‘Pharmageddon’: The Pharmacy Labor Crisis

Derick Alison
Derick Alison
15 Min Read

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    Jeremy Faust is editor-in-chief of , an emergency medicine physician at Brigham and Women’s Hospital in Boston, and a public health researcher. He is author of the Substack column Inside Medicine. Follow

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    Emily Hutto is an Associate Video Producer & Editor for MedPage Today. She is based in Manhattan.

In this Instagram Live clip, Jeremy Faust, MD, editor-in-chief of MedPage Today, and pharmacist Shane Jerominski, PharmD, the activist behind The Accidental Pharmacist, discuss the recent progress toward unionization among pharmacists and pharmacy technicians.

Watch part 1 of this interview here.

The following is a transcript of their remarks:

Faust: Let’s talk a little bit about the workforce issue. [There’s] a sense that people are banding together to say, look, we have to advocate for our own work conditions, not just for the wellness of the profession, but also for the safety of the patients. Can you tell us about some of the walkouts and labor movements that are cropping up?

Jerominski: Yeah. The reason why this got so much traction was — it really all goes back to the Kansas City walkouts. And for those of your viewers that don’t know or haven’t followed this at all, that was the flashpoint that really caught the media’s attention and helped the pharmacy community coalesce around the idea that we need to do something for patient safety and for quality of life and working conditions within retail pharmacy.

The Kansas City CVS/Target Channel is where this all started. There were organizers within the CVS/Target Channel in the Kansas City metro area that decided they were going to do something about the working conditions. What happened was that technicians were only given 20 hours a week. So each of these stores, even though they’re open 64 hours a week, they were only given 20 technician hours total, which means that’s a pharmacist by themselves the bulk of the time that this store is open.

Because CVS is considered very low volume — they’re not CVS’s priority. If it was up to CVS, I think they’d probably close half of [their pharmacies] or more. The problem is that even if you’re considered low-volume with 100-150 prescriptions a day, you still have all those vaccinations. That’s one pharmacist.

All they have to do is get stuck with an insurance issue, need to devote 15 minutes to this patient who’s getting released post MI or something like that, where they have a bunch of new medications and they need to be counseled about it. That alone backs up the pharmacist to the point where it’s unsustainable. You can’t have one person doing that, so they should never be left alone. But in a lot of states, it doesn’t matter. As long as there’s a pharmacist there, they’ll stay open. It’s a bunch of pharmacists working by themselves.

So they decided to come together and say, we are going to walk out because we need help. The two organizers got 24 stores in the Kansas City metro area to decide to walk out, and it got a response from CVS corporate that most pharmacists and technicians were frankly surprised by.

They flew out Prem Shah, the director of pharmacy [Editor’s note: Shah is the executive vice president and chief pharmacy officer for CVS Health], and their head of HR to Kansas City to sit down with these pharmacists and talk to them and see what they could do to get them to go back to work and to make working conditions better. They actually got a few concessions from CVS.

The problem is, with pages on the internet, now CVS wanted to play this off like it was very specific to this market. I put everything out onto my page immediately, and so did all these other networks and people that we work with for pharmacy pages and healthcare pages, and people were able to combat the rhetoric that this was just localized to the Kansas City market.

People were coming to the page and saying, no, this is happening in Texas, this is happening in Connecticut, this is happening everywhere. So, it’s not specific. This is widespread, not just at CVS, but across all retail pharmacy chains. This is the standard of care and it’s unsafe for patients.

More media attention built. My job at that point was just really to help put the information out there. It was utilizing all of my connections to make sure that it was going everywhere. And then it just built to Pharmageddon where I was one of the main organizers of this trying to say, this is across every platform. It’s not CVS specific, it’s not Walgreens. We’re going to do this together.

The end game for me was always to try and unionize. I’d been raising money for the last 2 years to try and explore the idea of national unionization or an organization that would really be focused on bettering pharmacists’ working conditions and technician working conditions. I raised about $23,000 before Kansas City, and that money had been sitting there for such a long time.

The organizers reached out to me and said, “Some of these technicians here want to support us, but they don’t want to lose out on 8 hours since they’re only getting 20 hours a week to begin with.” So I said, why don’t we pay them wage assistance from this money that I raised? And these technicians were being super honest, and that’s why the focus of my platform has been better pay for technicians to keep the good ones, because that’s really the key component here. They were being so honest in saying, “I’ve only worked 6 hours this week, but I’m going to make $16.50 an hour.” And I said, “Well, you’re getting a living wage today at $25 an hour, and we’re paying you for 8 hours.”

