'Branded Generics' Are Part of Confusion

Susan Hayes, president of consulting and auditing firm Pharmacy Outcomes Specialists, says she sees the alleged tactic centering on "branded generics." These products are branded drugs that are so cheap they are considered the generic of themselves, she says in an interview with DBN. This category of drug can account for up to 10% of overall drug utilization, she adds.

Branded generic products include the antibiotic Amoxil (amoxicillin), a drug that has been available for decades, Hayes explains. "There is really very little cost difference between Amoxil and amoxicillin," she says. "People just buy the brand, and there is very little generic utilization. They call the brand a generic."

A PBM trying to achieve an overall generic fill-rate guarantee might call Amoxil a generic, she says. "But if you want to price it and make the most profit, you'd want to call it a brand, because you get AWP minus 15% off of a brand." The same-priced amoxicillin, however, may appear on a PBM's MAC list, which could be sold to the payer at a discount of AWP minus 65%, she says.

By calling the product both a generic and a brand, the PBM is able to report that it dispensed a generic while charging a brand drug's 15% discount, Hayes says. "Although what [the PBM] should have done is give you the MAC price off of the generic equivalent. So [it's] running up your costs," she says as an example.

Such a tactic can boost a PBM's generic fill rate to 60% and more, which is a strong selling point for a PBM, Hayes says. "What they don't tell you is that all of these branded generics - that are a lot cheaper — are going to the fill rate, and they're really brand drugs. And [the PBM] is really charging you AWP minus 15%, and not the generic MAC price."

Helen Sherman, Pharm.D., director of pharmacy services at The Regence Group, which operates Blue Cross and Blue Shield plans in the Northwest, says that one of her biggest concerns is how miscategorizing drugs can be used by PBMs to inflate generic fill rates. "As PBMs compete, there is a multitude of ways that data can be manipulated to look favorable on a generic rate," she tells DBN.

"Our approach is that we report our generic fill rate according to how the medication was paid," Sherman says. "So if it was paid as a generic, it counts in the generic bucket, and if it was paid as brand, it was counted as a brand."

As a starting point, Regence uses drug pricing information supplied by First DataBank to categorize a product as a generic or a brand. First DataBank, however, does not specifically define a product as such, and some critics contend PBMs can easily manipulate and miscategorize drugs to suit their purposes.

Sherman says that Regence reviews drug products on a monthly basis, and will occasionally override First DataBank. This can happen when Regence doesn't feel that First DataBank's categorization aligns with how a pharmacy views the product, she adds. As such, Regence's policy on generic/brand categorization is designed to reflect the FDA's definitions. The insurer says it will classify a drug as "generic" when any one of the following are met:

The product's label name is the same as the generic name;

The product IS NOT designated as an "innovator product" by a drug data source;

The FDA approved the product under an Abbreviated New Drug Application (ANDA), and no New Drug Application (NDA) is on file;

• The product is designated as a generic in the FDA's Orange Book, which lists patents on drugs;
• The product was approved by the FDA as a generic according to information obtained via the Freedom of Information Act; or
• Other information from the FDA indicates the product is a generic.

Practices Said to Be Common

But some pharmacy benefit auditors contend that practices described by Cahn are common in the PBM industry.

Hal Holzman, president of auditing firm Pharmacy Data Management, Inc., says the alleged tactic benefits multiple stakeholders in different ways.

"The [drug] manufacturers want them to be classified as generics, because they know the patients are going to get [low] generic copays," Holzman tells DBN. "The pharmacies — depending on what their contracts are with the PBMs — may feel either way. Generally, they like generics because they have wider [profit margin] spreads. But if they're reimbursed as a brand, that is a really good deal [for the pharmacy]."

In fact, Holzman says, drugstores want the best of both worlds. "The gold standard, as far as the pharmacies are concerned, is to get brand reimbursement and generic copays for their patients," he says. But someone still has to pick up the tab, he adds. "The ones that are paying the big dollars — these things get paid for by someone — are the payers: the employers and insurance companies."

How much money this tactic actually costs payers depends on how aggressively the PBM manipulates the definition, Holzman says. "It can easily be a couple of percentage points [of total drug spend]," he says. Drug spending of large employers can total many millions of dollars per year.

