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    How to solve every problem in pharmacy

    A while ago I was talking with a friend who works in nearby Silicon Valley when I had a revelation that will solve pretty much every major problem the pharmacy profession faces. It might not surprise you that the solution to what ails us comes from the land of big ideas. The place where some guy named Jobs started a business in his garage that changed the world. Big ideas come from Silicon Valley, and it would seem only right that the solutions to pharmacy's big problems should come from there. That part isn't surprising at all.


    David Stanley, RPh
    What's surprising is that I am about to share the solution with you. Right here, right now, and I'm going to do it for free.

    The back story

    My friend, you see, is a computer programmer. And one day his employer came up with a plan to cut the amount of time it would take to "debug" the code in a new project. The company would pay its programmers for each error they found, giving them the incentive that has motivated every worker since the beginning of capitalism: cold, hard cash.

    The number of errors found skyrocketed, and I'm sure the genius who thought up this scheme looked in the mirror and basked in the reflected glow of success. Bonus checks went out to the programmers as promised, because metrics were being consistently met. It seemed like a win-win for everyone.

    But here's the thing. The project didn't seem to be going forward any faster. By any measure, the number of bugs in the code being brought to management's attention was through the roof, but there were still too many being found to speed up the overall job. What was going on?

    As it turned out, the programmers were creating bugs of their own to put into the code, and then they were claiming credit for finding them. Even in the home of the iPhone, Facebook, and the tablet computer, evidently things happen that would be indistinguishable from the antics at Dunder Mifflin.

    Here it comes

    I promised you a solution to the problems of pharmacy, though, and this story illustrates it perfectly. Are you ready? Fasten your seatbelt, because the drugstore business revolution is about to be revealed. Here it comes.

    You get what you pay for.

    That's the lesson to remember here. If all you pay for is computer bugs, that's all you're going to get. Similarly, if all you pay for is 30 pills in a bottle, that's all you're going to get.

    If you want your computer project sped up, you will have to pay for a quicker project, and if you expect pharmacists to be professionals, you will have to pay us to do professional things at a rate that allows us to do them.

    The greater good — and we know whose

    For example, do you think the powers that rule the drugstore have developed a heightened concern about the public health impact of influenza over the last couple of years? If so, a management job may be opening up in Silicon Valley that could interest you.

    Most of us know that the pressure we face to stick as many arms as possible this flu season comes from the same incentive that was dangled in front of those programmers: cold, hard cash.

    Our employers get paid far more for a flu shot than they do for 30 pills in a bottle, so we are forced to deliver as many flu shots as we can find arms to stick.

    Now, just imagine that each new prescription you fill is the equivalent of one of those computer bugs and that your employer will get paid for each one you counsel on, instead of the dollar to dollar-and-a-half the PBMs pay for 30 pills in a bottle. Do you think any patient would be left uncounseled?

    Amazingly though, people like David Snow, CEO at the time of Medco Health Solutions, can pay a dollar a prescription, then lament the "fiction that a pharmacist comes out and dialogues with you."

    You get what you pay for, David. And when you pay a dollar's dispensing fee, you get a dollar's worth of pharmacist services.

    I bet once my "you get what you pay for" business paradigm gets out there, there will be big things in my future, as people like Snow are replaced with people like me, who understand that they should pay for the things they want. I wonder whether a corner office in the sky may be in line for me as my idea revolutionizes the business of healthcare. Unless ...

    ... the people who are paying the pharmacy bills right now don't want our services. Unless ... they actually are getting what they want right now.

    Oh dear. We may have bigger problems than I thought.

    David Stanley is a pharmacist, blogger, and professional writer in northern California. He can be reached at
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    David Stanley, RPh
    David Stanley is a pharmacy owner, blogger, and professional writer in northern California. Contact him at [email protected]