Should Pharmacists Charge for Professional Advice or Services?

Published Online: Thursday, December 29th, 2011

The title says it all. I have a simple question for everyone today: should pharmacists charge for professional advice or services rendered to patients while on the job?

Specifically, think about all the interactions that community pharmacists have with patients and customers everyday at your local drugstore. Now think about how many times that pharmacist actually bills a patient for that advice. Usually, we are giving away our professional advice and even some basic services like blood pressure checks for free. And I can’t help but wonder if we should start charging for some of those interactions.

Think for a moment about everything you’ve done for patients at work recently if you are a community pharmacist. I can recall several times during my career where I did everything from checking a patient’s blood pressure to doing a blood glucose test for a diabetic. What about all the advice we’ve given regarding the proper use of prescriptions or over the counter (OTC) medications? The bill for all of that advice or those services was usually zero dollars.

For all the talk we do as a profession to highlight the fact that we are the drug experts of the healthcare system, I can’t help but wonder why we aren’t capitalizing more on that distinction? Put it another way, name another specialty field in the world of healthcare that doesn’t charge for their advice or services. I can’t think of one. They all demand payment for their knowledge and usually it doesn’t come cheap.

Now I know how this might sound. Why should a patient pay just to get some advice or a quick BP check from their local pharmacist? We are behind the counter all day anyway so why can’t patients tap into our knowledge for free? After all, those dispensing fees and profits made on prescriptions should cover our salaries and the store’s overhead right? Ah, but that isn’t the point. I’m not talking about profitability here. I’m wondering why we aren’t valued like other healthcare professionals who do charge for their advice or services.

Let me take a moment to point out that I would personally feel a little uncomfortable charging patients for every little piece of professional advice. Maybe that extreme isn’t practical or viable? But is the other extreme where we simply give away all of that advice or basic services really our best option as a profession?

We now live in an era where some doctors’ offices actually charge patients a fee just to call in a prescription even without an office visit involved. If a doctor’s time is worth say $10 or $20 just to call in a prescription, shouldn’t a pharmacist’s time be valued at something higher than zero dollars for everything we do for patients? Either that or pharmacies should fight to garner decent reimbursement rates for filling prescriptions that would reflect these other functions we do for the insurance company’s patients.

Let’s face the facts, everyone. The pharmacy profession has been devalued by everything from the drive-thru window to the $4 generic list. Are we further devaluing ourselves voluntarily by not charging for our area of expertise? Face to face medical advice is rarely free outside of your local pharmacy. Yet we continually give it away and then are told by the insurance world we’re no better than some robot. I don’t understand this at all!

Let’s use the ultimate pharmacy buzz word as an example of what could be. Everyone likes to talk about medication therapy management (MTM) services as the future of pharmacy. But often those services involve giving professional advice to patients we already do now, for free! Does calling our professional advice an MTM service finally deem that interaction worthy of asking for payment? If so, let’s just call everything we do MTMs and get the billing process started right now.

I’ve watched the profession of pharmacy veer down a dangerous path over the last several years. We’ve allowed insurance companies, big business, and politicians to take complete control over our profession. And as a result, we are now often thought of as glorified salespeople. We just happen to deal with drugs instead of other items like groceries or alcohol but the business model isn’t much different. And that has helped lead us down a path of professional devaluation.

And part of that devaluation reality includes giving away professional advice for free. Some patients even challenge the advice of a pharmacist based solely on something they read on the Internet or heard from a family member or friend who doesn’t even work in healthcare. It’s as if we don’t go through years of training and studying just to become pharmacists. And I can’t help but wonder if giving away tons of professional advice contributes to this mindset?

So what’s the answer? Should retail pharmacists demand to bill for advice and services rendered? Should I refuse to give a free blood pressure screening to an elderly woman who I know can’t or won’t go to the doctor to have her BP checked because of money? These are tough times and many patients can’t afford health insurance or even basic medical services like routine check-ups even if they have health insurance. Don’t we have a duty to do what we can for all of those patients even if we can’t charge them for it?

I’d like to know what others think. Are community pharmacists missing out by not charging patients and customers for professional advice or basic services? Would that just be a shameful money grab for the profession? Shouldn’t we expect some kind of payment for any professional advice or services we provide just like any other healthcare professional? What do you think?