pharmacy career paths

in 2024, how many pharmacists were employed in the US?

335,100

in 2024, how many pharmacists worked in community practice?

59%

in 2024, how many pharmacists worked in hospital/health-system practice settings?

21.7%

what is clinical practice?

any opportunity to speak to the patient you have teh chance t o counsel, improve his/her health literacy, and remove barriers to healthcare
services can be provided in any practice setting

why is the number of community pharmacies decreasing?

online and mail order pharmacies assume a larger market share

approximately how many traditional chains of community pharmacies are there?

25,000

approximately how many independent community pharmacies are there?

22,000

approximately how many supermarket community pharmacies are there?

7,000

approximately how many mass merchandiser or "big box" community pharmacies are there?

7,500

how many of community pharmacies are located within hospitals or medical clinics as outpatient (retail) pharmacies?

5%

what are outpatient (retail) pharmacies?

serve hospital employees, patients being discharged, and visitors
can be owned by the hospital, or in leased space by an independent pharmacist or a chain operator

what are the advantages to outpatient (retail) pharmacies?

potential for innovative patient services ("Meds to Bes", discharge counseling)

what are the disadvantages to outpatient (retail) pharmacies?

most are small, so there is little room for non-drug products (prescription and OTC medicines; some home diagnostic aids like glucometers, blood pressure cuffs; limited durable goods such as bedpans, walkers, etc.)

what is network spread?

difference between reimbursement from health plan and prescription reimbursement to pharmacy

what are direct and indirect remuneration fees?

pharmacy benefit managers (PBMs) take back money on adjudicated prescriptions for failure to meet undisclosed performance metrics

how do PBMs manage prescription drug benefit programs for health insurers, Medicare Part D, large employers, etc.?

develop and maintain the drug formulary (which drugs are covered; tier placement; how much the patient pays)
develop and maintain the network of pharmacies that patients can use (encourages competition from pharmacies to offer lower prices to join the network)
utilization management (prior authorization; step therapy requirements; drug therapy limits; deductibles; co-pays)
negotiate prices (on behalf of the health insurance plan) with pharmacies, manufacturers, and wholesalers

how can PBMs negotiate prices with pharmacies, manufacturers, and wholesalers?

manufacturers pay discounts or rebates to get their brand name drugs on the formulary and/or preferred tier
pharmacies negotiate reimbursement for both brand and generic drugs to be included in the network covered by the health insurance plan
health insurance plan reimburses PBM for drug at retail price, but PBM passes only a portion of the manufacturer rebate back to the health insurance plan

what are the PBM profit sources?

retention of manufacturer rebates
network spread
administrative fee and cost of dispensed prescriptions from health insurance plan
patient cost sharing
direct and indirect remuneration (DIR) policies on Medicare Part D prescriptions

what are the percentages of PBM profits from retention of manufacturer rebates?

1% with Medicare Part D, 20% with private/commercial health insurance plans

what is patient cost sharing typically based on?

retail drug price rather than the rebated cost from the manufacturer

how can PBMs profit from direct nad indirect remuneration policies?

they can take back money from the pharmacy months after the prescription was dispensed due to failure to meet performance on quality measures that are not made public

what are the 3 largest PBMs in the US?

CVS, Cigna, UnitedHealth Group
80% of all prescriptions are handled by these groups
all 3 are verticall integrated with a healthcare insurance plan and a mail order pharmacy

prescription drugs account for how much of independent pharmacy sales?

93%

how are chains better positioned to absorb lost profits?

by purchasing drug in bulk and offering expanded non-prescription products and services

how much of retail-based prescriptions do traditional chain pharmacies fill?

50%

how much of retail-based prescriptions do independent and franchise pharmacies fill?

about 20%

how much of retail-based prescriptions do big box pharmacies fill?

about 16%

how much of retail-based prescriptions do supermarket-based pharmacies fill?

about 14%

how do uncertain political climates affect traditional retail pharmacy chains?

Medicare price negotiations lead to decreased reimbursements
bipartisan bills have been introduced that could force healthcare insurance companies with PBMs to end integration with retail pharmacies

what is one result of the Affordable Care Act and Managed Care?

cost reduction through a focused shift to providing more healthcare services in the outpatient setting and preventing hospital readmissions
e.g. ambulatory care clinics, retail and hospital-based clinics, urgent care centers, outpatient surgical centers

how are pharmacies becoming increasingly involved in cost reduction?

some Walgreens offers "meds-to-beds" service for inpatients who are being discharged home, IF they have chose to fill their prescriptions at Walgreens
transitions of care (TOC)
retails clinics (e.g. CVS MinuteClinic)

what is transitions of care (TOC)?

coordination of care and responsibilities as the patient transitions from inpatient to outpatient or vice versa

why do medications occur more frequently as patients transition between inpatient and outpatient settings?

approximately 20% of patients are readmitted within 30 days of discharge
poor communication between health care providers
lack of patient follow-up
poor patient education
poor medication reconcilation

how can pharmacists help bridge transitions of care?