Complexity May Help Mask Practices

But Cahn asserts the definition manipulation takes place in the highly complex world of PBM contracting, which includes terms such as "branded generics" and "multi-sourced brands" - both of which provide wiggle room in categorizing products.

Categorizing a drug as a brand or a generic is integral to how a PBM determines its payment formulas and guarantees. Payments, in turn, are generally based on a drug's average wholesale price (AWP). PBMs use AWP listings from data warehouse companies — such as First DataBank Inc. and Medi-Span — to establish the pricing discounts and rebate levels that they provide to Rx payers. For example, a PBM may charge an Rx payer AWP minus 15% to 18% for a brand drug, and roughly AWP minus 60% for a generic drug that has been placed on a maximum allowable cost (MAC) list.

Using these formulas, Cahn contends, PBMs will switch definition of brands and generics for the purposes of:

Invoicing the client. The PBM may call the dispensed drug a brand because the contract allows far higher charges on brands than generics, typically around AWP minus 18% for brands and around AWP minus 58% for generics, she says;

Deciding whether to pass through rebates to the client. The PBM may label the drug as a generic, which would enable the PBM not to pass through any rebates since PBM contracts almost always state that rebates will be passed through only on brand drugs, Cahn adds; and

Demonstrating a high generic fill rate. The PBM may count a brand drug as having been generic to demonstrate a generic fill percentage rate, she says.

When asked by DBN to respond to these allegations, the country's three largest PBMs touted their transparency of pricing, and said they follow uniform industry standards in defining brands and generics.

Medco Health Solutions, Inc. "has one of the most transparent business models in the industry in which pricing is clearly laid out for our clients," said spokeswoman Jennifer Leone Luddy. "As such, we are not aware of any of these issues," she says.

CVS Caremark Corp. uses indicators contained in the regularly updated Medi-Span Master Drug Database (Medi-Span) and its associated files, or another nationally available reporting service of Rx drug information, to determine the classifications of drugs as either branded or generic, the company said, adding that this is in line with industry standards. "We work directly with our [PBM] clients as necessary to address any specific requirements they may have with respect to how brand and generic drug classifications are determined," CVS Caremark says.

Express Scripts, Inc. uses a consistent, uniform approach to defining brands and generics for all clients, says Michael Fondell, vice president of sales and marketing operations. "These definitions are an important part of our contracts with clients," he adds. "This is another example of our business model and commitment to ensuring clients and their plan members maximize the benefits of increased generic fill rates by using proven programs such as step therapy and zero-dollar copay."

PBMs Allegedly Manipulate Definition of 'Brand' and 'Generic' Rx at Payers' Expense

What is a generic drug? What is a brand drug? These questions would appear to have obvious answers, but that's not necessarily true in the Byzantine world of PBM contracting. Some industry insiders contend that many PBMs intentionally blur the definitions of "brand drugs" and "generic drugs" to suit their financial interests. Health plans and employer groups, meanwhile, are largely unaware that this purported scheme could be costing them millions of extra dollars per year on their drug spend, Rx consultants and auditors tell DBN.

"This issue is not on the radar screen of payers, consulting firms or anyone but the PBMs that are taking advantage of contract ambiguities to make a lot of money," says Linda Cahn, president of Pharmacy Benefit Consultants and an attorney who has reviewed hundreds of PBM contracts and litigated against PBMs.

PBMs frequently write contracts that lack any definition of "brand drug" and "generic drug," Cahn tells DBN. Or the contracts may contain such ambiguous definitions that PBMs can manipulate the terms to achieve financial gains that should flow to the Rx payer, she asserts. Cahn acknowledges that it's difficult to put an exact dollar figure on the practices, which may not be illegal. But other PBM auditors say it could be costing payers several percentage points on their total annual drug costs.

By miscategorizing drugs, Cahn asserts, PBMs achieve a number of financial aims. These include charging brand prices for generic products, retaining rebates for brand drugs by calling them generics, and misstating a health plan's generic drug utilization rate. When vague definitions are written into the contract, "PBMs can basically do whatever they want in connection with all matters related to brand and generic drugs," she says.

