Recession presents challenges for pharmacists

While pharmacies have not been immune to the downturn in the U.S. economy, the overall picture does not appear to be one of gloom and doom.

Consulting firm IMS Health recently reported that prescription drug sales slowed for the second consecutive year. Despite this report, in the first quarter of CVS’ fiscal year 2009, the company reported 152.4 million retail prescriptions filled, compared with 139.5 million at the end of the same quarter in 2008.

For the second quarter of its fiscal year 2009 (which ended Feb. 28), Walgreens reported 164 million total prescriptions filled, compared with 157 million at the end of the same period in 2008. Rite Aid does not have comparable published data but did report that pharmacy sales in core Rite Aid locations saw “strong” increases during the fourth quarter of fiscal 2008 (which ended in February 2009).

Pharmaceutical companies have taken notice of the current economic climate as well, by expanding patient-assistance programs. A recent example is Pfizer’s MAINTAIN (Medicines Assistance for Those who Are In Need) initiative, under which the company will cover the costs of more than 70 of its medications for up to a year for Americans who become unemployed in 2009, have no insurance, have been on a Pfizer drug for three months prior to becoming unemployed, and can attest to financial hardship.

Other companies also widening the scope of their patient-assistance programs include Shire, Merck, and Abbott. But do the changes within the economy and the pharmacy and pharmaceutical industries as a whole translate into actual differences for the dispensing pharmacist?

For Thomas Ohliger, RPh, of Ohliger Drug in Fairview Park, Ohio, the past several years have led to a belt-tightening. He has cut his staff by almost half and reduced the hours of remaining staff. What has kept him going, Ohliger said, is the fact that his store deals almost exclusively with generic drugs. “Thank God for generics,” Ohliger said.

Further west, in Baxter Springs, Kan., Brian Caswell, RPh, owner of independent pharmacy Wolkar Drug, said that while the effects of the recession have not been catastrophic for his business, there has been a “little bit of an uptick” in the number of questions patients ask about how they can reduce medication costs. “It’s great for me, because it promotes one of the key aspects that I think we can have as a service to our patients, and that is medication management,” Caswell said.

 The heightened importance of patient guidance and assistance with medication management is echoed by Christopher Turf, RPh, a pharmacy manager for Pharmaca, the 23-store western regional chain recently recognized by Drug Topics as 2009 Chain of the Year. Turf said that he has been seeing “a lot more people” asking for help saving money.

“The pharmacist is going to have a lot more opportunity to guide people and to help them make decisions on whether self-care is appropriate or whether they actually need to be seen by their healthcare provider,” Turf said.

According to Philip P. Burgess, RPh, MBA, who recently retired from Walgreens and currently runs pharmacy consulting firm Phil Burgess Consulting, once individuals lose prescription coverage, they become much more cautious about filling new prescriptions or obtaining refills. With medications they are already taking, patients are more likely to skip doses for non-acute conditions that show no short-term reaction for missed doses.

When asked which medications are actually being affected by the recession, Turf said he has seen declining sales of drugs that are widely available over the counter, such as antihistamines and stomach remedies. He added that pharmacists need to make sure patients understand that saving a few dollars now may not necessarily translate into better health later.

“The one thing we don't want to see customers doing is making arbitrary and uninformed decisions regarding their medications, because whatever savings they might incur on a temporary basis could be wiped out by the additional expenses paid on the back end due to any deterioration in their health,” said John Norton, public relations manager for the National Community Pharmacists Association (NCPA). The more that patients self-medicate, the more important talking to their pharmacist becomes, Caswell said.

“It’s even more important while people are self-medicating that they’re in touch with their pharmacist, because a lot of times people will go out and self-medicate and they’ll purchase things, maybe not even within my store but elsewhere, and unless I know what those are, it’s going to be hard to guard against potential interactions and subsequent adverse events,” Caswell said.

One of the ways drugstores compete with one another is with the sale of discounted generic medications; Wal-Mart, Target, and Safeway sell generics for $4, and other chains have similar discount programs. But while it’s hard to argue with more affordable medications, turning patients into comparison shoppers is not necessarily a good thing.

Caswell said that store-hopping was an issue even before the rise of $4 generics; it dates back to the advent of mail-order prescription programs. “If I have a patient who is obtaining medications from different sources, then I don’t have the complete medical record,” Caswell said. “Without that, I’m dispensing in the dark, which puts the patient at risk and puts me at risk, and it’s always been a real issue with me.”

Turf similarly laments the increasing tendency of patients to move from store to store in search of cheaper drugs, noting that he sometimes has to contact several pharmacies just to find out where a patient’s prescription originated, because the patient, having been to so many places, can no longer remember. Some patients even come to Pharmaca and ask for advice on their care but then obtain their medications elsewhere.

Ohliger said that while he doesn’t have a $4 program, he matches prices in order to retain patients, and he works with patients to try to consolidate their medications and bring down costs.

Other factors have an impact on how pharmacists can do their jobs today. Both Ohliger and Caswell bemoan the recent Medicare requirement that durable medical equipment suppliers obtain accreditation to an organization approved by Centers for Medicaid and Medicare Services. Caswell noted that this and other federal mandates, especially when coupled with declining reimbursements, are “coming at a very poor time for independent community pharmacy.” He added, “We need to be increasing access, giving people choices, and helping our providers stay open.”

Burgess thinks President Obama’s healthcare reform will bring needed change. “It doesn’t take a rocket scientist to figure out that there’s going to be significant pressure placed on the dispensing of prescriptions,” said Burgess, a member of the Drug Topics editorial advisory board. Caswell, who serves as fifth vice president of the NCPA and chair of its governmental affairs committee, said it’s too early to tell what might happen. “What I’m hearing is that really nobody’s been able to put their hands around this thing [Obama’s plan] yet,” Caswell said.

What seems certain, however, is that patients need their pharmacists now more than ever, whether for advice on splitting pills or help in finding a less expensive therapy. “I know there are times where you feel you don’t have enough time to do it,” Turf said of patient counseling. “But those interactions can be very valuable to both your business and your patients.”