Pharmacies in the United States

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There are approximately 88,000 pharmacies in the United States. Over half (about 48,000) are located within drug stores, grocery stores, hospitals, department stores, medical clinics, surgery clinics, universities, nursing homes, prisons, and other facilities. The remaining pharmacies are considered to be independent or privately owned. The top 25 pharmacy chain stores represent about 38,000 pharmacy locations in the U.S. and employ about 149,000 on-staff pharmacists. California has 8,015 pharmacies, the most of any state. Texas, Florida, New York, and Pennsylvania round out the top five states for pharmacy locations. [1] Nationwide, the number of community pharmacies increased by 6.3% between 2007-2015, and the number of pharmacies per 10,000 people (2.11) did not change. However, the number of pharmacies per-capita varies substantially across counties, ranging from 0 to 13.6 per- 10,000 people in 2015. [2]

Contents

Patient care services

Access

Community pharmacies offer basic preliminary health assessments in addition to dispensing prescriptions. The community pharmacist is considered to be the most accessible healthcare professional to the general public, as they are available to anyone on a walk-in basis. [3] Approximately 9 out of 10 Americans live within 5 miles of a community pharmacy. [4]

Dispensing prescriptions

The primary role of pharmacies in the US is to safely and accurately fill prescriptions ordered by healthcare providers for patients. The pharmacy may receive a prescription in many ways, including a hardcopy, verbally over the phone, or electronically from the provider's electronic medical record system (EMR) is linked to the pharmacy. [5] Upon receival, the pharmacy staff first verify or update the patient's profile in the pharmacy computer system. The profile includes the patient's name, date of birth, address, phone number, insurance, allergies, conditions, etc., all factors that help ensure the correct patient receives the correct and appropriate medication in a safe manner. The prescription details typically consisting of the medication name, dosage form, instructions, quantity, day supply, refills, etc. are entered into the computer. The pharmacist checks to ensure the prescription has been entered accurately, any interactions between other medication therapies or conditions, and appropriateness of the therapy for the patient. Depending on the pharmacy's computer system, the claim is either submitted for payment to the insurance, discount card, or filled for the cash price either after the prescription is entered or after the pharmacist checks the order. The prescription is then filled and completed prescription is then checked again by the pharmacist. [5]

Drug utilization review

Part of the dispensing process includes managing a patient's therapy, including prescription drugs and over the counter (OTC) medications and assessing their appropriateness of the therapy for the patient - this is also referred to as drug utilization review (DUR). The DUR process is completed by the pharmacist. The process reviews a patient's drug order in a systemic and comprehensive review against predetermined criteria and compared against a patient’s or a population’s data records. The DUR process often utilizes computerized algorithms to perform key checks with known data, and the results of the algorithms are reviewed by the pharmacist. Common issues analyzed are appropriate prescription medications dosage, drug interactions, duplications or contraindications with the patient’s disease state or condition. Evaluation or interactions are often classified in the following categories: [6]

DUR can be performed in prospective, concurrently, or retrospectively. Prospective DUR review is when a patient's planned drug therapy is evaluated before a medication is dispensed. Concurrent review is performed during the course of treatment with ongoing drug therapy. A retrospective DUR reviews drug therapy after the drug therapy is completed. The retrospective review helps detect patterns in prescribing, dispensing or administering drugs, or following with any post-therapy issues. [6]

DUR is helpful for all areas of healthcare by providing feedback on therapy performance and outcomes. Therapy reviews highlight prescribing behaviors compared to pre-set criteria or treatment protocols. [6]

