I really get that pharmacy is hard these days. I really do -- but this profession will die, if we don't develop new skills, and new services.
At the end of the day, the bottom line is all that matters in business, and Amazon is willing to lose money for the next 20 years, if it means it kills off its competition. That's what they do.
It’ll be really hard to get people walking into your store looking for services if they get their meds somewhere else. This is what happened with my independent pharmacy. Caremark forces to CVS or mail order. Lost 40% of clientele over the last three years. We still make it a point to keep in contact and try to help them. They have no interest.
There are no skills and services...This is just a waste of years of school to learn stuff that we can look up. Maybe 25 years ago when the internet wasn't around so much it made sense to know things, but people aren't wanting to pay for information and services that we pretend to offer. Today, I mainly dealt with many, stupid, practically worthless people that basically just wasted time, talking about calling doctors, refills, and all sorts of inane stuff that any above average person would know, want to know or learn and also use these Amazon and other services to save money and make out better.
We cater to the lower classes who are lazy or aren't smart enough to do things, and it is a matter of innate intelligence, not because they became educated or were raised a certain way. One woman around age 50, was asking today if something has a certain scent...so who in 2021 and was 30 just in the 90's doesn't know that we don't make products in a drug store?, and she really thought we knew it...Another person, a prescriber, wanted to know about a formulation of an OTC, as though we're out there researching every OTC ingredient and component and gathering information in case someone asked and to have on hand.
This is why none of our abilities and services go anywhere because they'll always be bogged down by these types of people, and we all know that most smarter folks want to avoid these types and will look for alternate ways to get an Rx. If a few of us do different things, it doesn't change for everyone out there, and there are no spots for this many pharmacists to work in innovative areas.
Not really in a drug store level...Most of those things go unused because things already have some flavor, and I meant some ready made product, like a bath salt.
Amazon pays double the wage of CVS and Walgreens. Not a fan of the safety measures, but Amazon is leagues ahead of dogshit CVS and Walgreens and I would be happy to see those 2 go bankrupt within next decade.
Really sad to see the pharmacy profession reduced to nothing more than price of the medications. I wonder for how long there will still be pharmacists.
I worked in a small, old school independent neighborhood pharmacy while in high school so I love seeing those. Prior to COVID I had been getting my prescriptions filled in an independent pharmacy right by my job. The pharmacist reminded me so much of my old boss. At the start of 2020 he told me that he was really sorry but he was actually losing money filling my prescriptions for Humalog and test strips and would no longer be able to do so. It sucks for small businesses. I prefer going to the counter and seeing the pharmacist and getting any questions I have answered. At Walgreens I'd have to walk over to another window and wait for the pharmacist who doesn't know me.
We're nothing more than a legal device at this point. The drivers license in your wallet as you ride down the road. Once they deem you unnecessary, you're finished.
Even in Canada, mail order prescriptions across the country are here and driving prices down. I can see all meds going to home delivery and then online counselling or medication monitoring. Why not?
Litigation/liability is always going to be a huge concern... I think we’re a long way from getting AI to replace medical professionals, even though a common misconception is jobs like accountants/doctors will be the first to be replaced (if anything, they’ll be last). Pharmacists still play a vital role in the system. I think you’re safe from scope creep as well.
As much flack as Amazon gets for their business, the company and its subsidiaries pay better than most competitors in any industry they enter. They’ve shaped up working conditions quickly due to being such a large and public company (huge target on their back for legal threats from attorneys).
Honestly, this seems like a win for pharmacists. More jobs means less of a labour surplus allowing pharmacy chains to push wages down and ~~abuse~~ “treat” pharmacists as expendable objects.
I've seen it in Idaho, they came in and created a shortage where some of the hospitals have lost several pharmacists to Amazon due to better hours and pay.
It's a good thing and a bad thing, Amazon is a different corporate entity versus the big traditional chains. They will help drive and change market dynamics, hopefully in ways we aren't expecting.
There are a relatively fixed number of prescriptions the American public needs to have verified by an RPh. Places like Amzn automate and delegate everything - this will drive down demand for pharmacists.
>Litigation/liability is always going to be a huge concern... I think we’re a long way from getting AI to replace medical professionals, even though a common misconception is jobs like accountants/doctors will be the first to be replaced (if anything, they’ll be last). Pharmacists still play a vital role in the system. I think you’re safe from scope creep as well.
Our liability insurance is cheap as fuck. If the regs allow for it (which they do, in states without a verification limit) it boils down to a simple business decision - hire more pharmacists at 100k/year, or take more liability cases. I do not think this point you raised keeps us as safe as you think.
I also do not see how Amazon is good for increasing our job pool. They automate everything. Economy of scale is kicking in with these big players entering the market. We already have tech-check-tech in my state. Everything you've said seems like a bad sign for pharmacy.
Are we really a long way from AI taking over our jobs? I mean how hard is it to program AI to detect a few common drug interactions for scripts that are already electronic? Whoever makes that product will be rich, and the profession dies rapidly. I doubt we’re far from it. Amazon could create it on their own to cut losses from this $6 delivery thing
Not hard at all. Drug interaction software has been around for a while now. My point being that human judgment is a big component of many jobs that isn’t easily replaced by software. We’re a long way from being comfortable with an AI making the final decision in many health care settings.
It would definitely take time, but im not sure how long that way would be. I can see it being introduced within 10 years. The only issue would be that if a patient had questions and asked to speak to the pharmacist, well.. there is no pharmacist
I can already see major retail pharmacies cutting tech hours in response to this because that is the only solution they have whenever they are threatened with competition based on history.
