In Praise of ‘My’ Pharmacy
My neighborhood pharmacy is a microcosm of what pharmacy teams have experienced the last few years. Because of its small space, my pharmacy has focused on prescriptions, some durable medical equipment, some overthe-counter meds.
Once upon a time, my pharmacy also sold purified water, Gatorade, Kleenex tissues, heating pads. The pharmacy staff has always taken me aside to coach me on which of my sinus meds needed to be taken on an empty stomach or with food.
“Not just a snack,” a pharmacist warned me once. “A full meal.”
When three of my friends, all under 50, got shingles, I talked to my doctor about the vaccine. But then I talked to my pharmacist about side effects. I was told to take it easy the day after, which turned out to be very good advice.
But really, my pharmacy team has always good-naturedly suggested that vaccinations should be followed by naps and general loafing around.
“I wouldn’t recommend working today,” a pharmacist said after administering a flu shot on a Sunday. “I recommend no chores.” He winked. I laughed. “How about popcorn and trashy TV? Is that all right?”
“Yup!”
Over the years, though, my pharmacy has changed. Long-time team members left, and staff turnover accelerated. They got rid of health-careadjacent products — ginger ale, saltine crackers, etc. — to discourage growing numbers of shoplifters. One day, I saw an armed guard at the door; pharmacy staffers had been robbed at gunpoint by someone seeking narcotics. Protective shielding was erected to keep customers out of staff and medication storage areas.
Then, COVID-19 happened, putting pharmacy staffers all over the world, including my friends, on the front lines of a pandemic.
Through all this, the team at my pharmacy has remained professional, supportive and patient focused. Outwardly to me, their dedication and enthusiasm have never waned.
I do wonder, however, how they’re faring behind the scenes and under years of stress. In this issue, we examine the American Pharmacists Association’s latest Pharmacy Workplace and Well-Being Reporting (PWWR) survey — and the results demonstrate the continued challenges that pharmacy teams stand up to every day in the name of serving patients.
To all pharmacy teams working so faithfully for the public good — with a special nod to “my” pharmacy friends — thank you for all you do. Judging from the latest PWWR, I fear you don’t hear that nearly enough. HMEB
Laurie Watanabe, Editor lwatanabe@wtwhmedia.com @CRTeditor
October 2024
hme-business.com
CO-FOUNDER & CEO, WTWH MEDIA Scott McCafferty
EDITORIAL VP, EDITORIAL DIRECTOR Tim Mullaney
EXECUTIVE EDITOR Bob Holly EDITOR IN CHIEF Laurie Watanabe lwatanabe@wtwhmedia.com
ART VP, CREATIVE DIRECTOR Matt Claney mclaney@wtwhmedia.com
SALES VP OF SALES
Sean Donohue
INTEGRATED MEDIA CONSULTANT Randy Easton
HME Business (ISSN 1940-6479) is published 4 times a year, March/April, June/July, September/October, and October/ November, by WTWH Media, LLC., 1111 Superior Avenue, 26th Floor, Cleveland, OH 44114.
© Copyright 2024 by WTWH Media, LLC. All rights reserved. Reproductions in whole or part prohibited except by written permission. Mail requests to “Permissions Editor,” c/o HME Business, 1111 Superior Avenue, 26th Floor, Cleveland, OH 44114.
The information in this magazine has not undergone any formal testing by WTWH Media, LLC, and is distributed without any warranty expressed or implied. Implementation or use of any information contained herein is the reader’s sole responsibility. While the information has been reviewed for accuracy, there is no guarantee that the same or similar results may be achieved in all environments. Technical inaccuracies may result from printing errors and/or new developments in the industry.
Corporate Headquarters: WTWH Media, LLC 1111 Superior Avenue, 26th Floor Cleveland, OH 44114 https://marketing.wtwhmedia.com/
Media Kits: Direct requests to George Yedinak, 312-248-1716 (phone), gyedinak@wtwhmedia.com.
Reprints: For more information, please contact Laurie Watanabe, lwatanabe@wtwhmedia.com.
The National Community Pharmacists Association (NCPA), in collaboration with dozens of other providers, has filed a class-action lawsuit against UnitedHealth Group and subsidiaries Change Healthcare and Optum following a cyberattack that severely disrupted health-care industry operations.