Immunizations

In the United States, all 50 states permit community pharmacists to administer immunization services, but regulations such as minimum patient age, types of vaccinations/immunizations, record-keeping, etc. differ from state to state. [7] In some states, such as Rhode Island and Idaho, certified pharmacy technicians with the necessary training may also provide immunizations. Pharmacists often require specific training and certification to legally be able to immunize in addition to their basic licensure. This generally includes annual or routine continuing education on eligibility criteria for specific immunizations, administration techniques, and cardiopulmonary resuscitation (CPR) or basic life support (BLS). [7] Community pharmacies contribute significantly to immunization rates as they offer expanded business hours, convenient locations, and lower costs compared to other healthcare providers. [8] Vaccinations may be given in community pharmacies either by a non-patient specific standing order or protocol from a licensed prescriber or a patient-specific prescription. [7] A standing order or protocol is frequently used by pharmacies as they permit assessment and vaccination of a patient without a clinician’s examination or direct order from the clinician. They prespecify the conditions in which a vaccine may be given: which populations may receive the vaccine, eligibility of patient, administration procedure, etc. [9] Most vaccinations provided by community pharmacies are given under standing order protocols, including flu vaccinations. [10] It is the pharmacist’s responsibility to screen patients to assess if a patient needs or should receive a particular vaccination when immunizing in a community pharmacy. [9] [8]

Pharmacy chains

The table below shows the top 25 pharmacy chains in the United States ranked by total number of pharmacists, according to the U.S. National Pharmacy Market Summary done by IQVIA in 2019. [1]

RankPharmacy chainHeadquartersPharmacistsStores
1 Walgreens Company Deerfield, Illinois 48,9869,323
2 CVS Health Woonsocket, Rhode Island 31,2359,600
3 Walmart Bentonville, Arkansas 15,3694,865
4 Rite Aid Corp Camp Hill, Pennsylvania 10,8692,721
5 Kroger Company Cincinnati, Ohio 7,5161,956
6 Albertsons Inc Boise, Idaho 6,1571,713
7 AmerisourceBergen Corporation Chesterbrook, Pennsylvania 4,8521,961
8 Publix Super Markets Inc Lakeland, Florida 4,7001,084
9 McKesson Corp Irving, Texas 4,5241,556
10 Costco Wholesale Corp Issaquah, Washington 2,179550
11 Cardinal Health Inc Dublin, Ohio 1,382518
12 Ahold Delhaize Usa Carlisle, Pennsylvania 1,380521
13 H E B Grocery Company San Antonio, Texas 1,310270
14 Meijer Great Lakes Limited Partnership Grand Rapids, Michigan 1,080238
15 Southeastern Grocers LLC Jacksonville, Florida 1,059327
16 Hy Vee Inc West Des Moines, Iowa 1,006249
17 Sears Holdings Corp (Defunct) Hoffman Estates, Illinois 945306
18 Kaiser Permanente Oakland, California 892131
19 Freds Inc (Defunct) Memphis, Tennessee 778301
20 Pharmerica Corp Louisville, Kentucky 61489
21 Giant Eagle Inc Pittsburgh, Pennsylvania 594204
22 Shopko Stores Operating Company LLC (Defunct) Green Bay, Wisconsin 574206
23 Ahold Delhaize America Salisbury, North Carolina 484170
24 Wegmans Food Markets Inc Rochester, New York 47988
25 Kinney Drugs Inc Gouverneur, New York 437113

Related Research Articles

<span class="mw-page-title-main">Over-the-counter drug</span> Medication available without a prescription

Over-the-counter (OTC) drugs are medicines sold directly to a consumer without a requirement for a prescription from a healthcare professional, as opposed to prescription drugs, which may be supplied only to consumers possessing a valid prescription. In many countries, OTC drugs are selected by a regulatory agency to ensure that they contain ingredients that are safe and effective when used without a physician's care. OTC drugs are usually regulated according to their active pharmaceutical ingredient (API) rather than final products. By regulating APIs instead of specific drug formulations, governments allow manufacturers the freedom to formulate ingredients, or combinations of ingredients, into proprietary mixtures.

<span class="mw-page-title-main">Pharmacist</span> Healthcare professional

A pharmacist, also known as a chemist or a druggist, is a healthcare professional who dispenses medications and who provides advice on their effective use, with the aim of preventing disease and promoting public health. Pharmacists often serve as primary care providers in the community, and may offer other services such as health screenings and immunizations.

<span class="mw-page-title-main">Pharmacy</span> Clinical health science

Pharmacy is the science and practice of discovering, producing, preparing, dispensing, reviewing and monitoring medications, aiming to ensure the safe, effective, and affordable use of medicines. It is a miscellaneous science as it links health sciences with pharmaceutical sciences and natural sciences. The professional practice is becoming more clinically oriented as most of the drugs are now manufactured by pharmaceutical industries. Based on the setting, pharmacy practice is either classified as community or institutional pharmacy. Providing direct patient care in the community of institutional pharmacies is considered clinical pharmacy.

