Change is the air that pharmacists will breathe . . .


Pharmacists face many changes in their work and the way they do it. But if they don't stay focused on one crucial fact, the rest won't be worth a hill of beans.

... and you'd better get used to it, or you will gag on what you insist on believing is poison gas.

The workload is just going to get worse - or better, if you are one of those management pharmacists who look only at prescriptions filled and the bottom line.

Especially the patients, who won't have to worry about being invisible, because they will no longer have to stand at the pharmacy counter for 5 minutes before anyone even acknowledges that they are there. The most experienced pharmacy staff members know that the instant they make eye contact with someone at the counter, they're dead.


PBMs are for-profit engines. You need reprogramming if you believe the airy-fairy claims that the PBMs are in business to look out for the health and welfare of the recipients. They're in this game to profiteer. The insurance cards are difficult because the actuaries project an increase in profit when patients give up and pay cash because the technician is having trouble with a card. Take a deep breath of that air of change and start refusing to sign contracts that benefit only the PBM.


"Tech-check-tech" is something that pharmacists are knee-jerking about nowadays. They worry that technicians will take over the clerical jobs that only a pharmacist can do and that pharmacists will lose their jobs.

I don't see it that way. Mary Ann, who has the tech job only because she is the cousin of your sister's brother-in-law, will not be checking anything. When the computer stops the process with interaction/allergy warnings and the like, the pharmacist will have to be called over, and only the pharmacist (with a secret password) will prevent the sky from falling. That is some of the air we are going to breathe.

Technicians qualified to check will have to get advanced training. The route to the title of advanced technician will be ponderous. This is how pharmacy always does things. If the American Pharmacists Association (APhA) gets involved, the process will be slow and complicated, because that is how APhA always does things.

Heard it before

In 1972, I attended a regular meeting of the California State Board, and in 2011 it's déjà vu all over again. The comments at that '72 meeting went like this: "If you allow technicians, pharmacists will lose their jobs" and "Allowing untrained help to type labels will put the public at risk."

My argument is that we will lose control of pharmacy if we do not have advanced technicians, because the workload avalanche that is coming will smother us, and there are forces that would love to see us fail. When the time comes that we're not able to keep up with the demand for prescriptions, that's when pharmacy will be viewed as a failed profession and there will be a void that people who don't give a hoot about our profession will rush to fill.

Tech-check-tech will be a reality. We would be smart to design it the way we want it, so that it will benefit the profession and you and me. I love the idea of getting away from the prescription mill. My practice has always been patient-centered. Face-to-face with the patient is my happiness on the job.

The bedrock issue

Here's that something worth going to the barricades for. It's the law in all 50 states: There must be a pharmacist present when a prescription is dispensed to the patient.

You have sat back and ignored any number of threats to the profession over the last 3 decades. You cannot do it anymore. We're not talking about discount cards or dollars-off coupons this time. We're talking about the fundamental law that defines you. Trust me, the same kind of brains that came up with the $4 Rx are scheming to get this law off the books. You and I must be willing to temporarily sacrifice our time, money, and well-being when the air of change smells this rotten.

Jim Plagakis is a community pharmacist in Galveston, Texas. You can e-mail him at
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