PULSE: Recession hits pharmacists and their customers

By Laura Raines, Pulse editor

According to a survey conducted by the American Pharmacists Association in February, pharmacists and their customers have not been immune to the effects of the recession. A large majority of pharmacists reported that the economic downturn had impacted their practice; nearly two-thirds said that it impacted their jobs.

“We are no longer telling students that they will always find a job in the metro Atlanta area,” said Michell Redding, PharmD, clinical assistant professor and director of the community pharmacy residency program at Mercer University College of Pharmacy and Health Sciences in Atlanta. “We believed that job security would never be a factor with pharmacists, but that’s changing.”

Some chain pharmacies have closed stores and others have cut back their pharmacy hours.

“As a result, there are fewer positions and pharmacists’ workloads are increasing,” Redding said. “We’re seeing a situation where a pharmacist — who may have had help in the past — is working long hours many days in a row. A pharmacist is the last person you want to be tired, because an error in pharmacy could be life-threatening.”

Redding said more customers are turning to pharmacists for advice. Some have lost their insurance or can’t afford an expensive drug that a doctor has prescribed.

“Pharmacists are more visible and accessible than most health care workers. Someone will say that they can’t afford a doctor visit, but have worrisome symptoms and want advice,” Redding said. “We want to help people, but it’s not our job to diagnose or prescribe.”

Pharmacists also are seeing patients tightening their belts by switching to cheaper, over-the-counter medications, not buying all of their prescribed medications, taking them improperly or switching to generic drugs.

“While patients may try to economize by splitting tablets, taking daily medications every other day or just waiting a month to refill prescriptions, these practices are harmful and can even be deadly,” said John A. Gans, chief executive officer of the American Pharmacists Association. “We encourage patients to talk to their pharmacists or physicians before stopping or altering any medication regimen.”

Duluth Rexall Drug Store owner Lynda Alley, RPH, poses in her pharmacy. Photo by Barry Williams/Special.

Duluth Rexall Drug Store owner Lynda Alley, RPH, poses in her pharmacy. Photo by Barry Williams/Special.

Pharmacists are spending more time helping patients find alternative solutions and negotiating the costs of their prescriptions.

“Wal-Mart started making some prescriptions available for $4 and many pharmacies followed suit,” Redding said. “While the $4 prescription has helped ease the recession woes for many patients, it is not without drawbacks.”

A generic drug may not be as effective or a drug may not have a generic brand, she explained. Doctors can’t always prescribe only what a patient can afford.

Another complication can occur when customers fill multiple prescriptions at different locations to get the best price.

“It makes it more difficult for a pharmacist to track harmful drug interactions or side effects if a patient is getting his medications from multiple pharmacies,” she said.

Independents hurting
Lynda Alley, owner of Duluth Rexall, has seen demand for compounding prescriptions decrease.

“Our gift section has dried up completely and the profit that we made selling medical equipment has gone down as well,” said Alley, R.Ph.

She relies on sales of gifts, equipment and nonprescription drugs to make up for the losses of filling fewer Medicare and Medicaid prescriptions.

“You get reimbursed $1.50 to $2.50 over cost for those prescriptions, which doesn’t begin to cover your computer software, labels, gas, lights and employee salaries or benefits. You need to be making $10 or $12 above the cost of those prescriptions elsewhere to break even,” she said.

Cash flow can be another challenge.

“You need to immediately restock a drug when you fill it, but you may not see payment for the prescription you filled for 10 to 30 days or more. You’re at the mercy of a check coming in,” Alley said.

“Every independent pharmacist I know says that this has been one of the hardest years ever.”

Because expensive drugs often need prior approval from an insurance company before filling, Alley spends hours on the phone with insurance companies and doctors offices trying to get customers what they need.

“It’s what you want to do, but [it's] still very time-consuming,” she said.

Alley is seeing fewer open positions for pharmacists in the commercial arena. “It used to be you could walk into a drugstore most anywhere and get a job. It’s getting tougher and tougher for everyone.”

Redding is advising students to diversify their experience because there are many places pharmacists can work besides drugstores.

“We’re having no trouble placing them in residencies and they can think about the academic world, hospital pharmacies, pharmaceutical companies or research,” she said. “We are always going to need pharmacists, but in this economy, they will need to think strategically about their careers.”

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