Pharmacy’s biggest problem in the outpatient space: the retail prescription

There’s a very interesting article at the Pharmacy Times that talks about the how the “retail prescription” has created a lot of problems for outpatient pharmacies, and it’s not what you think. At least it wasn’t for me.

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“The real problem is more fundamental, emanating from the most basic elements of pharmacy practice…How ironic that a factor which is such an integral part of the profession—the retail prescription—also functions as an internal deleterious force.

The prescription is pharmacy’s direct connection to the population at large. If the patient care services associated with prescriptions were fully optimized, pharmacists could collectively achieve improvements in the health and well-being of countless individuals that would be clinically and economically awe-inspiring. One only need review the findings of the Asheville Project to appreciate what can be accomplished by community pharmacists who provide comprehensive clinical services in concert with prescription processing.

There should be a baseline of direct patient care associated with EVERY prescription, with appropriate follow-up intervention as warranted. Imagine what pharmacy practice would be like if that were the norm, with medication therapy management (MTM) offered as a routine service for all prescriptions, not just those relating to select drugs or disease states.

Unfortunately, the reality of the typical community pharmacy work environment tells a different story. All the talk about shifting focus from product to patient has been largely just that—talk. Rather than building on the patient care potentials of the retail prescription, current pharmacy trends seem more intent on expediting the process as much as possible by employing strategies that range from automation to centralization.”

The article goes on to lay out a compelling argument as to why processing prescriptions is a problem. I’ll give you a hint, it has to do with the willingness to accept low reimbursement from insurance companies. The author, Daniel Brown, PharmD, lays out an interesting strategy to bring pharmacists out from behind the counter and put them in front of the patient. It’s a good plan, and you should all go read it. Unfortunately reality is standing in the way.

You see, retail pharmacies have no desire to provide direct patient care unless it helps them turn a profit. They are the ones that continually accept lower and lower reimbursement from insurance companies, which in turn force independents to do the same to stay in business. It’s a never ending race to the bottom. The problem is that retail pharmacies like Walgreens, CVS, Rite Aid, among others have deep pockets and great lobbies. Independent pharmacies find it difficult to compete. Oh sure, the retail pharmacies are “getting into integrated health”, but the plan isn’t to provide better healthcare. No, the plan is to increase their reach. Putting a retail store inside a hospital is a way to increase your script volume and customer base. Think about it. Ugh, Walgreens has even managed to put a retail store on the UCSF Medical Center campus. As a UCSF alumnus I find it disturbing.*

There are three things that must happen before pharmacists will be able to truly engage patients in the outpatient space:

1. Use technology as much as possible to minimize the time pharmacists spend filling and checking prescriptions. The technology is there, but not used appropriately. Should a human hand ever “fill” a prescription? Seems ridiculous in this day and age, but it happens millions of times a day. This is where I think pharmacy as a profession could learn a lot from logistic geniuses like Amazon. Seriously, when you boil it down to the nuts and bolts of it, pharmacy distribution is a logistics problem.
2. Work with Boards of Pharmacy (BOPs) to better define what pharmacists and technicians can do; see item #1. The time for pharmacists to physically touch prescriptions is over, but BOPs have been slow to respond.
3. Hospitals and healthcare systems need to partner with independent, i.e. community pharmacies to provide outpatient services for hospitalized patients upon discharge. Using national chains isn’t the answer because they don’t care about your local community, independents do. This should include delivering medications to the beside and providing patient education before discharge, follow-up after discharge, and thorough medication therapy management throughout the patient’s care. Difficult to get started for sure, but it would be worth it in the long run. Using local, community-based pharmacies is better for the patient, it’s better for the hospital, it’s better for the community, and it’s better for pharmacy.

Perhaps when the profession has accomplished the three goals above will Dr. Brown’s vision become a reality.

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*UCSF and Walgreens “reimagining pharmacy care”. Yeah, not so much…