The windy city is stirring things up in the pharmacy world. A proposal is heading before a city council could limit the number of patients a pharmacist could check to no more than 10 per hour, along with other safety restrictions as well. The move comes on the heels of a 2016 investigative report in the Chicago area that found 52% of pharmacies failed to warn patients about potentially dangerous drug interactions when presented with pairs of sometimes deadly prescriptions.
Representative Mary E. Flowers, D-Chicago, is the state bill sponsor, which is supported by union pharmacists throughout the region. For Flowers, this is clearly a public safety issue that cannot be ignored. “It is just a matter of time before there will be a major catastrophe,” she said, in a Chicago Tribune interview.
But the bill, identified as HB2392, seeks to do more than simply limit the number of prescriptions filled per hour. It would prohibit a pharmacy from operating without at least 1 pharmacy technician scheduled to assist the pharmacist. Additionally, pharmacies would be required to schedule at least 10 pharmacy technician hours for every 100 prescriptions filled. Finally, the bill mandates meal and restroom break times for pharmacists working more than a 7 hour shift and protects whistleblowers from repercussions if such regulations are not being followed.
The proposed regulations appear to have more opposition than support however. “You might have to rent Soldier Field to hold all the people who will show up to defeat this bill,” said Bob Stout, the president of the New Hampshire Board of Pharmacy.
Even the director of the Illinois Pharmacists Association, a group supported by pharmacists to promote their own profession, said the limits “don’t make sense.” There are an estimated 62 million prescriptions dispensed annually in the city of Chicago. According to the association website, the proposed new limits would result in “a 41 million prescription shortfall” and that Chicago would “need an estimated 1,000 new pharmacies to meet this shortfall.”
A major problem with the proposal, from my own perspective, is that it fails to grasp the economics of retail pharmacy. Today retail pharmacies operate on slim margins, and staffing is their biggest expense. The additional staffing would virtually guarantee that pharmacies could not operate profitably in Chicago. The result would mean fewer pharmacies and thus less health care for the city’s citizens.
The latest proposals also fail to appreciate that significant changes have already been implemented in Illinois, and they need to be given time to work. For example, new regulations now require patient counseling by a pharmacist in certain situations where, in the past, only an “offer to counsel” had to be made. Patients receiving a new prescription, a new dosage for their prescriptions or if they are a new patient to the pharmacy must be personally counseled now by the pharmacist on duty.
That being said, something more needs to be done to help ease the workload that contributes to pharmacy errors. One idea is that patient counseling must be separated out as a critical and separately billable expense. Pharmacies cannot operate safely at reimbursement rates that hardly cover current staffing costs, even in the most efficiently designed pharmacies. A simple solution would be to require the PBM industry to allow billable counseling sessions by a licensed pharmacist for new patients and new prescriptions.
Those really interested in patient safety need to speak up about the problems that exist in the pharmacy profession today. We need proposals that support the needs of patients, pharmacists and the business itself. Some of the Chicago-proposed solutions sound good. But if they are not adjusted to focus on adequate reimbursement for services then the result will ultimately be fewer pharmacies and less care.