Letters: February 2010

February 15, 2010

Pharmacists speak out about Medicaid patients, professional organizations, medication therapy management, and more.

Key Points

Beg to differ

I was alarmed to see the headline "Why do we loathe Medicaid customers?" [Viewpoint, October 2009]. I'm an independent pharmacy owner in Texas and I love our Medicaid patients. They're extremely appreciative and very respectful of our profession. And Texas Medicaid pays us like clockwork every Wednesday. What's to loathe? Compare this to private insurance plans that take their sweet time reimbursing us for our services and look every day for ways to decrease our reimbursement. I don't blame my patients for this, but I do make time to educate them about the system. In this day and age, pharmacists should thank God they have good, stable jobs. It's time to stop complaining and help promote our profession in a positive manner.

John P. Calvillo, PharmD
MISSION, TEXAS

I share David Stanley's observations and frustration that the disconnect between the working RPh and national and state organizations is increasing ["In My View," January 2010]. The misguided assumption that MTM is a viable business model for more than just a few pharmacies is an obvious example. (In a parallel, altruistic universe with different economic laws, it might work, but has anyone reviewed the Spartan reimbursements that haven't increased for years, which many payers are offering?)

Here in Washington State, our state association just begs to get duped by Medicaid on an annual basis. So much time and money spent in court and/or on negotiations with state bureaucrats could be eliminated if the state association would just say no once in a while. At least the well-grounded and responsible management at Bartell Drugs and Walgreens have seen fit to put the State Medicaid program on notice [See Upfront, page 21].

Perhaps the problem starts with how the professional organizations pick their leaders. Most seem content using committees to select candidates for one-year terms who meet the status quo instead of allowing for multi-year terms of candidates who are highly motivated. The current system produces fresh faces but stifles those who want to rock the boat. Even when someone fresh does come along, that person usually has to knock heads with a well-entrenched CEO who only has to wait a year before things get back to normal.

I lost faith (and didn't seek membership) in APhA shortly after graduating when it became apparent it was just a cult of personality ("Where's William Apple this month?"). Now they're building buildings, not relationships with the rank and file. Twenty-eight years later, they're still the same.

Richard Molitor, RPh
BOTHELL, WASHINGTON

Amen, brother

Hallelujah and amen to David Stanley's "You talkin' for me?" Drug Topics is finally back on track. The truth will set us free, I hope. Finally, a return to reality in the realm of pharmacy journalism. Keep up the good work!

Myron Bryant, RPh
NASHVILLE, TENNESSEE

Welcome to the real world

That is a GREAT article. It is just the kind of thing that pharmacists need to hear. It is rare for a pharmacy-related publication to print an article of this nature. Every pharmacist knows the problems in pharmacy, but few if any groups, organizations, or publications actually speak about those problems. I want to applaud Drug Topics for printing an excellent article that deals with real-world problems and with the problems of working pharmacists.

I want to read more articles like this.

Keith Ray, RPh
THAXTON, MISSISSIPPI

Dream on

I loved your article. It explains why I became so disillusioned with the professional associations a long time ago.

I run an independent store in a rural Texas county. No chains, no Wally World, and no other pharmacies for 30 miles each way. But what you say is the truth. I give my patients/customers everything I can, but MTM is a dream in the real world. I don't know how much support you'll get from APhA, but you hit the nail right on the head.

Tom Hill, RPh
WELLINGTON, TEXAS

MTM in chains

I agree wholeheartedly with Mr. Stanley. APhA's ideology is great, but not practical in today's chain-pharmacy practice setting. The chain pharmacy's major concern is increasing RX volume ($4 generics, etc.) without increasing payroll (more phamacists and techs).

We have known for years that pharmacists are uniquely trained to provide MTM, yet APhA acts as if this is a new idea. The articles written about MTM practice have pictures of a pharmacist sitting behind a desk dispensing knowledge to a patient; this doesn't look like any chain pharmacy I have ever seen. Of all the articles written by APhA about removing barriers to MTM, none can be applied to chain pharmacies.

APhA has contributed to successful implementation of MTM in many independent pharmacy settings; however, until MTM can be implemented by the chains, we are gaining nothing. How many patients frequent chain pharmacies? Do they not need MTM also? Instead of chastising the chain pharmacies for impeding the progress of MTM, APhA remains silent.

As Mr. Stanley stated, chain pharmacists don't have time to counsel, much less provide MTM services. Where is APhA on this issue? Doesn't our obligation to counsel on each new prescription come before MTM?

William Cobb, PharmD
RUSSELLVILLE, ARKANSAS

Two associations, one double standard

Kudos to you. You have precisely explained the double standard that exists in our profession. I want to use your letter as a response to both associations when they ask, "Why aren't you a member?" I have often said, "I enjoy the science of pharmacy, but hate the profession." Thank you for voicing what I have felt for so long.

Chad Morton, PharmD
MATHER, CALIFORNIA

What he said

Your article was right on. I applaud you for writing it. You stated all the reasons that I dropped my APhA membership, and unless they get their act together, all pharmacists should do the same.

Morris Lloyd, RPh, MS
LOUISVILLE, KENTUCKY

More action, less rah

Thank you for the article from Mr. Stanley. I have never heard this concern articulated so well. Please continue to publish these types of articles/editorials in Drug Topics. The pressure needs to be placed on APhA to actually do something for the pharmacy profession instead of merely being cheerleaders for their own officers.

Marianne Bergs, RPh
WAUKESHA, WISCONSIN

Sitting it out for the cause

Just wanted to say I read David Stanley's piece and I concur. I switched out of community practice 10 years ago because I didn't like the conditions at that time, and they have become much worse since then. Even though I am a member of the Michigan Pharmacists Association Hall of Honor, I let my membership lapse about 3 years ago. They seemed more interested in pursuing the mandate of live CE (I'm sure it wasn't solely because they are a major provider of live CE) than in improving working conditions. Their excuse was that they didn't want to alienate the chain execs who are also pharmacists, and they weren't a labor union, so they stay neutral. When you read the Code of Ethics, though, they are clearly on the side of patients. Improved working conditions should lead to better care. Until they stand up, I will sit out.

Jeff Rabinowitz, RPh
FARMINGTON HILLS, MICHIGAN