Pharmacists are caught in a bind; filling a prescription requires more than simply counting out some pills; at minimum, there is a safety check and a need to ensure that the prescription is medically correct and correctly filled. Other delays might be due to insurance coverage or finding a generic version to substitute for an out-of-stock brand-name product.
The average dispensing fee is usually in the $11 to $12 range per prescription. Pharmacists generally make about $63.00 hourly, so you need five prescriptions just to cover your labor costs. Of course, as with most healthcare financing, that $11 to $12 figure is bogus. Many dispensing fees are determined by pharmacy benefit managers who pay $2 to $3 per prescription, raising the number of prescriptions an hour to 20 or more just to cover labor. New York is proposing a standard $10.18 fee. [1]
Pharmacists have outsourced some work to pharmacy technicians to increase the productivity of dispensing medications, although the safety checks are ultimately their responsibility. Mail-order pharmacies can further automate the filling of prescriptions. We could increase the number of pharmacists, and pharmacy schools have doubled since the early 2000s; unfortunately, enrollment has declined. The corporate response is simply to work faster. But faster is not a factor favoring safety.
A simple answer to a complex problem
A more straightforward solution was floated in a recent article in Stat. According to a study by the research firm Iqvia, 25% of all medications for chronic illness are prescribed for 90 days before requiring a refill. Changing those 90-day scripts to annual scripts would reduce prescriptions by 18%. That is a significant reduction in workload and, as the Stat article points out, far fewer chances for medication error. Given that most chronic medications are supplied in generic form, co-payments for an annual prescription should remain within the finances of most individuals.
There is only one fly in the ointment. Reducing those prescriptions from 90 days to annually also reduces revenue from dispensing fees by a far more significant 75%.
“The good news is that of the two major chains where pharmacists have spoken out, one, CVS, is owned by a very large insurer who could make this idea a reality.”
If it were simply an insurance company, reducing their costs would be a corporate win. But CVS is not merely an insurer; it is a pharmaceutical retailer and a pharmacy benefit manager (CVS Caremark). If you have any doubt, whether it is the insurance or pharmacy wagging the corporate dog, understand that CVS, the pharmacy, purchased Aetna, the insurer, for $69 million in 2017. [2] Given all the inter-relationships, any savings or revenue shifts simply move from one pocket to another.
Those financial savings may be illusory, but the time savings are not. It is unclear whether CVS and other pharmacy systems will put their pharmacists' burnout and their customers' satisfaction ahead of their bottom-line revenue. But you can do your part simply by asking your physician to write full-year prescriptions for your chronic medications.
[1] Those fees pile up, especially considering that Medicaid dispensing fees in New York are already set to that level and account for $784 million in expenses. Expanding those fees to all health plans would cost an estimated $3 billion – and you know that we will be paying the bill.
[2] The merger of CVS and Caremark was one of “equals,” although the CEO of CVS led it.
Source: Filling 12-month prescriptions is one practical way to help the pharmacist crisis Stat
Chuck Dinerstein, MD, MBA
Director of Medicine
Dr. Charles Dinerstein, M.D., MBA, FACS is Director of Medicine at the American Council on Science and Health. He has over 25 years of experience as a vascular surgeon.
