If you can't get paid for what you do, you can't afford to stay in business. So what are pharmacists supposed to do?
By Truman Lastinger, RPh
Throughout history, occupations have been replaced by new innovations. In the United States, building and assembling wagon wheels was once a way of life for many men. Local sawmills were an everyday part of living. In the South, well diggers were long in demand. Blacksmiths made a good living for generations. In the early to mid-twentieth century, extraction of turpentine from pine trees was a common occupation.
Nowadays, mule-skinners and ox drivers are no longer with us. Nobody cuts barrel staves any more. Dime stores and general stores are practically a thing of the past. All too often, locally owned hardware stores have been replaced by superstores.
It appears to me that pharmacy is in the process of changing also. Over the past few years, corporate America has taken over our ‘’profession.” No longer does a pharmacist have any say as to what drug he will purchase. Nor does he have time to interact with patients - “customers” - even though he is mandated to do so by OBRA. Now he is under fire when he refuses to fill a narcotic prescription, as he was taught to do.
And he has no say as to how much the drug he is responsible for costs. He has absolutely no say as to what he will charge for the drug.
The pharmacist has always provided a service. The problem is that there is no way he can bill for or get paid for this service.
Originally the price for this service was included in the markup on the drug that was sold or dispensed. In the ’60s, the pharmacy schools and the pharmacy associations promoted a professional fee rather than a markup. They said that a professional fee was necessary for the public and other healthcare professionals to recognize that the pharmacist is also a professional.
Pharmacists blindly accepted this innovation, and the professional fee became the automatic markup on the drug being dispensed. Because there was no method proposed to account for inflation, we were stuck with a fixed markup. As the price for the drugs in a prescription increased, the only way a pharmacy could stay in business was to cut down on employee payrolls or fill more prescriptions.
Then third parties took over processing and paying for the prescriptions.
Today, the drug companies, the insurance companies, and the benefit managers have complete control of the profession of pharmacy.
For one thing, the drug manufacturers have an interesting control over the FDA. The life of the patent on a drug is extended unduly when the manufacturers change the salt, the dissolving point, and even the shape of the drug, with no real advantage over the original. Then as soon as they can’t get any more mileage out of the patent, they get the FDA to approve the sale over the counter. Apparently these drugs were not dangerous enough for the last 10 years to warrant Rx only.
The only way I can figure it is by the money involved. When the manufacturers have to supplement the costs of the FDA, they have to have an influence on what the FDA approves.
We are simply becoming extremely educated technicians who cannot sit down to eat lunch. We have to squeeze in a trip to the bathroom. In order to make money, the pharmacist is being pushed to do MTM and immunizations without having the proper time to do so. And when the MTM and immunizations are provided, the corporation gets the money, not the pharmacist.
I feel that now we are witnessing the law of diminishing returns in action. There is no way pharmacy can survive when there is not enough revenue to meet costs.
Earlier this year, the news outlets covered Walgreens’ unsuccessful attempt to leave its home state and acquire a percentage in an overseas company that would allow it to move to Switzerland, all in order to reduce taxes.
Walgreen leadership apparently felt that something was necessary to reduce overhead and still maintain the company’s business and protect its stock market value. The company has cut its personnel as deeply as it can do and remain in business.
The insurance companies and PBMs are running what I call pill mills. They are in a position to demand better prices or bigger kickbacks from drug manufacturers. They are using mail order and are not required to keep the records that retail pharmacist have to keep. Nobody has to sign for their prescription, and they do not have to verify that personal counseling with the patients is done. Apparently mail order only has to provide a phone number, in case the customers wants to know something about their meds.
The use of computers to fill prescriptions will only grow. Pfizer is now supplying Viagra directly to its customers and allowing CVS to do the billing. Obviously Pfizer can price Viagra any way it sees fit, through control of the average wholesale price.
Is community pharmacy a dying profession? What do you think?
Truman Lastinger lives in south Georgia. His new book, "From Farming to Pharmacy," a chronicle of 58 years in rural pharmacy, is available fromamazon.comandbooklogix.com. E-mail him at firstname.lastname@example.org.