<span class="mw-page-title-main">Medical prescription</span> Health-care communication from a physician to a pharmacist

A prescription, often abbreviated or Rx, is a formal communication from a physician or other registered health-care professional to a pharmacist, authorizing them to dispense a specific prescription drug for a specific patient. Historically, it was a physician's instruction to an apothecary listing the materials to be compounded into a treatment—the symbol ℞ comes from the first word of a medieval prescription, Latin: Recipere, that gave the list of the materials to be compounded.

<span class="mw-page-title-main">Prescription drug</span> Medication legally requiring a medical prescription before it can be dispensed

A prescription drug is a pharmaceutical drug that is only permitted to be dispensed to those with a medical prescription. In contrast, over-the-counter drugs can be obtained without a prescription. The reason for this difference in substance control is the potential scope of misuse, from drug abuse to practicing medicine without a license and without sufficient education. Different jurisdictions have different definitions of what constitutes a prescription drug.

An independent pharmacy is a retail pharmacy that is not directly affiliated with any chain of pharmacies and is not owned by a publicly traded company. Independent pharmacies are pharmacist-owned, privately held businesses in varying practice settings. They include single-store operations, pharmacist-owned multiple store locations, franchise, compounding, long-term care (LTC), specialty, and supermarket pharmacy operation. Independent pharmacy owners generally have more flexibility to build personalized customer relationships and they strive to differentiate their services from big-chain corporations.

IntercomPlus is the Walgreen Company's proprietary pharmacy computer system. It was founded as Intercom in 1981, and was the first large scale retail pharmacy computer system. It relies on VSAT satellite access and/or broadband connections to link the over 8,000 Walgreens retail, mail service, and specialty pharmacies. Through its usage, Intercom made Walgreens the largest private user of satellite transmission data in the world, second only to the U.S. Government. The design of the system enables seamless store-to-store prescription filling, making filling a refill at a location other than where it was filled originally essentially no different from filling it again at the original location.

<span class="mw-page-title-main">Thrifty White</span>

Thrifty White Pharmacy is an American pharmacy chain with operations in six states, Montana, North Dakota, South Dakota, Minnesota, Wisconsin, and Iowa headquartered in Plymouth, MN. The firm specializes in filling prescriptions, long term care consulting, community outreach, and specialty services. As of September 2016, Thrifty White received full URAC accreditation for its specialty pharmacy.

Pharmaceutical policy is a branch of health policy that deals with the development, provision and use of medications within a health care system. It embraces drugs, biologics, vaccines and natural health products.

A veterinary pharmacist is a specially trained pharmacist who dispenses veterinary drugs and supplies or products and advice to owners of companion animals and livestock. In addition, they advise the regulatory bodies and are involved in the formulation of veterinary drugs. Veterinary pharmacy is a field of pharmacy practice, in which veterinary pharmacists may compound medications, fill prescriptions, and manage drug therapies for animals. Veterinary pharmacists are licensed pharmacists who specialize in the distribution of medications for animals.

<span class="mw-page-title-main">Clinical pharmacy</span> Branch of pharmacy for direct provision

Clinical pharmacy is the branch of pharmacy in which clinical pharmacists provide direct patient care that optimizes the use of medication and promotes health, wellness, and disease prevention. Clinical pharmacists care for patients in all health care settings but the clinical pharmacy movement initially began inside hospitals and clinics. Clinical pharmacists often work in collaboration with physicians, physician assistants, nurse practitioners, and other healthcare professionals. Clinical pharmacists can enter into a formal collaborative practice agreement with another healthcare provider, generally one or more physicians, that allows pharmacists to prescribe medications and order laboratory tests.

<span class="mw-page-title-main">Pharmacy (shop)</span> Shop which provides pharmaceutical drugs

A pharmacy is a retail shop which provides pharmaceutical drugs, among other products. At the pharmacy, a pharmacist oversees the fulfillment of medical prescriptions and is available to counsel patients about prescription and over-the-counter drugs or about health problems and wellness issues. A typical pharmacy would be in the commercial area of a community.