Large PBMs contacted for comment by DBN say they follow accepted industry standards in defining drugs as brand or generic, and work with clients on addressing any concerns about the classification.

Is the Pharmacy Near You Selling Counterfeit Drugs?

(NaturalNews) The FDA has just issued a press release warning consumers who had prescriptions filled at two different "The Medicine Shoppe" pharmacies located in Baltimore (8035A Liberty Road and 5900 Reisterstown Road) that they could’ve received either counterfeit or expired drugs. Since some of the drugs in question are used to treat very serious conditions, the FDA is extremely concerned. There is currently no evidence that there are any problems with prescriptions filled at any other "The Medicine Shoppe" pharmacy locations.

Are any of These in Your Medicine Chest?

The following medications, if obtained from either of the above pharmacies, should be discarded:

* Lisinopril (20 milligrams)

* Guaifenesin/Dextromethorphan (600 mg and 1000 mg)

* Gabapentin (100 mg, 300 mg and 400 mg)

* Metoprolol (50 mg)

* Nifedipine (30 mg)

* Diclofenac Sodium (30 mg)

* Glucophage (500 mg Extended Release)

* Glucovance (125 mg and 500 mg)

* Glipizide/Metformin (2.50 mg/250 mg)

* Furosemide (20 mg)

* Tamoxifen Citrate (10 mg)

* Metformin HCl ER (500 mg)

* Calcitrol (0.25 micrograms)

Contact the FDA for Disposal Instructions

Anyone who is in possession of any of these drugs is requested to call the FDA at 800-521-5783 for further information on how to dispose of the drugs. These consumers should also contact their physicians to see what to do about replacement medications.

Report Adverse Events

Consumers and doctors should report any adverse events to the FDA's MedWatch program at 800-FDA-1088. Adverse events may also be reported by mail to MedWatch, HF-2, FDA, 5600 Fishers Lane, Rockville, Md 20852-9787. There is also a convenient place to report adverse events online: http://www.fda.gov/medwatch/report.htm.

Could This be Just the Tip of the Iceberg?

Obviously, while the FDA is currently issuing warnings concerning just two particular pharmacies, these kinds of problems are often like cockroaches. There usually are more hiding in the walls for every one in plain sight. Stories like this are a painful reminder that it often isn’t any safer to use prescription medicines obtained from a pharmacy than drugs bought on the street.

Taking medicine should not be like playing a game of Russian roulette. Unfortunately, incidents like this only serve to clarify the fact that people who are medication-free don’t have to spend sleepless nights worrying about whether or not their prescription medications are expired or counterfeit. Better still, they don’t have to worry about whether or not counterfeit drugs will kill them.

Types of pharmacy practice areas

Community pharmacy

Hospital pharmacy

Clinical pharmacy

Compounding pharmacy

Consultant pharmacy

Internet pharmacy

Veterinary pharmacy

Nuclear pharmacy

Military pharmacy

Nuclear pharmacy

Nuclear Pharmacy involves the preparation of radioactive materials that will be used to diagnose and treat specific diseases. It was the first pharmacy specialty established in 1978 by the Board of Pharmaceutical Specialties. Nuclear pharmacy seeks to improve and promote health through the safe and effective use of radioactive drugs for not only diagnosis but also therapy.

• HISTORY

The concept of nuclear pharmacy was first described in 1960 by Captain William H. Briner while at the National Institutes of Health (NIH) in Bethesda, Maryland. Along with Mr. Briner, John E. Christian, who was a professor in the School of Pharmacy at Purdue University, had written articles and contributed in other ways to set the stage of nuclear pharmacy. William Briner started the NIH Radiopharmacy in 1958. He also brought about principles and procedures important to the assurance of quality radiopharmaceuticals. Christian developed the first formal lecture and laboratory courses in the United States for teaching the basic principles of radioisotope applications. John Christian and William Briner were both active on key national committees responsible for the development, regulation and utilization of radiopharmaceuticals.

