The Revolution. #FlipthePharmacy Essay- written by Peter Kreckel, RPh, Thompson Pharmacy
One of my favorite contacts I made in my pharmacy career is the husband of my first pharmacy technician. His name was Jack and is known as the area’s finest finish carpenter. Jack would go to the lumbermill and hand select the boards, plane them down and could make anything from paneling to kitchen cupboards. Because I have no such handyman skills, I am always curious to converse with carpenters, plumbers and anyone that works with their hands.
I asked Jack if his Dad taught him his amazing carpentry skills. Jack replied no, that he learned them by working on his Dad’s rather large dairy farm. I asked Jack why he didn’t take over the family farm. Jack related that after he got out of the service in 1965, he was talking with his Dad about the new tractor he just purchased for $4,500. Jack’s Dad told him the last tractor he bought was a 1945 model, and that cost only cost him $1,500. Jack pressed on with his next question about the cost of a hundred-weight of milk in 1945 and was told it was $3.00. Jack inquired about the cost of a hundred-weight of milk and was told it was $4.00. Jack looked into his father’s eyes and said. “Dad, you just said that the cost of a tractor went up 300%, and the selling price for a hundred-weight of milk went up 30%. How long do you think a farm can sustain itself with numbers like these? ”
I feel that is where we are in the world of community pharmacy today. I remember back in the 1980’s when Medi-Met was the first payer in our area to reimburse pharmacists with a 5% discount off AWP. Everyone screamed and said pharmacies couldn’t sustain those reimbursements. Now that we are approaching AWP minus 20%, our profession is in a crossroads. Unlike Jack, we don’t want to abandon the profession, we need to make it work.
The Pennsylvania Pharmacists Association is promoting a new program called “Flip the Pharmacy.” Lots of promotion has been done encouraging pharmacists to participate. I am writing from the perspective of a pharmacist who is going through the program. I really lucked out when the powers that be assigned me John DeJames as my coach. John comes with colossal amount of clinical experience and is willing to share his knowledge base with me. This program relies on our experience as clinicians, using the knowledge base and customer care skills we have accumulated over our careers. I have been practicing for 38 years and I am not as interested in “Flipping My Pharmacy” as I am “flipping” this whole profession!
This is not the first flip for our profession, rather it is the third. Galen, the father of pharmacy started our profession by growing and dispensing his own medicinals around 200 A.D. He was a physician, philosopher and pharmacist. Flip the Pharma
cy 1.0 occurred in the early 1500’s when Paracelsus (aka Theophrastus Bombastus von Hohenheim) took opium and manufactured his own pills for distribution. This method of pharmacy practice lasted 400 years until the early 1900’s epinephrine was discovered, and an industrial chemist figured out a way to purify the compound. This technology was sold to Parke-Davis and was sold under the brand name Adrenalin®. Adrenalin® was the first purified drug manufactured by a pharmaceutical company. Flip the Pharmacy 2.0 was about to begin. Many of our senior pharmacists were trained in practice of pharmacy where compounding and manufacturing of tinctures, capsules, suppositories and powder papers were the major part of the pharmacy school curriculum.
Flip the Pharmacy 2.0 took over in the 1950’s when the manufacturers produced most of the products we dispense. Compounding gave way to dispensing of the premade drugs that we bought from our wholesalers. This practice of pharmacy left over from the 1950’s is still the way most pharmacists, be they hospital or community-based, practice our profession. Although most pharmacy school curriculums are intensive with therapeutics and patient care, the models most of us practice under do not lend themselves to the utilization of our skill set. We have the skills, getting reimbursed is another story.
Flip the Pharmacy 3.0 began on October 1, 2019 and is in progress now in the state of Pennsylvania, thanks to the work of Stephanie McGrath and the leadership of PPCN. We’re done growing herbs and medicinals. We’re done compounding drugs according to the physician’s orders. Hopefully we’ll soon be done dumping the pills from the big bottle to the little bottle. Patient care is what we are trained to do, patient care is what we should do, getting paid for our interventions is what we must do.
Many of us do these interventions every day. “Smear a topical protectant to baby’s butt before starting amox/clav. Take your calcium and iron four hours from your levothyroxine. Watch for red stools in baby’s diaper with cefdinir.” We do this stuff every day. We need to document our work using e-care plans and get reimbursed for the amazing service we do every day. Flip the Pharmacy will indeed revolutionize our profession the same way that Paracelsus and Parke-Davis did. Personally, this gray-haired pharmacist been waiting 38 years for such a change.