pharmacy career. I have learned a lot from these experiences. When I started, the chains weren't too bad to work for, but over the years I have witnessed the profession of pharmacy devolve into its current state.
What is now accepted as pharmacy practice in the chain pharmacy setting is a far cry from what it once was. Marketing ploys have changed the profession of pharmacy into simply a retail job. This post will focus on some of these ploys that have taken pharmacy to unprofessional place that it is today.
First up... insurance contracts. I can assure you that an independent pharmacist wasn't the first person to sign an AWP - 17% + $1.50 contract. It was the big boys. The ones who are able to withstand the lower reimbursement rates because they get larger discounts by buying in bulk. Smaller operations were forced to accept the low rates or risk being dropped from a PBM's network. Now the PBMs have developed multiple reimbursement formulas that capitalize on multiple reimbursement formulas. AWP, WAC, GEAP, FUL, and MAC may look like alphabet soup to you, but to the PBMs it's a means to guarantee that they will pay the least amount for a medication that they can. Some insurers have gone as far as to establish their own MAC lists. Good luck getting a copy of that list. In the take-it-or-leave-it world of PBM contracts, most pharmacists sign the contract without even reading the reimbursement rates. And we can thank the chains for starting us down that road.
Next on the list... gift cards and coupons. Pharmacy is a medical profession, not a marketing ploy. But rather than growing pharmacy business by offering superior medical care, the chains decided to start bribing patients to come to their establishments. Transfer two prescriptions and get 25 bucks in gift cards has become the norm. These days the chains use the gift cards to handle complaints from customers. That's right, I called them customers and not patients. Patients have relationships with their medical professionals. How many district managers have ever used the term patient counts? It's always customer counts. That's how they view the pharmacy patrons.
Next up... 24 hour pharmacies. Other than emergency departments, what medical professionals are open 24/7? Let's expand the question to professionals in general. How many lawyers have 24/7 hours? Or accountants? Yet pharmacists are working in these conditions all over the country. And if you've been paying attention to the news, you'll see that there have been a number of pharmacy robberies lately. Should medical professionals be putting their lives at risk so that Henry can pick up his Vicodin at 4:00 AM?
Ever see one of these... drive-thru pharmacies? Some will argue that drive-thru pharmacies offer a convenient alternative to people who may have difficulty walking back to the pharmacy department. Ask a person in retail pharmacy who actually utilizes the drive-thru. Rather than helping a very small segment of the patient population, drive-thru windows have advanced the notion of fast-food pharmacy.
Speaking of which... 15 minutes guarantees on prescriptions? Thank you, Rite Aid, for that wonderful idea. While I have worked at pharmacies that have been able to have wait times of less than 15 minutes, it was never guaranteed. The guarantee puts an extra level of stress on the medical professionals who work in the pharmacy. Can you imagine your dentist promising root canals in 15 minutes or less? You would question how professional the service would be. Enough said.
These are just some examples of what the chains have done. There are many other things that the chains have promoted that have helped to devalue the profession of pharmacy. Feel free to share them with me.
As a result, I have become a huge fan of Twitter. I can share quick thoughts and get feedback almost instantaneously. Recently I made a comment about chain pharmacy ruining the profession of pharmacy. A fellow Tweep asked me to explain. I was going to send him an email, but then it struck me that the topic could be something I could use for a blog post, so here it is.
Let me start out by saying that chain pharmacy has put a lot of food on my table and made a lot of house payments for me. I have worked in the chain environment for the first 16 years of my pharmacy career. I have learned a lot from these experiences. When I started, the chains weren't too bad to work for, but over the years I have witnessed the profession of pharmacy devolve into its current state.
What is now accepted as pharmacy practice in the chain pharmacy setting is a far cry from what it once was. Marketing ploys have changed the profession of pharmacy into simply a retail job. This post will focus on some of these ploys that have taken pharmacy to unprofessional place that it is today.
