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The Big One

Is this it? Could this be our time to shake up the pharmacy world? It may be the best chance we are given to take hold of the public narrative and drive our concerns into the public spotlight.

A few months ago, I was contacted by a reporter from the New York Times, Ellen Gabler. We talked at length on the phone and I was able to refer her to a few more sources. I hadn't heard anything else from her since July 2019, and I worried a bit that finding willing sources, or a way to report without backlash had been nigh impossible.

But today, her efforts have come to fruition in the NYT article, How Chaos at Chain Pharmacies Is Putting Patients at Risk. In some of the most comprehensive national-level coverage of the situation to date, Ms. Gabler details the overuse of metrics and how they impact patient safety at the nation's largest chain pharmacies.

The full-length article touches on many of the foundational issues we as pharmacists have bemoaned at length. Due to length, not every issue could be expounded upon - for example the impact of CMS/STAR ratings measures and how they affect pharmacy payments, and the involvement of PBMs in decimating our pharmacies' viability and marketplace competition are only touched on. But the primary focus of the article, metrics, are well elucidated and understandable to the general public. This is one of the only pharmacy articles I've seen in which the comments section overwhelmingly doesn't vilify us as pharmacists, instead pointing the finger at unregulated, for-profit healthcare schemes that leave patient care out of the equation almost entirely.

The most infuriating section for myself, on my first read through, was a call-back to something my own board inspector said to my face, about how his job was not to "regulate commerce." In the article, board officials are said to have claimed, "they had limited authority to dictate how companies ran their businesses." Recognizing that I have not stood in their shoes and am not an expert on law (though I obviously passed my law exams, and am left wondering if some folks need to re-take theirs), my question is HOW?

As the state board of pharmacy, you are the ONE regulatory body who has the ability to decide exactly the who, how, where, when, and what of pharmacy practice in your state. DO YOU OR DO YOU NOT ISSUE THE VERY LICENSE FOR EACH AND EVERY PHARMACY LOCATION IN YOUR STATE? Do you, or do you not have rule-making authority with respect to the requirements for issuance and maintenance of that license, by each and every pharmacy location in your state? Sure, maybe the regulations that we need for maintenance of those licenses aren't in place (yet). But how DARE you claim you are not empowered by rule of law to make them or at the very least, suggest them to legislature, as the designated entity for supervision of pharmacy practice.

Fortunately, the article also touches on the issue of regulatory capture - that is, that many state boards of pharmacy seats are occupied by officials from the very companies they purport to regulate - large, for-profit entities.

I don't know how much CVS, which is featured prominently in this article, will care about its implications. I doubt very much that they are "quaking in their boots" quite yet. But it is our job as pharmacy professionals to push this issue as far and wide as we can. The NYT article requires a login to read, and readers are offered a free sampling of articles prior to needing a paid subscription. I would encourage my readers to consider investing in a subscription, in hopes that Ms. Gabler may be able to continue her reporting on further pharmacy-related issues. I would also encourage you to share this as far and wide as you possibly can, as much as you possibly can. We may not see another opportunity to have the public ear like this for a very long time, if ever.

Don't let this article be a tiny Band-Aid on the foundational cracks in our system. Make it heard. Let the public know. Someone is supporting us with her time and the monumental effort it must have taken to report on this...let's support her back.

THANK YOU ELLEN GABLER and everyone else on your team!

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