Anti-meth PSA

Writer's block. So today I'll share a few photos to serve as a public service announcement in the battle against methamphetamine.







I'm not advocating meth with the above photo. It just allowed the Star Wars geek in me to include Chewbacca in a pharmacy blog.




This next one kinda reminds me of a certain actress who has some substance issues. Last name rhymes with Rohan (for the Lord of the Rings fan in me).












And the most compelling argument against meth:








I'm scared about this last one. I think my six year-old daughter might be on meth.

Oath of a Pharmacist

At this time, I vow to devote my professional life to the service of all humankind through the profession of pharmacy.


I will consider the welfare of humanity and relief of human suffering my primary concerns.


I will apply my knowledge, experience, and skills to the best of my ability to assure optimal drug therapy outcomes for the patients I serve.


I will keep abreast of developments and maintain professional competency in my profession of pharmacy.


I will maintain the highest principles of moral, ethical, and legal conduct.


I will embrace and advocate change in the profession of pharmacy that improves patient care.


I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.




I found a copy of the Oath of a Pharmacist that was provided to each member of my graduating class by the AACP while searching for something in my basement a few days ago. The ideas expressed in the oath are the ideal. Let's compare the ideas with reality in the community pharmacy.

I will consider the welfare of humanity and relief of human suffering my primary concerns. Not a 15 minute guarantee. Not playing insurance agent. Not dealing out gift cards. Pharmacists want to help those who are hurting and impact the health and well-being of the patients who come in to see us. Trying to do this while filling 300+ prescriptions per shift is difficult at best.

I will apply my knowledge, experience, and skills to the best of my ability to assure optimal drug therapy outcomes for the patients I serve. Um...yeah. With less than two minutes per prescription, "optimal drug therapy outcomes" means that the patient isn't going to die from the prescription. Community pharmacists are simply not given the time to do this. DUR. In retail/chain pharmacy? Other than glancing at a pop-up window for drug-drug interactions, what DUR is being performed?

I will keep abreast of developments and maintain professional competency in my profession of pharmacy. Community/retail/chain pharmacists are actually able to pull this point off. At least a majority are able too. Sometimes I wonder about the competency of the floater pharmacists who come through. And I've always been concerned about the competency of management. Seriously. But so has every other pharmacist.

I will maintain the highest principles of moral, ethical, and legal conduct. Pharmacists...yes. Manufacturers...no. But somehow pharmacists are lumped in with pharmaceutical manufacturers. And the insurance companies. For some reason people think it's the pharmacist who decided to increase their Lipitor copay from $15 to $45. But we'll take the blame. And give you a $25 gift card for your trouble.

I will embrace and advocate change in the profession of pharmacy that improves patient care. Advocate change. Most pharmacists are afraid to speak their minds to management. Until more pharmacists speak up, all the changes that are implemented won't be for better patient care, but for better earnings reporting to Wall Street. But don't hang your hat on the changes that are being proposed by academia. You have to remember that the bills still need to be paid. Before rolling out major changes to how pharmacy is practiced, we need to make sure that we will be reimbursed for the changes. Too many times the profession has started doing things for free, with the hopes of getting reimbursed when it becomes mainstream. You know where we are now, right?

I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public. Pharmacists are aware of the responsibility that we are entrusted with. Maybe some members of management need to spend a week behind the counter, shadowing pharmacists to see what responsibilities we have to the public rather than handing down additional tasks that benefit the corporate.

Chains...what are they good for?

I'm a huge fan of the social media. It gives me a chance to throw ideas out and see the response of others who are active in the social media. I try to share my thoughts at least once a week on my blog, but life gets hectic and sometimes I have trouble sitting down to put together a post.

As a result, I have become a huge fan of Twitter. I can share quick thoughts and get feedback almost instantaneously. Recently I made a comment about chain pharmacy ruining the profession of pharmacy. A fellow Tweep asked me to explain. I was going to send him an email, but then it struck me that the topic could be something I could use for a blog post, so here it is.

Let me start out by saying that chain pharmacy has put a lot of food on my table and made a lot of house payments for me. I have worked in the chain environment for the first sixteen years of my pharmacy career. I have learned a lot from these experiences. When I started, the chains weren't too bad to work for, but over the years I have witnessed the profession of pharmacy devolve into its current state.

What is now accepted as pharmacy practice in the chain pharmacy setting is a far cry from what it once was. Marketing ploys have changed the profession of pharmacy into simply a retail job. This post will focus on some of these ploys that have taken pharmacy to unprofessional place that it is today.