First up... insurance contracts. I can assure you that an independent pharmacist wasn't the first person to sign an AWP - 17% + $1.50 contract. It was the big boys. The ones who are able to withstand the lower reimbursement rates because they get larger discounts by buying in bulk. Smaller operations were forced to accept the low rates or risk being dropped from a PBM's network. Now the PBMs have developed multiple reimbursement formulas that capitalize on multiple reimbursement formulas. AWP, WAC, GEAP, FUL, and MAC may look like alphabet soup to you, but to the PBMs it's a means to guarantee that they will pay the least amount for a medication that they can. Some insurers have gone as far as to establish their own MAC lists. Good luck getting a copy of that list. In the take-it-or-leave-it world of PBM contracts, most pharmacists sign the contract without even reading the reimbursement rates. And we can thank the chains for starting us down that road.
Next on the list... gift cards and coupons. Pharmacy is a medical profession, not a marketing ploy. But rather than growing pharmacy business by offering superior medical care, the chains decided to start bribing patients to come to their establishments. Transfer two prescriptions and get 25 bucks in gift cards has become the norm. These days the chains use the gift cards to handle complaints from customers. That's right, I called them customers and not patients. Patients have relationships with their medical professionals. How many district managers have ever used the term patient counts? It's always customer counts. That's how they view the pharmacy patrons.
Next up... 24 hour pharmacies. Other than emergency departments, what medical professionals are open 24/7? Let's expand the question to professionals in general. How many lawyers have 24/7 hours? Or accountants? Yet pharmacists are working in these conditions all over the country. And if you've been paying attention to the news, you'll see that there have been a number of pharmacy robberies lately. Should medical professionals be putting their lives at risk so that Henry can pick up his Vicodin at 4:00 AM?
Ever see one of these... drive-thru pharmacies? Some will argue that drive-thru pharmacies offer a convenient alternative to people who may have difficulty walking back to the pharmacy department. Ask a person in retail pharmacy who actually utilizes the drive-thru. Rather than helping a very small segment of the patient population, drive-thru windows have advanced the notion of fast-food pharmacy.
Speaking of which... 15 minutes guarantees on prescriptions? Thank you, Rite Aid, for that wonderful idea. While I have worked at pharmacies that have been able to have wait times of less than 15 minutes, it was never guaranteed. The guarantee puts an extra level of stress on the medical professionals who work in the pharmacy. Can you imagine your dentist promising root canals in 15 minutes or less? You would question how professional the service would be. Enough said.
These are just some examples of what the chains have done. There are many other things that the chains have promoted that have helped to devalue the profession of pharmacy. Feel free to share them with me.
Fred Eckel July 14th, 2011 11:07:5411:54:56 AM
Eric, Yes some chain pharmacy operations have made drug dispensing a commodity activity. How much of the problem falls on the pharmacists who let it happen in the name of business. Sort of reminds me of the frog in the bucket that heats up and the frog burns up because of the gradual change in the environmental. Now it is almost too late to change it. The oversupply of pharmacists makes it easy to replace a non-cooperative pharmacist. A colleague pharmacist shared with me that he worked for a chain as a pharmacist manager, closed the drive-in window to assure a safe working environment, was overruled by the non-pharmacists store manager, left the pharmacy and was fired. Now he's having trouble finding a job. So much for challenging the system.
Karen Voigts July 14th, 2011 03:07:4603:46:35 PM
I work in 2 private pharmacies. We have always (I've worked in 1 of them for over 10 years, and the other over 24 years) walked outside to the cars of those few patients who can travel to the store, but are unable to walk in.
Years ago I worked in a pharmacy with a drive through window. In every other way, it was the least advanced pharmacy I'd ever been in ( if you could call having a drive-up window advanced pharmacy practice). Ask any pharmacist or tech who works a window. They'll tell you how difficult and unprofessional it is, especially with the burdens the chains put on them with limitations on time.
I don't even want to start on insurance contracts...
Years ago I worked in a pharmacy with a drive through window. In every other way, it was the least advanced pharmacy I'd ever been in ( if you could call having a drive-up window advanced pharmacy practice). Ask any pharmacist or tech who works a window. They'll tell you how difficult and unprofessional it is, especially with the burdens the chains put on them with limitations on time.
