Peter A. Kreckel, RPh

The high school football teams in our area are playing football. Only 250 people are allowed in the stands, including the team, coaches, cheerleaders, band, and parents. Everyone is frustrated. Kids have sacrificed their teen years in the weight room, on the practice field, and in the classroom preparing for their time to shine on the gridiron. Risks versus benefits. Kids playing football regularly have risks of concussion, strains, sprains, and broken bones.

To a kid, the risk is worth the benefits of participating in a team sport and possibly getting their chance to be a “star.” Ask any 9th grader’s parents about the benefits of their kid playing football and you will hear in the conversation the chance of a college scholarship.

Our society seems willing to take a risk if it sees benefits. Immuniza-tions, for example, have a very slight risk but great benefit. Antivaxxers focus on the miniscule risks and pay no attention to the benefits. My mom, who had many friends affected by 

polio in the 1930s and 1940s, marched all 4 of us to the high school to get our dose of Sabin oral polio vaccine when it became available in the early 1960s. Mom knew the benefits.

My dad, a World War II veteran, like millions of others, risked his life for the benefit of his country serving in the US Army. What he witnessed in the European Theater of action, from Northern Africa, Anzio beach, Rome, and Germany was so horrific that he never shared it with his kids. Dad knew the benefits. Back home, the citizens of our country were called upon to ration fuel, sugar, tires, steel, and other necessities for the war effort. A collective effort was made for the common good. They were referred to as the “greatest generation.” The country knew the benefits.

And now, we are asked to wear a cloth face covering, to not only protect ourselves but also to protect oth- ers during the coronavirus disease 2019 (COVID-19) pandemic. I work
in the pharmacy for nearly 9 hours each day and wear my mask the entire time I’m near anyone. Do the masks help? We got off to a rocky start 

with masking when the CDC recommended not wearing them in February and early March. On April 24, the CDC officially recommended wearing a mask. However, folks that choose not to wear the mask simply point to the February recommendations.

On the other end of the spectrum are the “mask police,” who want to call out everyone at the pharmacy who removes their mask, even for a brief moment. Yes, one of my customers did that, stating, “The workers could cough and get COVID all over my pills.” The plastic barrier, the sanitizing of the surfaces every hour, and the abundance of hand sanitizer were not enough.

I’d like to offer a proposal to those mask police out there. Whether you are in academia or management, I’d like all licensed pharmacists to join in unity on October 30 to support their brothers and sisters in community pharmacy by wearing a mask for the entire work day. We community pharmacists will even let you take yours off to eat lunch!

In the absence of rock-solid data to the contrary, wearing a mask seems to be a small sacrifice to protect each other’s health. One of the wiser health care practitioners I work with offered this: “We as a country do not have the collective grit to make large-scale sacrifices for the greater good of the society.” Big benefits...I’m not sure, but definitely a very small risk.

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In the absence of rock-solid data to the contrary, wearing a mask seems to be a small sacrifice to protect each other’s health.

Mask Wearing: A Small Sacrifice for the Greater Good

We all know that that Friday afternoons are hectic in the community pharmacy, especially the first of the month. One Friday, after finishing my typical lunch (yes, I take 10 minutes to do that), I called a pharmacy for a transfer for one of our patients. As I was on the phone, I overheard my technicians, Amber and Katie, looking for trifluridine eye drops. I reminded them to check the refrigerator. None there. After I was done with my call, I asked who wanted the trifluridine drops, assuming it was another Thompson Pharmacy. They said it was some eye doctor’s office but could not recall which.

About 7 years ago, my niece Rachel Fritz, who is now an optometrist, stayed at our home while interning at a local eye clinic. I came home after work one day and told her that a Medicaid managed care organization (MCO) denied a claim for trifluridine because the patient used their 6 prescriptions for that month. I called the ophthalmologist and got the medication changed to valacyclovir, knowing Medicaid would pay to treat genital herpes but not herpes keratitis.

“Uncle Pete, herpes keratitis is sight threatening, and you probably saved that patient’s vision,” Rachel said. Herpes keratitis needs to be treated within hours of diagnosis, and waiting 2 days for prior authorization is not appropriate. My techs called all the ophthalmology practices in Altoona, Pennsylvania, and tracked down the nurse who made the request.

I spoke with her, and she said no one in the city had the eye drops in stock. I told the nurse to give me the prescription over the phone and my driver would go to the warehouse to pick up this sight-saving eye drop. I called “Rich,” the representative at Value Drug, around 1:15 PM, and he set the wheels in motion. Less than 2 hours later, my driver, Don, appeared, drops in hand.

When the patient’s daughter came in at that day, she was most appreciative of our efforts. Her 90-year-old mother was a customer of a big-box store, where little effort was made to help this patient. The woman handed me her mother’s Medicare Part D card, and Amber ran the prescription through our pharmacy filling software. When Amber got the approval, her bright smile was absent from her face as she called me over.

Amber informed me that Medicare Part D had paid us $123.02 for this sight-saving eye drop that cost us $189.93, for a loss of $66.91. That’s not counting all the time my techs spent, the mileage and time my driver spent, and time I invested to help this 90-year-old woman get the medication because the big box had no interest in doing so. What should we do? I assured Amber that over the weekend, I would fill out the paperwork to challenge this gross injustice of payment.

My only wish is that the pharmacy team at this MCO could hear my niece say that herpes keratitis is sight threatening and needs to be treated immediately. There was no time to scour other warehouses to find a cheaper generic. This small, 1200-square-foot drugstore will take care of the patients and their problems that the big-box guys could care less about.

Clare Boothe Luce is attributed with saying “No good deed goes unpunished.” This independent pharmacist hopes that this is not the case for the herculean efforts made to help this most needy patient.