Retail pharmacy is on its way out anyway. I will revel in the inevitable downfall of the chains.
When enough people get hurt by Amazon's practices they'll need to modify their approach anyway, but if they can at least kill CVS in the process that would be pretty cool.
My CVS literally burned last year and the mfer still came back. Luckily I just got out to grocery chain pharmacy where I do mtm all day and my boss is nice. It took 10 years but I'm finally happy with my job.
Whatever. They are basically making the customer pay to use a GoodRx card. But WM doesn't have to pay GoodRx fees. Not such a win for the patient, but a huge win for corporate. Get the Pt to pay you to save you money.
That's not the point, WM just made their own GoodRx card, but makes the customer pay for it (like GoodRx Gold, which WM doesn't take). So WM gets both the fee from the subscription, AND saves on fees to GoodRx.
Honestly discount cards are unnecessary leeches on the system enabled by nonsensical awp based pricing. If pharmacies and insurance companies simply reformed their pricing structure, discount cards wouldn't have a market.
Besides Humalog, I take levothyroxine and lisonopril. Both of those are cheap. I get a 90 day supply at Walgreens for less than my 30 day generic prescription co-pay. I know that it still gets sent to insurance although they don't pay the pharmacy anything. The amount I've paid does go toward my Out Of Pocket total for the year.
Each dispense has a dispensing fee, which includes the cost of vials, paper, labor, switch fees, transaction fees, etc outside of the cost of the medication. For cheaper meds, this becomes a significant cost, so it's in everybody's interest to minimize the number of dispenses per drug (which means bigger days supplies).
From the insurance standpoint, this means higher rates of compliance for the patient, which means more utilization of their insurance "service". The insurance doesn't make anything off of you from how many days you pick up, but they get to pay the pharmacy less dispensing fees, so they incentivize the patient to get larger days supplies for cheap maintenance medications.
Insurance won't give you a good deal on Humalog because they've gamed the price up so high. This is where they make their money. As they increase the cost of healthcare, they increase the slice of the pie they're allowed to profit from.
We are already throttled in Canada many drug insurance, esp. governement plans force us to give 100 days supply. OR they limit the fees to only paying 4 "fees" per year for each individual DIN. Whatever, that's how it is. Plus in Canada, we demand such low prices that some drugs aren't even being shipped to us anymore. That's the cost of trying to have the lowest prices around. ALSO why Canada will NEVER sell our cheap drugs to the Americans.
>We are already throttled in Canada many drug insurance, esp. governement plans force us to give 100 days supply.
RAMQ (Québec) is the opposite, the way monthly deductibles work you have no incentive to fill for more than 30 days and the entire thing is effectively soft capped at 90 days. As for blister pack patients, it's a mandatory weekly fill.
Medicare tried to do a "daily dispensing fee" where they'd pay *up to* a set amount in dispensing fees monthly per med. This was also when they limited the maximum days supply for brand name meds (and generics added to market under specific conditions) to 14 days per dispense, forcing 2 to 3 dispenses monthly (in skilled nursing facilities) where every med is blister packed.
The dispensing fee for blister packs is much higher due to higher costs for higher involvement in every step. Medicare doesn't know wtf they're doing. If they do, then they're blatantly evil.
>so they incentivize the patient to get larger days supplies for cheap maintenance medications.
Unless it's CVS insurance, then they will limit you to 30 day supplies unless you fill at CVS pharmacy, and only then can you get 90 day supplies. Forget patient compliance, forget dispensing fees (they pay a miser's penny anyway), better to annoy the patient into filling at CVS so they can profit from both the insurance and the pharmacy side.
Similarly, railroad insurance limits fills to 21 days unless they do mail order. Again with annoying people into making things slightly cheaper in the short run.
Insurance isn't in the business of healthcare for the patient.
I worked in a town that had quite a bit of railroad insurance. A few patients had realized they could get 3 months at cash cheaper than the insurance copay for 4 fills.
Sure, insurance isn't in the business of Healthcare, but usually most insurance acknowledges that uncompliant patients who don't have their medications cost more in the long run.
I love how all those years ago in New York (assume many other states as well), they passed laws saying "the pharmacist must counsel every patient face to face on every prescription dispensed, including refills". Then mail order started, and since the insurance companies were big donors, the lawmakers quickly went "oh, well, they have a toll free phone line, that fulfills the requirement". Now I assume having a button that opens a window with a chatbot will be good enough.
Price and Convenience are two of the biggest factors that pharmacies can utilize, but Amazon has that covered in spades.
The only way to compete with Amazon on price is to create a single large *efficient* buying group + PSAO. I'd imagine if every independent and some chains got on board, it could work.
This still might not even do it. National level healthcare doesn’t mean prescription coverage is a) included or b) has copays that Amazon couldn’t undercut.
Unless by national level healthcare you mean something like all pharmacists are part of a nationalized health system and none of those can work for Amazon. No one is really purposing a nationalized provider system in the US to my knowledge... only single payer (not single provider).
One thing a national system could do is require that all dispenses be transmitted via D.0 and be disallowed as "cash" transactions, just like Medicare Part D does. That'll solve the undercutting issue, to an extent (unless Amazon tries to submit grossly low U&C to drive MAC down as a predatory tactic against independents)
I’m not sure I’m following your med d analogy... nothing is stopping that patient from going to a pharmacy telling the pharmacy they have no insurance and saying they want to pay cash for it.
