Pharmacy Times
Volume 0

In 2 different presentations I heard something I have notheard discussed for a long time. Both speakers suggestedthat we could experience an over-supply of pharmacists.Recently, I have heard some pharmacy leaders suggest thatthe supply of pharmacists seems to be adequate in their geographicarea, but they have not suggested an over-supply. Thefirst presentation suggested that as e-prescribing increases,expert system-enhanced computer systems become morecommon and technicians' role expand, the number of pharmacistsneeded to fill prescriptions will decline. The otherspeaker suggested that if pharmacy benefit managers (PBMs)are able to promote restricted distribution systems and mandatemore mail order usage, it could reduce the number ofprescriptions filled in community pharmacy. A PBM executivesuggested that there is an excess of 20,000 communitypharmacies because the existing mail order capacity couldabsorb the prescription dispensing from those stores and at alower 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 thenew Medicare Part D allows a prominent role for PBMs withrestricted distribution networks and mandatory mail orderoptions, then it is possible that there will be less need forpharmacists to dispense prescriptions in community pharmacy.Interestingly Walton, et al. reported (J Am Pharm Assoc2004;44:673-683) that the most accurate predictor of thenumber of pharmacist positions was the number of communitypharmacy prescriptions. Thus, it is logical to suggest thatany policy change to decrease prescription filling in communitypharmacy will adversely affect the number of pharmacistpositions. That is why you are now seeing campaigns frompharmacy groups to publicize the consequences of mail orderand restricted distribution systems on patient access as well asthe hidden costs associated with PBM programs. Of course,PBMs have mounted their own public relations campaign.This suggests that the economic consequences of any decisionsmade about where prescriptions will be filled couldhave significant financial implications. If these scenarios wereto occur in the next few years, are you prepared for the possibledecreased need for dispensing pharmacists?

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