A recent New York Times investigation revealed that retail pharmacies like CVS, Walgreens, and Rite Aid are pressuring pharmacists to fill prescriptions at an unsafe pace, leading to overprescribing and medication errors.
Interviews and records from numerous state pharmacy boards and burned-out pharmacists show how retail pharmacies see their employees as cogs in a machine designed to pump out as many prescriptions as possible. The goal of filling more and more prescriptions–whether or not it is safe for the patient–has been codified in retail pharmacies’ policies that push for automatic refills unnecessarily.
For example, one pharmacist in Missouri wrote to their state regulatory board, “We are forced to harass patients at check out to fill unnecessary meds, request unnecessary refills, and to enroll in automatic fill programs that result in dangerous duplications and meds to be filled that were intended for single time use.”
Doctors who prescribe medications have also noticed that something is going wrong at pharmacies. Psychiatrists who intentionally prescribe powerful medications for one month only to reduce the risk of overdose are stymied by pharmacies giving their patients 90 days worth of medications.
Other doctors have noticed that when they deprescribe (discontinue) a drug for a patient, the patient’s pharmacy may still continue to refill the medication automatically. Even medications that are not recommend to be taken long-term such as heartburn medication and sleeping pills, are often automatically refilled at the pharmacy. This leads to patients taking medications for months or even years longer than they were initially prescribed, increasing the risk of physical dependence and other side effects.
How can we protect pharmacists and patients from retail pharmacy profiteering? Clearly, retail pharmacies need better oversight. State pharmacy boards do not have the authority to change how retail pharmacies operate; most boards do not even require pharmacies to report error rates. State pharmacy boards need to be given the authority to investigate and fine companies for breaking labor laws and understaffing. First these boards will need to be expunged of conflicts of interest, as many boards include retail pharmacy executives.
However, giving state pharmacy boards more regulatory power will not fix the underlying issue of pharmacies and pharmacists being paid for volume rather than value. In most states, pharmacists are not recognized as health providers and cannot be reimbursed for clinical services, only for filling prescriptions. This limits their role to cogs in the pharmacy machine, when we could be utilizing their medication knowledge to helping conduct prescription checkups and reducing harmful overmedication. Medicare should recognize pharmacists as health providers, so that pharmacists can be integrated into clinical care teams.
It is becoming increasingly clear that Big Pharma is not the only industry that profits from medication overload. Retail pharmacies make more money when they fill more prescriptions, whether or not these medications are necessary or beneficial. To eliminate medication overload, we will need to reduce industry influence, not just from pharma, but from any industry that profits from and drives overprescribing, including retail pharmacies.