State of the Profession......The Future

Over the past few weeks, I've tried to present the profession of pharmacy as I see it. You may or may not agree with my views and that's fine. Depending on our practice setting and the patients we see, we will have differing views on where the profession stands currently.

But if we just look at where we are now, we are missing one of the key points I wanted to address with this series.

It doesn't matter where we are or how we got here. We can't change the past. All that matters is where are we going from here. So today I'm going to throw out some of the topics that seem to dominate the headlines when it comes to the practice of pharmacy and share my thoughts on them.


Tech-check-tech

A few years ago, several pharmacy outfits decided that it would be a good idea to offer generic medications at rock bottom prices. Four bucks for a month's supply of pills.

One of the consequences of these programs is a decreased profit margin on prescriptions. In order to maintain a profitable department, pharmacists have been forced to fill an increased volume of prescriptions in order to cover the costs of operating the prescription departments.

When you look at a pharmacy's P & L statements, the largest expense (after medication costs) is the pharmacist salary. You can hire four to six technicians for the price of one pharmacist. Don't you think that the non-pharmacist members of management are looking for ways to decrease or eliminate the need to pharmacists?

I'm not saying that we need to worry about this over the next year or so, but if you are not prepared for this we may see ourselves phased out of our own profession. Pharmacists need to start speaking up to our legislators and boards of pharmacy in order to make sure that the corporations don't phase us out. I hope I'm wrong on this issue.



Immunizations

In 1996 the APhA House of Delegates decided to push for pharmacist immunizations. After 14 years, pharmacists are able to give vaccinations in all 50 states.

So flippin' what?

How has this advanced the profession?

Pharmacists are now able to provide the same service that physicians and nurses have been doing forever. Doesn't really differentiate us, does it?

In fact, the beauty of pharmacist immunizations is that we can't bill for the act of giving the shot. When a physician gives a shot, they bill the insurance for an administration fee. Do pharmacists?

For the increased liability exposure, pharmacists receive absolutely nothing.



Medication Therapy Management

This is my pet project. I see this as the future of pharmacy.

MTM actually utilizes our unique skills as medication experts. But how do we market this? How can we get patients to want to pay us for these services.

Our profession has been tied to a product for so long that people are almost shocked when we say that we want to bill for the information that we possess. They think that the cost of the medication entitles them to all of the information that we can provide. Maybe if we actually made a decent profit on the product. But $1.85 profit on a script is going to get you $1.85 of info from this pharmacist.

We need to promote the informational side of what we do, but not give it away. OBRA 90 requires us to provide specific information during a counseling session. Anything above and beyond that should be compensated by either the patient or their insurer.

So far, I have not seen a successful model to follow in developing MTM services. I hope to be able to report back in five years and say "this is how I built my successful MTM business". We need to share our successes so that all of us may benefit.



Corporate ownership of pharmacies

North Dakota has it right. Pharmacists should be in control of the profession, not companies.



Pharmacist prescribing

Makes total sense to me. I mean, we are the medication experts. Heck, freaking nurse practitioners and physician assistants have prescriptive authority. And we don't? Hell, insurance companies have more prescriptive authority (via formularies) than pharmacists do.

APhA and other pharmacy organizations, this is a huge issue where we would like to see measurable progress that is reported back to us.







Pharmacists need to have a voice as our profession moves forward. Unfortunately, too many of us have settled for the nice lifestyle that our salaries allow us to have and are afraid to speak up on matters that affect the profession. We live in fear of losing that paycheck if we say something that our boss doesn't like.

It's easy to sit back and complain to our techs and fellow pharmacists about issues surrounding the profession of pharmacy, and then do nothing about it. It takes some gumption to actually speak out and make your opinion known about the direction of the profession.

It's us, the pharmacists, who will determine the future of our profession. There's one catch. You have to find your voice, then use it to be heard.

Quick question

Today's topic... Marketing materials for MTM services.


Anybody know where to get them?



Shoot me an email. ericrph (at) msn (dot) com

State of the Profession...Marketing

When you think of pharmacy marketing, what do you think of?




Is it something like this from the people over at Walmart:





Or maybe this offering from CVS:





Perhaps you think of a local, independent pharmacy's ad:





Maybe something like this from the Super Bowl?





Or this, presented by the ASHP:






Maybe your perception of pharmacy marketing is connected to the gimmicks that we've seen all too much of over the past 15 years.

• $25 gift cards for new/transferred prescriptions
• Fuel perks/ discounted gasoline
• $4 (or less) generic medications
• free antibiotics (and now, diabetes medications)

Whatever your perception of pharmacy marketing is, I think that we can all agree that it pretty much is centered around the product that we dispense. The large corporations try to get people into their pharmacies based on a few things:

• how convenient it is to get the product
  
• how cheap the product is
  
• what bonuses we'll give you for getting the product at our place

The corporations are going to continue to push the product. That's what they care about...sales.


But we, the pharmacists, need to promote the professional services that we provide. From the videos above, I like the message that the ASHP was trying to convey. They are attempting to show the other aspects of pharmacy. Just that, in the hospital setting, they can't bill for their services individually. Pharmacy is lumped into the rest of the hospital bill. If pharmacists billed for their services individually, the message of the ad would be great.

I'll be truthful here. I think that pharmacy needs to evolve into something different from what it is today if it is going to survive. I see outpatient medication therapy management and ambulatory care pharmacy as the future of the profession. If we think that counting pills will continue to be the bread and butter of pharmacy practice, we are set to be rudely awakened.

So how do we move from the product-determined method of payment to the service-based method of payment?

In a nutshell, I don't have a clue. But I do know that we need to start by billing for the services that we do provide. And when we do, we need to submit a dollar figure that shows how much we are saving the insurer. When we tell Mr Johnson to try XYZ cough syrup and keep him from running to the ER on Saturday night, we just saved the health care insurer at least $400. So we need to bill with that in mind. Maybe they'll pay us $15 when we save them $400. (I have an idea on how to pull this off. Details in a future post)


But back to the marketing of the professional services. I can see a series of videos that are basically testimonials where people share their story and explain how their partnership with their pharmacist improved their health. The commercial would include a link to a web-site that lists individual pharmacists who provide professional pharmacy services. We want to keep the focus on the pharmacists, not the building that they happen to work in.

We have studies coming out all the time that show the benefit of pharmacist involvement in the health care of our patients. We just need to be bold about it and put it out there for the public to see.