COVER STORY

2004: WILL YOU BE BETTER OFF?

An exclusive survey of pharmacists reveals what they are forecasting for the year ahead

While these are times that try men's souls, 2004 will probably not be a year in which pharmacists will have to "take cover" or "batten down the hatches." After all, 2004 is a Presidential election year. As one wag has observed, no one is going to "rock the boat" in such a year.

Whether pharmacists will be better off in 2004 will depend to some extent on the fate of the Medicare drug benefit legislation, an issue still up in the air at press time. If it does squeak through Congress, in the short term—meaning early next year—pharmacists will have to deal with Medicare-endorsed discount cards, over which both independents and chains have vehemently fought with the Administration. In the long term—that is, by 2006—pharmacists could see many cash-paying seniors disappear into drug plans administered by pharmacy benefit managers. In contrast, the legislation should be a boon to drug manufacturers, since it doesn't contain any price controls, and to PBMs, which have been salivating for the Medicare business.

As we look back over this year, you must admit it hasn't been a boring one. From the Medicare bill to SARS to Rx reimportation to drug counterfeiting—there certainly hasn't been a lack of burning issues to command center stage in 2003. Many of these issues will stick around in 2004, making for probably another year of shock and awe ahead for pharmacists.

What were the defining moments of 2003 and who were the winners and losers? Among those who came out on top are purveyors of the low-carb diet and storefront operators who have done a land-office business selling cheap drugs from Canada. Those that didn't have a good year are Eckerd, now on the auction block; syrup of ipecac, which experts said should be deep-sixed; and secondary wholesalers, currently about as popular as box-cutters on a 747.

Among the landmarks of 2003 are the following:

• Implementation of the privacy regulations under the Health Insurance Portability & Accountability Act

• Passage of a final rule speeding the entry of generics onto the market

• Prilosec going OTC

• Proposed merger of Caremark and AdvancePCS

• Reversal of the feds' decision to discontinue reimbursement for pharmacy residencies

• The death of Tim Webster, executive director of the American Society of Consultant Pharmacists, and the exits of Robert Elenbaas, executive director of the American College of Clinical Pharmacy, and Ronald Streck, president and CEO of the Healthcare Distribution Management Association

Will 2004 be a flush or flat year for pharmacists? Once again, Drug Topics surveyed pharmacists on such business indicators as their sales, profits, salaries, and hiring. A questionnaire was mailed in August to 2,085 pharmacists (1,000 hospital pharmacists, 750 independents, and 335 chain headquarter executives) who were selected on the nth name basis from our circulation list. When the field closed in October, we had responses from 273 hospital pharmacists, 197 independents, and 92 chain executives. Find out what they are forecasting in the pages that follow.

Meanwhile, here's hoping you have a robust 2004!

Independents: Still hoping for the best

These hardly seem like days for great expectations in pharmacy, what with continuing Medicaid reimbursement cuts triggered by state budget revenue shortfalls, Canadian drug importation spinning out of control, and a proposed Medicare prescription drug benefit dominated by pharmacy benefit managers. And yet, the vast majority of independent pharmacy owners feel positive that next year will bring more good business news.

Nearly three-quarters (72%) of the independent pharmacists who responded to the annual Drug Topics business outlook survey had a hunch that their business prospects in the year ahead are good to excellent. Their optimism is only slightly less than the 76% in last year's survey who thought 2003 would be kind to their financial fortunes. Breaking down the happy talk crowd, 43% anticipate good news in 2004, 24% foresee very good results, and 5% believe 2004 will create an excellent business environment.

Despite a jobless recovery and seesawing economic indicators, 60% of our respondents think sales will grow next year. But that's down from the 66% in last year's survey who thought 2003 would bring more consumers through their doors. The average sales increase for next year was pegged at 11%. One-quarter of independents think sales will remain flat, and 14% anticipate lower sales, down an average of 12%.

Like death and taxes, operating costs are an inevitable part of independent pharmacy life, so it's not surprising that 65% of our respondents anticipate higher overhead in 2004. The average cost hike was pegged at 8%.

At the end of the business day, when they subtract their costs from their sales, 42% of independents expect to pocket higher net profits next year, up an average of 9%. But one-third expect to hold the line, and 25% are braced to bank less net profit, 9% less, on average.