In the mid 1970s a petition was formed requesting the formation of a Section on Nuclear Pharmacy in the Academy of General Practice, currently called the Academy of Pharmacy Practice and Management. On April 23, 1975, the petition was finally approved by the American Pharmacists Association (APhA) Board of Trustees. Nuclear pharmacy thus became a new area in pharmacy.

Veterinary pharmacy

Veterinary pharmacies, sometimes called animal pharmacies may fall in the category of hospital pharmacy, retail pharmacy or mail-order pharmacy. Veterinary pharmacies stock different varieties and different strengths of medications to fulfill the pharmaceutical needs of animals. Because the needs of animals as well as the regulations on veterinary medicine are often very different from those related to people, veterinary pharmacy is often kept separate from regular pharmacies.

Internet pharmacy

Since about the year 2000, a growing number of Internet pharmacies have been established worldwide. Many of these pharmacies are similar to community pharmacies, and in fact, many of them are actually operated by brick-and-mortar community pharmacies that serve consumers online and those that walk in their door. The primary difference is the method by which the medications are requested and received. Some customers consider this to be more convenient and private method rather than traveling to a community drugstore where another customer might overhear about the drugs that they take. Internet pharmacies (also known as Online Pharmacies) are also recommended to some patients by their physicians if they are homebound.

While most Internet pharmacies sell prescription drugs and require a valid prescription, some Internet pharmacies sell prescription drugs without requiring a prescription. Many customers order drugs from such pharmacies to avoid the "inconvenience" of visiting a doctor or to obtain medications which their doctors were unwilling to prescribe. However, this practice has been criticized as potentially dangerous, especially by those who feel that only doctors can reliably assess contraindications, risk/benefit ratios, and an individual's overall suitability for use of a medication. There also have been reports of such pharmacies dispensing substandard products.

Of particular concern with internet pharmacies is the ease with which people, youth in particular, can obtain controlled substances (e.g., Vicodin, generically known as hydrocodone) via the internet without a prescription issued by a doctor/practitioner who has an established doctor-patient relationship. There are many instances where a practitioner issues a prescription, brokered by an internet server, for a controlled substance to a "patient" s/he has never met. In the United States, in order for a prescription for a controlled substance to be valid, it must be issued for a legitimate medical purpose by a licensed practitioner acting in the course of legitimate doctor-patient relationship. The filling pharmacy has a corresponding responsibility to ensure that the prescription is valid. Often, individual state laws outline what defines a valid patient-doctor relationship.

Canada is home to dozens of licensed Internet pharmacies, many which sell their lower-cost prescription drugs to U.S. consumers, who pay the world's highest drug prices. In recent years, many consumers in the US and in other countries with high drug costs, have turned to licensed Internet pharmacies in India, Israel and the UK, which often have even lower prices than in Canada.

In the United States, there has been a push to legalize importation of medications from Canada and other countries, in order to reduce consumer costs. While in most cases importation of prescription medications violates Food and Drug Administration (FDA) regulations and federal laws, enforcement is generally targeted at international drug suppliers, rather than consumers. There is no known case of any U.S. citizens buying Canadian drugs for personal use with a prescription, who has ever been charged by authorities.

Hospital pharmacy

A retail pharmacy located inside a hospital in Italy (Prato).

A hospital pharmacy is concerned with pharmacy service to all types of hospital and differs considerably from a community pharmacy.

Some pharmacists in hospital pharmacies may have more complex clinical medication management issues whereas pharmacists in community pharmacies often have more complex business and customer relations issues. Because of the complexity of the medication use system, many pharmacists practicing in hospitals gain more education and training after pharmacy school through a pharmacy practice residency and sometimes followed by another residency in a specific area.

Hospital pharmacies can usually be found within the premises of the hospital. Hospital pharmacies usually stock a larger range of medications, including more specialized and insvestigational medications (medicines that are being studies, but have not yet been approved by the FDA), than would be feasible in the community setting. Hospital pharmacies typically provide medications for the hospitalized patients only, and are not retail establishments. They typically do not provide prescription service to the public. Some hospitals do have retail pharmacies within them (see illustration), which sell over-the-counter as well as prescription medications to the public, but these are not the actual hospital pharmacy.

