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- Liza Weiss, RPh, PharmDa ()
I share your frustrations regarding the barriers to patient care as described in your editorial entitled, “Pharmacy Madness” (JACC 2000;35:802–3). However, as a Doctor of Pharmacy (PharmD), I find your description of the issue disturbing. The profession of pharmacy is no more in control of the barriers you described than the medical profession. Consistent with your description of your P&T Committee experience, Managed Care permits medical decisions (such as formulary inclusion or exclusion) to be made based upon business cases and not patient risk versus benefit. This is further perpetuated by patients’ willingness to enroll in (and thus support) such healthcare organizations coupled with their lack of willingness to pay for diagnostics or treatments not covered by their plans.
Clinical pharmacists in the hospital setting are under many of the same Managed Care pressures that physicians find themselves under in that there is constant pressure to evaluate the costs most closely tied to their function; while this correlates in part to diagnostic procedures for physicians, it correlates to medications for pharmacists. There is clearly a lack of understanding of the clinical pharmacist’s expertise given that you view your institution’s pharmacist as nothing more than a “SWAT team whose goal is to reduce inpatient pharmaceutical costs in specific areas.”
Community pharmacists practicing in a retail setting are under similar constraints. As pharmacists whose current primary role is to dispense medication and advise regarding those medications, they often find themselves as an involuntary liaison between the insurance plans and the patients who chose to enroll in them. Allow me to ensure you that pharmacy curriculums do not provide background as an insurance broker, nor do pharmacists desire to be in such a position. This environment is one of the principle reasons for the current shortage of retail pharmacists. This is heightened by the standardization of the Doctor of Pharmacy degree and its replacement of the Bachelor of Science curriculums nationwide. Pharmacists today go through 6 to 7 years of education whose foundation prepares students to practice pharmaceutical care in a clinical setting. It is nothing short of degrading to be forced by Managed Care to assume responsibility for poor medical decisions justified by business cases.
So, allow me to assure you as a pharmacist that I am equally frustrated by the constraints of Managed Care on the clinician’s ability to decide what is best for the patient. However, change will only be achieved when Managed Care is forced to change. Perhaps this is an endeavor on which physicians and pharmacists should collaborate since the goal of both professions is to optimize patient care.
- American College of Cardiology