NCPA filed the lawsuit in late July and said afterward in a news announcement, “In February, Change Healthcare was hit with a ransomware attack that brought payment and claims processing across the country to a halt. NCPA and the other plaintiffs say Change failed to take reasonable precautions against a catastrophic breach; [misled] them about its network security; and caused massive financial losses for health-care providers who were never reimbursed for services, and who incurred huge expenses trying to work around the downed system.”
Change Healthcare was handling 15 billion medical claims per year
NCPA noted in the announcement that Change Healthcare “handles medical billing for a huge chunk of the health-care industry,” while Optum is United Healthcare’s pharmacy benefits manager.
In May, the U.S. House of Representatives’ Energy & Commerce Committee, in explaining how the cyberattack happened and the fallout from it, said, “Change Healthcare is one of the largest health payment processing companies in the world. It acts as a clearing house for 15 billion medical claims each year — accounting for nearly 40 percent of all claims.
“The cyberattack that occurred in February knocked Change Healthcare — a subsidiary of the behemoth global health company UnitedHealth — offline, which created a backlog of unpaid claims.”
The Energy & Commerce Committee announcement added that the unpaid claims caused cashflow problems for many health-care providers, thus “threatening patients’ access to care.”
“The attack occurred because UnitedHealth wasn’t using multifactor authentication (MFA), which is an industry standard practice to secure one of their most critical systems,” the Committee announcement added.
Testifying before Congress in May, UnitedHealth Group CEO Andrew Witty estimated that one-third of the American population had their health information leaked to the dark web as part of the cyberattack, despite UnitedHealth paying a ransom of $22 million in Bitcoin to prevent that from happening.
accountable for their lax security measures and for their failure to provide our members with adequate support and assurances to alleviate the financial losses our members suffered,” said NCPA CEO B. Douglas Hoey in the lawsuit announcement.
“NCPA was against UnitedHealth’s acquisition of Change from the start. This breach proves that bigger is not better and that consolidation often leads to inefficiencies. Companies are so big they cannot protect every entry point and cannot respond quickly due to internal bureaucracy.
“The fact that issues remain unresolved is a testament to this point. This breach has cost our members a significant amount of money and time, and it is still not resolved months later.”
The organization also criticized how UnitedHealth Group reacted to the cyberattack.
Initial responses put providers, patients in precarious positions
“Not only did Change, Optum, and UnitedHealth fail to adequately protect data for millions of patients, but when they discovered the breach, they shut the entire system down without providing a workable alternative, leaving thousands of pharmacies without any way to process claims,” the announcement said.
“Because defendants disconnected the Change platform, many health-care providers lost their primary (and in some cases, their only) source of claims processing for their patients and did not receive payment,” the lawsuit said. “Health-care providers had to absorb these upfront costs.”
In fact, NCPA noted, in the days and weeks following the attack, many pharmacies chose to purchase new software at their own expense in an attempt to keep serving patients and to keep crucial operations going.
“Community pharmacies incurred the losses because they wouldn’t let their patients suffer,” Hoey said. “Senior citizens and people with chronic illnesses were especially vulnerable. They can’t afford to pay out of pocket for drugs that can cost thousands of dollars because a medical billing firm left itself vulnerable.
“It wouldn’t have been fair to patients, and it isn’t fair to leave pharmacies holding the bag.” HMEB
— Laurie Watanabe
A new partnership will bring together NikoHealth and RedSail Technologies “to elevate the service offered to HME/DME [home medical equipment/durable medical equipment] pharmacy customers.”
In a Sept. 10 news announcement, NikoHealth, a cloud-based HME management solutions provider based in Middletown, New Jersey, said the collaboration “will introduce RedSail Technologies’ SystemOne customers to the advanced, HME-focused features of NikoHealth’s cutting-edge platform.”
“NikoHealth was selected for its innovative approach to HME management,” the announcement added. “The platform boasts advanced features, including order and inventory management, resupply, flexible open APIs, and billing, with an industry-leading user interface. These capabilities make NikoHealth the ideal choice for RedSail customers seeking to future-proof their businesses.”
