How often during your field sales activities do you stop to check in with retail pharmacists? In fact, how often do you even think about retail pharmacists?

If you answered "very often" to both of those questions, you probably know how to take advantage of the retail pharmacist as a key resource to help drive prescription volume.

If your response was "Hmmm," you are missing out on a treasure trove of information about your products (and competitors) and you are overlooking a key link in the pharmaceutical sales chain.

So let's take some time to examine the retail sector. Read on and you will learn about some of the key responsibilities of retail pharmacists in today's managed care environment and why retail pharmacies belong on your call schedule. Specifically, you will find out how regular visits to retail pharmacies can help create mutually beneficial relationships.

Payers influence retail activity

When planning pharmacy calls, it's important to understand the degree to which payers influence activity at the retail counter. In today's world, managed care organizations — as well as Medicare and Medicaid — often limit physician prescribing autonomy, and all of these payers use a number of cost-control tools to encourage the utilization of preferred products. These tools include formulary tier structures, patient copayments, point-of-service edits, generic and therapeutic substitution, prior authorization, and step therapy.

All of these factors are frequently addressed at the retail pharmacy. In fact, in many states, pharmacists participate in collaborative drug therapy management agreements (see sidebar), which give them wide latitude in influencing product selection.

For these reasons alone, it is essential for sales representatives to include retail pharmacists in their selling activities.

The pharmacist's role

Let's start with the basics: how the retail pharmacy fulfills a prescription order.

Authorized

A patient shows up at the pharmacy counter with a prescription from a physician. Or perhaps the prescription is called in or faxed. However the prescription originates, the adjudication and fulfillment processes are essentially the same.

After reading the prescription order, the pharmacist checks the computer for the patient's personal and health plan information, drug interactions and allergic concerns, the product's formulary status, the cost of the drug, and the patient copayment. This information from the managed care organization (or other payer) advises the pharmacist on whether to dispense the prescription as written, automatically substitute another product, contact the physician and recommend a substitution, or consult with the doctor about therapeutic alternatives.

In situations where a health plan has an automatic therapeutic substitution policy in place, a doctor can typically override the rule by writing "dispense as written" (or "DAW") on the prescription order. A physician may also issue a DAW directive if an insurer imposes dosing limits on a product and the physician wants a patient to receive a larger dose.