A pharmacy business model to squawk about
I don't think much of self-proclaimed “visionaries” who make bold predictions of what the future holds. Show me the person who in 1990 accurately predicted the impact of the internet on people's lives and maybe I'll listen to her.
Mostly, though, people are about as accurate when they forecast the future as the pharmacy manager I saw quoted in a 1998 trade magazine article who said, "We're doing this for one reason, to help us free up time so we can spend more with the patients."
Are you spending more time with patients now than you were in 1998? Unless you bought your own store, as I did, I'd be willing to bet everything the future holds for me that the answer is no.
My two cents
Despite the foregoing, I'm going to make a guess as to what the future holds for our profession.
I don't mean members of our profession being afraid to confront the powers that be over our deteriorating professionalism, although that certainly is a cause. I'm talking about pharmacy following the model of the chicken industry — specifically, the relationship between the country's largest chicken processor, Tyson Foods, and the “contract farmers” who actually raise the company's birds.
These farmers take delivery of Tyson's chicks, buy Tyson's feed to give them, raise them in barns that meet Tyson's specifications (which can change and leave the farmer with no choice but to pay for expensive modifications), and are paid according to a “feed-in-to-pound-out” ratio.
The only thing the farmer actually owns is the barn itself, the piece of capital that just happens to be the worst investment in the whole industry. As journalist Christopher Leonard told National Public Radio's The Splendid Table: "The farmers have almost no control over the most important things in the operation ... So essentially they end up taking orders from a big company like Tyson Foods in the same way a serf might be tied to a lord many, many years ago."
Same story, different names
Now, let's rewrite some of that with minor changes.
“Pharmacists take delivery of the PBM's drugs and are sent their client's prescriptions, which must be filled in pharmacies that must meet the PBM's specifications (which can change and leave the store owner with no choice but to pay for expensive modifications).
The pharmacists have almost no control over the most important elements of the operation ... So essentially they end up taking orders from a big PBM in the same way a serf might be tied to a lord many, many years ago.