Over the Counter: A Peek Behind the Counter of Your Pharmacy

Susan Heuchert
October 1, 2016
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Ever wanted a peek behind the counter of your pharmacy? Let me give you a tour and an idea of what three decades as a pharmacist has shown me. Because my recommendations as a newly minted pharmacist are, in many cases, quite different from my recommendations today.

Changing Tide

To set the scene, let me give you a little history. When I first decided on pharmacy as a career, my goal was to help people understand what their medication was for, how to take it correctly and what possible side effects they may encounter.

Peek Behind the Counter of Your Pharmacy

Take a peek behind the counter of your local pharmacy.

Some side effects are temporary and will go away as the person continues to take the medication. Some are warning signs that the medication doesn’t work well for a patient. We were also regularly asked for recommendations about over- the-counter (OTC) medications.

I loved helping people find just what they needed after some careful questioning. It was a well-respected profession, usually at the top of surveys as the “most trusted professional”. Life was good. All that chemistry was worth it.

Over the years, it was up to the pharmacist to watch for drug interactions as best we could because in the 80s, pharmacies were just beginning to utilize computers. Up to that point, many pharmacies kept a written list of people’s medications so the pharmacist could visually check for problems.

This wasn’t much of an issue because we had a smaller percentage of customers with more difficult profiles (a list of their medications) and there weren’t as many ongoing medications for chronic conditions.

And most of the drugs were very familiar because new drugs became available on the market very slowly, at least by today’s standards. Oh, how the times have changed.

Advent of Generic Drugs

Peek Behind the Counter of Your Pharmacy

The advent of generic drugs changed the face of medications.

Years ago, few generic drugs were available because brand-name manufacturers held a 17-year patent to recoup the money they spent on research and development. I believe that was fair because the process of bringing a new drug to market is incredibly expensive.

Today, new generics regularly arrive in the pharmacy, a few every month or so. Are all those generics safe? I believe they are because the pharmacy team can access a resource called the “orange book” to check which manufacturer’s product passes equivalency tests. That eliminates inferior products as long as they use that reference.

What I found interesting is the generic version often is released by the brand-name manufacturer just before the patent expires so they can capture the generic market before other manufacturers.

Upjohn did that when they lost the patent for Xanax. Under the name of a company called Greenstone, they released the generic version, and it was the only generic available for months.

Another interesting fact is that different companies will use different fillers and binders to add to the active ingredient. This is generally no problem unless you react to the most commonly used lactose and corn starch.

You see, once a generic is available, many insurance companies will no longer cover the brand-name drug. Patients have to go through the extra step of requesting the doctor and pharmacist for an exception. Sometimes it works; sometimes it doesn’t. Try the generic first. If you cannot tolerate it, then it’s worth it to pay for the brand name.

Prescription Drug Explosion

Over the past 15 years or so, I notice more medications are prescribed and more changes in health care occur. People get their prescriptions from emergency rooms, walk-in clinics, hospitalists and primary care physicians.

It seems doctors today write  more prescriptions than ever. One reason is the endless stream of advertising by the pharmaceutical companies directly to the consumer.

It gets worse. Often, if someone has a side effect to a medication, the doctor will prescribe another medication to offset the side effect.

I have often talked to other pharmacy professionals about our education. We learn how the body functions and the chemistry. But once you become a professional, the emphasis changes to what drugs do in the body, how they work, how they help. We fail to ask WHY the body is not producing that substance anymore or WHY it is producing too much of another.

Impact of Chronic Illness

I often comment to my colleagues that I am disturbed by the increase in cancer, obesity, diabetes and other chronic illnesses and how these diseases affect younger and younger people.

There is an explosion of diabetic devices hitting the market. Don’t get me wrong, I think free enterprise is great and I’m happy there are so many options. But I am shocked at how quickly newer devices are hitting the market.

After spending my career behind the pharmacy glass helping patients with medications that address more chronic illnesses than ever, I personally believe the environment we live in is a significant contributor. From fast foods to household cleaners laced with ingredients that are tough for even a chemist to pronounce, people are becoming sicker.

We’ve become a society desperate for convenience. Knowing there is a ready market, manufacturers comply. Meanwhile we keep making room on the pharmacy shelves for the latest device or drug, shaking our heads and wondering what is next.


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