Year in, year out

Before anyone sang Auld Lang Syne last Dec. 31, 77% of the respondents in last year's survey thought 2003 would bring good to excellent results. As it turned out, 2003 has lived up to its advance billing, as 76% of our respondents reported positive results. Specifically, 38% said 2003 would be a good year, 31% said it would be very good, and 7% thought it would end up in the excellent category. On the down side, 20% reported fair results and 5% are doing poorly this year.

More than half of our respondents (57%) reported that the business climate in their neck of the woods is fair to poor. The region reporting the deepest economic doldrums was the South, where 60% of our respondents report a fair-to-poor climate. On the sunnier side of the street, 57% of our East Coast respondents are blessed with good to very good economic skies.

Positive vibes

Population growth; the demise of some competitors; more Rx volume; and better merchandising, advertising, and customer service as well as new programs were cited by independent pharmacists as reasons their business is better this year. Others pointed to compounding, the arrival of new generic drugs, and new physicians in their area.

A New York owner in practice for 42 years, who described himself as the "last of the dinosaur crowd," said, "I push the front end like crazy." An Indiana respondent has profited from niches including "compounding, home-health care, wellness, and women's health." And an Indiana R.Ph.-owner finds business is boosted because "more and more customers are finding out independents do it better."

Downside

It probably comes as no surprise that independents don't like M&Ms. No, not the candy. Medicaid, managed care, and mail order were the trio of negative factors most often cited by our respondents as drags on their businesses. About 30% cited lower third-party and Medicaid reimbursements as bad news for business. And 23% nailed their traditional nemesis, mail order. About 15% pointed the finger at local unemployment.

Having already endured past cuts, 54% of our respondents have braced themselves for Medicaid reimbursement taking another nosedive in 2004. Another 44% think Medicaid reimbursement will remain steady, and a Pollyanna-ish 2% believe their government reimbursement check in the mail will be bigger.

A new independent complaint this year is the growing specter of what they view as evil twins: U.S. storefront operations that steal their cash customers and their partners in crime, Canadian mail-order pharmacies that illegally ship medications back across the border. Nine percent of our respondents feel storefront operators severely cut into their Rx volume this year, and 44% think the operators stole a little bit of their Rx sales.

Against a backdrop of almost daily news about another state or city flirting with Canadian mail-order pharmacies, 53% of our respondents have a bad feeling that storefront operations will affect their business in the year ahead. Another 17% aren't worried about the Canadian competition, and 30% aren't sure whether their pharmacy will get caught in the stampede.

In last year's survey, nearly one-quarter of our respondents named HIPAA as one of their biggest challenges in 2003. This year's respondents came in with a split verdict: 49% said the federal privacy mandate has had no impact on their practices, but 46% reported negative repercussions. Another 5% said they've actually experienced a positive HIPAA bounce.

"I have yet to implement HIPAA," said one Iowa independent, who obviously missed the April 15 deadline. HIPAA is "a waste of time and money," lamented a Wisconsin owner. "There was lots of hype from leeches wanting to sell advice/products," groused a Tennessee R.Ph.-owner. And those were just comments from respondents who felt that HIPAA was a neutral factor in their practices.

Strange bedfellows

Next year will unleash the hounds of Presidential politics, so do independent pharmacists think it's better to stick with Bush or hand a Democrat a trip to the White House? Given the traditional Republican slant of independents, it's surprising that only 56% of our respondents think pharmacy would fare better under Bush. The 44% who favored the Democrats may have been put off by the President's Rose Garden embrace of PBMs. He wants them to offer discount Rx cards and administer a Medicare Rx benefit.

On the pro-Bush side, a Michigan independent simply "hates Democrats," while a California pharmacy manager doesn't want "another Clinton." But an Alabama pharmacist said, "Without Bush, I won't have to worry about money because we may all be dead from terrorists."

Those favoring a changing of the White House guard included a Florida independent who said, "Bush is owned by the insurance companies, HMOs, and pharmaceutical industry. He would like to see corner drugstores go under!" A Missouri independent thinks a Democrat would be the "lesser of two evils," and a California pharmacy manager said, "Democrats help poor and sick people, but Bush is for rich people."

In his first year as commissioner of the Food & Drug Administration, Mark McClellan passed muster with independents, who gave him an average rating of three on a scale of one on the low end to five at the top. The chief issue they want the commish to tackle is drug importation/ reimportation from Canada or elsewhere, which was cited by 47% of our respondents as their biggest FDA hot button. Coming in a distant second were the 16% concerned about the approval and availability of generic drugs.

