Gray Ethics

Remember when you were in grade school and you formed a “whip line”? Those that got on to the line late… knew that they were screwed… keeping up was not a viable long term option. Could Pharmacists be the ones at the end of the healthcare “whip line”… Look at the analogies … 40+ yrs ago.. Pharmacists were at the center of what was a very small whip line… involving the Pharmacist, Prescribers, and Patient… a convenience and very functioning “triangle”.. most of the Pharmacist were self-employed or worked for indys or small regional chains that were more like big “Mom & Pop” pharmacies than the chains that dominate the landscape today. We picked up the a few PBM’s, insurance companies and the regional chains started being absorbed by the growing/larger chains… These entities basically “bullied” their way gradually to be at the center/pivot point of the whip line. Successful indys were relegated to smaller markets – today > 50% of indys are operating in < 20,000 population - places that were "too small" for the big guys to generate enough revenue to support their 12,000 -18,000 foot print. Now that a very small number of PBM's are at the core/center of this whip line.. it seems that they are trying to speed up the rotation.. Who will be next to be thrown off the line? Walgreens has taken a stand with ESI... what happens if the ESI/Medco merger is approved.. is Walgreens going to have to capitulate? If this merger is not approved until after the election - because it could be viewed as creating "job losses" which any does not work well for any administration that is seeking reelection. IMO... both chains and RPH's are intermixed in the outer ends of this line... chains can just borrow money and/or issue more stock to raise money to try and survive and remain on the whip line.. The Pharmacists are not so lucky.. with the growing surplus of RPH's.. and seemingly the chains willingness to accept whatever reimbursement rate they are offered from the PBM's.. are RPH's being forced to work with "gray ethics".. when corporate management expects double digit per-cent increase in volume and expect double digit per-cent decrease in staffing.. it is probably just a matter of time that this train runs off its tracks. As of close of market 01/27/2012... ESI/Rite Aid/CVS/Medco are closer to their 52 week high than their 52 wk low.. Walgreens is closer to their 52 wk low. Of course Rite Aid's price at $1.40 - a 52 wk high .. is still officially a PENNY STOCK.. but the market believes who the winner are losers are going to be.. of course the market is highly volatile and they can change their "mind" at the drop of a hat. Is "gray ethics" taking short-cuts that we know we shouldn't do... if grey ethics spending an extra amount of time.. trying to take care of a "lazy patient"... or spending spending excessive time trying to placate a "hostile patient"...knowing that you will be more rushed to try and catch up what orders have piled up? Is grey ethics... doing what management is suggesting you do... nothing put in writing... knowing that what is being asked is - or may be - against the company P&P and/or law/practice act? Is gray ethics doing whatever needs to be done to "get the job done" thinking that the company will stand behind you... in a worse case? If you work for one of those chains.. who manage by the theory "it is our way or the highway..."... that they are going to support you when something goes terribly wrong? If you are PIC for such a chain... you have put your license on the line for maintaining the rx dept being "legal"... you are the "fall guy/gal" for the permit holder. Most boards view the permit holder as infallible - can no wrong ...because the RPH has agreed to be the "legal/responsible party" for the permit holder. How much extra do you get for all that ADDITIONAL responsibility/liability above and beyond being a staff RPH?

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