“For customers seeking a more HME-focused system, NikoHealth emerged as the preferred choice due to its next-generation, cloud-based HME system, which offers robust features that have garnered excellent
customer feedback,” said Josh Howland, president of pharmacy management systems at RedSail Technologies. “Key factors influencing our decision included NikoHealth’s rapid growth in the HME market and its modern, end-to-end solution with competitive pricing. We encourage everyone to connect directly with NikoHealth to explore these benefits further.”
RedSail Technologies’ pharmacy software, data solutions and services are used by 11,500 pharmacies who serve more than 9 million patients each month. The company’s customers include community, long-term care, outpatient, HME/DME, and specialty pharmacies. RedSail Technologies is based in Spartanburg, South Carolina.
“RedSail’s decision to partner with us for their HME clients validates our innovative approach and industry leadership,” said Michael Kutsak, NikoHealth’s CEO. “We are dedicated to facilitating seamless transitions and offering RedSail customers innovative solutions and unparalleled support. We are excited to empower them with the necessary tools to succeed in the HME/DME sector.” HMEB — Laurie Watanabe
The National Community Pharmacists Association (NCPA) has urged the Centers for Medicare & Medicaid Services (CMS) to issue “fair and common-sense contracting guardrails” between Medicare Part D plans/pharmacy benefit managers (PBMs) and pharmacies ahead of this year’s Medicare Open Enrollment period, which is due to begin in October.
In a Sept. 4 announcement, the NCPA said, “Medicare Part D makes up 36% of the average independent pharmacy’s business, and current contracting practices that reimburse pharmacies less than their costs to acquire medications, dispense prescriptions, and earn a reasonable profit are having a disproportionately negative effect on the solvency of pharmacies. They are also leading to questionable or even inaccurate pharmacy network information in the Medicare Plan Finder tool that allows seniors and caregivers to shop and compare Medicare Advantage and Part D plans.”
The NCPA’s recommendations include requiring Part D plans/PBMs “to notify pharmacies or their contracting entities about the pharmacies’ network status for the upcoming plan year, and that the contracts themselves must be opt-in, signed and finalized prior to Oct. 1 each year.”
The organization also wants CMS to require Part D plans and PBMS to make their contracts available on request to pharmacies “no later than the first week of June each year, when Part D bids are due, to give pharmacies and their contracting entities enough time to adequately analyze and negotiate a PBM contract.”
The NCPA asked for new contracts to be offered each year, “with payments and networks that cannot be changed without further negotiation and consent of all parties to the contracts.”
And the organization wants CMS to prohibit Part D plans and PBMs from bundling or tying participation in one network to another non-Medicare Part D network.
“If contracts are for more than one year, pharmacies find themselves in a relationship with plans/PBMs similar to the Eagles’ ‘Hotel California,’ which they can never leave,” NCPA CEO B. Douglas Hoey, pharmacist, MBA, told CMS Administrator Chiquita Brooks-LaSure and Meena Seshamani, M.D., Ph.D., CMS deputy administrator and director of the Center for Medicare. “We believe that plans/PBMs are attempting to lock our members into multiple year contracts to game CMS’s pharmacy access standards in Medicare Part D.” HMEB
“
— Larry and Audrey Jantzen Larry’s Home Oxygen, Inc. Enid, OK DMEPOS
Latest PWWR confirms ongoing workplace concerns for pharmacy teams
By Laurie Watanabe
If the Pharmacy Workplace and Well-Being Reporting (PWWR) system from the American Pharmacists Association (APhA) is meant to provide a glimpse into what pharmacy staffs face on the job — the latest PWWR installment can be summarized as “more of the same.”
And while confirmation that pharmacy staffs continue to work in sometimes hostile conditions with a number of causes, the bigger takeaway is that those negative experiences in the workplace often create a cumulative effect of raising staffers’ stress levels, intensifying feelings of burnout, weakening their personal relationships, and reducing their overall happiness.
The PWWR, launched in October 2021, “serves as a safe space to submit both positive and negative pharmacy workplace experiences in a confidential and anonymous manner,” the American Pharmacists Association (APhA) said in an Aug. 21 news announcement of the 10th PWWR report. “The goal of PWWR is to tell the stories of those
who submit their experiences so that the profession may begin to act on the findings and learnings.”
