RIP, Retail Pharmacy

I’ve been thinking about this for a while now — what’s going on in retail (chain) pharmacies mainly. It’s just been a struggle to put words around it as a pharmacist — where my own job has been working the bench in retail pharmacy several times throughout my career.

Now, after a lot of thought, I’m going to try. And I’m certain that this post may not end up being popular, but tough times call for tough terms.

If you’ve missed it — retail pharmacy is undergoing a revolution in the US. There’s a movement afoot to over work pharmacists, pharmacy technicians, and cut their pay. The New York Times recently had an article on the fact that retail pharmacy is under a lot of pressure to do more with much less, and they’re the latest in a string of major media publishing on the atrocities going on in retail pharmacy these days.

There’s a movement around the pharmacists & pharmacy technicians having decent working conditions, even with a hashtag, #pizzaisnotworking, which is basically calling out the bad working conditions in retail pharmacy that don’t have easy/quick fixes even with band-aids like free pizza as a thank you for service. While this movement has started gaining some traction for better working conditions, like 1/2 hour closed pharmacy lunch breaks — I argue, is that really enough?

I have a theory (and this is my opinion only): I think the mass chain pharmacy retailers actually want to drive the pharmacists out of the corner drug stores. Through more work, less help, and less pay, they’re going to make it happen too. Right now, we’re seeing crazy sign on bonuses of $50K plus for pharmacists with the big chains, but the conditions around those bonuses are either impossible, or contingent upon a lot of other things happening that it’s just not worth the golden handcuffs. That, and once the pharmacists realize that the bonuses are not worth their mental health, and they stop applying for these jobs, the mass chain execs are going to go over to the boards of pharmacy at all 50 states and declare they can’t staff stores safely or well, so why should they then need pharmacists on-site to fill prescriptions anymore?

Then state laws will change, and pharmacists will no longer be required to be at pharmacies (as they are right now).

Many retail pharmacies have also shuttered. They can’t find help, they’re getting robbed or destroyed too often, so they just simply chose to close the stores permanently. All of this is leading up to radical change coming, in that the corner pharmacy is going to be a thing of the past.

Maybe It’s Time to Let it Go

I see my brothers and sisters in retail pharmacy struggling, and then I see the rise of massive online mail-order pharmacies — like Amazon, Ro, Hims and Hers, TruePill, Mark Cuban — but I’m starting to think about…the customer experience too.

Seriously: When was the last time you thought, “Gee, I CANNOT WAIT TO GO TO THE DRUG STORE TO HAVE A GREAT CUSTOMER EXPERIENCE TODAY!”?

I’ll give you a second to think that one through.

Was your answer…NEVER?

Yeah, me too.

Full disclosure: I’ve NEVER been a shopper. I don’t like going to most retail stores, and the pandemic fueled that as well. The thought of going to a store to stand in line and kill my one finite resource — TIME — does not thrill me. The environment in most retail pharmacies is soul-sucking as well. I worked the bench as a retail pharmacist for many years and often felt — trapped. You have to stay within the confines of the pharmacy when it is opened as the pharmacist, and after 12 hour days with no breaks and dashes to the bathroom, I can’t say that is personally a great working environment that I really want to work in, let alone fight for as it is today with even more to do and less time and resources in which to do it.

Let me put my consumer hat back on: I’m going to date myself — but my previous pharmacy used to be…at Target. Why Target? Because I loved the experience of shopping at Target, at least pre-pandemic. I didn’t need a drive up for the pharmacy there either. And I didn’t need to wait in a line most times — I just strolled into the store, dropped off my refills, went shopping to find great brands and products I could only get at Target, and then pick up my script and leave. But it was TARGET itself, and not Target Pharmacy, that made that shopping experience great. (For the record, I’ve subsequently moved pharmacies.)

What’s my point here? Friends, I think it’s time to let the corner drug store as we know it today…to go away. Let it die…and may it rest in peace. DNR.

I know, there’s going to be mass hysteria and outcry with this opinion, but stick with me here for a second.

Getting Your Prescriptions a Different (And Better) Way

Think about all the purchases your household makes right now. For me, I buy nearly everything online anymore. (Yes, even at Target.) Most medications being refilled these days are for chronic conditions as well. Two of the 3 most commonly prescribed medication classes out of doctor’s offices these days are for chronic conditions, according to the CDC (antilipidemics and antidepressants. The other category is analgesics, which I argue could be acute or chronic, so I’ll set them aside.)

What if, instead of getting your chronic medications every 30 or 90 days, you could just go ahead and get a whole year’s worth or 6 months at a time instead? That cuts down on the trips to the pharmacy (which let’s face it, were not places we really wanted to hang out at even before the pandemic, and which during the pandemic became pretty dicey.)

Now that most states have e-Prescribing on board (Indiana officially had law start 1/1/22 with controlled substances), your prescription can go anywhere, to any pharmacy to be filled. Why not fill it at a mail order pharmacy or place where you don’t have to “go” to pick it up — it can be brought right to you, to your door?

But I’ve Got Some Questions….

I know what you’re thinking at this point: “But what if I have questions for my pharmacist?” These days, the online pharmacies have phone #s and chatbots that you can jump on and cue up on your OWN time from anywhere in the world and actually talk to a human, much faster than standing in line at a pharmacy. Telehealth and telepharmacy are now legitimate post-pandemic with many carriers. As long as mail order and national pharmacies have ways to connect with pharmacists and pharmacy technicians who are licensed and legit in your state, I think that could even be better than trying to talk to a pharmacist face to face with the phone ringing off the hook, 5 people waiting in the drive-through, and 2 others waiting on their flu shots in the lobby with a line of patients cued up for various needs. Do you really think your pharmacist is going to give you great, super thorough advice when other customers are lined up staring at them with daggers?