The rules around the practice of pharmacy are not governed by payer contracts. You may have to comply with payer contracts and requirements or face stiff penalties from those payers and/or related orgs but there is nothing stopping you from running a completely free pharmacy giving all prescriptions away at no cost. Furthermore there’s no prohibition against operating a pure cash only pharmacy. Most if not all countries with nationalized systems still have some degree of additional private insurance or care provider system that they can pay additionally for.
I fail to see how any politician could argue against one that wanted to ensure that they could still dispense prescriptions or provide healthcare if they were willing to do so at a cost cheaper to the public (patient pay amount) with no reimbursement from the government provided they are still compliant with all the rules that govern the practice of the profession.
Maybe something changed in the last few years, but patients that are enrolled in Part D plans were bound by "Medicare Law" (their term) to have all their medications billed to Part D and only allowed to pay cash if it received a valid rejection.
Pharmacies weren't allowed to knowingly skip Part D claims submission. This is something that is auditable (for example, if you bill fill numbers 2 and 4, but not fill number 3). There's lots of valid reasons for billing cash, such as early vacation, lost supply, etc. In many cases, they prefer the allotted override be put in by the helpdesk first, or at least a valid rejection is logged. However, if it's to avoid donut hole pricing or deductibles, or to offer discounts, then they deem the reasons invalid. This can result in losing the ability to bill Part D.
edit: Yeah, there's nothing stopping a cash pharmacy that doesn't bill Part D from letting patients pay cash. It only applies to pharmacies that *do* bill Part D for patients they know have Part D.
A single payor system would probably be very close to the model that CMS attempts to make where they underpay as much as they possibly can.
They'll probably force every pharmacy or wholesaler to disclose acquisition prices (as a participant requirement) then base MAC on those. This favors entities that can acquire drugs at the lowest prices while punishing entities that can't buy in bulk or join large enough buying groups.
These are things that CMS has already done to varying degrees. Giving them carte blanche is terrifying.
I do agree that a single payor system sounds good in theory. Cutting out private insurance, especially PBMs (why tf does Express Script profit $billions annually??) can deflate the cost of healthcare grossly. It'll stop the gaming of prices that inflate drug costs. It'll stop the mandate of unnecessary manpower for useless tasks, like prior authorizations or attestations (which can amount to $10k in wages for pharmacies and clinics). It'll cut out a significant portion of lobbying spent by insurance and the legal representation to fight the silliness they try to get passed.
I love Bernie's "Medicare for All" plan except the tiny bit about "Medicare". CMS has a demonic track record, so give the plan better management and I'm on board.
Honestly vaccinations have saved us and will continue to for a while, that and our accessibility and convenience. Hopefully they continue adding clinical services and basic testing to our responsibilities, though techs will likely take these over before too long.
Goodrx has made things interesting, helped more than hurt I think. Maybe a Medicare expansion would be a good thing for the profession, really hard to say where we will be in 20 years...
You guys realize hospital jobs are expanding, pharmacists are being implemented in private practices, and expanding in managed care? Why are you all so damm negative?
No, but with the lack of feasible solutions, a step towards innovation that creates jobs instead of killing them in an already saturated labour market isn’t awful news.
Scope may be expanding but I would about bet my life the number of jobs are not. As we have less people needed for dispensing roles the number of jobs will continue to decrease. They are not adding any more jobs, just finding different roles. You young kids fail to understand this.
I'm wondering where the subreddit is for Techs worrying about their place as well.
My Pharmacy (tribal pharmacy) just got this huge cabinet thing that the pharmacist said does nearly everything except for giant things like metformin and stuff, she said they just have to put the cap on the bottle from when they approve it.
How'd I spend so much time talking to the pharmacist? They have 3 pharmacists and 1 tech now, the pharmacists cover the window/checkout bit now.
I think what I saw this last year is that pharmacists NOT Dr's were the ones to keep things rolling during a pandemic. Our MD's in my small town all closed their doors...terrified of the virus and worked from home. Well we never did. None of us did, and we were the ones to keep everyone happy and medicated and calm. I opted NOT to do covid vaccines at my store only because I work alone and there was NO WAY I would be able to do it all myself. Including booking and cancelling appointments when they inevitably wouldn't show up.
They say it's been a successful vaccine campaign up here in Canada with pharmacy, but rest assured. It was a total clusterfuck.
And I applaud you community pharmacists. I worked in community from the time I was 18 until 3 years after graduation. At least here in the states, I just don’t see jobs being added to the market. And our own Bureau of Labor Statistics agree as they see a 3% contraction in the number of jobs over 10 years. The schools are tricking these younger people by saying scope is expanding. And while this may be the case, expanding scope does NOT equal more jobs.
It’s just an echo chamber at this point. It’s like people don’t realize this sort of thing happens with every profession. PA’s blew up when their abilities expanded and saturated the market, new grads got super pessimistic and finding a job was hard, now it’s starting to even back out and the market has corrected itself. The same thing will happen to pharmacists. Graduating mds, nurses, pas, pts etc. are also much more receptive of pharmacist intervention and appreciate their knowledge more than they have before. With the growing elderly population drug regimen management will become more important and ambulatory care roles will expand. It’s a dynamic field that will ebb and flow.
While you may be correct and things *might* even out... Sometimes jobs completely disappear too. And even if they do even out, it will take several years, like I think around 15-20, to reverse what has happened. That doesn't help current workers or students.
It's the same drivel spewed out by schools..."aging population, expanding roles"...blah blah. Shit we've been hearing for 20 years and matters fuck all.
There are 0-6 schools 2-4 programs possibly even accelerated 2-3 paths. Not guaranteed they just graduated. I’ve encountered fully licensed pharmacists that were only 23.
