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In the trenches: Behind the counter with 3 pharmacists

What keeps a pharmacist up at night? Sounds a bit cliché, doesn’t it? But retail pharmacists are confronted with many different issues throughout their day, from dealing with patients to company and government regulations that can make the job a bit tougher.

Although retail pharmacists across the United States work in many different settings, many face similar challenges. Drug Store News talked to three pharmacists — without identifying them or their employers — to capture a day in their work life and explore challenges they experience, as well as solutions.

Here is what we learned:

Case 1: Independent pharmacist near Seattle
At this bustling independent pharmacy, the pharmacists all focus on non-sterile compounding for the local community. The pharmacist said that many competitors focus on marketing and compounding for out-of-area patients, as well as local consumers, but employees at this operation focus on building relationships with local doctors and serving the community.

The independent employs a distinct, high-tech process for filling prescriptions. A technician performs data entry, including resolving insurance rejections, and then a second technician processes the prescription out of the packaging queue. No paper or labels are printed until the script is ready to be filled, reducing unnecessary use of paper. The second technician is located at a station that has a tech solution called Eyecon, which uses infrared technology to store pill images and ensures accuracy on filling, as well as RxSafe.

RxSafe is a tower containing a large portion of the inventory that can store up to 1,200 stock bottles. Once the label is printed, the technician scans the label, and the RxSafe sends out the stock bottle of medication. Eyecon scans the label and stock bottle for accuracy. It will alert the technician of an error by flashing red, even if the correct drug is scanned, and there is a distraction, and the wrong drug gets poured onto the counting tray.

At this operation, the pharmacist employs the use of a hanging bag system. By the time the prescription reaches the pharmacist for verification, it already is in the bag. This has saved a lot of time in the bagging process and allowed them to eliminate baskets. She has had success purchasing these bags at a better price by searching online for hanging library bags, which can be found at a larger variety and at better pricing. The pharmacist said the system “keeps things looking neat,” and that it is a “seamless process that eliminates a few extra steps.”

What is her favorite aspect of independent pharmacy? “The connection with customers and prescribers,” she said. Once the pharmacy began compounding, doctors started to view it in a more clinical light and started asking a lot of clinical questions they never asked when the pharmacy did not compound. Now, she said, they are viewed “as colleagues, someone who can help solve medical problems.” She enjoys the family environment of her independent pharmacy and being her own boss. She also enjoys the benefits of being a member of Professional Compounding Centers of America, which has a network of 30 pharmacists she can call for help if she needs assistance finding an answer to a tough question.

The pharmacist noted that it is important for independent owners to be alert to the possibility of employee theft. She told of a technician, who worked at the store and was later discovered to have been stealing from the company in a number of ways. This technician processed prescription refunds onto her own credit cards and opened fake charge accounts. At one point, the credit card company was alerted because thousands of dollars were being refunded onto her credit card.

The company, recognizing that this often is caused by employee theft, contacted the pharmacist and the employee’s stealing was uncovered. She noted that this employee was an otherwise star worker, often proudly pointing out ways that she had helped make money for the pharmacy. The technician worked hard to be her right-hand woman, she said.

The pharmacist said that a red flag with this technician was always printing unnecessary financial reports for her job description. She explained that by doing so, dishonest employees can gain access to information they use when developing their strategy.

The independent pharmacist stressed that since internal theft can be very damaging, owners must take extra steps to protect their assets. Employees should not have charge accounts nor should be able to create or edit charge accounts for others — only a very limited number of trusted employees should be able to do so, she said.

She also recommended that registers should be password protected. Only the pharmacist should be able to authorize a discount, price change or refund. She noted that proper security on the register is just as important as learning how to operate it.

A nice niche that she has carved out for the independent operation is bringing in high-end vitamin lines that cannot be found in chains. She started with Thorne vitamins and expanded to several others, with the store now carrying multiple lines of vitamins that typically do not sell to chains. She described it as an “additional revenue source and clinical service,” that the pharmacists enjoy and that helps the pharmacy stand out.

As is the concern with most independent pharmacies, she noted that insurance reimbursements have gone down, but she is “hopeful that PBM reform will come and is somewhat encouraged for the future.” The pharmacist advised fellow pharmacists to get involved with or donate to state and national pharmacist associations to help them promote and fight for the profession.

Case 2: Pharmacist working for a national retail operation for the last 15 years, and is now working in a high-volume store located in the Philadelphia area

At this chain, pharmacists work 10-hour shifts. The pharmacist said she arrives 30 minutes early — by choice and on her own time — to “get in and get settled.”

When she arrives, she knows that her resolution queue awaits and will only grow longer if she doesn’t work on it, undisturbed, before opening time. The resolution queue includes all prescriptions that must be addressed, such as prior authorizations, doctor calls and any troubleshooting issues. She explained that there could be 80-plus items in the queue when she arrives, and there is not a specified time when the prescriptions are due.

Generally, though, the system ranks prescriptions by priority — those due in the next 30 minutes, two hours or 72 hours. If a pharmacist starts to fall behind, the items will turn yellow to signal a deadline getting closer, or red if they are past due. Technicians and pharmacists must be efficient in watching priority and keeping prescriptions in order, she said.

At this operation, technicians are expected to fully answer phones and perform all data entry. She explained that they try to “create an environment leaving the least distractions for the pharmacist because no one else can do what I do.” A policy called “three before me” encourages technicians to collaborate and problem solve by asking three other people — if available — before asking the pharmacist. Usually, another technician can help solve the problem, allowing the pharmacist to concentrate on verification and clinical matters.

Prescriptions are checked in two stages. After the technician performs data entry, the pharmacist does a four-point check, verifying the accuracy of the data entry — patient name, drug/strength, directions, doctor. Any mistakes must be sent back to the technician to correct — pharmacists are not allowed to fix mistakes.

Once the prescription passes the four-point
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