Since it's been mired in political infighting, the Medicare Rx benefit legislation will not reach the President's desk by year's end, according to 45% of our respondents.

Among the 29% who think the Medicare bill will get Bush's signature, 54% think it will be bad news for pharmacy. On the other hand, 30% expect a positive impact and 16% don't think it will affect them one way or the other.

Take on technology

Independent pharmacy owners continue to be nowhere near the profession's bleeding edge when it comes to technology uptake. For example, 92% of our respondents do not have automated dispensing capability, and only 6% said they plan to automate next year. Only 2% report having a central fill operation, and only 13% can currently accept prescriptions sent directly to their computers. However, perhaps reflecting the national physician-pharmacy connectivity service being forged by SureScripts, 30% of those who are not connected plan to get with the e-prescribing program next year.

It appears that the dot-com meltdown may have taken a toll on independent pharmacies as well. In last year's survey, 45% of the respondents said they had their own Web site. This year, only 31% reported an on-line presence. Nearly three-quarters of the respondents with Web sites let patients refill scripts on-line, but business isn't exactly booming. On-line sales account for only 2% of their overall sales. While the bloom may be off the Web-hosting rose, more independent pharmacies—71%—have in-store on-line access, compared with 61% last year.

Carol Ukens

Chain executives are keeping the faith

The war in Iraq. Corporate scandals. Massive layoffs. A frail economy. There's no shortage of reasons to be glum. But, according to the Drug Topics business outlook survey, the majority of chain pharmacy executives should be satisfied when they say farewell to 2003.

Four out of 10 responding executives said they expected 2003 would turn out to be a good year, 32% said it would be very good, and 8% said 2003 would be excellent. A more pessimistic 20% said that the year would turn out fair, and 1% expect 2003 to turn out poorly.

Chains credited employee performance/ customer service, increased population, and new stores/locations and expansion for hiking their business. Echoing last year's grievances, the majority of chain executives named lower reimbursements, more mail-order pharmacies, and the economy/local unemployment as negative factors that have affected, or will affect, business this year.

When asked to compare their company's anticipated 2003 net profits with net profits tallied in 2002, 54% of chain brass expect profits to increase, 20% expect a decrease, and 26% believe profits will remain the same as last year. On average, those expecting a decrease in profits are estimating a 5% slide, while those anticipating an increase pegged the hike at 12%.

Chain executives said that when 2003 winds down, 13% of business would have come from cash customers, 18% from Medicaid, 66% from third-party plans, and 3% from other sources. Their forecast for 2004 looks pretty much the same: They see 11% of business coming from cash customers, 20% from Medicaid, 66% from third-party plans, and 3% from other sources.

Help wanted

The R.Ph. shortage is still a problem, but it is easing up slightly. More than eight out of 10 chain respondents (86%) believe there is a pharmacist drought, compared with 96% who reported the same in last year's survey. Of those respondents who noticed a shortage this year, 70% said the scarcity was somewhat severe, 17% said it was extremely severe, and 13% think it was not at all severe.

Things are looking up on another score: Only 69% of executives predict difficulty in finding pharmacists in their area of the country during 2004, as compared with three-quarters last year.

When queried about the number of pharmacists working in their chain pharmacies for 2004, 80% of the respondents said they expect to count the same number of white coats, 9% expect to have fewer R.Ph.s on their payroll, and 11% expect to welcome more pharmacists per pharmacy. The respondents expecting a decrease in R.Ph.s are estimating a decline, on average, of four pharmacists per pharmacy. The respondents expecting an increase are estimating an average increase of five R.Ph.s per pharmacy.

Fatter paychecks

Chain pharmacists are likely to see a slight bulge in their wallets next year, as nine out of 10 chain executives said R.Ph. salaries are on the upswing. But don't get too excited just yet. On average, the expected increase is 5%, compared with 7% last year.

Hello, technicians

Chain executives are still welcoming technicians to the workplace, but the pace has slowed down from the previous year. Peering into their crystal ball, only 30% of respondents said they are expecting an increase in the number of techs, compared with 54% last year. Sixty-five percent of the respondents stated that they expect the number of their techs to remain the same in 2004, while 6% expect a decrease.