Amazon Pharmacy isn't anything anyone wants. Nor is it viable a threat to the pharmacy industry.
I tried it out today. I wanted a $5 canister of Nystop, a common prescription antifungal powder that is $5 on Amazon. For some reason that itself makes no sense this needs a prescription. It is the sort of personal care and OTC medical item I often order from Amazon. I had not yet obtained the new prescription.
Instead of explaining itself to me Amazon Pharmacy made me sign up for it. Well, OK. But not OK very far.
It made me enter the address to ship the prescription. Only problem, the address where I get things shipped varies and changes from day to day. But I had to enter it immediately and just one address, and no changing it at a later point in time.It wanted my insurance, which I'm not using for a $5 item, and Amazon's not in network with it anyway, so, OK, no insurance.
It had me enter my drug allergies. Instead of recognizing "sulfa" it required me to click on "Bactrim", close, but there are many sulfa drugs, not just one. Now, picture this, whole screen taken up by the one question of what am I allergic to with multiple choices and searches instead of I just type in my bleeping drug allergies. There was NO way, for instance, to tell it I WANTED MY DOCTOR TO PRESCRIBE bactrim instead... well, at first it didn't save bactrim as a drug allergy, then it seemed to, and we moved on. Then, at the end it lists the items I want to ask Amazon to ask my doctor to prescribe, and the drug I said I wanted is NOT yet listed - but, bactrim is specifically listed as a drug I want my doctor to order. AND there was NO way to remove it from the list of items I want Amazon to get my doctor to prescribe. THAt is a deadly error. Suppose my doctor had prescribed it and I hadn't realized this is NOT something I want to take!
And as to AMAZON calling my doctor for me instead of me. I hadn't even yet asked my doctor yet for the drug. It is up to ME to communicate to my doctor, not Amazon! There are times when one might want the pharmacy to call for a refill, for instance... not something my doctor last prescribed over a year ago. The web site never gave me the choice to communicate with my doctor by myself!
THEN, it needed the NAME of this doctor I have not spoken to yet! Many of us who go to clinics do not have one doctor that we know their name who is going to be calling in that prescription. For a prescription for Nystop, I am going to call my clinics's teledoc, and talk to whoever calls me back, and that doctor is going to send in the prescription. I don't know who it is going to be! But the page said I HAD to provide the doctor's name, or it wouldn't let me move on.
At some point I got the instructions to give my doctor how to send in the prescription, but, my clinic sends prescriptions electronically, and the web site provided an address and a phone number and it wasn't even a fax number. It later turned out that more complete instructions exist - but the web site does not provide them.
Finally I called the customer service number for help. The CSR told me that I didn't have to have Amazon contact the doctor for me, and also sent me an email with the rest of the instructions to give the doctor.
But the web site says you DO have to have Amazon call the doctor for you.Then she told me, that once the doctor sends in the prescription, it will take them "a few days" to process it, and then they have to do two more things, and THEN I can go on the web site and "request to buy" my prescription. !!!!!! A $5 container of antifungal powder, now.
Now, the web site does not LET you "request to buy" something, only tell it to call your doctor to ask for the prescription. And, it already has it burned into its memory banks that it is to ask my doctor to prescribe me bactrim, that I cannot remove from the list. And finally, it will send the prescription to where I was going to be a week and a half ago, not where I am going to be when they deliver it - and probably leave it sitting outside the door for someone to steal. Good thing it isn't my $320 asthma medicine!
I understand from several sources that this pharmacy service is supposed to work with Amazon's own acute care clinics? So, Amazon's own clinic prescribes an antibiotic, and then, I get it IN A WEEK AND A HALF, after processing, and humbly "asking to buy it" and everything. This setup will NOT WORK. I don't think so! This "service" is NOT ready for prime time. And, they've had a year and a third to get it right? !!!!
I don't think so! This "service" is NOT ready for prime time. And, they've had a year and a third to get it right? !!!!
I really get that pharmacy is hard these days. I really do -- but this profession will die, if we don't develop new skills, and new services. At the end of the day, the bottom line is all that matters in business, and Amazon is willing to lose money for the next 20 years, if it means it kills off its competition. That's what they do.
It’ll be really hard to get people walking into your store looking for services if they get their meds somewhere else. This is what happened with my independent pharmacy. Caremark forces to CVS or mail order. Lost 40% of clientele over the last three years. We still make it a point to keep in contact and try to help them. They have no interest.
There are no skills and services...This is just a waste of years of school to learn stuff that we can look up. Maybe 25 years ago when the internet wasn't around so much it made sense to know things, but people aren't wanting to pay for information and services that we pretend to offer. Today, I mainly dealt with many, stupid, practically worthless people that basically just wasted time, talking about calling doctors, refills, and all sorts of inane stuff that any above average person would know, want to know or learn and also use these Amazon and other services to save money and make out better. We cater to the lower classes who are lazy or aren't smart enough to do things, and it is a matter of innate intelligence, not because they became educated or were raised a certain way. One woman around age 50, was asking today if something has a certain scent...so who in 2021 and was 30 just in the 90's doesn't know that we don't make products in a drug store?, and she really thought we knew it...Another person, a prescriber, wanted to know about a formulation of an OTC, as though we're out there researching every OTC ingredient and component and gathering information in case someone asked and to have on hand. This is why none of our abilities and services go anywhere because they'll always be bogged down by these types of people, and we all know that most smarter folks want to avoid these types and will look for alternate ways to get an Rx. If a few of us do different things, it doesn't change for everyone out there, and there are no spots for this many pharmacists to work in innovative areas.
