Opinion: Perish Together as Fools?

September 6, 2019

We need to stand up for anywhere our profession has a profound impact on healthcare, writes Kreckel. 

Dr. Martin Luther King once said, “We must learn to live together as brothers or perish together as fools.” We know he was referring to society as a whole, but this could easily be extended to the profession of pharmacy.

I’m not much of a philosopher, so I prefer to compare our profession to a cable TV show, Storage Wars. This wildly popular show depicts owners of second-hand shops bidding on storage lockers that they briefly glimpse before the auctioneer starts the bidding. 

The drama of this show is not so much the bidders getting the best deal possible, but rather in “putting the screws” to each other. The bidders do not take pride in finding value for their businesses, but in making the other guy pay! With everyone trying to ruin the other person’s business, the only winner is the auctioneer.

I watch this program and compare it to our profession. I see Dave Hester, the “bad guy” who frequently bids up the locker, as the large pharmacy chains. They’ve got the money to make bad business decisions and have enough assets to survive the bumps and bruises of those decisions. Like Dave, their goal isn’t so much in ensuring the viability of their business, as driving the others out. 

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One of my biggest disappointments in our profession is the role of the pharmacist embedded in the PBM or health plan system. I get frustrated to no end when I see my fellow pharmacists working behind the scenes to make the jobs of their colleagues in community practice almost unbearable. Sad to say, I have precepted some of these pharmacists as students. I have seen these pharmacists set up parameters for insulin dispensing that force pharmacists into violating the law, such as opening packages of insulin pens to fulfill the day supply cap set by the managed care organizations.

One local health plan recently changed SGLT2 inhibitors. Only one SGLT2 inhibitor has been proven to prevent death. It was removed from the formulary and replaced with an SGLT2 inhibitor that has no proven cardiovascular benefits. They also removed the only DPP4 inhibitor that does not require renal dosing and replaced it with a DPP4 inhibitor that has three different strengths because of renal dosing. These pharmacy departments took the best drug in each class and replaced it with the worst drug in each class. Their brothers and sisters in community pharmacy must call the physicians’ offices to make changes for these inferior drugs. 

I teach my pharmacy students to learn the drug class, indication, mechanism of action, and side effects. Then I tell them to learn the salient differences between these drugs in that class, such as the benefits and dosing parameters. That is what separates us pharmacists from the other healthcare professionals. This subset of pharmacists who work for these managed care organizations has failed the profession and themselves miserably. 

The decisions these health plan pharmacists are making are based only on financial criteria. You don’t need a pharmacist to do that; accountants are more skilled at it.

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I have a word of caution from this very experienced pharmacist to these health plan pharmacists. Your day is coming when a novice accountant will be sitting in your position simply because you have demonstrated a total disregard for pharmacokinetics and therapeutics. 

When we see the recent shenanigans with Walmart, laying off pharmacists and replacing them with younger (and cheaper) pharmacists, we need to be shouting from the rooftops. We need to stand up for our brother and sister pharmacists in hospitals, community practices, clinical practice, and anywhere our profession has such a profound impact on healthcare. 

Remember the words of Dr. King: live together or perish together as fools. Picture Dave Hester from Storage Wars in a white lab coat.