Sometimes I feel that I am alone in my thinking about what the future of pharmacy holds. Having been a pharmacy manager at each of the companies that I have worked for, I have had access to the financial reports. Over the years, I have seen a steady decline in the gross profits on each prescription.
And when I speak of gross profits, I’m not talking in terms of a percentage. I’m talking about actual dollars.
At my current pharmacy, about sixty percent of our prescriptions have a total pharmacy reimbursement of under ten dollars. Due to the effects of $4 generic pricing and how insurers adjust their MACs, WACs, and GEAPs based on the usual and customary prices that are submitted to them, a good portion of the prescriptions bring in less than five dollars.
When we look at the percentages, the pharmacy is making a profit of 30, 40, or even 80 percent. But an eighty percent profit on a four-dollar prescription is $3.20.
How long can you stay in business filling scripts for a $3.20 profit? Not too long unless you are cranking out 30 scripts per hour, per pharmacist. And that’s just to break even.
What is the profession going to do in order to continue to generate a revenue stream?
Medication therapy management is one possible avenue. But why would somebody want to pay for a service when there a pharmacists and pharmacies that are giving the service away?
Right there is the major problem to pharmacists getting reimbursed for their services.
Too many pharmacists and pharmacies are giving away the one product that we have that is all our own….information about medications.
Over the years, pharmacists have embraced the idea of being the most trusted profession. Over the last few years some other professions have taken over the top spot, but pharmacists still rate pretty high. I don’t know if holding the top spot messed up our brains, but for whatever reason it has become taboo for a pharmacist to think about (gasp) charging patients for the information that we possess.
We are the only “professional” profession that doesn’t charge for our specific knowledge. Granted, we are required by law to provide certain information when we are counseling a patient on their prescription. But where in the law does it state that we can’t charge for information that doesn’t directly relate to a prescription that we are dispensing?
If I have a question about a contract that I am about to sign and run it by my attorney, I can expect a bill in about a week for his time. If I send an email to an accountant with a question about the tax consequences of a financial decision, I can expect a bill. Heck, if I ask an interior decorator their opinion on what color would look good in my foyer, I would expect to receive a bill.
So why do we, as pharmacists, answer the questions from lawyers, accountants, interior designers, or anybody else without charging for the information? I think that my time has value. Why shouldn’t I charge for my time when I am using it to answer a question that can only be answered by somebody who has a pharmacist license?
It is my opinion that we, as a profession, need to wake up and realize that we have valuable information. We need to stop giving it away to every Tom, Dick, and Harry that walks into the pharmacy. If we want to be valued as the medication experts, we need to assign a value to what we provide. The only way to do so is by charging for our specific, professional knowledge.
Pharmacists need to step back and take a good hard look at where the profession currently stands. We also need to visualize where we want it to go. If you are satisfied making two or three bucks per prescription, don’t do a thing.
But if you want to see the profession grow into something more than pill-slinging, we need to look at ways to advance the non-dispensing aspects of the profession. It’s going to require thinking outside of the box. I have some ideas that I will be sharing in the future. I urge you to share your ideas as well.