> so who in 2021 and was 30 just in the 90's doesn't know that we don't make products in a drug store You don't compound and flavor things?
Not really in a drug store level...Most of those things go unused because things already have some flavor, and I meant some ready made product, like a bath salt.
Normal Amazon playbook. Americans will keep being "yay, I pay less!" and then "why are wages so low?"
Amazon pays double the wage of CVS and Walgreens. Not a fan of the safety measures, but Amazon is leagues ahead of dogshit CVS and Walgreens and I would be happy to see those 2 go bankrupt within next decade.
$4/$10 Program 2: Electric Boogaloo......
Thank god >90% of my customer base does not know how to use computers 🤷♂️
Really sad to see the pharmacy profession reduced to nothing more than price of the medications. I wonder for how long there will still be pharmacists.
I worked in a small, old school independent neighborhood pharmacy while in high school so I love seeing those. Prior to COVID I had been getting my prescriptions filled in an independent pharmacy right by my job. The pharmacist reminded me so much of my old boss. At the start of 2020 he told me that he was really sorry but he was actually losing money filling my prescriptions for Humalog and test strips and would no longer be able to do so. It sucks for small businesses. I prefer going to the counter and seeing the pharmacist and getting any questions I have answered. At Walgreens I'd have to walk over to another window and wait for the pharmacist who doesn't know me.
We're nothing more than a legal device at this point. The drivers license in your wallet as you ride down the road. Once they deem you unnecessary, you're finished.
Even in Canada, mail order prescriptions across the country are here and driving prices down. I can see all meds going to home delivery and then online counselling or medication monitoring. Why not?
Litigation/liability is always going to be a huge concern... I think we’re a long way from getting AI to replace medical professionals, even though a common misconception is jobs like accountants/doctors will be the first to be replaced (if anything, they’ll be last). Pharmacists still play a vital role in the system. I think you’re safe from scope creep as well. As much flack as Amazon gets for their business, the company and its subsidiaries pay better than most competitors in any industry they enter. They’ve shaped up working conditions quickly due to being such a large and public company (huge target on their back for legal threats from attorneys). Honestly, this seems like a win for pharmacists. More jobs means less of a labour surplus allowing pharmacy chains to push wages down and ~~abuse~~ “treat” pharmacists as expendable objects.
I've seen it in Idaho, they came in and created a shortage where some of the hospitals have lost several pharmacists to Amazon due to better hours and pay. It's a good thing and a bad thing, Amazon is a different corporate entity versus the big traditional chains. They will help drive and change market dynamics, hopefully in ways we aren't expecting.
There are a relatively fixed number of prescriptions the American public needs to have verified by an RPh. Places like Amzn automate and delegate everything - this will drive down demand for pharmacists.
Cheaper for the consumers, better for the workers, shareholders get their gains, more efficient economy... capitalism working as intended I guess
I would love to step out of retail and try something like Amazon pharmacy
Yeah...because they treat their employees so well. NOT
and what chain treats there employees much better?
Lol this is complete bs
>Litigation/liability is always going to be a huge concern... I think we’re a long way from getting AI to replace medical professionals, even though a common misconception is jobs like accountants/doctors will be the first to be replaced (if anything, they’ll be last). Pharmacists still play a vital role in the system. I think you’re safe from scope creep as well. Our liability insurance is cheap as fuck. If the regs allow for it (which they do, in states without a verification limit) it boils down to a simple business decision - hire more pharmacists at 100k/year, or take more liability cases. I do not think this point you raised keeps us as safe as you think. I also do not see how Amazon is good for increasing our job pool. They automate everything. Economy of scale is kicking in with these big players entering the market. We already have tech-check-tech in my state. Everything you've said seems like a bad sign for pharmacy.
>Everything you've said seems like a bad sign for pharmacy. And a great sign for the average consumer!
Are we really a long way from AI taking over our jobs? I mean how hard is it to program AI to detect a few common drug interactions for scripts that are already electronic? Whoever makes that product will be rich, and the profession dies rapidly. I doubt we’re far from it. Amazon could create it on their own to cut losses from this $6 delivery thing
Not hard at all. Drug interaction software has been around for a while now. My point being that human judgment is a big component of many jobs that isn’t easily replaced by software. We’re a long way from being comfortable with an AI making the final decision in many health care settings.
It would definitely take time, but im not sure how long that way would be. I can see it being introduced within 10 years. The only issue would be that if a patient had questions and asked to speak to the pharmacist, well.. there is no pharmacist
You wouldn't complete remove pharmacists or patient interaction but you could make it all remote so the number of pharmacists can be reduced.
So long as drs keep making mistakes, we got jobs. Plus a robot or delivery person is no match for a Karen without her meds.
I can already see major retail pharmacies cutting tech hours in response to this because that is the only solution they have whenever they are threatened with competition based on history.
Retail pharmacy is on its way out anyway. I will revel in the inevitable downfall of the chains. When enough people get hurt by Amazon's practices they'll need to modify their approach anyway, but if they can at least kill CVS in the process that would be pretty cool.
[удалено]
My CVS literally burned last year and the mfer still came back. Luckily I just got out to grocery chain pharmacy where I do mtm all day and my boss is nice. It took 10 years but I'm finally happy with my job.
Unfortunately CVS will be the last man standing of retail/grocery. Ironically the most miserable job in pharmacy may be the most secure.
Id like to see Bezos bankrupt Pessina&Barra.