Compounding pharmacy

Compounding pharmacy is the process of mixing drugs by a pharmacist or physician to fit the unique needs of a patient. This may be done for medically necessary reasons, such as to change the form of the medication from a solid pill to a liquid, to avoid a non-essential ingredient that the patient is allergic to, or to obtain the exact dose needed. It may also be done for voluntary reasons, such as adding favorite flavors to a medication.

Uses

During research and development

Pharmaceutical compounding is a branch of pharmacy that continues to play the crucial role of drug development. Compounding pharmacists and medicinal chemists develop and test pharmaceutical formulations for new drugs so that the active ingredients are effective, stable, easy to use, and acceptable to patients.

In the community pharmacy

Physicians may prescribe an individually compounded medication for a patient with an unusual health need. This allows the physician to tailor a prescription to each individual. Compounding preparations are especially prevalent for:

• Patients requiring limited dosage strengths, such as a very small dose for infants
• Patients requiring a different dosage form, such as turning a pill into a liquid or transdermal gel for people who can't swallow pills due to disability
• Patients requiring an allergen-free medication, such as one without gluten or colored dyes
• Patients who need drugs that have been discontinued by pharmaceutical manufacturers because of low profitability
• Patients who are taking bioidentical hormone replacement therapy, specifically the Wiley Protocol
• Children who want flavored additives in liquid drugs, usually so that the medication tastes like candy or fruit
• Veterinary medicine, usually for a change in dose

Clinical pharmacy

Clinical pharmacy is the branch of Pharmacy where pharmacists provide patient care that optimizes the use of medication and promotes health, wellness, and disease prevention Clinical pharmacists care for patients in all health care settings but the clinical pharmacy movement initially began inside Hospitals and clinics. Clinical pharmacists often collaborate with Physicians and other healthcare professionals. Clinical pharmacists have extensive education in the biomedical, pharmaceutical, sociobehavioral, and clinical sciences. Most clinical pharmacists have a Doctor of Pharmacy (Pharm.D.) degree and many have completed one or more years of post-graduate training (e.g. a general and/or specialty pharmacy residency). Many clinical pharmacists also choose to become a Board Certified Pharmacotherapy Specialist (BCPS), a Board Certified Oncology Pharmacist (BCOP), or a Board Certified Psychiatric Pharmacist (BCPP) through the Board of Pharmaceutical Specialities (BPS).

Within the system of health care, clinical pharmacists are experts in the therapeutic use of medications. They routinely provide medication therapy evaluations and recommendations to patients and other health care professionals. Clinical pharmacists are a primary source of scientifically valid information and advice regarding the safe, appropriate, and cost-effective use of medications.

In some states, clinical pharmacists are given prescriptive authority.

Basic components of clinical pharmacy practice: 1) Communication 2) Counseling 3) Consulting

Scope of clinical pharmacy:

Community pharmacy

19th century Italian pharmacy

Modern pharmacy in Norway

A pharmacy (commonly the chemist in Australia, New Zealand and the UK; or drugstore in North America; retail pharmacy in industry terminology; or Apothecary, historically) is the place where most pharmacists practice the profession of pharmacy. It is the community pharmacy where the dichotomy of the profession exists—health professionals who are also retailers.

Community pharmacies usually consist of a retail storefront with a dispensary where medications are stored and dispensed. The dispensary is subject to pharmacy legislation; with requirements for storage conditions, compulsory texts, equipment, etc., specified in legislation. Where it was once the case that pharmacists stayed within the dispensary compounding/dispensing medications; there has been an increasing trend towards the use of trained pharmacy technicians while the pharmacist spends more time communicating with patients.

All pharmacies are required to have a pharmacist on-duty at all times when open. In many jurisdictions, it is also a requirement that the owner of a pharmacy must be a registered pharmacist (R.Ph.). This latter requirement has been revoked in many jurisdictions, such that many retailers (including supermarkets and mass merchandisers) now include a pharmacy as a department of their store.

Likewise, many pharmacies are now rather grocery store-like in their design. In addition to medicines and prescriptions, many now sell a diverse arrangement of additional household items such as cosmetics, shampoo, office supplies, confectionary, and snack foods.

