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A Special Report:
If You Don't Get it Right Somebody Else Will

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Improving compliance is a major opportunity not only to grow the pharmacy business, but also to improve the health of millions of Americans and reduce total health care costs.

Almost one-third did not fill one or more new prescriptions in the past year; 27 percent did not
pick up one or more refills last year.

Once you get past price, the other major obstacles to patient compliance, things like forgetting
to take one's medications, the perception that the medication is not actually needed, or even that the drug is not covered by the patient's insurance, pharmacists can intervene and make a difference. Often, the challenge for the pharmacist lies in bridging the distance.

Research suggests that there is a breakdown of communication occurring at the pharmacy counter. While 64 percent of pharmacists say they offer their patients counseling, on average only 20 percent of customers accept. Although there is a lot to the old expression, "the customer is always right," in this case it really doesn't apply. As pharmacists told Drug Store News, too many customers think they have all the information they need already. "If your heart's not in it, you're just not going to be able to get past the fact that a patient doesn't appear to want counseling," one pharmacist explained.

According to a recent online poll of pharmacists conducted by Drug Store News, the mean time pharmacists spent in the typical patient consultation session was about three minutes.

Sometimes it means forcing yourself on the patient somewhat, pharmacists explained; it's about not taking no for answer.

"I think we have an obligation to our profession to make the patient listen," said one California pharmacist. "We need to say, 'Yeah, you might have been on [this drug] for years, but what's happening? How is it going with it?' And all of a sudden, they'll say, 'Well, now that you mention it, I've got this cough.' … Before you know it you're picking up on side effects and things that they may not have been thinking about."

And it's not just enough to ask if they have any questions; that's a cop-out, pharmacists told Drug Store News. Many don't really know what questions they should be asking.

"I think that the easiest wrong question you can ask a patient is 'Do you have a question for the pharmacist?' Because there is an easy way to answer that: 'No,' 'I'm in a hurry,' 'I need to get going,'" one panelist said. "You have to be proactive and find a reason to talk to them about their therapy, not just take the easy way out and ask if they have any questions for the pharmacist."

"I mean what kind of stupid question is that?" remarked another. "I ask, 'Have you ever been on this medication before?' And if they say, 'No,' I go into my whole spiel."

At least a few panelists noted that this type of proactive intervention is not only an opportunity to improve compliance, but it is also a last chance to ensure that the medicine in the bag is the medicine the customer is supposed to be leaving with.

"We require consulting on all new scripts; that includes refills," one panelist explained. "It gets to be a little annoying for the patient. But I think it's good; who's to say that the doctor renewed the right prescription? So, when I say, 'Mr. Jones, have you had this before?' And he says, 'Oh sure, been on it for years.' But then I reach into the bag and pull out a bottle of birth control pills."

Pharmacists in general also lament that their patients use multiple pharmacies to fill their prescriptions; as many as 48 percent, according to the 2007 Pharmacy Satisfaction Digest.

"You have part of their profiles over at the other store and the rest of it's at your store," one pharmacist explained. "It makes it complicated to find out what medications they are on—it's definitely a problem."

Overall, about 59 percent of pharmacists say that their chains conduct compliance mailings, and many are also doing telephone reminders—some automated but some performed by an actual pharmacist in the store. In general, chains are dealing with a three- to 10-day window before the systems initiate a reminder call.