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Independent pharmacists fight burnout and industry pressures as Rite Aid and CVS close stores


Dennis Czerw, owner of Parkway Pharmacy in Philadelphia, served 175 new customers in January. He was “astounded,” he said, given that vaccine demand dropped off later in the month.


In February 2021, before the COVID-19 vaccine was available to most people, Parkway had 40 new customers. Vaccinations have brought many new people through the door in recent years and several nearby chain pharmacies have closed, but that doesn’t mean Czerw’s business is booming.


“My prescription numbers aren’t growing as much as I’d like them to” for several reasons, he said.


In some instances, Czerw has to turn away a patient because it costs more to get the medication than he’ll get back from the patient’s insurer. He doesn’t like doing that, he said, but he is restricted from changing the price to cover the difference. Sometimes, an insurer will prohibit a patient from patronizing an independent pharmacy such as Parkway, or their co-pay will be lower at a chain.


“Every prescription that comes in the door you have to evaluate for profitability,” Czerw explained. “Too many of the wrong ones can drive you out of business.”


Chain pharmacists across the United States have been speaking out about understaffing, long hours, and unrealistic demands of their jobs as companies such as CVS, Walgreens and Rite Aid try to stay profitable in a pinched industry. Like independent druggists, the National Association of Chain Drug Stores has said pricing and fees set by pharmacy benefit managers — the companies that handle prescription drug plans for health insurance — are to blame.


Similarly, American Pharmacists Association CEO Michael Hogue recently condemned these benefit managers for “breaking the backs of community pharmacies.” But Hogue also criticized employers that have stayed profitable by placing strict quotas on staff — prescriptions per hour or vaccines per day, or even time on the phone with patients.


At most big chains, “you’re going to spend your day like your hair is on fire,” said Czerw, who used to work at a CVS.


Independent pharmacists say they don’t want to create those kinds of work conditions. But they’re dealing with the same financial pressures as the larger companies and lack control over revenue from their main product, prescription drugs.


“We have to focus a lot of our time on the sustainability and viability of our business because of the insurance reimbursement model we currently face,” said Czerw. “We could be put out of business tomorrow if the insurance companies snap their fingers and so choose.”


The cost of maintaining a full staff


During the COVID-19 pandemic, pharmacists continued to provide essential services, noted Nishaminy Kasbekar, chief pharmacy officer at Penn Medicine and president of the American Society of Health-System Pharmacists. Once a COVID-19 vaccine became available, demand for immunizations only added to the workload, often without the ability to hire more staff, she said.


“When people look at pharmacy they just look at what’s happened in retail,” said Kasbekar, opining that professionals in hospitals have better job satisfaction. Seeing the retail pharmacy environment has “scared a lot of students.”


Pharmacy technicians, who prepare medications under a pharmacist’s supervision, are in short supply, Kasbekar said, and while there’s not currently a pharmacist shortage, lower enrollment at pharmacy schools suggests that could become a problem.


Pharmacy technicians play an important role in keeping the workflow manageable, but chain pharmacies often pay too little, said Daniel Hussar, a professor emeritus of the Philadelphia College of Pharmacy and author of the monthly newsletter The Pharmacist Activist.


Hussar recalled the experience of a former student who became a pharmacist at a Rite Aid in North Philadelphia and lost all her techs to a Wendy’s when it opened nearby because the pay was better.


“Both pharmacists and technicians are under a lot of pressure,” Hussar said. “A comment I often hear from those individuals is, after working a 10- or 12-hour shift ... ‘The day was a blur. I just pray that I didn’t make a mistake that might harm someone.’ ”


But independent pharmacies, generally, “have not succumbed to the temptation to understaff,” Hussar said. People who work at chain pharmacies will jump at the chance to leave and work for an independent store, he added.


One independent pharmacy manager in the Philadelphia suburbs, who asked to remain nameless out of concern for their store’s insurance contracts, said turnover is rare at their business.


“We staff our stores more than a chain would. The pay is competitive, the benefits are competitive,” the suburban manager said.


“I’m not going to treat my employees the way a chain does. … I’m not going to reduce our staff the way a chain would,” the suburban pharmacy manager said. “If you start cutting staff and having to work faster, that’s where mistakes happen.”


That makes their profit margins even more precarious.


Learning how to survive


Czerw’s pharmacy is located inside a condominium building, and many of his clientele are senior citizens, he said. He tries to make it “as easy and convenient as possible” for his customers to get their medications so they stick with him. He’s currently working on a project that would allow them to sync up prescriptions so they can make one regular trip to the pharmacy for multiple medications.


He’s also training Parkway staff to suggest additional products and services. He shares the store’s profits with his staff to incentivize those patient interactions.


“I can’t have every conversation myself,” he said. “Where we can really stand out (from competitors) is with education and experience.”


Hussar said many independent pharmacies have turned to alternative revenue streams for survival, such as medical equipment or high-end merchandise. He recalled one alumnus whose store became well known for its gift shop. Hussar invited him to speak to his class one day, and the pharmacist brought a scented candle for each student.


“His comment to the students was, ‘I have more (profit) selling one candle than I do when dispensing four prescriptions,’ ” Hussar said. The same independent pharmacist later sold his prescription business to a national chain that opened a location nearby, Hussar said, not wanting to compete with a large corporation.


Rob Frankil, executive director of the Philadelphia Association of Retail Druggists (PARD) said pharmacies are frequently reimbursed below-cost on medications, but they have little or no leverage to negotiate with insurers. PARD has been lobbying for legislation “to make it a more fair landscape for pharmacies and patients,” Frankil said, and coaching independent pharmacy managers on how to grow profits elsewhere in the business.

Czerw, who is PARD’s president-elect, called it “a David vs. Goliath” scenario. He said he wants to continue dispensing prescriptions for years, but “with the landscape we face it’s not a guarantee.”


“If, God forbid, the store doesn’t survive, I don’t know what I’d do. It wouldn’t be work for a chain,” said Czerw, who at 41 has a lot of career left ahead.


That’s a hypothetical that many pharmacy owners and managers are constantly weighing, said Frankil.


“Pharmacy is in our blood. We care about people,” Frankil said. But “you can’t take care of people if you lose your mind.”


Reporter: LIZZY MCLELLAN RAVITCH, THE PHILADELPHIA INQUIRER

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