During the past decade, the pharmacy business has undergone a remarkable amount of change, from the rise of mail order pharmacies to legislative changes such as the Medicare Part D prescription drug benefit and the recent Affordable Care Act (ACA). One of the impacts has been a steady reduction in the number of community pharmacies, as larger corporations increasingly dominate the market.
Local pharmacist Janet L. Coleman is defying that trend, recently opening Pacific NW Specialty Pharmacy in Vancouver. Coleman is a compounding pharmacist, meaning she prepares custom medications for those with special medical needs.
“A lot of medications are either unavailable or there’s a reason why somebody can’t take them, whether it is allergies, or the strength isn’t right, or the person can’t swallow for instance,” she said.
For patients who have difficulty with commercially produced medications, compounding pharmacists are able to customize solutions in a variety of dosage forms, including capsules, oral liquids, topical preparations, eye and ear drops and injections.
Coleman noted that her sterile environment allows her to produce the full range of medications.
“We make it for the patient specially,” she said. “It’s all from scratch. We have a sterile room, so that sets us apart from other pharmacies that do compounding, as we can do eye drops and injectables and that kind of thing.”
Coleman went on to say that much of her business comes from people who have been trying commercial pharmaceuticals, but have not been getting the needed results. Additional demand comes from alternative medicine practitioners.
“Quite a bit of naturopath business comes our way, because they really are trying to be specific to that patient.” Coleman said.
Conventional pharmacies generally provide medications in defined dosages and forms. Also, some commercial medications contain substances that can be detrimental to the patient, such as preservatives, dyes, coatings and other additives.
Compounding pharmacists are able to focus directly on the unique needs of each patient, including only the ingredients required by the patient’s condition, in the proper proportions and dosages.
Coleman also noted that she also serves local veterinarians. Animals, she said, often have unique needs when it comes to medications.
“It’s amazing how different animals can be, whether it’s a cow or a sheep or a rabbit or a dog, just with metabolism and what each can take as a drug.”
Whether for humans or animals, Coleman said that the job can present some complex issues.
Fortunately, she noted, she has a broad network of support when she needs it.
“We’re members of something called PCCA (Professional Compounding Centers of America). That’s a group in Houston that has 30 chemists on staff, so when there’s a question they are there to help us, and some of them specialize in veterinary,” she said.
As the number of community pharmacies has been shrinking in recent years, this type of specialization appears to be one of the best options for pharmacists interested in running their own businesses.
“Honestly, in general, pharmacy is struggling,” Coleman said of conventional pharmacies. “There just isn’t the reimbursement from the insurance companies. The bigger pharmacy companies can absorb it, but if you’re a little guy you just don’t have the buying power. So there just aren’t many community pharmacies anymore.”
Reimbursement rates are just one of several problems that community pharmacies face these days, according to Douglas Hoey, CEO of the National Community Pharmacists Association (NCPA).
In a letter published earlier this week in the congressional newspaper The Hill, Hoey said “the largest impediment to independent community pharmacies… is the bureaucratic morass they must wade through…”
Hoey added that greater oversight and legislative remedies are badly needed for the PBM industry. PBMs – or pharmacy benefit managers – are individuals hired by a health insurance plan to process claims and to negotiate prices with drug manufacturers. These individuals, according to Hoey, often engage in questionable business practices.
“Many of these issues were covered by legislation that was introduced in the last Congress, but it failed to progress,” he wrote. “An NCPA priority this year is to have such legislation reintroduced that would address PBMs’ lack of timely generic drug pricing updates and fair pharmacy audit standards.”
In any event, Coleman wants people to know that they have more options than they might think when it comes to care, and that independent community pharmacies are an integral part of the healthcare network.
“Whether it’s in knowing the person, for customer service or in drug interactions, there’s a whole relationship thing you lose when local pharmacies struggle,” she said.