March 2009


Many pharmacies are now offering their patients a thirty day supply of generic medications for the low price of $4.  Most think that this is the greatest thing since sliced bread.  I know people who were spending $40 to $200 a month or more on prescriptions that are now saving a great deal of money.  This savings not only makes most of them very happy but boosts their self image by making them feel like saavy shoppers.  On the surface it may seem like a win-win situation.  But is the $4 prescription phenonema really an answer to the need for better, more cost efficient pharmacy services?


Let me share a couple of experiences that may seem unrelated to the $4 prescription.  This past year I was interviewing website developers and given a number of quotes for setting up my website.  Several of them gave me bids and explanations of what they would do for me at very reasonable prices, considerably below others designers I spoke to.  But the little voice kept creeping into my head saying “you get what you pay for”.  I opted to go with a website developer who was willing to go beyond the basics of building the site; one who was willing to provide their services to me to ensure that I would be able to manage and optimize it as well.  I am not only getting a website that I can be proud of but also learning how to use other web based tools to support my business.  By doing this my life has been made simpler and I will benefit long term from their advice and support.


Another example that comes to mind is auto repair.  I had a car that had clutch problems that needed to be taken care of.   I sought out the nearest “shade tree mechanic” type of shop that had the lowest labor charges in town.   He installed a new slave cylinder which solved the clutch problem for about two days.  I made repeated trips to the mechanic’s shop over the next few weeks finding that he had no long term solution for the problem.   I went to another shop and found more knowledgable mechanics who solved the problem the next day.  Had I just taken the vehicle to them in the first place my life would have been simpler and it would have cost less money in the long run.  I wished that the voice would have reminded me that “you get what you pay for”.


Where am I going with this?  Pharmacy services are more than just counting and pouring, licking and sticking the labels that go on the $4 prescription bottles.  Ask yourself some of these questions. How much money are you saving buying ten prescriptions a month at $4 each from a pharmacist who fails to tell you how to take them correctly?  Does the pharmacist take the time to know your medical condition sufficiently and to listen to your questions and provide information needed to treat your condition?  And what of the medications prescribed that are not on the $4 list? Does the pharmacist just charge you the $89.67 price for that prescription or does he take the time to discuss less expensive alternatives with your physician?  Do you even have the opportunity to really talk to him when you need to?


Purchasing pharmacy services is really not any different than your other purchases in life.  You will usually always “get what you pay for”.  Many pharmacies are now understaffed trying to keep businesses profitable selling $4 prescriptions.  Their pharmacists are under a great deal of pressure trying to ensure that your prescriptions are ready when you request them.  Patients are complaining of long wait times for prescriptions as well as the lack of adequate counceling from the pharmacist.   The $4 prescription price provides instant gratification while ignoring the pharmacy services that are truly going to benefit the patient. Remember “you get what you pay for” the next time you are buying your $4 prescription and ask yourself if it’s really worth it in the long run.


Recently I began wondering if the pharmacy profession really learned anything from OBRA ’90. As I looked back to my days in pharmacy school one of the things I remembered most is the emphasis placed on the necessity of patient counseling. Many of the discussion centered on how we needed to start patient counseling/consultations in hopes of someday getting reimbursed for that service. I must confess that I received payment for patient consultation on occassion and actually had a modestly lucrative business on the side as a long term care pharmacy consultant. So what happened in the last twenty-five plus years to change the way pharmacists consult with their patients?

Along came the Omnibus Budget Reconciliation Act of 1990 .

OBRA’90 ( mandated that pharmacists expecting to receive Medicaid payment would have to provide specific levels of service to ensure quality care. The following three standards were set forth were expected to be met:

1.Prospective drug use review (ProDUR)
2.Patient counseling
3.Maintaining proper patient records

Since the passing of OBRA’90 effective use of technology has automated both ProDUR and patient record keeping. Pharmacy computers now routinely scan patient records to check for drug/drug interactions, allergies and other conflicts and alert pharmacists for possible intervention. But how many of those potential intervention points are just overriden by the pharmacist without proper review? And what about the patient counseling standard? Most if not all states have passed pharmacy legislation requiring a pharmacist to counsel patients since OBRA’90. Is that because pharmacists have failed to meet the basic OBRA’90 requirements?

It’s pretty obvious that OBRA’90 did not motivate all pharmacists equally on the importance of patient counseling. I don’t understand why some pharmacists have been reluctant to get involved with the evolution of their profession and provide effective patient counseling. Perhaps those pharmacists are practicing in a workplace not conducive to patient counseling or maybe they are fearfull of patient interaction. Possibly they are just not interested in getting involved, in which case I would suggest they consider a new profession. Regardless of the specific scenario, I think it is time for another call for action. Pharmacists need to get involved in counseling and educating their patients now!

Health information technology (HIT) is the great driving force in healthcare today. Healthcare 2.0 is becoming the norm. Even social networking is being used to improve healthcare and patient outcomes. The advent of electronic medical records (EMR’s) and personal health records (PHR’s) gives pharmacists an opportunity to get involved in patient care. Pharmacists are trained patient record keepers as well as trained patient counselors. Pharmacists are capable of educating their patients to the benefits of PHR’s if they choose to do so. The opportunities are here now for those pharmacists who are willing to invest time to educate themselves. Now is the time to get involved. Learn about PHR’s and the other innovations that are changing healthcare today and get involved by counseling and educating your patients. Remember, true motivation can never be legislated, it must come from within.