Consumers Scrimping on Prescriptions

A story in the New York Times this week tells the story of pharmacy patients faced with a heartbreaking choice: basic necessities or medication. The article follows several individuals who have started splitting pills, skipping doses or eliminating medications altogether. Their reasons? While some patients cite concerns about drug side effects or new clinical trials, more often than not these efforts are an attempt to save money.

"People are having to choose between gas, meals and medication," said Dr. James King, the chairman of the American Academy of Family Physicians, a national professional group. He also runs his own family practice in rural Selmer, Tenn.

"I've seen patients today who said they stopped taking their Lipitor, their cholesterol-lowering medicine, because they can't afford it," Dr. King said one recent morning.

Rising prices and a sinking economy have squeezed many Americans' budgets, and consumers are cutting back in a number of ways. But taking incorrect doses or skipping pills can have potentially life-threatening implications.

Have you seen fewer or less-frequent refills at your pharmacy? If so, how do you think such practices impact patient quality of care?

In Sour Economy, Some Scale Back on Medications [New York Times]

Got Ranbaxy?

Pharmacists are calling for Ranbaxy Laboratories products to be pulled from store shelves after the FDA banned imports of 41 drugs produced in India for sale as generics and store-brand OTC medications here in the U.S.

"I think a store recall may be justified. I probably wouldn't dispense any more Ranbaxy products if we can replace the stock," said Holly Henry, incoming president of the National Community Pharmacists Association. "At this point, let's just pull all the Ranbaxy products, just to save face with my patients... This alert is a concern. My advice to my pharmacists is we better stop dispensing this stuff."

The FDA acted months after finding quality problems including cross-contamination and sterility lapses at Ranbaxy. In July, the Justice Department charged Ranbaxy with systematic fraudulent conduct, false and fabricated information, and attempts to conceal violations of current Good Manufacturing Practices regulations from FDA. Now a Congressional committee is investigating.

Remember just last year, Ranbaxy's Ohm Laboratories had to recall 1.3 million bottles of children's loratadine syrup, produced for chains including CVS, Walgreen's and Rite Aid because it "exceeded impurity specification." Also in 2007, Ranbaxy had to recall 73 million gabapentin (generic Neurontin) tablets. In fact, the first FDA warning about quality problems at Ranbaxy factories came way back in 2006.

So after all this, retail chains are saying they'll "keep a close eye on the FDA warnings" and "look into" finding another supplier for generics and store-brand OTC drugs - but why aren't they pulling Ranbaxy from store shelves?

Meet Delphine P.

Panorama City, CA

I have worked with Rite Aid since 1993, and I have practiced pharmacy since 1983. I once even ran my own independent pharmacy in Ivory Coast.

There are some major differences between practicing pharmacy in Ivory Coast and in the retail industry in America. For example, here the marketing aspect of the work takes over your time. We have a competitor coupon program that causes customers to move from store to store just to get the coupons. This makes it harder to work with them as patients. As a pharmacist, you should be using your knowledge to help the patients, to take care of them.

There are so many retail pharmacies now and the way the companies keep up is to make the pharmacist work harder, which keeps us from taking the time to give our professional advice. When we get pressured for time by the company, it can impact our professional judgement.

I'm getting involved with the Put Pharmacy First campaign because we need real change.

Meet Samantha M.

Philadelphia, PA

Hi, my name is Samantha Martin. I am first a mother, and second a retail pharmacist in Philadelphia, PA.

I think the retail pharmacy industry would really benefit by having additional pharmacists available at each location for the sole purpose of counseling patients.

Pharmacists are possibly the most under-utilized resource for patients in the current health care system. We can be accessible and available to patients 24 hours a day. Quality patient counseling can help prevent trips to the Emergency Room, hospitalization, treatment failure, and therapy non-compliance, amongst other things.

The only way to make this change happen is to solve the problem from the top down. There needs to be a legislative solution. I believe insurance companies must be forced to fully reimburse pharmacies for all their professional services, and retail companies must be forced to provide additional pharmacists in exchange for the reimbursement.

Meet Celywn F.

Los Angeles, CA

My name is Celywn Francis. I've been with my company for over 20 years. The pharmacy industry isn't everything I expected it to be when I started. You don't have as much time as you would like. It is always rush, rush rush. You don't have enough time to obtain important information from the patients, to get as much information as possible to make a decision.

Working in the large retail chains is very stressful. Especially if the volume of the store is large. You have to do so many prescriptions with a limited amount of help. When you don't have enough support staff, the pharmacist has to do the job of cashier, clerks, everybody. This keeps the pharmacist extremely stressed out. I have all this extra work to do plus filling the scripts and this can put my license at risk. You get so tired you may see one thing but it may be something else. Technicians may type in directions incorrectly.

Lisa T.

Tewksbury, MA

Pharmacists and the profession of pharmacy has been around for a very long time and it has been one of the most respected professions. I began working in the field as a teenager and found it very rewarding (and still do). Since I found the job to be so fulfilling and interesting, I decided to go to school and become a pharmacist. I've been a pharmacist now for 10 years. In my earlier years of being a pharmacist I made an effort to do the most I could for each store that I worked at. Most of those stores had been 24hr stores filling anywhere between 2,500-3,200 prescriptions per week. Even though we were real busy I never even cared about taking a break, I had a lot of energy and getting through a 12 hour day was a piece of cake.

However, once I had a family and more responsibilities accumulated outside of work I realized that work was just another piece of the puzzle. I'm still in retail 15 years and could potentially be here forever. But as time goes on, I realize that I'm not the young energizer bunny that I once was.

Through the years as more and more prescriptions are being filled, more drugs are coming into the market, more drug interactions being discovered, more black box warnings, more duty to warn concerns...etc... it has become more difficult to help our patients to the fullest. It has been more difficult to keep up with the demands of the job.

Meet Jamal L.

Randolph, MA

My name is Jamal Liles. I'm a retail pharmacist in Massachusetts, and I have a question. Are pharmacist's healthcare professionals or cashiers and manufacturing floor workers?

After six years of school I'm sick of being asked at the drive through window "can you get me...?" You can fill in the blanks. Would a patient ask their doctor "can you put me in the computer" or "can you get me some lunch from the cafeteria"? Of course not. So why are pharmacists asked to do these things? Are we healthcare professionals or not?

Also, we can all agree that techs are extremely important so why can't we compensate them for there talents? Better paid techs means happier techs means better techs period. So what's the answer? What are pharmacists and how do we become what we thought we'd be? I think this is the first step.

Meet Lan T.

My name is Lan Tran. I came to the US from Vietnam in the 1980s, went to high school in Los Angeles then college and eventually pharmacy school. I started as a pharmacist in 1989, 19 years ago.

I like helping people, that's why I came into this career. But there are many problems that make things harder.

There's too much paper work, reports, emails. I don't think it is necessary. It's not related to the patients. Even though we delegate this to the techs, it still takes us a lot of time. It puts more stress on us. You come in, and you have a whole stack, a list of things you have to do, you have to let the tech do, it takes away from working with the customers.

Meet Ray F.

My name is Ray Funatsu and I've been a pharmacist since 1963. In '74 I started working as a manager with Sav-on until '94; that's when I stepped down because it got to be a little too much. I worked until 2000 and retired and now I'm on-call.