Grand openings

While only a little over one-quarter (26%) of survey respondents reported that they are planning to open new stores in 2004, you can expect to see more grand openings per organization in 2004. Of the responding executives who do plan to break ground, the average number of stores to be opened is 48. Last year, the average number of new stores per organization was projected to be only six.

What's the most popular format for expansion? Mimicking the response they gave a year ago, respondents named freestanding buildings as the way to go when it comes to opening new pharmacies.

Going on-line

On the technology front, 65% of chains reported that they have a Web site. This is up from last year, when 60% acknowledged offering this resource. Of those that are wired, almost two-thirds (62%) hawk their wares on-line, with the majority selling a variety of products such as OTCs, Rxs, and sundry items. However, these sales account for only 4% of their overall business.

A whopping 95% of the respondents that have a Web site allow their customers to refill their Rxs on-line, a significant uptick from 55% last year.

Of those respondents whose pharmacies don't have a Web site, 22% said they plan to launch one within the next year. Fewer than half of the respondents (45%) have in-store access to the Internet. Of those who do not, about 25% plan to add it in 2004.

Chains have been busy this year adding the capability to accept Rxs sent directly to their computers. Forty-two percent of respondents currently accept Rxs sent directly to their pharmacy's computer, compared with only a little over 25% last year.

Most chains are not putting automation on their to-do list. Eighty percent of respondents said their pharmacy does not use automated dispensing technology. Of those who don't, only 7% said they plan to automate in 2004.

Most chains are also still not jumping on the central fill operation bandwagon. Only 13% of responding chain executives have such an operation. Don't expect that to change in 2004. None of the chains that don't have central fill plan to add it in 2004.

Hot news issues

Chain executives were asked to rate the top three pieces of news for pharmacy in 2003. The most important news for 2003 was cheap drugs from Canada. Sixty-five percent of respondents named this issue as No. 1, 2, or 3, followed by the Medicare drug benefit legislation (55%), and the implementation of HIPAA (54%).

Four more years

With 2004 being a Presidential election year, almost two-thirds (65%) of the responding chain executives expressed the opinion that it would be better for pharmacy if Bush stayed in the White House for four more years than if a Democrat moved in. Among the verbatim responses from execs who wanted to see Bush retained were the following:

• "Will give continuity to whatever is in progress."

• "Possible better Medicare and Medicaid coverage."

• "No viable Democratic candidate in the field."

• "Republicans are the lesser of the two evils."

Those execs who favor a Democrat moving to Pennsylvania Avenue gave the following verbatim responses:

• "Bush hasn't done anything to help the elderly get better Rx benefits. It's really sad when I have patients who have to choose which drug they are go- ing to pick up this month because they can't afford all their prescriptions."

• "Bush is antipharmacy and is repaying PBMs for political contributions."

Finally, one disgusted exec compared picking between Bush and the Democratic field as "choosing between jock itch and hemorrhoids."

Almost half of the respondents (43%) aren't holding their breath for a Medicare outpatient drug benefit to pass Congress and be signed by the President at the end of the year. Twenty-four percent anticipate the legislation will pass and be signed, and 33% said they didn't know if the benefit would become law.

Of the respondents who expect the Medicare outpatient drug benefit to become a done deal, almost half (48%) think it will have a positive effect on their practice, 38% expect a negative effect, and the remaining 14% feel the legislation will have no impact on their pharmacy.

What HIPAA privacy act?

More than half of the responding chain executives (57%) feel there has been no impact on their practice since the HIPAA privacy regulations went into effect this past year. Thirty-four percent said they have experienced a negative impact, and only 9% reported a positive effect.

The verbatim responses included the following:

• "Customers resent the extra paperwork and rules."

• "We were doing it before HIPAA started."

• "Guidelines required more expense in training and implementation!"

• "People hate it!"

Reimbursement headaches

This past year could go down as the one in which many states experienced budget deficits and cut their Medicaid reimbursement rates to pharmacies. More than half of the responding chain executives (56%) said their states cut their Medicaid reimbursement in 2003.

More than half of the respondents (53%) expect to see their Medicaid reimbursements to stay the same in 2004. Forty-four percent of chain topsiders anticipate their Medicaid reimbursements to deteriorate next year, and only 3% expect a rosier picture ahead.

Chains give nod to McClellan

When asked to rate the overall performance of the new FDA commissioner, Mark McClellan, as it relates to their practice, chain execs gave an average rating of a three on a scale of one to five, with one representing very dissatisfied and five meaning very satisfied.

