For this edition of the “May the Support be With You” newsletter, we’re going forward in the Star Wars timeline but back to 1983 with Return of the Jedi. There is so much to love about this film, whether it’s Luke facing the Emperor and showing off his newly acquired skills courtesy of Master Yoda or Lando Calrissian getting the opportunity to put his talents to use and pilot his old ride, the Millennium Falcon.
Despite many loving the cuddly and carnivorous Ewoks and their gibberish sounds, arguably, the most famous line from the movie was “It’s a Trap!” This was uttered by Admiral Ackbar, masterminding the rebel attack on the Death Star II. The rebel alliance had intentions of attacking an inoperable Death Star station with its shields down, catching the empire by surprise. As it would turn out, the rebels knowing the location of the Death Star II near the Endor Moon was indeed intentional. Not only were the Death Star’s shields still up, a fleet of cruisers and TIE fighters awaited them.
The rebels were pinned between a planet destroying space station and an overwhelming fleet of empire pilots. Although, many in healthcare may feel pinned between two entities crushing their soul and joy for patient care, none feel it quite like retail pharmacists. I wouldn’t doubt that seasoned retail pharmacists issue a warning similar to that of Admiral Ackbar to new pharmacy school graduates.
In recent conversations, we’ve examined how pharmacy benefit managers (PBMs) generate profit, however, excluded one that isn’t a primary profit source but has devastating effects on pharmacies, price protections. Price protections account for the administration fees paid to PBMs by clients in return for low negotiated prices with pharmacies for drugs. While these strategies aim to control costs, they often create financial strains for retail pharmacies, impacting their ability to provide comprehensive patient care.
Key Challenges in Retail Pharmacy:
1. Financial Pressures: Retail pharmacies operate on slim profit margins due to razor-thin negotiated drug prices with PBMs. This financial squeeze necessitates high prescription volumes to maintain profitability.
2. Time Constraints: Pharmacists face intense time pressures, focusing primarily on verifying prescription quantity, accuracy and safety. This leaves limited opportunities for extended patient counseling or in-depth clinical reviews. Similarly, the intensive level of research into relevant studies needed to optimize patient outcomes, require time that these pharmacists simply don’t have.
3. Systemic Demands: Retail chains, driven by profitability goals, place additional strain on pharmacists’ workload and resource allocation; this has led to enormous rates of burnout. Furthermore, use of time for research to improve outcomes isn’t supported by chain pharmacies, as this doesn’t increase revenue.
4. Access to Data: Retail pharmacists lack access to important labs and histories that are necessary to make insightful, clinical recommendations.
Despite these challenges, retail pharmacists remain pivotal as accessible healthcare providers in our communities. They possess invaluable insights into patient care and play a crucial role in ensuring medication safety.
Exploring Opportunities and Innovations: There are emerging models, such as cost plus, designed to help pharmacies cover their costs effectively without incurring losses, operating similar to PBMs’ pass-through model. These innovations show promise but require broader adoption to reshape industry norms and improve overall patient care outcomes.
A Call to Action: Until there is a huge change in the way retail pharmacies generate revenue, someone must be a second set of eyes on patient drug management. We’ve seen how PBMs’ greed created profit for themselves at the cost of patient outcomes and low client drug spend; and now we’ve seen just how limited retail pharmacists are in providing clinical patient care due to the pressures they’re under from both PBMs and the chain pharmacies which employee them. New approaches are necessary, ones that fill this role by offering clinical pharmacist insight, coordination with care teams and profit aligned with their clients’ best interests .
Let’s recognize and appreciate the dedication of retail pharmacists in our communities and what they offer their patients. However, we must address the current poor outcomes and excessive drug costs we face and implement solutions to address these issues.
As always, May the Support be With You!
Dr. Ryan Garner Apothicor Wellness