I don't even want to start on insurance contracts...
Ed Sandoval July 27th, 2011 10:07:0610:06:15 AM
Back in the old days, thirty years ago, the patient not the customer knew who their pharmacist was. Now, even with manadatory laws on counseling and HIPPA we are lucky if we counsel any patients since the volume exceeds the counseling..Sad, very sad.
Terrell Milby July 27th, 2011 01:07:3401:34:05 PM
I have been an independent pharmacist for 20 years and what I have observed is the continued "cheapening" of our profession by the use of the gimmics mentioned, plus the $4.00 lists and the free antibiotic list offered by other chains. By doing this we have made our services worth less and less and makes the education we received seem less and less valuable to society. Where does it end? It ends when chains are the only game in town. Until laws are changed to prevent the criminal acts chains are commiting against independents, or until we are allowed to negotiate for prices as one unified group, our very existence falls into question. Do we go down without a fight, or do we have any high ground whatsoever to fight from. Good question.
Gary Oleson July 28th, 2011 02:07:0302:03:47 AM
Go ahead. Take a cheap shot at chain pharmacy. As long as you're at it you just might look around at other players. The Fat Cats driving reimbursements down over the years. Big Business, Big Pharma, Big Government, Big Education --- they are all to blame. Not to mention that we allowed(encouraged?) this to happen. Open your own lazy eyes and realize that the source for our grievances comes from the push to "socialize" medicine and our own unwillingness to confront these problem as they became evident.
Eric, you are as much to blame as the chains. Just because the end game is uglier than you might like, you wash your hands and point the blame at the chains. Shame on you and your myopic view of the world. You are to blame, too! Don't complain unless you have a solution. Either we all hang together, or surely will will hang individually.
Eric, you are as much to blame as the chains. Just because the end game is uglier than you might like, you wash your hands and point the blame at the chains. Shame on you and your myopic view of the world. You are to blame, too! Don't complain unless you have a solution. Either we all hang together, or surely will will hang individually.
Eric Durbin July 31st, 2011 06:07:5806:58:34 AM
Gary,
I suggest that you visit my blog (link on sidebar) to see some of the ideas that I have suggested for the advancement of the profession. I am well aware of all the players who have driven the profession to where it is today.
I had a "little state of the profession" series on the blog last September/October. You might want to check it out.
Eric
I suggest that you visit my blog (link on sidebar) to see some of the ideas that I have suggested for the advancement of the profession. I am well aware of all the players who have driven the profession to where it is today.
I had a "little state of the profession" series on the blog last September/October. You might want to check it out.
Eric
J Robin August 16th, 2011 06:08:4406:44:20 AM
Pharmacist are to blame really! Our salaries in the 80's were above average but modest. It wasn't until the 90's that our pay exploded, but it was at a cost! Most pharmacist are not in a union. This was to our benefit because our salaries increase greater than they would ever if we were unionized, the only downside is that we have zero protection other than our profession association, which none of us belong to because we do not want to pay the annual dues. I work with nurses that are unionized and I hear at least monthly that the work that they should be doing is against their union contract and that pharmacy needs to do it. Pharmacist need to be unionized, if we were we would never be in the place we are today.
Jennifer B February 3rd, 2012 09:02:1109:11:46 AM
Didn't Dominos Pizza get into trouble for a 30 minute delivery guarantee because of the amount of accidents the drivers were causing? How many people will Rite Aid kill???
Overnight Pharmacist May 15th, 2012 06:05:3206:32:46 PM
I work as an overnight pharmacist at a retail chain store that is surrounded by 9 emergency rooms. We absolutely need 24 hour pharmacies. With all of those emergency rooms, I am extremely busy filling the recently discharged patient's prescriptions. Most of them had been waiting so long in the er, that by the time they come to me, their medicine that was given in the er is starting to wear off. Most cannot wait until a pharmacy opens later in the morning. At least in my particular chain, no one is forced to work that shift. Those of us that do, love working it. As far as the robberies, it does happen, but it is just as likely to happen during the day. In our area, most of the robberies occur during the lunchtime hours.
