You mention automation efficiencies as one of your reasons (and you stipulated to a lesser degree), but I actually think that will come as a benefit to pharmacists. As automation helps speed along the filling side of pharmacy, this will allow pharmacists to do what I think they are best trained and equipped to do, which is to do patient consultations and have larger roles in medication management for patients. If anything, I would think increased automation in a pharmacy would effect the number of technicians you find in a pharmacy.
Retail is a very large part of pharmacy as a profession, but it is not the only part. Hospital pharmacy, industry and research, as well as long term managed care pharmacy are all viable profession options which I think are growing.
The problem I have with mail order pharmacy is that medication is not something that you should be able to simply punch in a number on a website and have in your mailbox within 3 days - plus free shipping! (sarcasm) My dad is on 2 or 3 prescription drugs for his ailments, and he is always helped out by our local Walgreens pharmacist with his questions and likes to have things cleared up about what to expect from them in terms of side effects. That has been a huge help to my dad, and I think it's something that we, as pharmacists, can and should provide to patients. It's also something that you cannot get from mail order. And some people will try to say, "Well they can just read it off the bottle and the mail orders can add a supplementary paper explaining what to expect from the drug and other adverse effects, etc." Sure they can, but that doesn't mean the patient will read them. The prescription bottles say on there what it is, how much to take and when to take them, so if it were that easy patients wouldn't need any consultation whatsoever. And what kinds of precautions can mail order pharmacy provide for patients with multiple conditions which will require different drugs to be used in combination with one another.
The article raises some interesting points, but I find it hard to believe that mail order pharmacy will become a huge staple. It will only take one tragic event involving a mail order drug, covered in a Dateline exclusive or a CNN special report, to begin the mail order backlash. I know money is a big drawing point to mail order pharmacy, but even in that article that you linked us to states:
Forbes Article said:
One study by economist Robert Maness and Loyola University law professor James Langenfeld--and paid for by pharmacies--supports Wasson. A single drug, the report says, may cost less by mail than it would in a store, but the average mail-order prescription is pricier. That's because PBMs steer consumers away from generics and toward more expensive brand-name drugs, for which they're rewarded by manufacturers. In a suit the Justice Department accuses Medco, among other things, of favoring drugs made by its former parent, Merck. PBMs are under legal assault from unions, states and retailers, with allegations ranging from overcharging to antitrust violations.
According to that quote, the difference in price really is minimal, although it's always good to be skeptical about any study paid for and supported by the people who has interest at stake (the pharmacies paid for the study).
Anyways, I pretty much agree with what Kwakster posted as well. One of the problems right now with retail is perception, and the idea that the pharmacy is just a place to pick up your prescription as fast as you can. There is a lot of potential in retail pharmacy for increased patient care, but pharmacists have to have a big role in turning that potential into reality and I see no reason why that can't happen with more and more qualified, talented students applying and graduating from pharmacy schools across the country. Like Kwakster said, we have to give patients a reason to come to the pharmacy and give them reasons why their medications should come through us, not their mailbox, and so we need to be able to offer services that our training as pharmacists should already provide.
