The National Community Pharmacists Association (NCPA) asserts that “pharmacists are underappreciated, judging by the design of many public and private sector prescription drug plans” (

Adam J. Fein, PhD, author of the Drug Channels blog (, begs to differ. “Are pharmacists undervalued?” he asks. “Not if money equals appreciation.”

Adam J. Fein, PhD

Fein, president of Pembroke Consulting, analyzed the Bureau of Labor Statistics’ just-released 2012 Occupational Employment and Wages report and finds that pharmacist salaries “grew faster than did overall health care worker salaries and overall U.S. salaries.”

Pharmacist salaries grew 2.6% from 2011 to 2012, when the average gross salary for pharmacists at retail, mail, and specialty pharmacies was $117,000. Meanwhile, salaries for all “health care practitioners and technical occupations” (a classification in the government’s Standard Occupational Classification System) grew by only 1.1% in 2012.

It looks as if buying medications at such places as Walmart is also having an effect. “For the first time, pharmacists at mass merchants had the highest average pharmacist salaries,” says Fein. “Pharmacists at mass merchants, who also saw the biggest pay jump, now earn a full-time average of $117,990 (+3.8%).”

When evaluating pharmacy dispensing fees, pharmacy directors at health insurance plans should realize that salaries are a retail pharmacy’s biggest expense, says Fein. “Payroll is about 70% of a pharmacy’s operating costs.”

Pharmacist employment and salary, by dispensing format, 2012
Dispensing format Total employment % change vs. 2011 Average annual salary % change vs. 2011
Mass merchants with pharmacies 31,870 2.2% $117,990 3.8%
Chain and independent drug stores 122,840 2.7% $116,980 2.6%
Supermarkets and pharmacies 22,590 1.7% $111,040 2.0%
Mail pharmacies 3,110 8.7% $109,640 3.2%
Total 180,410 2.6% $116,288* 2.7%
*Weighted average
Data include only pharmacists employed in retail, mail, and specialty pharmacies
Source: 2012 National Occupational Employment and Wage Estimates, U.S. Bureau of Labor Statistics. March 2013

Pharmacy revenue growth slowdown

That’s not the only shift that occurred in the pharmacy business last year. Fein reports, “For the first time, revenues at U.S. pharmacies and drugstores declined ... in 2012.” The orange line tracks the data; the straight line averages the data.

Pharmacy revenue growth slowdown

Source: Pembroke Consulting analysis of Bureau of Census data. Data are not seasonally adjusted.
2013 data compare 2012:Q1 to 2013:Q1.

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.