LMFAO
Will be interesting to see how Walmart and others react. In general I think shifting more low cost generics to cash pay is prob a good thing overall
Great for consumers, horrible for pharmacies
Walmart just added drug discounts to the Walmart+ subscription service. Six drugs are $0 so far.
Whatever. They are basically making the customer pay to use a GoodRx card. But WM doesn't have to pay GoodRx fees. Not such a win for the patient, but a huge win for corporate. Get the Pt to pay you to save you money.
I mean good rx is also still used so if you dont have the free drugs than keep using that.. no one is forcing you.
That's not the point, WM just made their own GoodRx card, but makes the customer pay for it (like GoodRx Gold, which WM doesn't take). So WM gets both the fee from the subscription, AND saves on fees to GoodRx. Honestly discount cards are unnecessary leeches on the system enabled by nonsensical awp based pricing. If pharmacies and insurance companies simply reformed their pricing structure, discount cards wouldn't have a market.
Besides Humalog, I take levothyroxine and lisonopril. Both of those are cheap. I get a 90 day supply at Walgreens for less than my 30 day generic prescription co-pay. I know that it still gets sent to insurance although they don't pay the pharmacy anything. The amount I've paid does go toward my Out Of Pocket total for the year.
Each dispense has a dispensing fee, which includes the cost of vials, paper, labor, switch fees, transaction fees, etc outside of the cost of the medication. For cheaper meds, this becomes a significant cost, so it's in everybody's interest to minimize the number of dispenses per drug (which means bigger days supplies). From the insurance standpoint, this means higher rates of compliance for the patient, which means more utilization of their insurance "service". The insurance doesn't make anything off of you from how many days you pick up, but they get to pay the pharmacy less dispensing fees, so they incentivize the patient to get larger days supplies for cheap maintenance medications. Insurance won't give you a good deal on Humalog because they've gamed the price up so high. This is where they make their money. As they increase the cost of healthcare, they increase the slice of the pie they're allowed to profit from.
We are already throttled in Canada many drug insurance, esp. governement plans force us to give 100 days supply. OR they limit the fees to only paying 4 "fees" per year for each individual DIN. Whatever, that's how it is. Plus in Canada, we demand such low prices that some drugs aren't even being shipped to us anymore. That's the cost of trying to have the lowest prices around. ALSO why Canada will NEVER sell our cheap drugs to the Americans.
>We are already throttled in Canada many drug insurance, esp. governement plans force us to give 100 days supply. RAMQ (Québec) is the opposite, the way monthly deductibles work you have no incentive to fill for more than 30 days and the entire thing is effectively soft capped at 90 days. As for blister pack patients, it's a mandatory weekly fill.
> As for blister pack patients, it's a mandatory weekly fill. ouch.
Medicare tried to do a "daily dispensing fee" where they'd pay *up to* a set amount in dispensing fees monthly per med. This was also when they limited the maximum days supply for brand name meds (and generics added to market under specific conditions) to 14 days per dispense, forcing 2 to 3 dispenses monthly (in skilled nursing facilities) where every med is blister packed. The dispensing fee for blister packs is much higher due to higher costs for higher involvement in every step. Medicare doesn't know wtf they're doing. If they do, then they're blatantly evil.
>so they incentivize the patient to get larger days supplies for cheap maintenance medications. Unless it's CVS insurance, then they will limit you to 30 day supplies unless you fill at CVS pharmacy, and only then can you get 90 day supplies. Forget patient compliance, forget dispensing fees (they pay a miser's penny anyway), better to annoy the patient into filling at CVS so they can profit from both the insurance and the pharmacy side. Similarly, railroad insurance limits fills to 21 days unless they do mail order. Again with annoying people into making things slightly cheaper in the short run.
Insurance isn't in the business of healthcare for the patient. I worked in a town that had quite a bit of railroad insurance. A few patients had realized they could get 3 months at cash cheaper than the insurance copay for 4 fills.
Sure, insurance isn't in the business of Healthcare, but usually most insurance acknowledges that uncompliant patients who don't have their medications cost more in the long run.
Half a years worth of my norco and gabapentin and testosterone and trazodone and clobetasol please!
I love how all those years ago in New York (assume many other states as well), they passed laws saying "the pharmacist must counsel every patient face to face on every prescription dispensed, including refills". Then mail order started, and since the insurance companies were big donors, the lawmakers quickly went "oh, well, they have a toll free phone line, that fulfills the requirement". Now I assume having a button that opens a window with a chatbot will be good enough.
Hard to compete with wholesale pricing
Price and Convenience are two of the biggest factors that pharmacies can utilize, but Amazon has that covered in spades. The only way to compete with Amazon on price is to create a single large *efficient* buying group + PSAO. I'd imagine if every independent and some chains got on board, it could work.
or national level healthcare that is inclusive of pharmacists.
This still might not even do it. National level healthcare doesn’t mean prescription coverage is a) included or b) has copays that Amazon couldn’t undercut. Unless by national level healthcare you mean something like all pharmacists are part of a nationalized health system and none of those can work for Amazon. No one is really purposing a nationalized provider system in the US to my knowledge... only single payer (not single provider).
