editor'sNOTE: Pharmacists?Not PBMs?Provide Invaluable Service

Fred M. Eckel, RPh, MSPharmacy Times Editor-in-Chief

Mr. Eckel is professor and director ofthe Office of Practice Developmentand Education at the School ofPharmacy, University of North Carolinaat Chapel Hill.

Community pharmacists enjoya key advantage over mailorderpharmacies?the abilityto communicate face-to-face with patients.We often seem reluctant to usethat advantage, however. This problemis brought into sharp focus by the continuinggrowth in mail-order prescriptionvolumes. The pharmacy benefitmanagement (PBM) industry likes toportray this growth as evidence of thebenefits of mail order and suggests thatpatients prefer to get drugs by mail.

In reality, the growth in mail order isdriven largely by unfair competition. Patientsoften use mail order not becausethey want to, but because they areforced to do so. Payers, driven by thePBMs that operate their pharmacy benefitas well as the mail-order pharmacies,mandate mail order or artificiallymake it more attractive by loweringcopayments. PBMs, of course, use themail-order pharmacies to bulk up profits.

This does not mean, however, thatwe simply should observe this trendwithout taking action. Instead, it makesit more urgent that we recognize anduse the advantage that we have. Manypatients still have a choice, and studiesshow that, given that choice, mostpatients prefer the direct interactionand convenience that their neighborhoodpharmacy can provide.

We need to seize this opportunity. Tomake sure that patients understandthe value of community pharmacy, weneed to demonstrate how we can helpthem. Through face-to-face communication,community pharmacists canprovide the help and counseling that isparticularly needed by older patients,patients with disabilities and chronicdiseases, and those who are taking themost medications.

Too often, we are not visible enough.Often patients interact primarily withtechnicians and may not even beaware of the extensive work that thepharmacist is doing behind the sceneson their behalf. Our technicians providevaluable services, but they do not representa compelling reason for apatient to use a community pharmacyrather than mail order.

Unless patients experience firsthandthe value that we can provide, theymay see little reason to use the communitypharmacy at all. They may seelittle difference between receivingtheir drugs from a local pharmacy andgetting them from their postal worker.

As a profession, we need to findways to talk to patients about theirconditions and their medications. Wehave an ideal opportunity to showpatients how valuable we are, and it isup to us to take advantage of thatopportunity. If we do not, we cannotcomplain if the trend toward mail-orderpurchasing continues to grow.