Comments on Drug Channels: The Dark Side of Pharmacy Efficiency

I am a WalMart pharmacist and I have a lot of empa...

2008-02-22T14:22:00.000-05:00

I am a WalMart pharmacist and I have a lot of empathy for the comments I've read. Yes, the whole fast food analogy gets tiring at times. I have had people insist on interupting me to yell about the wait times to the point I've actually said that if they are in such a hurry, they need to let me get back to filling prescriptions, because standing there listening to their complaints is making the wait time longer. Fortunately we have a good store manager and a DM who both know us and know that we are doing our best.

Our biggest lag time right now is actually at the cash register--the line there can be pretty long even when we are caught up filling-wise. Even with 2-3 cashiers. Between verifying the pick up, signing HIPPA aggreements, signing for insurance, getting ID for controlled substances (we have problems both with fradulent prescriptions and people claiming somebody else picked up their Vicodin), and the whole pseudoephedrine mess, it can take a long time just to check out.

I admit to having real mixed feelings about the $4.00 program, as I don't like feeling that I am working for less income to the pharmacy, but I've seen some *very* happy patients--I've had a Mom in relief tears because her prescriptions for her child are going to be less that $20.00. I've heard from many seniors, that even with Medicare D coverage, they have worked with their Doctors and are now saving hundreds of dollars.

I've also seen selfish folks who get mad because they have the notion that all our generics are $4.00 and that we can get every drug as a generic and they should be $4.00 too.

One thing that escapes notice is Walmart. When I s...

2008-02-19T13:38:00.000-05:00

One thing that escapes notice is Walmart. When I started with Walmart, the focus was on good service. There was enough staffing and the emphasis was on building a loyal clientel.

When Walmart went to the $4 prescription plan, staffing levels were predictably cut. Now the service level has declined considerably. Most of the Walmarts I have worked at lately are falling apart. Wait times have increased dramatically, third party issues go unprocessed (which means people are not getting the drugs they need), and yes mistakes have gone up. I know of several mistakes that have happened over the last 6 months.

Remember, you can't get something for nothing. Walmart and the chains get higher profits, but the price was lower quality care.

Those chain stores that have made business vs prof...

2008-02-14T07:42:00.000-05:00

Those chain stores that have made business vs professional decisions of 4 dollar generic prescriptions or FREE pushed our profession down an even darker spiral. Give credit to those chains that held their ground and seek a more reasonable price for their dispensing services. We have made the profession the same type of commodity that we have made generics a commodity. State boards of pharmacy need to step in aggressively because driving volume to these pharmacies by "giving" away services will only drive errors and ultimately those pharmacists that provide the services required by those laws will be driven out of business by those "big box" or combo operations that seek to sell higher marging private label products and use pharmacy as a loss leader. The question I ask, if this were your business would you give away $4 prescriptions or free and still expect to stay in business? We have reached a point of insanity with this. What does $4 or free tell our political folks when it comes to reimbursement?......

USA Today has a follow-up story in today's paper a...

2008-02-13T13:14:00.000-05:00

USA Today has a follow-up story in today's paper about the role of pharmacy technicians: Drugstore chains rely on pharmacy technicians.

Adam

The "fog of war" in pharmacies is actually the "fo...

2008-02-13T12:15:00.000-05:00

The "fog of war" in pharmacies is actually the "fog of PBM messaging". Minute by minute we get
messages of drug interactions which are well below any threshold of clinical significance. Add to that the incessant explanations needed address questions of copays,
prior auths, step therapies and deductibles. A pharmacists job is stressful. I own a community pharmacy, staff it well with CPHTs and have added several levels of robotics and workflow scanning to assure accuracy. It's still a bear.
Assuring 100% accuracy in this environment is the goal. Will the "fog of pharmacy" create errors? Unfortunately, yes. I shudder at the risks every day.

If one were using total quality management techniq...

2008-02-13T09:10:00.000-05:00

If one were using total quality management techniques to manage the process one of the conclusions you would quickly come to is that errors could be reduced simply by eliminating some of the variables in the process. One that clearly stands out involves the pharmacist taking capsules or tablets out of one bottle, counting them and putting them into another bottle. Significant time could be saved by packaging in typical unit of prescription sizes. Medicines used to treat chronic conditions could be packaged in bottles containing a 30 day supply. Blister packaging or small bottles could be used for antibiotics and such that have a shortened dosing regimen. Doing so would reduce time and cost at the pharmacy while manufacturers cost could at least be offset by rationalization in package sizes. Another benefit to manufacturers and patients could be increased patient compliance. Think birth control packaging.

Adam, excellent posting, as usual. To me, this po...

2008-02-13T08:04:00.000-05:00

Adam, excellent posting, as usual. To me, this posting is screaming for eprescribing more than ever. If we really got eprescribing to work not only would it address the time to fill issue but it could even feed back the cost so the doctor and patient could make informed decisions based on alternatives, solving the other question...cost.

Then I could find the motor oil that was on sale!

A