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    A day in the life of Kafka's pharmacist


    David Stanley, RPh
    "If Kafka had designed pharmacies instead of writing novels," I thought to myself, "the workday would probably go a lot like this." I was on the phone with a nice lady at the help desk of a large pharmacy benefits manager (PBM), who was telling me there was nothing they could do to approve my customer's claim, that he would have to call the customer service department of his plan's sponsor.

    Except that's exactly what my customer, standing approximately 6 feet away from me, was doing on his cell phone at that very moment.

    The customer service department that the nice lady at the PBM assured me was the key to solving this problem was telling the customer to have his pharmacist call the PBM's help desk.

    I asked the nice lady whether maybe I could hold the 2 phones next to each other so she could work it out with customer service. She was not amused.

    "He's covered," she assured me, "He's just in a group that's not covered."

    Kafkaesque indeed.

    The big one

    I won't say which PBM was behind this snow job, but I will say it's the biggest one. And about to get bigger.

    I'll also tell you that the next day the CEO of that PBM was featured in a trade press story that said he "Champions Robots Over Pharmacists."

    He might have a point. A robot could have sent that customer away empty-handed much more quickly than an actual pharmacist would be able to.

    The CEO's real problem with retail pharmacies seemed to be that we don't talk to patients enough.

    "There's a fiction that a pharmacist comes out and dialogues with you," he was quoted as saying in the article. "In reality, a high school student hands you a script from the shelf."

    Thing is, I do remember a time when I could dialogue with almost everyone who came to the counter, and I know the reason I can't anymore has a lot to do with the fact that I have to fill a lot more prescriptions to stay in business these days, because the PBMs who've taken over the industry pay pharmacies around $1.50 for each one. So the PBM itself is responsible for the situation its CEO was decrying.

    Evidently the phrase "You get what you pay for" never comes up in business school.

    Can a machine do this?

    Except for that $1.50, I remain far more accessible to that PBM's customers than those who are forced to obtain their prescriptions through the mail.

    Remember, that customer with the insurance problem was just 6 feet away from me. He or anyone who comes into the store can stand right in front of me and talk my ear off to their heart's content — and trust me, many do — without ever having to press "1" for English or being told that while their call is very important, it's not quite important enough to answer just yet.

    Factor in the number of times I provide emergency supplies when customer's mailed prescriptions fail to arrive on time; the amount of time I spend guiding people through the maze of over-the-counter drug options, handing them exactly what they need; the adverse outcomes I prevent every time I give an immunization; and I would say that that CEO gets a lot for his money.

    He should be down on his knees thanking community pharmacists for the role they play in his customer's care, instead of implying that we add no value. He should be, but I doubt I'll see it anytime soon.

    Job 1 — while it lasts

    In the end, I was able to call the covered-but-not-covered customer's doctor and have his prescription changed to a medicine that cost less than his co-pay would have been. As he left, I wondered how long it would be before they could program a robot to do such a thing and reminded myself that as long as everyone kept the patient's best interests as their No. 1 priority, I'll never have to worry about a metal monster taking over my job.

    Which means I'm kinda worried.

    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]