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    Prescriptions for pharmacy survival may be a bitter pill


    David Stanley
    When I was little, I used to dream of being an airline pilot. I loved the thought of being in control of a massive hunk of metal hurtling down a runway at breakneck speed, rising into the sky to land half a world away. I could get paid to see the world and expand my horizons. The glamour, the adventure, the excitement! Then I found out that I was color-blind and that people who had trouble distinguishing colors were barred from flying commercial aircraft.

    In the end I think it was for the best. If I had ended up flying airplanes for a living, I would have found myself employed in an industry that has gradually devalued skill and professionalism as profit margins have become less than razor-thin. An industry that has seen consolidation leave only a few major players. An industry whose core problems stem from the fact that it has lost pricing control over the product it provides. An industry with a business model that seems to be built on antagonizing the customer.

    Which, on second thought, sounds an awful lot like the profession in which I ended up, minus the jet lag.

    Most of us probably didn't pay a lot of attention to business majors when we were in college. After all, weren't they the ones constantly out partying while we were struggling to master the Krebs cycle? Unfortunately, the business majors have far more influence over the practice of pharmacy today than pharmacists do, and it's going to be up to them to find a way out of the pickle our profession finds itself in.

    Interestingly, the airline industry seems to have turned a corner by breaking down the various tasks involved in flying and allowing customers to pay for the ones they value. Transporting your bags is neither required nor cost-free for the airlines, but it does add enough to the travel experience that people are willing to pay for it. I would argue that contacting your doctor for refills when your prescription runs out should be similarly valued. A dollar per faxed request could go a long way toward saving us from the $1.50 PBM dispensing fee.

    Unfortunately, the pharmacists who imagine themselves the leaders of our profession seem intent on giving away what we already do while trying to convince people to pay us for a concept, medication therapy management (MTM), that sounds good in theory but has yet to take hold in the real world. It would be as if the airlines were banking their future on charging customers more for supersonic air travel. The idea is sexy, it's possible, and it's been done on a small scale, but the $25 baggage fee has done far more to ensure the survival of United Airlines than the Concorde ever did.

    I find it interesting to note that after years of talk from the American Pharmacists Association and other leaders of the profession about how MTM is the future of pharmacy, it has been custom compounding, the old-fashioned charging for a product, that has been largely responsible for stopping the extinction of the independent drugstore.

    The last time I was at the airport, I made a point of watching the flight crews as they left the aircraft at the end of their workday. They looked as tired and worn down as I feel at the end of a 12-hour shift.

    The ticket agent behind the counter next to the gate was as frantic as one of my technicians managing the chaos of the after-work pharmacy rush. The look on the face of the man who was told that he had just been bumped from his flight was the same as that of a patient being told that his prescription for Benicar will require a prior authorization.

    As I looked around, I realized that we are all in the hands of the business majors now, and I thought of the ones from my freshman dorm who had a habit of coming back from bar-hopping just as I was wrapping up my studying for the night.

    I wish I had paid more attention to those business majors back then. Like it or not, we are indeed in their hands now.

    David Stanley is a practicing community pharmacist in 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]