economyef fects Pharmacy in a down-and-out world I Are economic woes affecting the profession? In January, the U.S. economy lost almost 600,000 jobs. Unemployment in the construction business reached 18% in February, and the economic downturn was even felt in traffic congestion, which was down 25% for the same month, as consumers stopped shopping, traveling, or in some cases, going to work. U.S. News and World Report predicts drastic changes--possibly including Chapter 11 filings--for such companies as Rite Aid, Chrysler, Dollar Rent A Car, Blockbuster, and Krispy Kreme. To find out how the crisis is affecting pharmacists around the country, Pharmacy Today recently conducted a taking their medications or not taking them consistently and ending up in the emergency department (ED). Many of these patients are seniors with diabetes who come to the ED with their disease out of control. Darling estimated that Three Rivers typically saw 2 such patients per week in the past; they now see up to 10 per week who require a hospital stay to have their diabetes reregulated. Three Rivers Health Center is also feeling the effects of the economic crisis in its fiscal operations. Funding for renovation and technology upgrades has disappeared and the hospital is trying in every way to economize, although that is difficult with Patients are much less interested in being counseled about their prescriptions; they are constrained by time and are more upset if the pharmacy happens to be temporarily out of their medication. Van Horn said, "They don't have the time; they don't have the money; picking up the pills is not a chore they look forward to every month." In the doughnut hole Elaine, who did not want her real name used, practices at a chain pharmacy in south Florida, where many of her patients are retirees or older patients concerned about job security. She has seen dramatic changes in patient behavior in recent months. Formulary changes have moved some essential drugs to nonpreferred status, effectively putting them out of reach for patients who can't afford the higher copay. As a result, Elaine sees patients not taking their medications or "Even $4 prescriptions are beyond their reach." nonscientific survey of community and health-system pharmacists. It revealed that 60% have seen an impact from the economic downturn on their job and 75% have felt an impact on their practice. Respondents named the top effects of the downturn on their practice as lower profit margins, decreased staff or closed pharmacy, lower number of patients or prescriptions, negative cash flow, and less time to counsel. Asked about the effects of the economic slowdown on patients' actions, more than 60% of respondents said their patients are turning to purchasing $4 or $5 prescriptions, not taking medicines, switching to lower cost generic alternatives, or altering adherence (splitting pills, skipping doses). One pharmacist told Today, "Now, even the $4 prescriptions are beyond [some patients'] reach." rising numbers of patients lacking private insurance coverage. For every percentage rise in the number of Medicaid patients the hospital serves, Darling told Today, it loses $1 million per year. trying to stretch them out for longer periods. In early December, a patient contacted Elaine to find out how she could make her four insulin pens last until the first of January when she would again be eligible for Medicare coverage. Many of her patients had already hit the Medicare Part D "doughnut hole" in September. Elaine told Today that many seniors are getting drugs from Canada through direct mail services. She sees patients picking up maybe one out of the five prescriptions that are waiting for them; they will pay for the one that is most urgent at the moment. Elaine works with physicians to find acceptable alternatives when a patient is faced with a formulary change that puts the medication out of reach. She explained, "Most physicians realize, `If I don't change [to an alternative drug], I'll see them in the emergency department in a month.'" Elaine tries to counsel every patient, especially those who are struggling financially. She said, "I don't want any patient walking away because they can't afford their medication." --Carli Richard m a rch 2009 Pharmacy Today 43 No time or money Carol Van Horn, BPharm, MBA, has seen a 6% to 7% increase over the past 3 months in the number of patients at the safety net clinic where she volunteers 8 to 12 hours per week, in addition to her regular job at a community pharmacy. At the safety net facility--Old Town Clinic in Portland, OR--Van Horn is beginning to see underinsured and uninsured patients in addition to the usual patient population of homeless people. She has increased her volunteer hours to help with the higher volume at the clinic. Since Van Horn began dispensing $4 generic prescriptions at the supermarket pharmacy in October, the number of generic prescriptions filled per week has increased by 500. She senses a rising level of stress throughout her patient population that she attributes to anxiety over the hard times in the economy. Hospital effects At the Three Rivers Health Center in Michigan where Leonard Darling, BPharm, works, outpatient surgery is down and inpatient care is "through the roof." Darling suspects patients are not www.pharmacist.com workforce.indd 43 2/25/09 2:57:08 PM