If you’ve visited a big-chain pharmacy recently you may have experienced massive delays in filling your prescription. Promised wait times of 15 minutes are a thing of the past. You’re lucky if you’re able to pick-up your prescriptions the same day, and even luckier if the pharmacy is open when you show up.
Many patients in Kansas City and the surrounding areas were unlucky when at least a dozen CVS Pharmacies were forced to close due to a pharmacist walkout that started approximately 2 weeks ago. While CVS and its customers were upset, many pharmacists and technicians rejoiced. To my knowledge, this has been one of the largest, organized walkouts carried out by pharmacists to date. After years of unsafe staffing, increased COVID-19-related responsibilities, massive burnout, and mounting frustrations over the lack of long-term solutions from big-chain pharmacies, many community pharmacists and technicians are finally overcoming their fear of retaliation, and taking matters into their own hands. The goal is not to demand more pay or vacations, but to call for more resources to best serve their patients.
A Pharmacy Pot Waiting to Boil Over
Unsafe working conditions at chain retail pharmacies that put employees and patients in harm’s way aren’t new. Each year in the U.S., an estimated 7,000 to 9,000 people die as a result of a medication error. Hundreds of thousands more experience, but may not report, an adverse drug reaction or other complications. In California alone, an estimated 5 million pharmacy errors take place annually.
I got a taste of this when I first started working as a pharmacy technician 10 years ago. Pharmacy technicians are essential to running an optimal pharmacy operation. Technician responsibilities include data entry of hard-copy and e-prescriptions, counting medications, collecting documentation for controlled substances, processing insurance claims, coordinating with doctor’s offices to complete prior authorizations, requesting refills, working the drive-thru, ringing customers out — you get the point, but the list goes on. And all this while maintaining good customer service.
Pharmacists, meanwhile, do much more than just “slap a label on it.” As medication experts and the last line of defense to ensure patient safety, they’re responsible for screening every prescription and verifying the five rights: right patient, right drug, right dose, right timing, and right route of administration. If there are any issues, they must reach out to the provider to clarify. After pre-verification and double checking that the technician input the prescription correctly, the technician then fills the prescription, and the pharmacist performs a final verification to ensure there are no contraindications or other concerns. Other pharmacist responsibilities include transferring and receiving prescriptions over the phone, counseling patients, maintaining an accurate medication and controlled substance inventory, and ensuring compliance with laws and board of pharmacy regulations. Unless you are at a high-volume store, it is common to only have one pharmacist staffing the pharmacy at a time, making it impossible to leave for even a bathroom break during a very long shift. This was all true even before the pandemic, which added even more responsibilities to an already burnt out pharmacy workforce.
A Boiling Point: The Walkouts
Multiple attempts at an organized, nationwide walkout failed between 2020 and 2022. These walkouts were largely communicated over social media and Reddit, and despite anonymous tips, they were never covered on national news.
Now, the momentum may be shifting, thanks to a few brave pharmacists fulfilling the Oath of the Pharmacist to ensure high quality, safe care for all patients. The recent walkouts began with a few pharmacists on Thursday and Friday, September 21 and 22. Despite CVS sending Chief Pharmacy Officer Prem Shah to meet with the pharmacists the following Tuesday, no agreement was reached, and another round of walkouts took place on Wednesday, September 27. Ironically, Pharmacy Workforce Suicide Awareness Day took place the day before the initial Kansas City pharmacists walkout.
For insight from someone in close contact with Kansas City CVS pharmacists after the walkout, I spoke with Bled Tanoe, PharmD, a hospital pharmacist in Oklahoma who previously worked for Walgreens. She is the creator of #pizzaisnotworking, a movement aimed at bringing public awareness to the unsafe working conditions pervasive in big-chain retail pharmacies, and the main public relations contact for a team of anonymous state pharmacist leads who advocate for local change.
Tanoe shared her advocacy group’s official statement: “The Kansas City walkout was independently planned by local pharmacists, separate from #pizzaisnotworking. However, their bravery advocating for more resources from a Fortune 4 company like CVS is a revolutionary moment in pharmacy. It’s a reminder to all pharmacists and technicians that the power is in their hands. It’s shined public light on the fact that many pharmacists have been acting in fear and they are no longer willing to accept working conditions that put themselves and their patients in harm’s way. It’s crucial to take advantage of this momentum while there is still national media coverage.”
Tanoe is a much-needed buffer for pharmacists (like myself) who want to help the movement but must remain anonymous to protect their job. I believe this fear is part of what has enabled chain pharmacies to perpetuate unfair working conditions. Until now.
Following the walkout, many pharmacists were stunned at the radio silence from the American Pharmacists Association (APhA), the only pharmacy organization that represents all sectors of pharmacy, including retail. It wasn’t until late Tuesday night, September 26, 6 days after the initial walkouts and the day before the even larger walkout on Wednesday, that they issued a press release.
Many pharmacists Tanoe spoke with feel the press release fell short of the APhA mission to support pharmacists. Despite the fact that the headline statement offers support for the Kansas City pharmacist walkouts, not once does it explicitly mention unsafe staffing or name any specific pharmacies. According to Tanoe, it communicates to those involved in the #pizzaisnotworking movement that they cannot fully rely on the support of APhA to represent them.
This was in stark contrast to a statement released by APhA earlier this year. Interim executive vice president and CEO Ilisa Bernstein, PharmD, JD, was quoted in a well-received, supportive press release that called out what many pharmacy staff felt was truly contributing to big-chain staffing issues: “It is incorrect to say that there is a shortage of pharmacists or pharmacy technicians. More accurately, there is a shortage of pharmacists and technicians willing to work under the current conditions.”
A Revolutionary Moment in Pharmacy
Kansas City pharmacists pulled off what many pharmacists and technicians have only dreamed of but never followed through on for what many express as fear of retaliation. As a pharmacist and someone who’s been closely following pharmacy advocacy accounts across social media for the last 3 years, I believe these walkouts have created an inflection point. Pharmacist and technician sentiment seems to have changed. More pharmacy staff are willing to speak up on behalf of their patients and bring more needed change than ever before.
However, unlike professionals in some other industries, pharmacists are not unionized on a large scale. Previous attempts at unionizing have largely failed. Shane Jerominski, PharmD, created a GoFundMe page years ago to help lead pharmacy unionization. Before the Kansas City walkout, small and infrequent donations were common. Now, more than $50k has been raised.
While CVS did eventually issue an apology and promise to make changes to improve working conditions, this doesn’t solve the broader issues in many big-chain pharmacies. Systemic changes are needed. To be sure, more walkouts are expected. According to Tanoe, a walkout from Walgreens is already being planned for October.
This is a rare and revolutionary moment in the pharmacy profession. These strikes reinforce how committed pharmacists and technicians are to protecting their patients’ safety in the long-term. It shows pharmacists and technicians will no longer accept short-term fixes or empty promises. It is crucial that big-chain pharmacies, pharmacy organizations, and the pharmacy workforce they represent recognize that these walkouts will continue to grow in frequency and size unless they can work together to tangibly improve pharmacy working conditions nationwide. APhA and other pharmacy organizations will be critical in ensuring these changes stick.
In the meantime, we can all expect even longer wait times at the pharmacy counter.