In 2 different presentations I heard something I have not heard discussed for a long time. Both speakers suggested that we could experience an over-supply of pharmacists. Recently, I have heard some pharmacy leaders suggest that the supply of pharmacists seems to be adequate in their geographic area, but they have not suggested an over-supply. The first presentation suggested that as e-prescribing increases, expert system-enhanced computer systems become more common and technicians' role expand, the number of pharmacists needed to fill prescriptions will decline. The other speaker suggested that if pharmacy benefit managers (PBMs) are able to promote restricted distribution systems and mandate more mail order usage, it could reduce the number of prescriptions filled in community pharmacy. A PBM executive suggested that there is an excess of 20,000 community pharmacies because the existing mail order capacity could absorb the prescription dispensing from those stores and at a lower cost. In 2003, mail order filled 17.2% of all prescriptions, and, more importantly, this was the fastest growing segment, with over a 10% increase over the previous year. If the new Medicare Part D allows a prominent role for PBMs with restricted distribution networks and mandatory mail order options, then it is possible that there will be less need for pharmacists to dispense prescriptions in community pharmacy. Interestingly Walton, et al. reported (J Am Pharm Assoc 2004;44:673-683) that the most accurate predictor of the number of pharmacist positions was the number of community pharmacy prescriptions. Thus, it is logical to suggest that any policy change to decrease prescription filling in community pharmacy will adversely affect the number of pharmacist positions. That is why you are now seeing campaigns from pharmacy groups to publicize the consequences of mail order and restricted distribution systems on patient access as well as the hidden costs associated with PBM programs. Of course, PBMs have mounted their own public relations campaign. This suggests that the economic consequences of any decisions made about where prescriptions will be filled could have significant financial implications. If these scenarios were to occur in the next few years, are you prepared for the possible decreased need for dispensing pharmacists?
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