The future of pharmacy

In the coming decades, pharmacists are expected to become more integral within the health care system. Rather than simply dispensing medication, pharmacists will be paid for their patient care skills.

This paradigm shift has already commenced in some countries; for instance, pharmacists in Australia receive remuneration from the Australian Government for conducting comprehensive Home Medicines Reviews. In the United Kingdom, pharmacists (and nurses) who undertake additional training are obtaining prescribing rights. They are also being paid for by the government for medicine use reviews. In the United States, the Clinical pharmacy movement has had an evolving influence on the practice of pharmacy. Moreover, the Doctor of Pharmacy (Pharm.D.) degree is now required before entering practice and many pharmacists now complete one or two years of residency training following graduation. In addition, consultant pharmacists, who traditionally operated primarily in nursing homes are now expanding into direct consultation with patients, under the banner of "senior care pharmacy."

Pharmacy First - Minor Ailment Scheme

It has been estimated that in the UK up to 150 million GP consultations per year are for conditions that may be self treatable. This means that on average up to 16 appointments per GP/Nurse per day could potentially be saved by introducing a Community Pharmacy Minor Ailment scheme!

Our aim in Torfaen is to introduce and maintain a successful Community Pharmacy scheme to help save some of these appointments by offering free advice and treatment through The Pharmacy First Scheme.

From May 2006, every pharmacy in Torfaen was given the opportunity to provide this service and 19 out of 21 pharmacies can now offer the Pharmacy First scheme. These Pharmacies are:

Abersychan Pharmacy
Alliance Pharmacy, Cwmbran
Boots the Chemist, Cwmbran
Boots the Chemist, Pontypool
Health Plus Pharmacy, Pontnewynydd
Lloyds Pharmacy, Croesyceiliog
Lloyds Pharmacy, Fairwater
Lloyds Pharmacy, Llanyravon
Lloyds Pharmacy, Pontnewydd
Lloyds Pharmacy, West Pontnewydd
Lloyds Pharmacy, Griffithstown
Lloyds Pharmacy, Pontypool
Mayberry Pharmacy, Trevethin
Mayberry Pharmacy, Pontypool
Health Centre, Blaenavon
National Co-op, Blaenavon
National Co-op, Garndiffaith
S C Powell, Pontnewydd
Shil Pharmacy, Thornhill

Hospital pharmacy

Pharmacies within hospitals differ considerably from community pharmacies. Some pharmacists in hospital pharmacies may have more complex clinical medication management issues whereas pharmacists in community pharmacies often have more complex business and customer relations issues.

Because of the complexity of medications including specific indications, effectiveness of treatment regimens, safety of medications (i.e., drug interactions) and patient compliance issues ( in the hospital and at home) many pharmacists practicing in hospitals gain more education and training after pharmacy school through a pharmacy practice residency and sometimes followed by another residency in a specific area. Those pharmacists are often referred to as clinical pharmacists and they often specialize in various disciplines of pharmacy. For example, there are pharmacists who specialize in haematology/oncology, HIV/AIDS, infectious disease, critical care, emergency medicine, toxicology, nuclear pharmacy, pain management, psychiatry, anticoagulation clinics, herbal medicine, neurology/epilepsy management, paediatrics, neonatal pharmacists and more.

Hospital pharmacies can usually be found within the premises of the hospital. Hospital pharmacies usually stock a larger range of medications, including more specialized medications, than would be feasible in the community setting. Most hospital medications are unit-dose, or a single dose of medicine. Hospital pharmacists and trained pharmacy technicians compound sterile products for patients including total parenteral nutrition (TPN), and other medications given intravenously. This is a complex process that requires adequate training of personnel, quality assurance of products, and adequate facilities. Several hospital pharmacies have decided to outsource high risk preparations and some other compounding functions to companies who specialize in compounding.

Community pharmacy

A pharmacy (commonly the chemist in Australia, New Zealand and the UK; or drugstore in North America; retail pharmacy in industry terminology; or Apothecary, historically) is the place where most pharmacists practice the profession of pharmacy. It is the community pharmacy where the dichotomy of the profession exists—health professionals who are also retailers.

