Rutgers University to close all student pharmacies on campus

ornithoptor

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May 7, 2011
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Greetings, it has been a while since I have posted anything. I have been busy with my new job in the last 6 months.

There has been are a lot of posts in this forum on job cuts, hour reductions or retail pharmacies closures. Although the impacts touch us all, we have to respect the those decisions as part of normal business cycle. Public held companies must meet their financial targets and earning forecast.

Link below is the news on "Rutgers University Student Pharmacy Closure"


This development actually worries me a lot. For years, schools do not touch pharmacies even when they bleed financially, as the pharmacies provide needed services to students who are paying customer to school. Of course, mail order plays a factor in the decision making. However, it can't be helped but wonder the directions and impacts of this decision. It is not about pharmacist jobs or pays, it is about the "Value of Pharmacy" in the eyes of decision makers everywhere. It is a game changer.

Next, should we be concerned for hospital outpatient pharmacies that don't turn profit?
 

Gombrich12

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Dec 4, 2013
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You should be more concerned about the many grocery stores that will be getting out of pharmacy over the next 5 years. Grocery stores started struggling once walmart entered the grocery market and now that ALDI is massively expanding they will really be hurt. You should expect to see grocery stores begin to look more like ALDI/LIDL in the future where there is lower service and no pharmacy at all. I also expect some grocery chains will strike deals with CVS/WAG to run the pharmacies inside the stores and others will just close up and sell the files. CVS/WAGs could take over their pharmacies and bring in low wage pharmacists at $35-40/hr and run them profitably.
 

BidingMyTime

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It surprises me that a college would go to mail-order for their students. Most student scripts are going to be for antibiotics and other acute meds. Other than BCP's, most students aren't going to be on chronic meds. Of course, with Obamacare, most students are covered under their parents policies, which may require them to use an in-network pharmacy, so I'm guessing Obamacare has had the biggest effect on college pharmacies (not mail-order.)

As Gombrich says, I think grocery store pharmacies will be the next major contraction.
 
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ornithoptor

ornithoptor

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May 7, 2011
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You should be more concerned about the many grocery stores that will be getting out of pharmacy over the next 5 years. Grocery stores started struggling once walmart entered the grocery market and now that ALDI is massively expanding they will really be hurt. You should expect to see grocery stores begin to look more like ALDI/LIDL in the future where there is lower service and no pharmacy at all. I also expect some grocery chains will strike deals with CVS/WAG to run the pharmacies inside the stores and others will just close up and sell the files. CVS/WAGs could take over their pharmacies and bring in low wage pharmacists at $35-40/hr and run them profitably.
You are absolutely right; We need to be concerned about our grocery and retail pharmacy closures and workforce reductions. People have discussed that with numerous threads in this forum. I sincerely hope that all pharmacists and students are fully aware of what you described. I agree that those are immediate issues and your insights are much appreciated. Like you, I am not sure what actions we can take at this point to slow down the impacts.

The scope of this article deals with the strategic direction of at pharmacies in a defined area. The urgency here is that the perception of pharmacy has changed drastically for University or even hospital OP setting. These types of pharmacies were previously untouched by the saturation and considered as a safe haven.

This type of Pharmacies have provided services to students or patients(drugs, advices, aspirins, condoms) and likely a financial loss leader for the last twenty years. Now, this service is no longer deemed needed. Organizational finance does not seem to be the main driving factor as they are hiring more psychiatrists and social workers. What is changing the perception of pharmacies so they are the first ones on the chopping block? (even though pharmacist salary is trending down.)

For people who work in hospital and University services: have you begun to notice this trend? How hard does your pharmacy team have to defend the existence of unprofitable pharmacies under budget review? How much time are you given to turn things around. If you are in one of those pharmacy, have you planned your exit strategies?
 

lord999

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This type of Pharmacies have provided services to students or patients(drugs, advices, aspirins, condoms) and likely a financial loss leader for the last twenty years. Now, this service is no longer deemed needed. Organizational finance does not seem to be the main driving factor as they are hiring more psychiatrists and social workers. What is changing the perception of pharmacies so they are the first ones on the chopping block? (even though pharmacist salary is trending down.)
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Bit more complicated, actually. Student Health Services including medical and specifically pharmacy mostly date from the 1970s. The reason being that before HIPAA, a student in college if they filled at a local pharmacy or went to a physician, many states obligated those providers to report their findings to their guardians if they were still under financial dependency. You can think of the implications when "My baby girl is getting the Pill. WHAT?!!!", and the old pharmacists who date from that time used to have to deal with this and would even refuse to dispense to any young woman who they even suspected of being a dependent (which meant that the only young women who had access to contraceptives were thought and known to be of a certain type). The idea with those was that if all of those services were provided on campus, the FERPA Act passed in the early 1970s would cover the privacy of the health services and dispensing under educational records rather than health records.

With the passage and implementation of HIPAA, this regulatory loophole is no longer necessary, and the service is expensive to provide. There has been mission drift from that purpose to more general matters. But, the original point of the service was not to make money or even be terribly convenient, it was there for political reasons and was one of the interesting developments that helped the Women's Liberation movement forward by providing safe contraception without societal penalty.

If you happen to chat with John Colaizzi, he has stories about his time at Pittsburgh where he did have to do the former when he was an apprentice and later pharmacist. Many of the elder pharmacists know some of the stories of practice then that would be contradictory or even beneath ethics today.
 