Electronic prescription is the computer-based electronic generation, transmission, and filling of a medical prescription, taking the place of paper and faxed prescriptions. E-prescribing allows a physician, physician assistant, pharmacist, or nurse practitioner to use digital prescription software to electronically transmit a new prescription or renewal authorization to a community or mail-order pharmacy. It outlines the ability to send error-free, accurate, and understandable prescriptions electronically from the healthcare provider to the pharmacy. E-prescribing is meant to reduce the risks associated with traditional prescription script writing. It is also one of the major reasons for the push for electronic medical records. By sharing medical prescription information, e-prescribing seeks to connect the patient's team of healthcare providers to facilitate knowledgeable decision making.

Medication therapy management, generally called medicine use review in the United Kingdom, is a service provided typically by pharmacists that aims to improve outcomes by helping people to better understand their health conditions and the medications used to manage them. This includes providing education on the disease state and medications used to treat the disease state, ensuring that medicines are taken correctly, reducing waste due to unused medicines, looking for any side effects, and providing education on how to manage any side effects. The process that can be broken down into five steps: medication therapy review, personal medication record, medication-related action plan, intervention and or referral, and documentation and follow-up.

<span class="mw-page-title-main">Remote dispensing</span>

Remote dispensing is used in health care environments to describe the use of automated systems to dispense prescription medications without an on-site pharmacist. This practice is most common in long-term care facilities and correctional institutions that do not find it practical to operate a full-service in-house pharmacy.

Electronic Prescriptions for Controlled Substances (EPCS) was originally a proposal for the DEA to revise its regulations to provide practitioners with the option of writing electronic prescriptions for controlled substances. These regulations would also permit pharmacies to receive, dispense, and archive these electronic prescriptions. These proposed regulations would be an addition to, not a replacement of, the existing rule.

Separation of prescribing and dispensing, also called dispensing separation, is a practice in medicine and pharmacy in which the physician who provides a medical prescription is independent from the pharmacist who provides the prescription drug.

<span class="mw-page-title-main">Collaborative practice agreement</span> Egal relationship between clinical pharmacists and collaborating physicians

A collaborative practice agreement (CPA) is a legal document in the United States that establishes a legal relationship between clinical pharmacists and collaborating physicians that allows for pharmacists to participate in collaborative drug therapy management (CDTM).

<span class="mw-page-title-main">Pharmacy management system</span>

The pharmacy management system, also known as the pharmacy information system, is a system that stores data and enables functionality that organizes and maintains the medication use process within pharmacies.

<span class="mw-page-title-main">Drug utilization review</span>

Drug utilization review refers to a review of prescribing, dispensing, administering and ingesting of medication. This authorized, structured and ongoing review is related to pharmacy benefit managers. Drug use/ utilization evaluation and medication utilization evaluations are the same as drug utilization review.

References

  1. 1 2 "U.S. National Pharmacy Market Summary". OneKey by IQVIA. July 2019.
  2. Qato, Dima Mazen; Zenk, Shannon; Wilder, Jocelyn; Harrington, Rachel; Gaskin, Darrell; Alexander, G. Caleb (2017-08-16). "The availability of pharmacies in the United States: 2007–2015". PLOS ONE. 12 (8): e0183172. doi: 10.1371/journal.pone.0183172 . ISSN   1932-6203. PMC   5559230 . PMID   28813473.
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  6. 1 2 3 "Drug Utilization Review | AMCP.org". www.amcp.org. Retrieved 2021-01-15.
  7. 1 2 3 "The Community Pharmacist as a Provider of Immunizations". Pharmacy Times. Retrieved 2021-05-16.
  8. 1 2 "The Impact of Community Pharmacies on Immunization". Pharmacy Times. Retrieved 2021-05-16.
  9. 1 2 Vaccinating Adults: A Step-by-Step Guide. Immunization Action Coalition. 2017. ISBN   978-0-692-94976-4.
  10. "State Public Health | ASTHO". www.astho.org. Retrieved 2021-05-16.