About your Oct. 10 cover story, how can we tell our technicians and cashiers that they have been replaced by a refill ATM? Fortunately, this isn't an attack on my job ... yet!

Pharmacists, grab that phone and tell your higher-ups that you won't work in a setting that replaces people with robots. The workers being assaulted here have a very small voice in corporate America. Let us pharmacists flex our muscles of integrity in the face of corporate greed.

Colin Price
Rite Aid pharmacist
Sandy, Utah

There have been many articles in your journal and other pharmacy journals that in essence state that pharmacy benefit managers don't allow patients freedom of choice-the opportunity to choose between retail and mail order as their drug distribution system. I agree with the sentiment that PBMs have been harmful to point-of-service retail drug distribution, but for a reason other than freedom of choice.

PBMs don't make the decision on whether health plans use mail-order or retail pharmacy. Payers (employers and HMOs) are given the "freedom of choice" to choose whatever style of drug distribution system they want for their employees or clients. They may choose retail, mail order, a combination of the two, differing co-pays, and so on. The PBMs then act as the traffic cop enforcing the speed limit. The cop does not set the speed limit nor does he care whether the speed limit is 55 or 75 miles per hour. Whatever the state lawmakers "choose," the cop will enforce the limit.

I agree that the PBMs are ineffectual and are actually corrupt policemen, corrupt in that they have incorrectly informed the payers of the virtues and values of mail order and AWP discounting. But pharmacy is also to blame for our inability to market successfully the virtues of a point-of-service (POS) drug distribution system against the PBMs' marketing of mail order.

I have sat on advisory panels while pharmacy complained about the unfairness of mail order but presented no business plan that countered the PBM argument that a bigger AWP discount was better and mail order was even better yet.

APhA, NCPA, GPOs, and state organizations have not been able to convince the payers that POS distribution is a superior value, despite the fact that it obviously is. That is where I put the blame-too much emphasis by these pharmacy organizations on solving the problem politically and too little time, effort, and money on marketing the value of POS distribution and disease state management.

It is the payers we should be addressing and not the government. Convince the payers and government will follow, as it always does. We cannot outspend the PBMs politically, but the payers can and will, if we convince them of our value.

Do not look for political solutions. Just present the facts that POS drug distribution is more patient friendly and has better health outcomes than mail order. GM and Ford do not want to talk to lobbyists; they want a business plan that reduces cost, improves health outcomes, and is patient/employee friendly.

Retail pharmacy can do this and is doing this, but no one in the marketplace knows this, and the marketplace is where it counts.

Jim Fields, R.Ph.
President, Waynesville Pharmacy
President, Pharmacy Services Provider
Waynesville, Ohio

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