Pharmageddon: Too Few Pharmacists + Too Much Work = Dangerous Errors Impacting Customers

Shortages of pharmacists are causing booming workloads and increasing errors, resulting in mistakes that can severely harm pharmacy customers. Your local pharmacy may mistakenly provide you with medications that do nothing to help your medical condition but give you severe and life-threatening side effects. You may also receive the wrong instructions, so you take so little medication it has no effect or so much you suffer injuries.

The issue’s become so acute that as many as 4,500 pharmacists and pharmacy technicians from multiple chains, including CVS, Rite Aid, and Walgreens, walked off the job in a joint action in October, according to USA Today.

Pharmacy Mismanagement Harms Customers

California is a case in point for a nationwide problem. The Los Angeles Times reports that:

• The American Public Health Association estimates US pharmacies make about 54 million dispensing errors each year, with 2.3 million potentially causing harm
• California pharmacies commit about 5 million errors annually, reports California’s Board of Pharmacy. This is an estimate because pharmacies aren’t required to register errors with the state
• Most mistakes the board learned of occurred at chain pharmacies such as CVS and Walgreens
• Pharmacists at these businesses may fill hundreds of prescriptions each day while performing other work
• In a 2021 survey of California licensed pharmacists, 91% of those at chain pharmacies responded that staffing wasn’t high enough to provide adequate care. Just 62% stated stores followed rules mandating mistake disclosures to customers

Some of the mistakes reported include:

• A customer was given a powerful steroid that can cause bone damage instead of a heartburn drug
• A pregnant customer fell after she received two medications prescribed to someone else
• A pharmacist gave the wrong instructions for anastrozole, which treats breast cancer. The customer was told to take half a tablet twice a day instead of twice a week. As a result, she suffered adverse side effects

Sometimes, customers take the wrong prescriptions for months. 

In response to the allegations, CVS told the Times that, “Patient safety is our highest priority.” They claim that after they learn of an error, they “care for” the customers and take steps to correct it. Walgreens stated they have a “multi-step” process with “numerous” safety checks to reduce the chances of an error. After they learn of one, they claim they’ll find the cause to try prevent it from happening again.

Pharmacy Mistakes Can be Fatal

As many as 9,000 people in the US die annually due to prescription errors, according to one study. Deaths due to pharmacy errors make up more than 10% of malpractice claims filed against pharmacists, according to a 2019 report by two insurance companies. The leading cause of fatalities in these cases is overdoses. Drugs’ dosage strengths were too high, or instructions mistakenly told customers to take more medications than they should have.

Pharmacy Staff are Doing More in Less Time

CVS, Rite Aid, Walgreens, and Walmart have cut pharmacy staffing levels while giving staff additional duties. Ten years ago, stores may have had two pharmacists and six pharmacy technicians filling 500 prescriptions daily. Staff may now be half that. There are higher prescription levels, plus vaccine appointments, rapid tests, and patient phone calls.

Tasks are timed and measured against goals that emphasize speed and profits. Staff who don’t meet expectations can face discipline, reassignment, or termination. Daniel A. Hussar, a professor who taught at the Philadelphia College of Pharmacy for 52 years, said pharmacists are treated like fast-food employees,  pressured to upsell customers and race through orders. Hussar said this causes common, sometimes fatal mistakes.

The pharmacy industry deals with increasing drug costs, changing consumer habits, online competition, and decreasing revenues caused by pharmacy benefit managers (PBMs). They manage health insurers’ prescription drug programs and have cut retail pharmacies’ profits to the point about 70% of prescription medications are sold at a loss.

These middlemen negotiate with manufacturers on drug prices, decide the drugs covered by insurance plans, and set reimbursement rates for pharmacies buying and selling the drugs. Over time, PBMs demanded higher rebates from manufacturers and pocketed more savings instead of passing them to pharmacies and customers.

Over the past decade, the US has lost more than 3,500 locally owned pharmacies, according to the National Community Pharmacists Association, which is made of independent pharmacies. Now, big chains are following that trend. CVS, Walgreens, and Rite Aid recently announced the closure of hundreds of pharmacies. Rite Aid filed for bankruptcy in October.

With independent pharmacies disappearing, their customers are going to chains, which are losing money on prescription sales and putting more pressure on employees to do more in less time, creating situations where mistakes are inevitable.

Ex-Lexington Pharmacist Fills Out Prescriptions While Miscarrying Child

According to USA Today, Wendy Lear, a former Lexington pharmacist, is an example of what pharmacists face, and indirectly, the cause of many pharmacy mistakes. She started with CVS in 2009 after the chain bought her employer, an independent pharmacy.

Initially, CVS employed enough pharmacists to handle the workload. Over the years, they cut staffing while adding work to those who stayed:

• Lear claims she worked while miscarrying her first child because her boss couldn’t find a replacement and begged her to work. She talked to customers on the phone and filled out prescriptions while she bled and cramped until she had to lie down on the floor
• Another time, she was sick with norovirus and vomiting in a trash can behind the pharmacy counter. Management asked her to work until a replacement could be found. She reached the point where she couldn’t continue, texted her boss she was leaving and closing the pharmacy. Lear was told to keep it open and have the store manager (not a pharmacist) care for patients, which, according to Lear, is illegal

Lear said her job demands became too intense, and the risks of errors were too great (especially if she was the only one in the pharmacy). She left CVS in 2021 and now works for an independent pharmacy in Virginia.

Why Not Just Hire More Pharmacists?

Thousands of retail pharmacists left the industry during the first two years of the pandemic, according to data from the Bureau of Labor Statistics, which reported a 6% drop in employment numbers between 2019 and 2021.

Thousands left the industry during the COVID-19 pandemic, but those numbers have rebounded. Those intelligent and ambitious enough to earn a Ph.D. to become a pharmacist have many options. Given how stressful the job has become, would-be pharmacists are going elsewhere.

Applications to US pharmacy schools dropped almost 70% from their peak in the fall of 2009 to the fall of 2021, according to the American Association of Colleges of Pharmacy. Pharmacists were coming out of schools at nearly 15,000 a year at their peak. That’s expected to drop to about 11,000 by 2025.

The US is facing the prospect of fewer, overworked pharmacists increasingly pressured to do more in less time to boost pharmacy revenues, creating the conditions that can lead to more mistakes when an aging population will need more medications while fewer people become pharmacists.

Are You or a Loved One Injured by a Pharmacy Mistake?

If you or a family member are injured due to negligence by a pharmacy or pharmacist, we can help. Call the Fleck Firm at (270) 446-7000 or complete our online contact form to schedule a free consultation. We’ll discuss what happened, your injuries, how Kentucky law may apply, and your best options. Insurance companies have lawyers. You should have one, too.