Why Can’t My Doctor Fill My Prescriptions?

Next up — your doctor or healthcare provider — why can’t they just run the pharmacy too?

That’s a terrible idea.

Why? Because there are over 20,000 different prescription drugs on the market at any one time. They can’t possibly diagnose, treat, and then know everything they need to know about each and every drug on the market and warehouse millions of dollars in drugs in their offices. That’s way too much to fit inside of one brain and one office. There, in my opinion, always needs to be a second check to make sure that drugs are dosed safely, that drug utilization review is actually conducted by a pharmacist before those scripts hit the lips or bodies of patients, period.

Physicians, just like the rest of us, can’t do everything.

But I’m in the Middle of Nowhere…

Rural health has its own challenges, granted. However, I don’t think Amazon limits where it can reach geographically in the US. And, the drones are coming for pharmacy fulfillment as well — and while I think that’s worthy of another entire post on challenges and benefits, either way, there are not many places that the USPS, UPS, Fedex, and Amazon cannot reach.

Pharmacists: Why Are We Fighting for the Status Quo?

Last, I want to speak to my colleagues in pharmacy here for a moment and ask — why are we fighting so hard for something that we don’t really love?

Most pharmacists I know have left their retail jobs. But the pharmacists I speak to these days still in retail hate their jobs. Literally, it’s making them sick and they want out. My best advice all along here has been — whatever job you’re in — if it’s making you miserable, you have to move onward and find another job — that’s a better fit for you and your family.

So I’ll ask the hard question: If we don’t like current retail pharmacy working conditions — if we don’t have the resources we need to safely and effectively do our jobs — then why are we fighting so hard for this setup as it exists today, or even as it did pre-pandemic?

We shouldn’t! We should be looking for employers who have safe and good working conditions for their employees. And great, happy, healthy employees are nearly always going to provide better patient customer experiences than those who are oppressed and working in terrible conditions.

Of course, if you loved retail prior to the pandemic, I still challenge you as a pharmacist or a pharmacy technician to define what specifically you loved about the job so much and then still try to find a position where the working conditions are decent, you’re fairly paid, and your health and wellbeing are intact and you can practice in the areas that you love.

Is a 30-minute lunch break really going to cut it for you and make you happy as a retail pharmacist? Only you as the individual can answer that.

Ideas on How to Make The Prescription Process Better

Pharmacists often love to call out problems without any fixes, so here are a few thoughts that I have on a few fixes as this part of the healthcare industry resets in the US:

  1. More Mail Order, and MO180 or MO365 — If drugs cost under a certain threshold for a 1 year supply (lisinopril 10 mg for #365 tables, as one example, is $14.43 at GoodRx) — then why not let us get a year’s supply? We should be going to see our primary care providers once a year — that’s when adjustments could happen — and then write for that 365 days’ supply all at once. The cheaper low-cost generic maintenance drugs really don’t need to be filled 30 days at a time. If you’re worried about customer service, check-in on a mail-order pharmacy’s net promoter score. That’s a scale for customer satisfaction.

On or near-site clinics offer mail order pharmacy as well.

2. R180 or R365 — ditto to above, but in retail. Less trips to stand in line and wait…for that time you’re never going to get back. Think of the script as a trip to your dry cleaner — and don’t expect it to be filled on the spot.

3. Vending machines — Do we really need a lot of fuss on a Z-pack as long as someone entering the drug and processing the claim is doing DUR and counseling for the patient?

4. iPharmacy — If you really need to talk to someone about your drugs, schedule a Genius bar appointment with an actual pharmacist where you get your drugs filled, who can sit down and talk to you about your issues, and give you their full and undivided attention. Why pharmacy has never set up this genius bar model, I’ll never know. It’s beyond time.

5. Specialty Drugs — The big non-secret now is that most specialty drugs are already mail-order only because they’re either limited distribution drugs and/or most retail pharmacies do not stock them. As long as the mail-order specialty pharmacies have 800#s and chatbots or multiple ways to communicate with patients, this segment of the market is pretty much already set up anyway as mail order.

6. For Pharmacists — I know, change is scary. But, you have and add INCREDIBLE value to employers/payers, to healthcare insurance plans, to PBMs, and to patients. You just need to find a setting where you can employ your most valuable skill set to the profession — your KNOWLEDGE — to patients. That might mean charging for it as well. And that’s okay! You should not be tied to your profession on how fast you can count by 5’s anymore. Let the vending machines and drones take care of that. Your patients need you to focus on your value — your knowledge — and impart that education to the patients who need it. What if our libraries employed pharmacists? What if large employers hired their own personal company pharmacist for helping and educating their workforce? Between those 2 examples alone, tens of thousands of pharmacy jobs could be created.

This post may not be popular right now, and I get it. But, having been there and done that at the bench, I know how incredibly hard it was to do well BEFORE the pandemic. It has to be next to impossible to do well now, with tech hours being cut and angry long lines of customers who don’t understand the pressure that pharmacy is under right now.

I’m suggesting with the post that it’s time to let that old model go. Let’s move on, may it rest in peace. Our pharmacists and pharmacy technicians as well as our patients/customers all deserve better.

This is a morbid topic, granted. But it really is a valentine to my first profession — of pharmacy. There is a better way. We just need to move on and let the old way die — may it rest in peace.

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Erin L. Albert is a pharmacist inter alia. Opinions here are hers and hers alone.

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