As soon as we started doing that, we went from $23,000 raised to $64,000 raised in the matter of a month and a half. We have paid out wage assistance to over 175 technicians, now, all over the country during Operation Spotlight and during the Kansas City walkouts.

Faust: Just to be clear, this was kind of informal in that this walkout wasn’t a union thing. It’s almost like it’s the power of collective action even without the organization.

Jerominski: A fancy word for it or the historic word for it is a “wildcat strike.” Essentially, you’re trying to do something that normally happens under the protection of unionization, and that’s why Walgreens and CVS were trying to play it off like it had very little impact on our stores.

These were people that were risking their job to say that, so the fact that over 200 people participated and 390 shifts were canceled during a 3-day walkout — that was from Pharmageddon, those were our rough statistics from this exit survey that everybody didn’t participate in. That’s still a lot of people. We had a poll earlier and 4,500 people wanted to participate, but a lot of them backed out because of those concerns about losing their job.

Faust: Which is pretty impressive.

Another thing that I just think is interesting is that it would be very easy to sort of say, oh, this is one bad apple. But you have the bigger picture in mind. I feel like every other week there’s an airline that gets named and shamed for some terrible behavior, and everyone says, “We’re going to boycott this airline,” and then 2 weeks later it’s the next one. It’s like all evened out because everyone’s terrible.

It’s sort of the same thing here. You’re not going to say, oh, it’s just this one bad apple. It’s a canary in the coal mine for the system that needs to be fixed. I think the experience is that there’s momentum there.

So, what is happening? Is there a movement for unionization?

Jerominski: Yeah. After that, my end game was always to try and have some kind of national push for unionization, because that is the cycle. We have media attention on it, there’s been lots over the years, but then Walgreens and CVS and companies like that are big enough to wait it out, and the public forgets about it. The outcry goes away, and we all do business as usual.

So I’ve been talking to unions for a while — UFCW [the United Food and Commercial Workers Union], Kaiser, and IAM Healthcare. The director of IAM Healthcare and I have been in contact for over 2 years, since I started raising money for unionization.

After all of the [walkouts], we had lots of media attention. I was on the television a couple times. Because of that, IAM was ready to take the plunge and say, okay, this is not just a group of a few people that have some followers on the internet. These people are serious about change. So they decided to put some resources to it and create the Pharmacy Guild, which is under the umbrella of IAM Healthcare, which is under the umbrella of IAM.

IAM, I should say for people who don’t know, is the International Association of Machinists and Aerospace Workers.

Faust: There are organizations that sort of oversee everything. We have emergency physician groups and pharmacy groups. What’s their take? And from like — I was going to say big pharma, but that’s not what I mean — what I mean is from the governing bodies that look after the profession, how do they feel about this movement?

Jerominski: So APhA [the American Pharmacists Association] took a great stance during the walkouts, saying that they support pharmacists’ effort to make practicing in these environments safer. They haven’t really come out formally and said anything about the Pharmacy Guild. We just launched last week.

Basically all we’re doing now is collecting people who are interested in exploring unionization, but also there’s going to be an organizational component to this that seeks to have regulatory reform and a legislative component to it to try and demand change through legislation.

I can say that the response from the pharmacist community has been huge — 30,000 people went to the site in the first few hours it launched — it actually crashed the page on the first day and it briefly crashed the page for about 15 minutes on the second day. I’m not at liberty right now from IAM to tell you exactly how many people have signed up, but the numbers are overwhelming and there’s a lot of work to do.

They actually allocated even more resources toward this. So they’ve made a big investment in attorneys, economists, and a communications department. There’s a lot of work to be done, but this is the biggest response they’ve had to try and organize anywhere before. So they’re excited about it, as am I.

What it looks like in the future and what response we get from our national organizations like NCPA [the National Community Pharmacists Association] and APhA is yet to be seen. I have a great relationship with APhA right now. Dr. Hogue [Michael Hogue, PharmD, CEO of the APhA] is doing some great things and he’s taken a really bold response to all of this and taken the side of pharmacists, even if they are, I wouldn’t say beholden, but they have big corporate sponsorships from companies like Walgreens and CVS. So to do something that’s really siding with the pharmacists, I have to applaud them.

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