First up... insurance contracts. I can assure you that an independent pharmacist wasn't the first person to sign an AWP - 17% + $1.50 contract. It was the big boys. The ones who are able to withstand the lower reimbursement rates because they get larger discounts by buying in bulk. Smaller operations were forced to accept the low rates or risk being dropped from a PBM's network. Now the PBM's have developed multiple reimbursement formulas that capitalize on multiple reimbursement formulas. AWP, WAC, GEAP, FUL, and MAC may look like alphabet soup to you, but to the PBMS it's a means to guarantee that they will pay the least amount for a medication that they can. Some insurers have gone as far as to establish their own MAC lists. Good luck getting a copy of that list. In the take-it-or-leave-it world of PBM contracts, most pharmacists sign the contract without even reading the reimbursement rates. And we can thank the chains for starting us down that road.

Next on the list... gift cards and coupons. Pharmacy is a medical profession, not a marketing ploy. But rather than growing pharmacy business by offering superior medical care the chains decided to start bribing patients to come to their establishments. Transfer two prescriptions and get 25 bucks in gift cards became the norm. These days the chains use the gift cards to handle complaints from customers. That's right, I called them customers and not patients. Patients have relationships with their medical professionals. How many district managers have ever used the term patient counts? It's always customer counts. That's how they view the phamracy patrons.

Next up... 24 hour pharmacies. Other than emergency departments, what medical professionals are open 24/7? Let's expand the question to professionals in general. How many lawyers have 24/7 hours? Or accountants? Yet pharmacists are working in these conditions all over the country. And if you've been paying attention to the news, you'll see that there have been a number of pharmacy robberies lately. Should medical professionals be putting their lives at risk so that Henry can pick up his Vicodin at 4:00 AM?

Ever see on of these... drive-thru pharmacies? Some will argue that drive-thru pharmacies offer a convenient alternative to people who may have difficulty walking back to the pharmacy department. Ask a person in retail pharmacy who actually utilizes the drive-thru. Rather than helping a very small segment of the patient population, drive-thru windows have advanced the notion of fast-food pharmacy.

Speaking of which... 15 minutes guarantees on prescriptions? Thank you Rite Aid for that wonderful idea. While I have worked at pharmacies that have been able to have wait times of less than 15 minutes, it was never guaranteed. The guarantee puts an extra level of stress on the medical professionals who work in the pharmacy. Can you imagine your dentist promising root canals in 15 minutes or less? You would question how professional the service would be. Enough said.

These are just some examples of what the chains have done. There are many other things that the chains have promoted that have helped to devalue the profession of pharmacy. Feel free to share them with me.

One of my favorite songs

Florida pharmacists and the PCMA

A few weeks ago I came across an article that talked about the state of Florida's employee prescription benefits. The jist of the story was that state employees and retirees were being forced into using the mail order option for certain medications. This isn't anything new. Employer groups force their enrollees into mail order all the time.

But the article quoted an organization that I had not heard of previously. The Pharmaceutical Care Management Association (PCMA).

The name of the organization sounds like it has the best interests of the patients in mind. I mean pharmaceutical care is in the name of the organization. But is that really the case. On June 16 and 17, the PCMA came out with guns blazing, attacking independent pharmacies for wanting to protect their profits instead of caring for the patients.

I don't see it that way.

Anybody who has worked in community pharmacy knows of the problems that occur when patients are forced to use mail order options. Hours are wasted every week in efforts to get a two-week supply of medication covered for patients whose mail-order prescriptions haven't arrived.

When community pharmacists are filling prescriptions for medications used for acute situations, we are dependent on the software at the insurance company to flag potential drug-drug interactions since the entire history is not available to the community pharmacist. The PCMA tries to assure us that their software catches all potential interactions and that complete insurance claims history is available to both the mail order and retail pharmacy to screen for interactions.

Did you catch that?

The PCMA says that the insurance claims history is available to both the mail order and retail pharmacy. I've never been provided with a patient's claims history in order to conduct a thorough DUR, but that's not the point.

I don't know about where you work, but in my area a lot of people bypass the mail order mandate and just pay cash for their maintenance medications. Over the last five years, there has been a huge uptick in this practice since four dollar prescriptions have rolled out.

The so-called safety check that the PCMA touts is actually being bypassed. Complete DUR evaluations are not being performed and patients are being put at risk. Pharmacists are not given an accurate picture of a patient's drug therapy.

The PCMA knows, as do community pharmacists, that the best pharmaceutical care is provided when a patient gets all of their prescriptions filled at one pharmacy. The PCMA is just afraid to admit it out of fear of losing money.

I applaud the pharmacists who have spoken out against the state of Florida and the PCMA. Your voice is being heard. Don't give up the fight.