The top three FDA issues McClellan should tackle in 2004 are drugs from Canada (39% indicated this as their No. 1, 2, or 3 issue), generic drug approvals and availability (32%), and streamlining new drug approvals (23%). Additional issues execs believe are worthy of the commissioner's attention are drug reimportation, drug counterfeiting, and herbal regulations.

Eleven percent of the respondents feel that the proliferation of storefront operations that help U.S. patients obtain drugs from Canada or other countries has severely cut into their Rx volume this past year. Fifty-one percent of chain execs feel it has only cut their Rx volume a little bit, while 22% stated it hasn't affected them and 16% don't know whether or not it has affected their bottom line.

More than half of the respondents (57%) expect the proliferation of storefront operations that help U.S. patients obtain drugs from other countries will affect their business in 2004. Twenty-two percent of chain execs are confident that foreign drugs will not affect their pharmacy's Rx volume next year, and 21% don't know whether it will affect their pharmacy or not.

Chains nix switches

About half of the respondents (48%) stated that the Rx-to-OTC switches for Claritin and Prilosec have had a negative effect on their pharmacy's bottom line. However, 29% have experienced no effect, and 22% have actually seen their bottom line increase because of the switches.

Fifty-nine percent of chain execs gave a thumbs-down to seeing more Rx-to-OTC switches in 2004. Among the 41% of respondents who were in favor of more Rx-to-OTC switches, Allegra and Zyrtec were mentioned the most as drugs they would like to see go OTC. Antifungals, cholesterol busters, Plan-B, Preven, Prevacid, Flexeril, Celebrex, Vioxx, Viagra, and Zyban were also deemed good candidates for Rx-to-OTC switches.

Stumbling blocks

Finally, chain executives were asked to reveal what they think would be the biggest challenges in 2004. More than one-quarter (29%) of them cited competition from other chains, one-quarter believe the R.Ph. shortage will be a headache, 15% listed cutbacks in Medicaid reimbursement, 13% worried that competition from storefront operations will keep them up at night, 6% anticipate drug shortages, and 14% identified some other issue as their major challenge for 2004.

Sandra Levy

Chain forecast for 2004 in three key business areas

Health-system pharmacists see rosy picture ahead

When health-system pharmacists look back on 2003, they'll be singing its praises, at least from a financial perspective. However, they'll paint a somewhat different picture when it comes to problems associated with drug and personnel shortages. As for the future, health-system pharmacists predict that 2004 will be very similar to 2003—overall pretty good.

The results of an exclusive survey conducted by Drug Topics revealed that in terms of reaching their financial goals and contributing to their net revenue, 2003 was generally an upbeat year. Sixty percent of respondents reported that 2003 would turn out to be a lucrative business year. When asked in 2002 to forecast the financial picture in 2003, only 44% of the respondents predicted that 2003 would be a good year financially.

One respondent attributed the positive financial news this year to increased patient census while another pharmacist cited good inventory and drug management.

On the flip side, 31% of the respondents expect 2003 to be only a fair year, while 9% see 2003 turning out to be poor in terms of their financial goals and net revenues.

Budget pros and cons

According to survey data, health-system pharmacists, on average, reported having $8.4 million in their 2003 departmental budgets for drugs, personnel, and miscellaneous expenses.

Most survey respondents said that they anticipate staying within their budget for 2003. Eighteen percent reported that they would definitely stay within their budget, while almost half (47%) noted that they probably would. On the other hand, more than one-quarter (26%) revealed that they probably would exceed their budget, and 8% said they definitely would not make ends meet. Just 1% reported that they didn't know whether or not they would stay within their 2003 budget.

One pharmacy manager said that he would probably not stay within budget for 2003 because of the high cost of new drugs and manufacturers' backorders that forced the pharmacy to purchase drugs at premium cost or use more expensive alternatives. Another respondent blamed increased drug utilization and lack of formulary compliance for busting his budget.

Twenty percent of the respondents reported that they had to cut their 2003 departmental personnel budget. Drug budgets, on average, were cut by 8%, while personnel budgets were cut by 10%. Hospitals with more than 400 beds had their drug budgets cut more than did hospitals with fewer beds. Some 12% of the respondents had to cut their 2003 personnel budget.

