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Bottled Up by HMOs

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``Ask your local pharmacist," say the drug ads. To which I mutter, "And why not ask your local anvil salesman, while you're at it? And iceman! And soda jerk!"

As most of us who patronize chain drugstores can attest, the kindly local pharmacist is but a distant memory - and distant, period. Somewhere in the back, he or she toils amid the pills while a high school-educated pharmacist technician takes our prescriptions with all the enthusiasm of a Jack-in-the-Box lifer: "Insurance card? Date of birth? OK. Come back in an hour."

When we do, of course, half the prescription will be waiting for us. And the other half we can pick up in a couple days. That's not an inconvenience, right?

I was just about to write a column railing about how America's pharmacists are becoming less helpful than the cable company, when I actually talked to some. And guess what?

They're madder than I am! They can't stand what's happening to their profession. They're bored, harassed and, worst of all, stuck on the phone with insurance companies two or three hours every day.

Good thing the Valium is locked up!

It turns out that managed care not only is driving patients crazy with restrictions and doctors crazy with paperwork, it's also making it almost impossible to get face time with pharmacists.

"I certainly never imagined when I was in pharmacy school that it would be like this," says Jim, a Rite-Aid pharmacist in Philadelphia.

In school, he said, the students practiced patient consultations. "You'd sit down and say, 'Let's review your medicine. Do you know what you're using it for?' But it kinda turns out those instances are really rare."

They're rare because pharmacists are overwhelmed with behind-the-scenes busywork. Thanks to an aging population and endless advertising by the drug companies, Americans are demanding ever more medications. This year, pharmacists will fill 3 billion scripts. By 2005, 4 billion. So volume is way up while the shortage of pharmacists grows steeply.

But what's really jamming the system is the fact that the insurance industry has stepped in between the doctor, pharmacist and patient.

Today, the vast majority of prescriptions are paid for, at least in part, by the insurance companies. Because these companies dictate which drugs they will cover, pharmacists are constantly on the phone with them.

Say, for instance, your doctor prescribes Lipitor for your cholesterol. The pharmacist types this into the computer, which replies, "Drug denied." Now the pharmacist has to call the HMO to find out which cholesterol drugs it will cover. Then he has to call the doctor to ask her which of these she'd like to substitute. And then he has to call the patient to say, "We're giving you something else. OK?" That's three calls to fill one prescription.

How do little-guy local pharmacists manage to keep their humanity faced with these same tribulations?

Well, for one thing, many of them own their stores, so for them, it's personal. Also, they don't face the same stocking problems that chain-store pharmacists do. The chains usually get their medicines once a week. Local pharmacies get deliveries daily, so they don't have to frustrate their customers with as many shortages.

Nonetheless, it's hard for the little guy, too. "When I was a kid, my friend's dad had a little pharmacy with a soda fountain," recalls Sam Kalmanowitz, the pharmacist at Kaye's Drugs in Meriden, Conn. "I fell in love with it. I loved the way he went in the back behind his cage and did his little thing. But if I had a crystal ball, I might not have made the same decision."

It's too bad Sam doesn't have a magic pill for the pharmacy industry. Because it is seriously ill.



Lenore Skenazy is a columnist for the New York Daily News, 450 West 33rd Street, New York, N.Y. 10001; e-mail:


(c) 2003, New York Daily News. Distributed by Knight Ridder/Tribune News Service.

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