Yesterday, the New York Times published an article entitled “How Chaos at Chain Pharmacies is Putting Patients at Risk.” The article recounts how current economic and corporate structures are negatively impacting how pharmacies practice, which in turn can lead to serious, and sometimes deadly consequences. These pressures come, in large part, from the Pharmacy Benefit Manager (PBM) industry, which has commoditized drug products to the point where pharmacies are paid very little for the important job they do.
The article poses many significant and troublesome issues facing pharmacies and pharmacists today and paints a largely negative portrait of pharmacy. But this picture is incomplete; not all pharmacies or pharmacists participate in the type of practices described in the article. When Cheri Schmit, the Director of Clinical Pharmacy for GRX owned Medicap Pharmacies in Iowa, first read the article, she had a very emotional response which she shared with the members of the ThriveSubscribe community.
This article describes the exact OPPOSITE of what we are trying to achieve with CPESN and Flip the Pharmacy! Reminding patients to refill medications and contacting prescribers for refills CAN help improve health and patient outcomes. But only if the patient is receiving a medication that is safe and effective and helping them actually meet their therapy goals. This requires a pharmacist to spend time with a patient and assess their medication and health needs and then assess the safety and effectiveness of medications, gaps in therapy, clinical metrics, etc with a very holistic patient approach and then collaborate with other health care providers.
Cheri is involved with the Community Pharmacy Enhanced Services Network (CPESN) and the Flip the Pharmacy program, both of which champion pharmacy practiced in a very different way than described in the NY Times article. Cheri went on to state:
Sometimes the right thing for the patient is to NOT dispense a medication. There has to be a system that removes the PBM and PAYS the pharmacist for this interaction vs paying them to dispense a product. It’s not about the product! Inundating prescribers with refill requests to meet quotas and metrics is not only bad for patients but bad for the profession! It does NOT portray us as health care providers but rather as refill robots looking to meet a quota AND it taints how we are perceived and treated by health care providers. When a pharmacist brings a valid patient concern to a provider they
a) might not take us seriously and
b) are in the habit of ignoring pharmacy requests because they see our communication as useless, unfounded busywork.
These are regular themes on the Thriving Pharmacist. The economic model that is currently entrenched in the pharmacy benefit is unstainable. Pharmacies are regularly paid just the cost of the drug product plus a dispensing fee of $0 to $1. It is no wonder that staffing in pharmacies has been shrinking and stress levels have skyrocketed. Pharmacies are forced to fill more prescriptions on very tight margins just to survive. This is the recipe for errors like those reported in the article. And the recipe card comes directly from the kitchens of the PBMs. Cheri concludes with:
In the end, our profession should always come down to the patient and what is best for the patient. And it is my belief that the best thing for the patient is to have a trusted pharmacist who is accessible to them in their community and who will spend time TALKING with them and assessing their medication and health care needs. This is why Flip the Pharmacy and transforming the practice of pharmacy across the country MUST succeed! Yes, I want pharmacy to survive and prosper but ultimately, patients need the Flip the Pharmacy community pharmacy model to succeed and prosper.
It is more important than ever for every pharmacist to take charge of their profession. Today. Because if we don’t make THIS encounter count, we won’t have many more opportunities going forward.