Five Weeks?

There will be “Tech Check Tech” and I think it will be sooner than later. We cannot continue to define our jobs as what we do to run “The Prescription Mill” and still call pharmacy a profession. A this stage, we are presiding over a professional failure.

I testified at a meeting of The California Board of Pharmacy in August of 1972. The California board rotated the cities where they held the meetings. This one was in San Francisco. The number one issue that had gathered a list of maybe 15 people who wanted to testify was: Shall a new designation of pharmacy ancillary help called “Pharmacy Technician” be allowed.

People went ape-shit. The unions were there. The Guild was there. The associations were there. All of these people defined pharmacists as “Prescription Mill” minders and that was what we did in 1972. They warned that pharmacists would be out of jobs if technicians were allowed to type prescription labels. They screamed that patients would be put in danger. They all were smug and self important and then Jay Pee stepped up to the microphone. If the union chiefs had tomatoes, they would have been flinging them. The head of The Guild shook his fist at me.

My message to the board was simple, “We do this or we are dead as a profession”. You know how that turned out. Without technicians, we would be dead in the water. We would not be able to provide essential medicines to all patients in an effective, efficient and timely manner. We would be a failed profession.

We cannot afford that. When there is “Tech check Tech”, you can go do what pharmacists at mandated by law to do. I do not have to remind you of what that is because you break the law 100 times a day.

“But, Jay Pee, how can you trust technicians to deal with interactions, dosage irregularities and those types of incidences?” You don’t. That would be idiotic. When the pharmacy software stops the process and warns: Look at this. Only a pharmacist can look at it and sign off. I think you do that with a secret password. In Washington state, my password was: JPOK.

For “Tech Check Tech” to work, we need a new designation. I suggest “Advanced Pharmacy Technician”. They must be trained by the industry and not by the companies. I do not believe that all drug store/ big box/ grocery companies can be trusted. Rite-Aid will do anything to try to get a profit. CVS has a reputation of cheating. Just Google CVS in trouble. The list is huge. The APhA loves this kind of shit. Let them do it. I have no doubt that an Advanced Pharmacy Technician designation earned by working through an APhA program would produce the real deal.

Celebrate. What do you do?

You counsel. You explain to the young mother with a 4 year old asthmatic child how to use the Xopenex MDI with a spacer. In the process, you discover that the young mother is illiterate and she cannot read the dosage instructions on the tapered dose of prednisolone liquid. You go and be a professional.

I do not expect that this process will be slick and easy. It will be new. I can attest to the value of counseling, on Rx, on OTC drugs, on wound care. People like it.

There are pharmacists who will not want to do this. Go into real estate.

There are pharmacists who will not be competent. Now, that is scary. Should the pharmacists who give inaccurate counseling advice or incomplete counseling advice continue to get a six figure salary?

This is coming, you guys. Better get ready now because we want to run this ship. We do not need non-pharmacist MBA Masters of the Universe anywhere in the process.

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Written by Jim Plagakis in: Jp Enlarged |

13 Comments »

Pharmaciststeve says:

April 11, 2012 at 4:42 pm

@Jim… where I work… tech-checking-tech is SO 20th century… we have COMPUTER CHECKING TECH and a custom build robot that fills orders.. without any person checking them… and the robot is 100 miles away.. A RPH only has to check controls .. and that is because of inventory control… nothing more.
Because I work in LTC… I don’t deal with patients… mostly nurses and some doctors… which .. at times.. I have to educate both on certain therapies.
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On the down side.. I have to supervise …at times … 10+ technicians… which means that I end up walking a lot around a 20,000sq ft+ facility plus -on going – interruptions and questions… while I trying to do a review of a pt’s therapy… often 20+ meds..
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Yes we need techs… but every work environment that I see existing today .. or proposed for the near term.. will not – IMO – optimize what we are capable of doing.
wellillbe says:

April 11, 2012 at 6:37 pm

look at express scripts job app site. They have a tech posistion open titled. “Consulting technician”. Jim, I dont even think pushing the RPH as consulting is going to stop them now.