Community pharmacies usually consist of a retail storefront with a dispensary where medications are stored and dispensed. The dispensary is subject to pharmacy legislation; with requirements for storage conditions, compulsory texts, equipment, etc., specified in legislation. Where it was once the case that pharmacists stayed within the dispensary compounding/dispensing medications; there has been an increasing trend towards the use of trained pharmacy technicians while the pharmacist spends more time communicating with patients.

All pharmacies are required to have a pharmacist on-duty at all times when open. In many jurisdictions, it is also a requirement that the owner of a pharmacy must be a registered pharmacist (R.Ph.). This latter requirement has been revoked in many jurisdictions, such that many retailers (including supermarkets and mass merchandisers) now include a pharmacy as a department of their store.

Likewise, many pharmacies are now rather grocery store-like in their design. In addition to medicines and prescriptions, many now sell a diverse arrangement of additional household items such as cosmetics, shampoo, office supplies, confectionary, and snack foods.

Nature of the Work

Pharmacists distribute prescription drugs to individuals. They also advise their patients, as well as physicians and other health practitioners, on the selection, dosages, interactions, and side effects of medications. Pharmacists monitor the health and progress of patients to ensure the safe and effective use of medication. Compounding—the actual mixing of ingredients to form medications—is a small part of a pharmacist’s practice, because most medicines are produced by pharmaceutical companies in a standard dosage and drug delivery form. Most pharmacists work in a community setting, such as a retail drugstore, or in a health care facility, such as a hospital, nursing home, mental health institution, or neighborhood health clinic.

Pharmacists in community pharmacies dispense medications, counsel patients on the use of prescription and over-the-counter medications, and advise physicians about patients’ medication therapy. They also advise patients about general health topics such as diet, exercise, and stress management, and provide information on products such as durable medical equipment or home health care supplies. In addition, they may complete third-party insurance forms and other paperwork. Those who own or manage community pharmacies may sell non-health-related merchandise, hire and supervise personnel, and oversee the general operation of the pharmacy. Some community pharmacists provide specialized services to help patients with conditions such as diabetes, asthma, smoking cessation, or high blood pressure; others also are trained to administer vaccinations.

Pharmacists in health care facilities dispense medications and advise the medical staff on the selection and effects of drugs. They may make sterile solutions to be administered intravenously. They also plan, monitor and evaluate drug programs or regimens. They may counsel hospitalized patients on the use of drugs before the patients are discharged.

Pharmacists who work in home health care monitor drug therapy and prepare infusions—solutions that are injected into patients—and other medications for use in the home.

Some pharmacists specialize in specific drug therapy areas, such as intravenous nutrition support, oncology (cancer), nuclear pharmacy (used for chemotherapy), geriatric pharmacy, and psychiatric pharmacy (the use of drugs to treat mental disorders).

Most pharmacists keep confidential computerized records of patients’ drug therapies to prevent harmful drug interactions. Pharmacists are responsible for the accuracy of every prescription that is filled, but they often rely upon Pharmacy technicians and pharmacy aides to assist them in the dispensing process. Thus, the pharmacist may delegate prescription-filling and administrative tasks and supervise their completion. Pharmacists also frequently oversee pharmacy students serving as interns.

Increasingly, pharmacists are pursuing nontraditional pharmacy work. Some are involved in research for pharmaceutical manufacturers, developing new drugs and testing their effects. Others work in marketing or sales, providing clients with expertise on the use, effectiveness, and possible side effects of drugs. Some pharmacists work for health insurance companies, developing pharmacy benefit packages and carrying out cost-benefit analyses on certain drugs. Other pharmacists work for the government, managed care organizations, public health care services, the armed services, or pharmacy associations. Finally, some pharmacists are employed full time or part time as college faculty, teaching classes and performing research in a wide range of areas.

Work environment. Pharmacists work in clean, well-lighted, and well-ventilated areas. Many pharmacists spend most of their workday on their feet. When working with sterile or dangerous pharmaceutical products, pharmacists wear gloves, masks, and other protective equipment.

