Marsha K. Millonig

Results recently released from the annual J.D. Power 2019 U.S. Pharmacy Study showed that patients enjoy visiting brick-and-mortar pharmacies and find a great deal of satisfaction from talking with their pharmacist. More specifically, nearly 90% of patients surveyed in the annual report said they communicate with the pharmacist and staff in person.

The U.S. Pharmacy Study measures customer satisfaction with brick-and-mortar and mail-order pharmacies. The 2019 study is based on responses from 12,059 pharmacy customers who had a prescription filled during the three months prior to the survey period of May–June 2019 (see list below).

This does not surprise me, given my experiences working as a pharmacist in a variety of settings in the past 25 years. When I am practicing at the pharmacy, I try to help at the will-call window when possible, because it allows that interaction without the pharmacy technician asking the patient to step to the counseling area and having me visit there. I can do both at one time. Patients are hungry for information. Several times a year I make a mental note to track the questions I am asked during a pharmacy shift. The variety might surprise those unfamiliar with the day to day in the pharmacy environment. Last week during one short shift, on the OTC (over the counter) front alone I was asked about:

    • The best type and dosage form of vitamins for a 2-year-old patient, and what determined quality.
    • What treatment parents could try for allergies for their first grader.
    • The difference between several denture adhesives and dosage forms.
    • What drug interactions existed for a dog being treated for a chronic condition with more than one medication.
    • Which probiotic might work best for an adult patient being prescribed an antibiotic.
    • Which brace would be best for a sore knee, and how to use it.
    • What available OTC antifungal could be used with a feeding tube.

A No-Cost Service

Pharmacists are indeed the most accessible healthcare professional, and most of our counsel is provided to the patient at no cost. The counseling provided with a prescription is not separately compensated by the patient. Yet in these times of decreasing reimbursements and continued pressure on pharmacy margins from direct and indirect remuneration (DIR) fees, lower-than-product-cost payments and inability to service the patient’s entire medication needs due to some medications coming from specialty pharmacy, patients are still able to access and receive advice from pharmacists at nearly every corner, for now.

I wrote in the July/August ComputerTalk issue about the correlation between pharmacy closures and decreased medication adherence. State pharmacy association executives have talked about the calls they are receiving from owners desperately trying to keep their doors open. And it is not just independent pharmacies that are being impacted:

Operations and staffing levels are being managed extremely tightly in response to this pressure. It is an increasingly rare occasion when I pick up a shift where things are not behind or that the daily pressure to keep up is not great. In the meantime, flu season is upon us, and the goal to provide this important service is being emphasized in the pharmacy community; people have come to expect this important public health service from their pharmacist. This increased demand for services is being accomplished with the same resources. In the long term, this balance is not sustainable. How long before patient satisfaction decreases?

On a 1,000-point satisfaction scale, patients gave high ratings to their interactions with pharmacists:
  • 940 points when four or more issues were discussed
  • 917 points when two issues were discussed
  • 884 points when one issue was discussed

There are some breaks coming. The FDA has delayed enforcement of the Drug Supply Chain Security Act’s (DSCSA) return requirements on wholesalers to ensure that all returned products have the bar-coded product ID. I imagine this may also be pushed back for pharmacy/dispenser compliance next year.

Additionally, the United States Pharmacopeia (USP) announced this week that the effective date for new revisions made on June 1, 2019, to <795> Pharmaceutical Compounding – Nonsterile Preparations and <797> Pharmaceutical Compounding – Sterile Preparations, as well as a new chapter, <825> Radiopharmaceuticals – Preparation, Compounding, Dispensing, and Repackaging, has been postponed indefinitely until the appeals process has been completed. USP received appeals on certain provisions in <795>, <797>, and <825> from a broad range of individuals and organizations. My understanding is there is significant disagreement in the pharmacy community about changes to beyond-use dates on one of the monographs, among other key issues. Now, following its bylaws, USP will follow an appeals process, which includes postponing the official date of the monographs. Stakeholders who submitted appeals on the compounding chapters have requested further review by an appointed panel.

Access the references and additional resources

J.D. Power 2019 U.S. Pharmacy Study.

Articles on Shopko, Walgreens, CVS, Lunds & Byerlys pharmacy closures.

DIR reform.

United States Pharmacopeia (USP) announcements.

FDA Drug Supply Chain Security Act’s (DSCSA) return requirements.

Stay tuned on all fronts. I’ll keep you posted in the weeks and months ahead. In the meantime, I encourage pharmacy computer system vendors to continue to think of innovations that can help further streamline workflow in the pharmacy and support their customers. CT

 

 

Marsha K. Millonig, B.Pharm., M.B.A., is president and CEO of Catalyst Enterprises, LLC, and an associate fellow at the University of Minnesota College of Pharmacy Center for Leading Healthcare Change. The author can be reached at mmillonig@catalystenterprises.net.