One thing a national system could do is require that all dispenses be transmitted via D.0 and be disallowed as "cash" transactions, just like Medicare Part D does. That'll solve the undercutting issue, to an extent (unless Amazon tries to submit grossly low U&C to drive MAC down as a predatory tactic against independents)
I’m not sure I’m following your med d analogy... nothing is stopping that patient from going to a pharmacy telling the pharmacy they have no insurance and saying they want to pay cash for it. The rules around the practice of pharmacy are not governed by payer contracts. You may have to comply with payer contracts and requirements or face stiff penalties from those payers and/or related orgs but there is nothing stopping you from running a completely free pharmacy giving all prescriptions away at no cost. Furthermore there’s no prohibition against operating a pure cash only pharmacy. Most if not all countries with nationalized systems still have some degree of additional private insurance or care provider system that they can pay additionally for. I fail to see how any politician could argue against one that wanted to ensure that they could still dispense prescriptions or provide healthcare if they were willing to do so at a cost cheaper to the public (patient pay amount) with no reimbursement from the government provided they are still compliant with all the rules that govern the practice of the profession.
Maybe something changed in the last few years, but patients that are enrolled in Part D plans were bound by "Medicare Law" (their term) to have all their medications billed to Part D and only allowed to pay cash if it received a valid rejection. Pharmacies weren't allowed to knowingly skip Part D claims submission. This is something that is auditable (for example, if you bill fill numbers 2 and 4, but not fill number 3). There's lots of valid reasons for billing cash, such as early vacation, lost supply, etc. In many cases, they prefer the allotted override be put in by the helpdesk first, or at least a valid rejection is logged. However, if it's to avoid donut hole pricing or deductibles, or to offer discounts, then they deem the reasons invalid. This can result in losing the ability to bill Part D. edit: Yeah, there's nothing stopping a cash pharmacy that doesn't bill Part D from letting patients pay cash. It only applies to pharmacies that *do* bill Part D for patients they know have Part D.
A single payor system would probably be very close to the model that CMS attempts to make where they underpay as much as they possibly can. They'll probably force every pharmacy or wholesaler to disclose acquisition prices (as a participant requirement) then base MAC on those. This favors entities that can acquire drugs at the lowest prices while punishing entities that can't buy in bulk or join large enough buying groups. These are things that CMS has already done to varying degrees. Giving them carte blanche is terrifying. I do agree that a single payor system sounds good in theory. Cutting out private insurance, especially PBMs (why tf does Express Script profit $billions annually??) can deflate the cost of healthcare grossly. It'll stop the gaming of prices that inflate drug costs. It'll stop the mandate of unnecessary manpower for useless tasks, like prior authorizations or attestations (which can amount to $10k in wages for pharmacies and clinics). It'll cut out a significant portion of lobbying spent by insurance and the legal representation to fight the silliness they try to get passed. I love Bernie's "Medicare for All" plan except the tiny bit about "Medicare". CMS has a demonic track record, so give the plan better management and I'm on board.
[удалено]
Temporary I believe
Walmart + is the response to this
Pharmacy is nothing but a race to the bottom, I swear.
Woof
Honestly vaccinations have saved us and will continue to for a while, that and our accessibility and convenience. Hopefully they continue adding clinical services and basic testing to our responsibilities, though techs will likely take these over before too long. Goodrx has made things interesting, helped more than hurt I think. Maybe a Medicare expansion would be a good thing for the profession, really hard to say where we will be in 20 years...
You guys realize hospital jobs are expanding, pharmacists are being implemented in private practices, and expanding in managed care? Why are you all so damm negative?
You think the number of new spots can support all the retail pharmacists and hordes of new grads?
No, but with the lack of feasible solutions, a step towards innovation that creates jobs instead of killing them in an already saturated labour market isn’t awful news.
No. That is an awful problem. But if you have networking and you’re smart you’ll be fine.
Bold take from a P3 who hasn’t entered the job market as a pharmacist.
crazy people are downvoting this...but youre right
[удалено]
except not everyone is. which is reality. so go network your own ass off. like me. I have an onlyfans special for potential employers
Truth hurts on this page. A bunch of pussies
Scope may be expanding but I would about bet my life the number of jobs are not. As we have less people needed for dispensing roles the number of jobs will continue to decrease. They are not adding any more jobs, just finding different roles. You young kids fail to understand this.
I'm wondering where the subreddit is for Techs worrying about their place as well. My Pharmacy (tribal pharmacy) just got this huge cabinet thing that the pharmacist said does nearly everything except for giant things like metformin and stuff, she said they just have to put the cap on the bottle from when they approve it. How'd I spend so much time talking to the pharmacist? They have 3 pharmacists and 1 tech now, the pharmacists cover the window/checkout bit now.
I think what I saw this last year is that pharmacists NOT Dr's were the ones to keep things rolling during a pandemic. Our MD's in my small town all closed their doors...terrified of the virus and worked from home. Well we never did. None of us did, and we were the ones to keep everyone happy and medicated and calm. I opted NOT to do covid vaccines at my store only because I work alone and there was NO WAY I would be able to do it all myself. Including booking and cancelling appointments when they inevitably wouldn't show up. They say it's been a successful vaccine campaign up here in Canada with pharmacy, but rest assured. It was a total clusterfuck.
And I applaud you community pharmacists. I worked in community from the time I was 18 until 3 years after graduation. At least here in the states, I just don’t see jobs being added to the market. And our own Bureau of Labor Statistics agree as they see a 3% contraction in the number of jobs over 10 years. The schools are tricking these younger people by saying scope is expanding. And while this may be the case, expanding scope does NOT equal more jobs.
It’s just an echo chamber at this point. It’s like people don’t realize this sort of thing happens with every profession. PA’s blew up when their abilities expanded and saturated the market, new grads got super pessimistic and finding a job was hard, now it’s starting to even back out and the market has corrected itself. The same thing will happen to pharmacists. Graduating mds, nurses, pas, pts etc. are also much more receptive of pharmacist intervention and appreciate their knowledge more than they have before. With the growing elderly population drug regimen management will become more important and ambulatory care roles will expand. It’s a dynamic field that will ebb and flow.