Most full-time salaried pharmacists work approximately 40 hours a week, and about 10 percent work more than 50 hours. Many community and hospital pharmacies are open for extended hours or around the clock, so pharmacists may be required to work nights, weekends, and holidays. Consultant pharmacists may travel to nursing homes or other facilities to monitor patients’ drug therapy. About 16 percent of pharmacists worked part time in 2006.

History of pharmacy

Muslim pharmacy

In the field of pharmacy, the first drugstores were opened by Muslim pharmacists in Baghdad in 754, while the first apothecary shops were also founded by Muslim practitioners.

The advances made in the Middle East by Muslim chemists in botany and chemistry led Muslim physicians to substantially develop pharmacology. Muhammad ibn Zakarīya Rāzi (Rhazes) (865-915), for instance, acted to promote the medical uses of chemical compounds. Abu al-Qasim al-Zahrawi (Abulcasis) (936-1013) pioneered the preparation of medicines by sublimation and distillation. His Liber servitoris is of particular interest, as it provides the reader with recipes and explains how to prepare the `simples’ from which were compounded the complex drugs then generally used. Sabur Ibn Sahl (d 869), was, however, the first physician to initiate pharmacopoedia, describing a large variety of drugs and remedies for ailments. Al-Biruni (973-1050) wrote one of the most valuable Islamic works on pharmacology entitled Kitab al-Saydalah (The Book of Drugs), where he gave detailed knowledge of the properties of drugs and outlined the role of pharmacy and the functions and duties of the pharmacist. Ibn Sina (Avicenna), too, described no less than 700 preparations, their properties, mode of action and their indications. He devoted in fact a whole volume to simple drugs in The Canon of Medicine. Of great impact were also the works by al-Maridini of Baghdad and Cairo, and Ibn al-Wafid (1008-1074), both of which were printed in Latin more than fifty times, appearing as De Medicinis universalibus et particularibus by `Mesue' the younger, and the Medicamentis simplicibus by `Abenguefit'. Peter of Abano (1250-1316) translated and added a supplement to the work of al-Maridini under the title De Veneris. Al-Muwaffaq’s contributions in the field are also pioneering. Living in the 10th century, he wrote The foundations of the true properties of Remedies, amongst others describing arsenious oxide, and being acquainted with silicic acid. He made clear distinction between sodium carbonate and potassium carbonate, and drew attention to the poisonous nature of copper compounds, especially copper vitriol, and also lead compounds. For the story, he also mentions the distillation of sea-water for drinking.

Chinese Pharmacy

The beginnings of pharmacy in China are ancient. It stemmed from Chinese alchemy. Shennong is said to have tasted hundreds of herbs to test their medical value. The most well-known work attributed to Shennong is The Divine Farmer's Herb-Root Classic. This work is considered to be the earliest Chinese pharmacopoeia. It includes 365 medicines derived from minerals, plants, and animals. Shennong is credited with identifying hundreds of medical (and poisonous) herbs by personally testing their properties, which was crucial to the development of Traditional Chinese medicine.

Japanese pharmacy

In ancient Japan, the men who fulfilled roles similar to those of modern pharamacists were highly respected. The place of pharmacists in society was expressly defined in the Taihō Code (701) and re-stated in the Yōrō Code (718). Ranked positions in the pre-Heian Imperial court were established; and this organizational structure remained largely intact until the Meiji Restoration (1868). In this highly stable hierarchy, the pharmacists -- and even pharmacist assistants -- were assigned status superior to all others in health-related fields such as physicians and acupuncturists. In the Imperial household, the pharmacist was even ranked above the two personal physicians of the Emperor.

Pharmacy

Pharmacy (from the Greek φάρμακον 'pharmakon' = drug) is the health profession that links the health sciences with the chemical sciences, and it is charged with ensuring the safe and effective use of medication. The scope of pharmacy practice includes more traditional roles such as compounding and dispensing medications, and it also includes more modern services related to patient care, including clinical services, reviewing medications for safety and efficacy, and providing drug information. Pharmacists, therefore, are the experts on drug therapy and are the primary health professionals who optimize medication use to provide patients with positive health outcomes. The term is also applied to an establishment used for such purposes.