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    A pharmacy business model to squawk about


    David StanleyDavid StanleyI 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.

    See also: Reformulate, remonetize — and let the patient beware

    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."

    See also: Working together for the greater good: MD vs. RPh

    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.

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


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    • Anonymous
      David you nailed this one, even with the very clever double entendre of "chickenization." My own prediction for the future is that in 20 years most pharmacists will be replaced by pharmacy techs and robots. Sorry to all the new grads with ridiculous student loan debt but you may not work long enough to see that debt paid. With the trend towards increasing tech-pharmacist ratios prevailing today the end is almost in sight. Thankfully so is my career. Looking forward to the day that APhA changes its name to American "Phowl" Association...
    • JoseLopez
      David, its too late. I don't see how this will be reversed. The PBMs have total control of the government and the laws. PBMs are our worst nightmare, paying us 1.50 for a months worth of medication while their CEOs are making 20 million yearly. It would be possible to make some changes in our doomed landscape, if it was not for APhA and other organizations, who keep pushing provider status. I have very valid reasons why concentrating on getting reimbursed for cognitive services, will result in total annihilation of our profession. And this push, while totally disregarding the reimbursement issue is wrong. This no push-back by our professional representatives is and will result in what you call "Chickenization". There is nothing preventing PBMs from reimbursing us whatever they feel like, NOTHING.