medication reconcilation
medication therapy management
patient counseling and education

what are retail clinics?

smal private spaces inside chain or bix box pharmacies staffed by a prescriber (Nurse Practitioner or PA)
state regulations differ
currently more than 3000 in the US

what are the logistics of retail clinics?

walk-in
convenient hours, although not 24/7
location facilitates pharmacist consultations and patient counseling
appropriate for several non-life-threatening conditions
typical visit costs approximately $110

what are retail clinics designed for?

to target patients with chronic diseases to increase healthcare access, patient education and empowerment, and medication adherence
to decrease hospital readmissions and reduce healthcare costs

what are the benefits of pharmacist immunizations?

pharmacist-provided immunizations are shown to be safe, cost-effective, and readily accessible
patients can typically walk in
vaccination rates have improved as pharmacist-administered vaccinations have expanded

what is the average cost of an adult vaccination in a pharmacy?

$54.98

what is the average cost of an adult vaccination in a physician's office?

$65.69

what are the NJ state regulations for pharmacist immunizations?

may not administer vaccines to children less than 7 yrs old
the flu vaccine can only be administered to children 7-12 yrs of age (with an authorized prescription and written parental consent)
any permitted vaccine can be administered to patients beyond 12 yrs old (with written parental consent for patients 12-18 yrs of age)

what are specialty pharmacies?

specialize in high cost, complex medication therapies (biologics, injectables) for patients with complicated or rare chronic diseases
e.g. cancer, rheumatoid arthritis, multiple sclerosis, genetic disorders
typically the only pharmacies who manage risk evaluation and mitigation strategies (REMS) drug programs

what do REMS requirements generally involve?

a limited distribution network
e.g. the physician must apply for the drug on behalf of the patient, who must meet certain enrollment criteia
favors drug acquisition and handling by specialty pharmacies (often by mail order)
these drugs are generally not available through regular retail pharmacies

what are the responsibilities of dispensing or staff pharmacists in hospital pharmacy?

drug preparation and dispensing
purchasing
monitoring of drug therapy, including interpretation of lab results
overseeing drug administration
responding to problems (e.g. missing/wasted doses, adverse drug events)
responding to codes (respiratory or cardiac arrest)

what does it mean for a hospital pharmacy to be decentralized?

a main pharmacy and satellite pharmacies in select patient care areas such as oncology, pediatrics, critical care

what are the roles of staff pharmacists?

interact regularly with physicians and nurses, but less so with patients
in satellite pharmacies, often have a hybrid position, responsible for patient rounding and clinical pharmacy activities as time allows

what are the roles of dedicated clinical pharmacist positions?

generally do not include drug dispensing responsibilities
typically based in one or more patient care areas and are a member of the multidisciplinary healthcare rounding team

what are drug distribution systems?

unit dose systems
automated dipensing cabinets

what are unit dose systems?

24hr supply to each patient in unit-of-use packaging
medication cabinets can be filled by technicians or automated/robotic technology

what are automated dispensing cabinets?

located directly in patient care areas
only accessible to autorized personnel
cabinet inventory generally checked and refilled by technicians

what are antibiotic stewardship programs?

design to manage and reduce antibiotic resistance
identify inappropriate use, excessive cost
designate certain antimicrobials for restricted use
monitor and report antimicrobial resistance patterns
typically chaired by an infectious diseases (ID) physician and co-chaired by an ID-trained clinical pharmacist
work closely with the P&T committee, which must vote to impose drug restrictions, add new antimicrobials, etc.

what are pharmacokinetics services?

consults involve drugs with a narrow therapeutic index
e.g. warfarin, phenytoin, gentamicin, vancomycin
clinical/staff pharmacists interpret the drug [ ] and consult with the prescriber to adjust the dose or temporarily discontinue the medication

what is the narrow therapeutic index?

a small difference between the minimum therapeutic and minimum toxic blood concentration

what is the R&D in the pharmaceutical industry?

discover new molecular entities (NMEs)
early testing for proof of concept
establish "lead candidates"
secure drug patent(s)

what is pre-clinical testing?

short and long-term toxicity studies in at least 2 animal species
manufacturing process
indications of disease effect
Investigational new drug (IND) application

what are the clinical trials?

phase 0
pahse I
phase II
phase III
new drug application (NDA)
phase IV (post-marketing studies)

what is marketing in the pharmaceutical industry?

manufacture, distribute approved drugs (recoup investment)

what type of opportunities do pharmacists have?

jobs in:
pharmaceutical formulation development
clinical manufacture and supply
quality assurance
regulatory affairs
medical information
PK and drug metabolism
project management
commercial business development
marketing and sales

what is the post-graduate training required for pharmacists?

there is no job that absolutely demands a particular residency/fellowship
it all depends on who you compete with for that job

what are the benefits of completing a PGY1 or PGY2 residency?

hospitals are increasingly looking for pharmacists who have completed at least a PGY1
many clinical pharmacist positions are specialized and candidates who have completed specialized PGY2 residences have an advantage