Should pharmacies use incentives to encourage transfers?
Friday, March 17, 2017
"Transfer your prescriptions today and get a $25 ABC Pharmacy gift card!" We've all seen this sort of advertising, often employed by a pharmacy just moving into the area to get new customers. And, to some degree, the strategy seems to work.
But is it right? Should this sort of approach go on?
Maybe not, at least according to the Tennessee Board of Pharmacy in a new ruling that also had the support of the Tennessee Pharmacists Association.
Board of Pharmacy Director Reginald Dilliard told the Knoxville News Sentinel: "For safety reasons and for good patient care, it has always been encouraged for patients to use one pharmacy in order to know their pharmacist and have all records of their medications centrally available for drug utilization review and to prohibit possible interactions with drugs being prescribed by multiple prescribers. Encouraging patients to transfer their prescriptions by offering incentives is counterproductive to this, and many states have a provision in rule prohibiting this practice."
Personally, I have always been uncomfortable with the image of pharmacy created by offering an incentive for transfers. It seems to fall beneath the idealized dignity of the profession that I have known and loved for many years. At the same time — whether I like it or not — pharmacy currently operates on a business model that is entirely consistent with such incentives. I wish it were otherwise, but it's true.
Take the "get your medicine quickly" mentality that is promulgated by our drive-up window model. Or the "15 minutes or less" guarantees promoted by some pharmacies. Or the "$4 generic" bargains that make professional consultations financially unsustainable. Or the ever increasing tech-to-pharmacist staffing ratios that means pharmacists are checking more prescriptions per hour than ever before.
I assume Tennessee has not passed any laws about these things.
This new law in Tennessee also ignores the fact that our current retail pharmacy system already encourages a fractionalized prescription business by allowing insurance companies to incentivize mail-order pharmacy. If we are going to be consistent, then they should outlaw all managed care from luring patients to get some of their medications by mail order by raising co-pays at the local pharmacy level.
Or what about when these insurance companies "incentivize" the use of a particular pharmacy chain by offering different co-pays between competing pharmacies. Why can big insurance companies negotiate for better prices but not consumers?
Or what about when insurance companies can force patients to use a "specialty" pharmacy to obtain some medications that could, frankly, be dispensed locally just as easily and more safely. Do these drugs not have the same risk of drug interactions? Of course they do. But we don't do anything to outlaw that type of fracturing of patient care.
And I don't even want to start talking about those limited distribution drugs (LDD) that are FDA approved but can only be dispensed from a handful of select pharmacies in the nation.
Or why don't we require insurance companies to cover all OTC medications that are prescribed? Failure to do so means patients will shop around, picking up their supplements here and there, sometimes online, when a better model would have them get them all through the pharmacy to check for potential interactions.
My point is this: We don't seem to have any objection to fractionalizing patient care, creating incentives or splitting up their prescription profile if the insurance companies will benefit from it. But if an individual drug store, trying to make a go at it, wants to offer $25 to someone to try their pharmacy, they will be in violation of this new law. I don't get it.
At the end of the day, I guess I'm not totally convinced that these transfer offers truly result in clinically significant patient care problems. Could they? Sure. But do they? I don't know that we have an answer to that question. The articles I have read that oppose the concept of transfer incentives all use language like "potentially detrimental" and "might be harmful," but there is no real evidence of the risk.
I've been practicing for 25 years and have seen hundreds if not thousands of patient transfers occur, but I can't recall any case in which patient care was compromised by a transfer. The fact is when patients transfer to our pharmacy, we typically try to go directly through the MD and get original orders for all meds so we can do a thorough review of their profile.
If, however, there was evidence that such incentives were harmful, it would be an argument against allowing patient transfers altogether, not just outlawing incentives to do so.
I may be the minority report on this issue. I care for patients, and I care for this profession. But I can't get all worked up about a transfer coupon. I just think there are more important issues on which to focus.
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