Dec 7, 2018
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Thanks for the interesting historical perspective, lord. It sounds like the age of the student health center has passed. I was a Rutgers student and went to Hurtado health center and the pharmacy to get a Hep B vaccine and PPD placed. It took me about 2 hours on the first visit, since it was a six step process:
1) Sign in with receptionist
2) See nurse to get prescription for Hep B
3) Wait in line 15 minutes to drop prescription off at pharmacy 50 feet away
4) Wait in another line to pay
5) Wait once more now in a third pharmacy line to pick up the Hep B vaccine
6) Bring Hep B back to the nurse in step two so she could administer it.

I went back two days later to have my PPD read. It took two full hours and I completely missed a class (one of the important ones, too).

I went elsewhere for my second and third Hep B injections. This was admittedly just two experiences from a decade ago, but if this Soviet-style multiple queuing wasn't fixed, the closure of this pharmacy will only improve students' health. There's a Walgreens 2500 feet away, so walking off campus is definitely an option. I remember classmates saying not to go to a student health center: it's faster and easier to drive to your hometown PCP. I'm sure Adderall was dispensed at the health centers, but I speculate the drug of choice was azithromycin: Rutgers being the university with the second highest average number of sexual partners, ranked at 9.33 behind Temple's 10.8 (source: Targum 12/7/2017). It's just a 1.5 hour trainride between the two, so maybe there's some overlap.

Former Dean Colaizzi also told the story of how patient counseling in the paternalistic 1960s was about avoiding answering the patient's questions, instructing the patient to just follow the doctor's orders: "I'm not sure what drug this is or what it does, just take one of these two times a day."

But as to the broader question, I feel the value of the pharmacist has always been questioned. It's a tough sell. Pharmacists cost $1 a minute. They need to switch a lot of IVs to PO in the hospital setting to justify that cost. The big saves, preventing rehospitalization or sentinel events, aren't measured in a way that captures value added by pharmacists. Counseling became mandatory in the 90s in a time when drug info was hard to come by. Researching a drug meant calling your friend who had a Physician's Desk Reference. With the advent of internet search engines, I feel that the age of counseling too has passed. The young-ins abhor face-to-face interaction and prefer to have their meds droned in or 3D-printed right to their iVial. However, I don't think my job will be put on the cutting block: they wouldn't dare eliminate an APhA member with a 3.8 overall GPA.
 

Pharmacy is a Scam

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Jan 9, 2019
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But as to the broader question, I feel the value of the pharmacist has always been questioned. It's a tough sell. Pharmacists cost $1 a minute. They need to switch a lot of IVs to PO in the hospital setting to justify that cost. The big saves, preventing rehospitalization or sentinel events, aren't measured in a way that captures value added by pharmacists. Counseling became mandatory in the 90s in a time when drug info was hard to come by. Researching a drug meant calling your friend who had a Physician's Desk Reference. With the advent of internet search engines, I feel that the age of counseling too has passed. The young-ins abhor face-to-face interaction and prefer to have their meds droned in or 3D-printed right to their iVial. However, I don't think my job will be put on the cutting block: they wouldn't dare eliminate an APhA member with a 3.8 overall GPA.
You hit the nail right on the head. Pharmacists are paid $1/minute to switch IV to PO or to dose vanco in the hospital setting and >$1/minute in the retail setting (historically, at least) to count by fives. And yet they clamor for “more reimbursement from PBMs for the services we provide” - if I were in charge of reimbursement, why would I pay someone $20 to fill a prescription? I would pay them maybe a buck or two because even a high school dropout can do that type of work.

People are now starting to come to realize that pharmacists are huge cost centers for organizations and don’t provide good ROI as there is not a black and white method to measure impact of pharmacy services. Let me throw this out there for some food for thought: if a hospital had a readmission rate of 0.01% and the value of a “clinical pharmacist” is to reduce hospital readmissions, then are pharmacists really needed at all? At that point you’re getting a higher cost-avoidance ROI of $120k/yr per pharmacist you don’t hire than you’re spending on patient dollars due to hospital readmissions.
 
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Lubeckd

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You are absolutely right; We need to be concerned about our grocery and retail pharmacy closures and workforce reductions. People have discussed that with numerous threads in this forum. I sincerely hope that all pharmacists and students are fully aware of what you described. I agree that those are immediate issues and your insights are much appreciated. Like you, I am not sure what actions we can take at this point to slow down the impacts.

The scope of this article deals with the strategic direction of at pharmacies in a defined area. The urgency here is that the perception of pharmacy has changed drastically for University or even hospital OP setting. These types of pharmacies were previously untouched by the saturation and considered as a safe haven.

This type of Pharmacies have provided services to students or patients(drugs, advices, aspirins, condoms) and likely a financial loss leader for the last twenty years. Now, this service is no longer deemed needed. Organizational finance does not seem to be the main driving factor as they are hiring more psychiatrists and social workers. What is changing the perception of pharmacies so they are the first ones on the chopping block? (even though pharmacist salary is trending down.)

For people who work in hospital and University services: have you begun to notice this trend? How hard does your pharmacy team have to defend the existence of unprofitable pharmacies under budget review? How much time are you given to turn things around. If you are in one of those pharmacy, have you planned your exit strategies?
Yes exit ops