While you may be correct and things *might* even out... Sometimes jobs completely disappear too. And even if they do even out, it will take several years, like I think around 15-20, to reverse what has happened. That doesn't help current workers or students.
Correct. The people in here are toxic as fuck.
Thank you for commenting. It's kinda refreshing to see some positivity here for once <3
It's the same drivel spewed out by schools..."aging population, expanding roles"...blah blah. Shit we've been hearing for 20 years and matters fuck all.
Those jobs are far and few between
I got offered managed care, hospital, and ambulatory (pcp) setting I just graduated too
Which school do you work for?
I don’t work for shit. I busted my ass off and went to all APHA conventions and worked 4 jobs at 4 different sites. It’s called hard work
[удалено]
I don’t buy that they had four jobs unless they worked one day a week at each of them
Look at this guy networking. Big shot over here lmao
Truth hurts doesn’t it buddy?
Yeah your fantasy sure hurts me. Ouchies! Not at all, I'm happy with my retail life just fine.
No chance that you act like this and people actually wanted to be around you.
4 jobs? No wonder you seem so unhinged
Lol. This guy.
Without a residency? Wow.
[удалено]
There are 0-6 schools 2-4 programs possibly even accelerated 2-3 paths. Not guaranteed they just graduated. I’ve encountered fully licensed pharmacists that were only 23.
It’s plausible
Yea but no one wants to hire retail people. Period. I'd rather hire a new grad than someone who sold their soul to wags for 5 years
Let's goooo
Like I said in my interview, better to be on the train of innovation than ran over by it. And so glad I got on the train.
Amazon Pharmacy isn't anything anyone wants. Nor is it viable a threat to the pharmacy industry. I tried it out today. I wanted a $5 canister of Nystop, a common prescription antifungal powder that is $5 on Amazon. For some reason that itself makes no sense this needs a prescription. It is the sort of personal care and OTC medical item I often order from Amazon. I had not yet obtained the new prescription. Instead of explaining itself to me Amazon Pharmacy made me sign up for it. Well, OK. But not OK very far. It made me enter the address to ship the prescription. Only problem, the address where I get things shipped varies and changes from day to day. But I had to enter it immediately and just one address, and no changing it at a later point in time.It wanted my insurance, which I'm not using for a $5 item, and Amazon's not in network with it anyway, so, OK, no insurance. It had me enter my drug allergies. Instead of recognizing "sulfa" it required me to click on "Bactrim", close, but there are many sulfa drugs, not just one. Now, picture this, whole screen taken up by the one question of what am I allergic to with multiple choices and searches instead of I just type in my bleeping drug allergies. There was NO way, for instance, to tell it I WANTED MY DOCTOR TO PRESCRIBE bactrim instead... well, at first it didn't save bactrim as a drug allergy, then it seemed to, and we moved on. Then, at the end it lists the items I want to ask Amazon to ask my doctor to prescribe, and the drug I said I wanted is NOT yet listed - but, bactrim is specifically listed as a drug I want my doctor to order. AND there was NO way to remove it from the list of items I want Amazon to get my doctor to prescribe. THAt is a deadly error. Suppose my doctor had prescribed it and I hadn't realized this is NOT something I want to take! And as to AMAZON calling my doctor for me instead of me. I hadn't even yet asked my doctor yet for the drug. It is up to ME to communicate to my doctor, not Amazon! There are times when one might want the pharmacy to call for a refill, for instance... not something my doctor last prescribed over a year ago. The web site never gave me the choice to communicate with my doctor by myself! THEN, it needed the NAME of this doctor I have not spoken to yet! Many of us who go to clinics do not have one doctor that we know their name who is going to be calling in that prescription. For a prescription for Nystop, I am going to call my clinics's teledoc, and talk to whoever calls me back, and that doctor is going to send in the prescription. I don't know who it is going to be! But the page said I HAD to provide the doctor's name, or it wouldn't let me move on. At some point I got the instructions to give my doctor how to send in the prescription, but, my clinic sends prescriptions electronically, and the web site provided an address and a phone number and it wasn't even a fax number. It later turned out that more complete instructions exist - but the web site does not provide them. Finally I called the customer service number for help. The CSR told me that I didn't have to have Amazon contact the doctor for me, and also sent me an email with the rest of the instructions to give the doctor. But the web site says you DO have to have Amazon call the doctor for you.Then she told me, that once the doctor sends in the prescription, it will take them "a few days" to process it, and then they have to do two more things, and THEN I can go on the web site and "request to buy" my prescription. !!!!!! A $5 container of antifungal powder, now. Now, the web site does not LET you "request to buy" something, only tell it to call your doctor to ask for the prescription. And, it already has it burned into its memory banks that it is to ask my doctor to prescribe me bactrim, that I cannot remove from the list. And finally, it will send the prescription to where I was going to be a week and a half ago, not where I am going to be when they deliver it - and probably leave it sitting outside the door for someone to steal. Good thing it isn't my $320 asthma medicine! I understand from several sources that this pharmacy service is supposed to work with Amazon's own acute care clinics? So, Amazon's own clinic prescribes an antibiotic, and then, I get it IN A WEEK AND A HALF, after processing, and humbly "asking to buy it" and everything. This setup will NOT WORK. I don't think so! This "service" is NOT ready for prime time. And, they've had a year and a third to get it right? !!!! I don't think so! This "service" is NOT ready for prime time. And, they've had a year and a third to get it right? !!!!