Fred M. Eckel, RPh, MS
Pharmacy Times Editor-in-Chief

Mr. Eckel is professor and director of the Office of Practice Development and Education at the School of Pharmacy, University of North Carolina at Chapel Hill.

Community pharmacists enjoy a key advantage over mailorder pharmacies?the ability to communicate face-to-face with patients. We often seem reluctant to use that advantage, however. This problem is brought into sharp focus by the continuing growth in mail-order prescription volumes. The pharmacy benefit management (PBM) industry likes to portray this growth as evidence of the benefits of mail order and suggests that patients prefer to get drugs by mail.

In reality, the growth in mail order is driven largely by unfair competition. Patients often use mail order not because they want to, but because they are forced to do so. Payers, driven by the PBMs that operate their pharmacy benefit as well as the mail-order pharmacies, mandate mail order or artificially make it more attractive by lowering copayments. PBMs, of course, use the mail-order pharmacies to bulk up profits.

This does not mean, however, that we simply should observe this trend without taking action. Instead, it makes it more urgent that we recognize and use the advantage that we have. Many patients still have a choice, and studies show that, given that choice, most patients prefer the direct interaction and convenience that their neighborhood pharmacy can provide.

We need to seize this opportunity. To make sure that patients understand the value of community pharmacy, we need to demonstrate how we can help them. Through face-to-face communication, community pharmacists can provide the help and counseling that is particularly needed by older patients, patients with disabilities and chronic diseases, and those who are taking the most medications.

Too often, we are not visible enough. Often patients interact primarily with technicians and may not even be aware of the extensive work that the pharmacist is doing behind the scenes on their behalf. Our technicians provide valuable services, but they do not represent a compelling reason for a patient to use a community pharmacy rather than mail order.

Unless patients experience firsthand the value that we can provide, they may see little reason to use the community pharmacy at all. They may see little difference between receiving their drugs from a local pharmacy and getting them from their postal worker.

As a profession, we need to find ways to talk to patients about their conditions and their medications. We have an ideal opportunity to show patients how valuable we are, and it is up to us to take advantage of that opportunity. If we do not, we cannot complain if the trend toward mail-order purchasing continues to grow.