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Monday, November 24, 2014

An Open Letter: Dear State Board of Pharmacy-Transfers

Dear YOUR State Board of Pharmacy,

My name is The Cynical Pharmacist and I am a licensed, practicing pharmacist in YOUR STATE. It is my mission today to ask you to outlaw prescription transfer incentives. While I understand the YOUR STATE Board is not in the business of regulating company practices, they are in the business of protecting their State's citizens.

Pharmacy is a profession. We expect to be treated as healthcare professionals. We expect to be respected as professionals. If we allow our services to be bartered for gallons of gas and free gift cards, we are nothing more than cheap hookers, a profession which does not require a license.

We pharmacists are not in the position to make these changes to our state laws. You are. You give us our licenses. You take them away. You write the laws that govern how pharmacy should be practiced in your state. We listen to you. It is time you listen to us.
There are several states that have already outlawed the incentivizing of prescription transfers. This list includes New York, New Jersey, Oregon, Alabama, Mississippi, New Hampshire, and Arkansas. Simply put, prescriptions are not commodities to be traded on the retail market. These are life-altering medications that make a huge impact on a patient's life.

My concern with continued acceptance of this practice in YOUR STATE goes deeper than transfer errors. It goes deeper than the possibility of mistakes. It goes deeper than missing interactions and therapeutic duplications. It is about perception. We are the most accessible professional in all of healthcare. We gladly give away all of our professional services for free. The problem isn't companies attempting to buy patient loyalty. Studies have shown less than a 20% retention rate on patients who use coupons and incentives. The problem is lack of respect that arrives as a side effect with these programs. If we do not respect ourselves, we simply cannot expect our patients, and even other healthcare professionals, to respect us. I am starting a campaign to take my profession back. It starts with your help.

I have broached this subject directly with my State Board in the past. I have spoken with other pharmacists who have also contacted their State Boards and had similar results. The Boards' refusals to enter this discussion often boil down to the following argument: The Board does not exist to regulate company policy. I have mentioned each of the following situations before and received the equivalent of a shoulder shrug from those with whom I spoke. According to these members, the following are simply anecdotal and they have no proof that these can happen, do happen, and even if they did, the frequency with which they actually occur.

1. The risk for errors increases each time a prescription is transferred. The more times you fill it, delete it, call it in to another pharmacy, and give a verbal order to someone else, the risk increases. (Think of the telephone game in kindergarten.)

2. Time is wasted on transfers for coupons that could be spent on any other professional task. Each time I have to step away to get a transfer or give a transfer for a patient, I am at risk of speeding through something to catch up. I may miss a drug interaction. I may dispense an incorrectly filled prescription. The risk that I may make an error increases.

3. Patients complain about not being able to shop around or "going South" for the winter. There are states that only allow single transfers. Simple. If the rules exist, patients will adjust to them. They will get two prescriptions: one for home and one for their desert oasis. (Think about how well everyone adjusted to no refills on Hydrocodone-containing products recently.) Also, with most insurance plans, the patients' copays are the same at nearly every pharmacy. They shouldn't need to shop it around.

4. Grown adults use their elderly parents' medications to make money. This is true. I have seen it firsthand. Do the parents know? Is that their right? We have people who will carry folders with their parents' prescription receipts from all the local pharmacies. Every week they will drive from pharmacy to pharmacy, transferring CVS to Target, Target to Walgreen's, Walgreen's to Rite Aid, Rite Aid to Wal-Mart. Next week, they repeat the process. This should not be allowed to happen. If an error occurs, who will get in trouble? The pharmacies. Who will pay the price? The elderly parent. Your job as State Board involves looking out for the health and wellbeing of your citizens. 

Patients will complain states are taking away their rights. I believe they are taking advantage of a system that never should have existed in the first place. We need to make our profession more professional. It starts with you. It starts with this law change. It has to start now. I want my profession back. Please.

I would be happy to attend a Board meeting to discuss my proposal further.

Thank you for your time and consideration.

I have included a link to Alabama’s law, a state that changed most recently.

“A pharmacist and a pharmacy should never offer or participate in the offering a financial award or benefit, not related to competitive retail pricing of any drug, to induce or encourage any individual to transfer a prescription from one pharmacy to another.”

Statutory Authority:
effective June 13, 2011. Amended: December 16, 2011; effective January 20, 2012.
Herb Bobo, R.Ph. Secretary
Code of Alabama 1975; §34-23-92.
Original rule filed: May 30, 1990; Effective July 30, 1991; Amended: May 9,

Here is the verbiage currently proposed in Virginia.


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