This small, 1200-square-foot drugstore will take care of the patients and their problems that the big-box guys could care less about.

No Good Deed Goes Unpunished

Although the quote “take the time to walk a mile in his moccasins” is often attributed to the Native American culture, it in fact comes from a poem written by Mary T. Lathrap in 1895, originally titled Judge Softly. I feel we can adapt this to our profession: “take the time to work a shift in his/her lab coat.” 

I joined my son-in law Mark for a conference in Las Vegas, where he gave three presentations for PAIN WEEK. One evening we attended a show, and we were seated next to a patron who told us she worked in marketing. She named the pharmacy chain, one of the bigger ones. 

She said her focus on marketing is the “store experience.” She described how they fit people with contact lens and glasses and send them into the store and track their eye movements. Amazingly, most eyes seemed to focus on finding a trash can! She described how they focus on signage, color, music, lighting, shelf placement, and anything that could improve the “store experience.”

Amazon Acquires Second Healthcare Business

She also described how a bunch of her colleagues are traveling to London to witness how British pharmacies operate. When they get back to the U.S., they are going to implement ideas gained from watching their British counterparts in this chain’s “wellness centers.” 

Finally, the independent pharmacist couldn’t resist, I asked: "Did you ever spend a day in one of your pharmacies to see why your pharmacists are so unhappy? Did you ever see the overworked pharmacist, technicians, and cashiers answering phones, staring at computer screens, and trying to accomplish all 10 plus metrics.” I have a few colleagues that work for said chain, and they are the most unhappy healthcare professionals anywhere. I advised her to come to my pharmacy when I’m staffing, and then head down the street to their chain and see the difference.

Imagine one of the biggest drug chains spending millions of dollars, when this community pharmacist knows the obvious. I call their store for a prescription transfer, and it takes at least six minutes for a pharmacist to get to the phone. Through the wizardry of electronics and social media, I can save this chain a bundle of money so they can use that money to get more staffing. 

First off, their CEO makes almost 23 million dollars a year. That equals 184 pharmacists’ salaries. For my pharmacist colleagues, the 23 million could hire an almost 1000 technicians, full time at $12.00 per hour. Secondly, let’s cancel your marketing staff’s trip to London. I can tell you what works to increase customer satisfaction. Third, start paying attention to your store staff, if they are too afraid to speak up, don’t be surprised. 

I told this member of your marketing team “the only reason most people go to your chain is because they are forced by your PBM.” Your chain’s pharmacists work extremely hard and get less technician hours every year. They are told to do more with less. Cancel your marketing trip to London, and come to Altoona, PA, where this 61-year-old passionate pharmacist is more than willing to help rescue the 12,000 plus careers of your pharmacists. Not that Altoona PA is an expensive place to stay, you can save even more money by staying at our house. I can accommodate four of you in one of our three empty bedrooms!

Give me a call, I can assure you the phone will be answered within 4 rings! Show up in your white lab coat and sturdy shoes, and you’ll learn so much more than you would taking a trip to London.

From Pete Kreckel, why chain pharmacists have answers that chains are looking for.

Opinion: What Chain Pharmacies Can Learn from Independents

On July 15, my daughter Gretchen Garofoli appeared before the Senate Subcommittee to discuss financial barriers to adult immunizations. The night before she headed to Washington DC, I said “nothing to worry about GG, but please while you’re there get me an appointment to the FDA. I’ll have them straightened out in a couple of months before I get fired!” 

Many of us in healthcare feel that the Food and Drug Administration (FDA) are in the back pockets of the drug companies. It seems that the FDA are always catering to the desires of the pharmaceutical manufacturers. In a 

, I implored the FDA to standardize the appearance of all generic drugs. This would show beyond a doubt that the FDA is concerned about patient safety. No one ever contacted me. Hey, I’m just a community pharmacist whose major concern is always the safety of his patients. Heck, old Kreckel doesn’t even have a political action committee!

Back in October 2013, my niece Rachel Fritz was staying at our home when she was doing an optometry rotation in State College. I presented an online lecture on optometry at the college. After I completed my lecture, she asked “Uncle Pete, why didn’t you tell them about the cap colors on ophthalmic products?” Rachel explained that the anticholinergics had red caps, prostanoids had teal caps, anti-inflammatories had grey caps, antibiotics had brown caps, et cetra. In over 30 years of community practice, I never had this explained to me. I’ve yet to meet a pharmacist who ever had this covered in pharmacy school. The American College of Optometry pushed the FDA for this, they even 

 to minimize variations on the color green! 

Last week, at the doctor’s clinic I work at, once again there was great confusion regarding the asthma/COPD inhalers. I’ve complained about this for years that there is no standardization of asthma inhalers with respect to appearance. We’ve heard horror stories of people using steroid inhalers for emergency, and no one steps up to push standardization. 

My niece, now Dr. Fritz, says that optometrists use these color codes to talk with patients. “Use the yellow cap (Timolol) twice daily, and your teal color cap (Xalatan) at bedtime.” She says during post-refractive surgery, it is less complicated when instructing patients when to use the red, gray, and brown cap colors.

I’d like to see the FDA take the initiative to resolve this issue. I’ve heard some of the sales reps say they would have to retool their equipment to change these colors. Fifteen years ago, we were selling generic albuterol inhalers for $8.00 each, and the FDA had the manufacturers change the valves to accommodate CFC-free formulations, to minimize chlorofluorocarbons that were allegedly damaging the ozone layer. Albuterol inhalers all cost over $50 now. Most of the other inhalers for asthma or COPD cost over $300. Certainly, the lives of my asthma and COPD patients deserve as much attention as the ozone layer.

"I’ve yet to meet a pharmacist who ever had this covered in pharmacy school," writes Kreckel. 