By Sahar Chmais
Amazon has taken over many business services, from technology to groceries; but they have added on a new business venture – Amazon Pharmacy.
Amazon’s convenient service has been an expanding crutch during the COVID-19 pandemic, where the company’s profits grew in the billions while small businesses have been shutting down left and right.
When Amazon announced its pharmacy feature, big box pharmacies like CVS instantly saw a drop in their stocks. If large corporate names have felt the negative financial effects of Jeff Bezos’ newest brain-child, what should happen to local pharmacies?
There are some things that local pharmacies believe Amazon cannot do for local patients the way a local pharmacist can, because at the end of the day, a pharmacist is a healthcare specialist and not just a dispensary. Local pharmacies have also had to withstand the takeover of the larger pharmacies over the years and drug discount cards. But the bigger pharmacies might have a larger threat on their hands than the local pharmacies.
“I have strong opinions on mass retailers getting involved in healthcare,” said pharmacist and owner of the Buda Drug Store, Tammy Gray. “Those are two different types of business; healthcare versus retail. Having a license and inventory doesn’t fulfill the need to give individual care and availability of pharmacists for patients to ask questions.”
The role of the pharmacist is much larger than counting the pills, bottling them and giving them out. In many cases, Gray said, a pharmacist knows his or her patients, and know that more than one doctor may be prescribing medication, and if a pharmacist is paying attention, might catch dangerous medicine interactions.
“It’s fairly common we will have a prescription come over from a doctor for medication that interacts with medication from another doctor,” Gray told the Hays Free Press/News-Dispatch. “We recently had one which would have led to an adverse reaction and more than likely landed the patient in the hospital. We called the doctor and asked them if they knew the patient was on this other medication – they did not.”
Then there are other cases where a pharmacist can notice a pattern that could lead to drug dependency or addiction.
Opioid medication can be a very beneficial and useful drug, said Jim Martin, pharmacist and owner of Martin’s Wellness Dripping Springs Pharmacy. But these medications have caused an epidemic in their misuse and have landed many pharmaceutical companies in billion-dollar lawsuits due to misleading information on their addictive nature.
“As part of what local pharmacies do, we monitor the use of a patient’s opioids,” Martin said. “There are plenty of reasons to take them, but plenty of reasons they can be taking them wrong. That’s something a relationship provides; we can have that conversation of ‘you’re taking too many pills and you need to talk to your doctor.’ Many times we help patients get off of strong medications.”
Martin said that oftentimes, a patient will have surgery, use opioids, but because these drugs have a strong addictive nature, the patient will get hooked on it without realizing.
While Amazon will not be able to send out Schedule II drugs, which are categorized as highly-addictive medications, as are “most opioids,” they will be able to send out other medications that can be addictive. These include: tramadol, a synthetic opioid, acetaminophen with codeine or codeine, sleeping pills, benzodiazepine medications such as alprazolam, commonly known as Xanax and more. All of these medications are classified as addictive, but not as addictive as Schedule II drugs.
The worry in having these medications sent to a household and dropped off at the doorstep is anyone can have access to the drugs, which might be misused, Martin explained.
Gray added that deliveries get dropped off at the wrong address sometimes. And sometimes people steal packages off of a doorstep. What is the protocol then, when medication lands in the wrong hands?
There is also an issue of having a medication out in delivery trucks which cannot withstand extreme weather, such as the Texas heat. Gray worries about what will happen to the medications that have high chemical instability and how these conditions can alter their nature.
Both Gray’s and Martin’s pharmacies deliver to people’s homes; this service was brought on after COVID-19 as a safety precaution for patients. But the process with these pharmacies is more verified.
Anyone who receives medication has to be the patient or an agent the patient has put in charge of getting the prescription. The medication also does not sit in a delivery vehicle for long hours.
Amazon does pose as a threat to these local pharmacies and even big box pharmacies, but this is not the biggest threat local pharmacies have faced.
Big box pharmacies, such as Walmart, H-E-B, CVS, Walgreens and more did the most damage to places like Buda’s Drugstore and Martin’s Wellness Dripping Springs Pharmacies. The big pharmacy model is based off of some financial loss in the healthcare service, but they make up for it through the grocery and household items they sell, Gray explained. This is something she had experienced first-hand from working in a big box pharmacy before opening her own store.
The other big detrimental hit many local pharmacies took is from drug discount cards. These cards are not coupons, Gray said. They are discounts that pharmacists are responsible paying for. Large stores like H-E-B will participate in these programs, because they know that people will walk in and buy from the store. Many local pharmacies cannot afford to lose that much money and cannot make up the costs in selling other goods.
The danger in these cards, besides undercutting profits for pharmacies, is that a lot of times they take patient information, Gray said.
“It’s an avenue to collect data,” Gray stated, “and data is valuable to these companies because they can turn around and sell that to numerous entities.”
Amazon has partnered with Inside RX, which will give uninsured patients discounts on medication. According to Amazon, Inside RX provides Amazon with information about purchases made at participating pharmacies, yet they state that they “do not collect personally identifiable health information from Inside RX.”
Even with its discounts, convenient service and a growing patronage, Gray and Martin persist in their methods and their paths.
Martin said that many of his customers are small business owners and they continue to use his pharmacy because they value that relationship and the hard work of a small business. Gray is in a similar position as Martin with her customers. She acknowledges the new challenges, but trusts in her patients.
“It will affect me,” Gray said, undefeated. “But I think it will affect the big boxes more. I’m a little fish in a big sea. My people are my people. I have patients that drive from San Marcos or Lockhart to come see me. They come here because of us — thankfully that’s important to some people.”