The reason I am adding to this blog is to express my discontent with the direction our profession is going. With the addition of all types of immunizations, wellness testing, and etc, we are becoming more like advanced level nurses than we are pharmacists. Our expertise is being underutilized so we can perform tasks that quite frankly are better suited for nurses or advanced level practitioners. I understand that it is making these things more accesible, but at what cost? Patients now have to wait longer to get their prescriptions due to flu shots, wellness tests and etc. Most of the time there is only one pharmacist on duty. Since the more strict counseling guidelines have come into effect a pharmacist is expected to be at numerous places at one time. For example, if a pharmacist is out performing a cholesterol test, a person trying to pick up their prescription must now sit and wait until the pharmacist is done giving the test.Even though this may just be a continuation of a maintenance med, the patient must still wait till the pharmacist physically comes over to them before it can be rung up. A prescription can no longer be sold and sent over to the consulation window for counseling. Texas now requires that a pharmacist engage the patient before the transaction at the register can proceed. Stores do not give you additional man hours to help accomodate these additional tasks. So you can see the additional stress added to the pharmacy staff and the increased possibility of errors. All these additional "Beneits for the customer" have only increased the amount of angry customers, stressed out the pharmacy staff, and increased the likelihood of errors. This isnt the profession I went to school for.
The reason I am adding to this blog is to express my discontent with the direction our profession is going. With the addition of all types of immunizations, wellness testing, and etc, we are becoming more like advanced level nurses than we are pharmacists. Our expertise is being underutilized so we can perform tasks that quite frankly are better suited for nurses or advanced level practitioners. I understand that it is making these things more accesible, but at what cost? Patients now have to wait longer to get their prescriptions due to flu shots, wellness tests and etc. Most of the time there is only one pharmacist on duty. Since the more strict counseling guidelines have come into effect a pharmacist is expected to be at numerous places at one time. For example, if a pharmacist is out performing a cholesterol test, a person trying to pick up their prescription must now sit and wait until the pharmacist is done giving the test.Even though this may just be a continuation of a maintenance med, the patient must still wait till the pharmacist physically comes over to them before it can be rung up. A prescription can no longer be sold and sent over to the consulation window for counseling. Texas now requires that a pharmacist engage the patient before the transaction at the register can proceed. Stores do not give you additional man hours to help accomodate these additional tasks. So you can see the additional stress added to the pharmacy staff and the increased possibility of errors. All these additional "Beneits for the customer" have only increased the amount of angry customers, stressed out the pharmacy staff, and increased the likelihood of errors. This isnt the profession I went to school for.
Your comments are valuable to us. Thank you.
Eric, Pharmacist
Blog Info
Eric Durbin, RPh, discusses the challenges that pharmacists face today, and what is needed to advance the profession.
Author Bio
Eric Durbin, RPh, is director of pharmacy for a critical access hospital located in east central Ohio. Prior to taking this position, he worked in the community pharmacy setting for 16 years, during which time he learned a great deal about the obstacles pharmacists face in providing quality service and patient care; the often complicated relationship between pharmacists and patients, as well as pharmacists and physicians; and what is required to advance the pharmacist profession.
Mr. Durbin graduated from Ohio Northern University, where he earned a BS in Pharmacy. He started a medication therapy management consulting company in 2009, the same year he began writing the popular blog, "Eric, Pharmacist." In his blog, Durbin seeks to address the key issues pharmacists face while offering helpful insights and solutions.
Mr. Durbin is a member of the American Pharmacists Association. He can be found on Twitter at www.twitter.com/EricRPh.
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666 Plainsboro Road
Building 300
Plainsboro, NJ 08536
P: 609-716-7777
F: 609-716-4747
Copyright HCPLive 2006-2011
Intellisphere, LLC. All Rights Reserved.