And until the advanced tech is held responsble legally for putting the right pill in the right bottle, the RPH will still be held accountable and hence the reason why we fight it so

WellMan, That is why I think this is good. The “Powers” have to design a new system in which the Advanced Technician does 90% of the dispensing work and the RPh does 10%. At the counseling station, sitting down comfortably, with a terminal. The pharmacist counsels. Including opening the bottles and showing the pills. Bar code scan, a picture of the pill. One second final verification. When the pharmacist dos that scan, the computer records the price. When the counseling is complete, the pharmacist can do the sale or the data can be sent to a register. I can’t tell you how this will work. I don’t really care abut the particles. I believe it will work. I won’t worry about it. THEY have to figure it out. Not my job. I am in love with the possibilities. That is what makes life worth living. POSSIBILITIES. Jay Pee
Loup garrou says:

April 11, 2012 at 8:44 pm

Have to disagree…the system is so chaotic now…constant mysteries courtesy EPIC style RX systems…inputting errors…filling errors…given to wrong patient etc. etc.
that someone has to be at the end to try and cover it all. Of course the Big Boyz will blame it all on peons and in the pinch buy the screw ups….Attn Newbies…stay out of retail.
Peon says:

April 12, 2012 at 8:08 am

Loup garrou…you said it…”Newbies…stay out of retail”. In 40 years of pharmacy, I have never seen a more bleak looking future for retail pharmacists.
Goose says:

April 12, 2012 at 6:51 pm

Hey all,
I have a CphT that works for me that flunked out of pharmacy school but had a degreee in allied health (whatever that is). Anyway he is an instructor at a trade school for pharmacy techs. Sounds like a cash cow to me. Through loans and grants, these kids are paying around 20 large to get a “degree” as a pharmacy tech. I think at slightly above minimum wage, it’s going to take almost as long for these suckers to pay off their loans and it will a pharmacy student.
My tech is paid really well to teach this class too, Around $30/hr.
bcmigal says:

April 13, 2012 at 9:50 pm

Peon and Loup, I would say “stay out of any kind of pharmacy.” It’s no fun anymore.
Peon says:

April 14, 2012 at 3:27 pm

Goose, if your tech can teach 4 hours per day then that would be more than he would make working a full day in the pharmacy. It does look like a lot of folks are making money off training pharmacists and techs. Pharmacy has become their ‘cash cow’.
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To JP, I understand what you are saying and I think it is the most feasible; however, I doubt that is what will actually happen. Unless there is some radical change in pharmacy, which is unlikely, then pharmacists are going to be stuck in irritating, busy, distracting, slave jobs. I cannot help but think that a squeeze is coming which will squeeze pharmacy salaries and the chains ability to make money. The government will be forced to address the deficit or face the same thing that is happening in Europe…one way or another cuts will have to take place. There will have to be cuts to medicare, medicaid, and all government programs. This means a cut in reimbursement by medicare and medicaid. What will follow? Chains will have decreased profits and pharmacists salaries will go down. We all know that our current health care system is frought with miss management. The insurance companies have taken advantage of patients and providers for a very long time. They are pricing themselves ‘out of the market’ for a lot of people. What I am seeing is a lot of people with company insurance that is terrible. My neighbor needs surgery, but he says he will have a $5,000 deductible and he just can’t afford it, so he is delaying surgery. The relationship between insurance companies, wholesalers, and drug manufacturers is geared toward gouging the consumer. We see this with drugs like Solodyn. There are lots of drugs like Solodyn that essentially gouge the consumer. Sure a lot of insurances pay for it, but the cost is transferred to the consumer through higher premiums. The high cost of drug coverage is mostly due to these outrageously priced drugs. I keep wondering why insurance companies will pay for them, unless they are getting a ‘kickback’.
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Pharmacists are in a very bad position. Even if pharmacist’s organized, boycotted, and protested, they would not achieve significant change. The chains can only pay and do so much because the insurance companies, the government, and the PBM’s control the purse strings of pharmacy.
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Technology may be the only hope we have. But, as we have all seen, technology comes slowly to pharmacy. The movement to e-scripts is frought with a lot of problems. The technology there is just not good enough to take the pharmacist out of the prescription filling loop. There will have to be changes at physician offices to make this new technology work. As it is, e-scripts are a mess!
pharmacyslave2000 says:

April 15, 2012 at 1:35 pm

As Peon stated, the coming healthcare reform poses the most threat to the future of the profession, not these silly programs the corporations dream up. Pharmacy re-imbursements are ALWAYS the first to get cut. As those re-imbursements decrease, the corporations will have to make changes to stay profitable. You can not simply increase volume. There are a finite number of prescriptions to be filled and MTM is still not a viable part of the business. I can forsee one of the big three taking the step to actually decrease the hourly pharmacist rate. Now is the time as the shortage is over and there are plenty of new grads. looking for jobs as well as many more coming soon. We work in a “me too” industry and as soon as one company makes it work, the others fall in line. It is a scary time to be in this profession. I don’t feel comfortable at all in my position nor am I comfortable with what the future may hold. Healthcare is going to change drastically and we as pharmacists are going to get hit hard when that change begins.
Peon says:

April 15, 2012 at 6:30 pm

pharmacyslave2000, yes, cuts are coming and I expect one chain to drop their pay rate and the rest will fall in line. I don’t believe the money will be there for MTM. We all know that we can provide a valuable service via MTM. Given the legal right, we can slash the cost of prescription medication drastically, and improve patient outcomes. But, who will pay for it? If the government continues their current way of handling Medicare Part D, then MTM would just be another added expense. We pharmacists have known for decades how to save tons of money for Medicaid and for the consumer. But, our current system is not really geared to saving money. It is geared to making money for the insurance companies, drug companies, and PBM’s.
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Our economy is in poor shape and is not currently recovering. I think we can all see the cuts coming. We have run deficits too long….fought too many expensive wars…and spent money on frivolous things. Now, we are in debt up to our eyeballs. The debt will have to be slashed! The baby boomers starting to get Medicare and the huge debt are on a collision course. The government always starts cutting providers first. I think we will see a lot of physicians stop taking Medicare. The question is whether the chains will, at some future point, stop taking Medicare when they can no longer make money.
Pharmaciststeve says:

April 15, 2012 at 6:42 pm

IMO.. our fate rests with the Supreme Court and Obamacare – as much as I have a distaste of a national health insurance. If it is implemented.. we will have 30-50 million people thrown into the system… reimbursements will be cut for all services… we will see a lot of 55+ GP/FP’s just throw in the towel and/or go to work for someone else and work their 40 hr weeks… needless to say a lot of prescriber manhours will be lost. There is not enough ARNP, NP, PA’s to pick up the slack.. we may not even have enough existing medical offices available to handle all the pts.. unless we go to 12-16 hrs X 7 days a week or longer…
Unfortunately… when they come looking for some healthcare professional.. it will be the PharmD’s… those of us with a BS… regardless of experience… will be relegated to “second class” RPH’s…
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I see all the states moving to higher and higher tech/RPh ratios .. maybe even UNLIMITED… just look at what WAGS is doing with their “RPH out front”.. Their “Power prgm” that was to reduce the cost of filling a Rx to $1.25-$1.50 has seemingly not been well received… it started in FL & AZ ~ four years ago and was to expand rapidly across the country.. it is DOA…
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I have been told that WAGS is already “modifying” their “out front program”.. the RPH is really going to be sitting at a desk on the back side of the counter, closing in most of the Rx dept from pt imposing themselves on the Rx dept staff… and they are going to have “someone” out front – like a wellness ambassador… standing at a podium “out front”…
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IMO… the “crisis year” will be 2015… there are suppose to be 4000 more RPH’s coming out of school than needed and Obamacare will be out the window or being implemented…. ESI/MEDCO merger will start having impact on majority of now existing contracts.
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Expect 2013 or 2014 to be your last raise… if you get any raise those two years… be prepared as of 2015 for a “shirt” to walk in and tell you that they have a PharmD that is will to take your job for xx,xxx.xx less per year.. and if you are a PharmD.. you have <24 hr to decide if you want to keep your job and work for the lessor amount.. and if you have a BS.. expect to be asked how much lower pay you will accept …than the new PharmD is agreed to work for … to keep your job..and expect this to be at least a annual experience… until our wages "bottom out" in the $35 -$40/hr range… if we are lucky.. we will then start to see pharmacy schools closing as quickly as they are now opening…
Peon says:

April 16, 2012 at 8:08 am

Pharmaciststeve, I have not said it. I have detested saying it. You said it: Obamacare could be good for pharmacists! For decades, our country could have supported a moderate national healthcare program, much like Europe. Obamacare is actually a bit of a smart move because it is forcing more people into this quasi-national health insurance so there will be more people paying into it.
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The problem with all national health insurance is the long term consequences. I don’t believe there are many countries in the world that are going to be able to afford it. Europe has been paying for it by going deeper in debt. There is a limit to debt. I can remember, about 20 years ago, politicians and Keynesians talking about how national debt did not matter. It does matter! Some of the European countries have had enormous tax rates to pay for it. And, just look at Europe, the US has protected them since WWII. They have spent almost nil on a military and protecting themselves. Imagine the impact on the US with our wars and military expenses, where we are protecting Europe and who knows what other countries, once we add national health insurance to the coming baby boom generation!
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All of this may not be gloom and doom. I have personally seen a lot of waste in Medicare with duplicate tests. A patient goes to one doc and he runs a test then to another and that doc runs another test. Shared medical records would save tons of money. We all know the importance of medical cards with health records imbedded in the card. In fact, it could open up whole new areas, especially for pharmacists, because it could give us access to the patients health records(can you say MTM?). As it is, we are ‘blind’ when it comes to a patients medical condition. This has been one of the biggest disadvantages we have had since the inception of pharmacy. Imagine a pharmacist ‘out front’ in the pharmacy with a patients medical records and access to a list of all the medications a patient is taking! Pharmacists could save the healthcare system a ton of money! Again, as bad as I hate to say it, there are some good things in Obamacare. I think the direction, with Obamacare, is for national health records and there may be enough insightful people behind Obamacare to see how to utilise pharmacists to their full potential. And, on the subject of too many pharmacists, this is true under our current system. But, there is going to be a huge need for more and more healthcare people as the baby boom generation retires and ages. I can even see a need for more and more pharmacists.
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There are a number of scenarios for the future of the US and for pharmacy. The US has wasted so much money and resources since WWII. The US is going to have to learn to stop wasting its resources and to make better use of them. We have had one war after another that has drained away our money and given us nothing in return. We have let our infrastructure take a second seat to all these wars. What we need is to bring our troops home, slash our military industrial complex, stop wasting money on most of the government programs, and build a new infrastructure. Part of that infrastructure should be in our healthcare system. The answer does not lie in more doctors, more nurses, more pharmacists and etc, but in the infrastructure and the way we administer healthcare. I can see the opening up of vast new ways to do things in healthcare and we have a generation coming along that will adopt it and take advantage of it because they have their iphones, ipads, and etc. The internet is a vast ‘resource’, and it will be used more in the area of healthcare in the future…that is if we can get our heads out of the sand.
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I know that most of my posts sound like gloom and doom, and over the next several years, possibly 5 to 10 years, I don’t see much good coming to chain pharmacists. I do see the possibility of really good things happening. But, currently, they are only possibilities. So, I predict bad things for us chain pharmacists in the coming years, but I also see vast new potentials for us. Whether those potentials will be realized or not, is anyone’s guess.
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Sorry for the long post. This forum is a place for us pharmacists to express ourselves and sometime I think I get carried away. :) I want to thank JP for providing us with this forum. I think we all learn a lot from each other and all those pharmacists that just come here and browse, I would urge you to participate. I know that you have something to say and I know I would like to hear what you say. I learn something from everyone that posts here. This forum is one of the few things we have where can be ourselves and not be restricted by all the restrictions we have at work. Steve knows a heck of a lot about what is happening with regard to these big corporations and I learn a lot from him. I keep thinking that if we can learn enough from each other, that we will be able to think of ways to improve our conditions. I keep thinking that there are some of you pharmacists, out there, that have some terrific ideas, something we have never considered, and that those ideas, when implemented, could change pharmacy for pharmacists.
gloryuprising says:

April 17, 2012 at 2:15 pm

I said it once and I’ll say it again. For 40$/hr I would tell my employer to shove it and go and open my own pharmacy and I suspect it wouldn’t be much more work then I already do now.
Pharmaciststeve says:

April 18, 2012 at 12:23 pm

@glory… good luck with that… building a pharmacy from scratch is very expensive… plan on being able to get your hands on $250,000 – $500,000.
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Over 50% of the existing indys are in communities < 20K population. I am sure there are opportunities out there.. but with 80-95% of the Rxs being paid by PBM's so you have very little pricing power… and with the new ESI/MEDCO merger.. it is unlikely that margins will go no where but DOWN…
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You must have a niche business within your pharmacy. Female pharmacists can do “Women’s Health”. Any pharmacist can do “Aging Well”.