The latest PWWR installment reported on the second quarter of 2024.
Pharmacy staffs still enduring abusive behavior
Since its creation in late 2021, the PWWR has received more than 2,200 submissions, including 108 for the latest installment.
For the second quarter, 60% of respondents identified themselves as pharmacists, while 20% were pharmacy managers/supervisors/ pharmacists in charge. Pharmacy owners accounted for 3% of this quarter’s respondents, while another 3% of reporters were pharmacy technicians. Two respondents were pharmacy students.
Respondents work in a wide range of practice settings, including supermarket pharmacies, mass-merchant pharmacies, independent pharmacies, hospital/institutional pharmacies, and chain pharmacies with four or more locations.
ANGRY CUSTOMER: ADOBE STOCK/IVAN
DALLAS, TX SEPTEMBER 15 - 17, 2025
Book your 2025 sponsorship by September 30 to lock in 2024 sponsorship rates.
BROUGHT TO YOU BY
DME Pharmacy | Stress Test: Workplace Conditions
“The findings from this cycle mirror those of the past nine, highlighting a continued trend of a hostile workplace,” said Brigid K. Groves, PharmD, MS, APhA vice president of professional affairs. “Pharmacy personnel should not face safety fears or abuse from patients, supervisors or coworkers.
Organizations must review harassment policies and reporting procedures and adopt a zero-tolerance stance against abuse. In response, APhA has released a zero tolerance flyer for pharmacies to post in public areas of the pharmacy.”
Nine of the 108 respondents reported positive experiences via the PWWR. The other 99 reports were negative.
Understaffing at the root of many negative reports
Among negative reports, staffing/scheduling and workload expectations were most commonly mentioned.
Respondents also reported negatively on working conditions; pharmacy metrics; training and education; and having their professional judgment restricted when caring for a patient.
For Q2, 11 respondents said they had personal safety concerns.
And 91% of respondents who submitted negative reports said the problems were recurring ones.
Harassment on the job continues to be a commonly reported problem, with 33 respondents saying they’d experienced verbal, emotional or sexual harassment while at work, and five respondents reporting being threatened with physical harm or actually suffering physical harm.
Understaffing was common when negative experiences were reported: Just 3% of respondents said staffing was not a root cause of their negative experiences.
Inadequate staffing was the most commonly reported root cause of the negative experiences that were shared, though many respondents said their negative experiences had more than one root cause.
“The negative experiences this cycle included many of the same threatening and abusive stories described in detail in the previous analysis,” the PWWR report said. “As previously noted, these stories tell a highly personal account of the difficulties
91% of respondents who submitted negative reports said the problems were recurring ones
in working in retail pharmacy. … There were 460 total root causes listed for the 99 negative experiences reported, averaging nearly 4.7 root causes per event (compared to 4.8 root causes per event in the last reporting cycle). Nearly all the negative experience reports (91%) were described as a ‘recurring problem.’”
Key takeaways from this PWWR installment
As for key points this time around, “positive experiences were infrequently reported. There were nine reports this period,” the PWWR summary said. “These reports did not offer compelling stories that have not been described in previous analyses.”
The summary also acknowledged similarly familiar negative reports.
“The themes overtly expressed in the negative experiences submitted in this 10th analysis period remain fundamentally unchanged when compared to previous periods,” the summary said. “There were two notable and unique findings that were not seen in previous analyses.
“One reporter questioned APhA’s
intentions in collecting PWWR Experience Reports. A different reporter called out APhA, NCPA [National Community Pharmacists Association], and Congress for failing to fix systemic problems in pharmacy.”
And several pharmacy professionals confirmed that current events are also impacting their workplaces.
“The other notable finding is that several reporters are stating that the Israeli-Hamas conflict has affected co-worker and customer relationships in an overtly negative way. External politics being brought into the workplace is not unexpected and mostly likely an unavoidable circumstance; however, the reporters who were adversely affected did not mention if there were workplace rules about how these conflicts would be managed or if there were administrative systems to do so.” HMEB