Pharmacy shortage

Personnel shortages continue to plague health-system pharmacies on a regional basis. In our survey, 90% of the respondents acknowledged a shortage of pharmacists in their region of the country. Three-quarters of the respondents said that the shortage is somewhat severe, while 15% noted that the shortage is extremely severe. Only 10% stated that the shortage in their area is not severe at all.

When asked to indicate their opinion of the top three pieces of news that impacted health-system pharmacy in 2003, respondents ranked drug shortages first, followed by drug errors and the pharmacist shortage (see table).

Top pieces of news for health-system R.Ph.s in 2003

Looking ahead

Health-system pharmacists expect the 2004 business year to be similar to what they had predicted for 2003, according to survey results.

Six out of 10 respondents expect their 2004 departmental drug budget to increase, 30% expect it to remain the same, and 10% anticipate a decrease. On average, respondents expecting a decrease envision a 9% drop in their 2004 drug budget. Those respondents looking forward to an increase are expecting a 10% change on average.

Roughly two-thirds (65%) of respondents expect hospital pharmacists' salaries to increase. One-third predicted that pharmacists' salaries would remain the same, while only 2% believe that salaries will decrease.

Of those respondents expecting a decrease, they envision a 6% drop, on average, while hospital pharmacists expecting an increase estimate a 5% jump, on average.

In the nonpharmacist category, 62% are expecting technician and other nonpharmacy personnel salaries to increase in 2004, with the hike at 4%, on average. Another 37% anticipate those salaries to remain the same and only 1% is expecting a decrease in nonpharmacist salaries. Of the respondents who predicted a salary decrease, they forecast a 6% drop, on average.

Pharmacy personnel

When asked about the number of pharmacists they expect to have in their pharmacy in 2004, 79% of the respondents stated that they expect it to remain the same, 18% expect an increase, while 3% predicted a decrease.

Almost three-quarters (72%) of total respondents anticipate difficulty in finding pharmacists for employment in their region in 2004.

As for technicians, 78% of the respondents stated that they expect the number of their technicians to remain stable, 19% expect an increase, and 3% anticipate a decrease.

JCAHO

The Joint Commission on Accreditation of Healthcare Organizations is expected to enact several new standards that hospitals must meet in 2004, including medication management and unannounced surveys. According to survey results, the majority of responding hospital pharmacists have been preparing to meet these new standards. Specifically, 20% of the respondents stated that they were very prepared to meet these new standards, while 70% claimed to be somewhat prepared. Only 10% of the respondents declared that they are not prepared at all to meet the new JCAHO requirements.

Pharmacists taking action

Health-system pharmacists were given a list of actions and asked whether their hospital has taken or will take these actions in 2004. The top three actions most health-system pharmacists have taken in 2003 or plan to take in 2004 are to set up efforts to reduce errors, to document pharmacist interventions, and to encourage pharmacy technicians to become certified.

Technology

Computerized physician order entry (CPOE) and bedside bar-coding are two hot technologies touted by patient safety experts as beneficial tools in helping to reduce medication errors and adverse events. Yet, according to our survey, hospitals are slow in adopting both technologies.

Eighty-five percent of respondents reported that they don't have a CPOE system in their facility. Of those who don't have a CPOE system, only 16% plan to install such a system in 2004. More large hospitals reported using CPOE than smaller facilities.

Regarding bedside bar-coding systems, 92% of the respondents reported that their hospital doesn't use such technology. Of those who don't use bedside bar-coding, more than one-quarter (27%) plan to install such a system in 2004.

New drugs

In 2003, according to survey respondents, the following drug products—Xigris, Aranesp, Abilify, Natrecor, and Neulasta—were mentioned most often as having the greatest impact on their budgets. In terms of drug classes, antibiotics and oncology/chemotherapy were the categories cited most often as having the greatest impact on their budgets. Nearly two-thirds (63%) of the respondents don't expect to see any new drugs in 2004 that will turn out to be budget busters.

Finally, when asked what they thought was the biggest challenge their pharmacy would face in 2004, more than one-quarter (26%) of the respondents expect budget management/finances to pose the biggest challenge, followed by staffing issues. Ten percent cited cutbacks in insurance and third-party reimbursements, another 10% predicted rising drug costs, and 42% mentioned some other type of challenge that will await them in 2004.

Anthony Vecchione

 

Judy Chi. Cover Story -- 2004: WILL YOU BE BETTER OFF? Drug Topics Dec. 8, 2003;147:62.