It had the makings of a great day. The Pacific was calm, there was a light breeze and there were whales in the bay. Carrying a large net bag, I boarded an excursion boat that was going on a whale watching trip. An hour out, the excursion boat met up with a small skiff and four of us, dressed in wetsuits and carrying SCUBA gear transferred to the skiff and set out for our dive site. Along the way a whale surfaced close to us. We sat in the boat and looked up at the whale towering over us and swimming beside our little boat. We continued on, the whale swam away, and we arrived at our dive site, a seeming open area of water with small juttings of rock reaching past the water’s surface. Donning our gear, the divers all set on the gunwale and rolled backward into the chilly Pacific waters. We gathered just under the skiff, checked to make sure everyone was OK, and began our descent.
Ten feet down, the red light began to be filtered out by the water above us, thirty feet down more light filtered out and colors began to fade, fifty feet and the water is beginning to get cold, eighty feet and we’re beginning to pass the comfort level of purely recreational divers, one hundred feet and we know we’ll not be able to maintain this depth long. Because of nitrogen dissolving in the blood after being at depth you must ascend slowly to minimize chances of the bends and we didn’t have enough air in our tanks to tarry. One hundred and eight feet and there it was. The cave we were looking for.
The opening was massive. A black hole in the rock wall. In we went. All of us gathered just inside the entrance facing inward. We were looking at nothing. Just blackness. Just the sound of our bubbles.
Then the dive leader turned on his massive underwater spotlight. The cave reached both above and below us probably thirty or more feet, but reached only about twenty feet across. From below us, to above us lined up against the cave wall were sharks. Sleeping sharks. A dozen or more of them and we woke them up! As we hovered there in the water, at the cave opening, over one hundred feet below the surface, the sharks turned toward us almost in unison and started swimming toward the light. Fortunately, they were just heading for the opening, swimming past us close enough to touch on their way to open ocean.
That was my first time in a sleeping shark cave. It was not my first time diving with sharks, nor the last. You may think me crazy. You may pass this off as stupid, but I can tell you it was safer dealing with the depth and the sharks in the water than it is dealing with the sharks at a PBM. In my office we have been reviewing new contracts for the 2021 contract year. You want scary? Take a look at those contracts. One, in particular, nearly guarantees a loss of over thirteen dollars on each prescription. Talk about sharks circling in the water……
Years ago I was having a discussion with an independent pharmacist about what the PBM’s were up to. “They’re going to cut us out, cut us off completely” was the comment I remember. And yes, PBM’s have done a pretty good job of separating us from our patients, but they have not yet totally cut us off. “No”, I said, “starve us out is what they’re going to do.” I hate being right, but with each successive contract it becomes more evident starving us out is exactly what is happening. We have no recourse, we have no remedies. Just try to survive and realize that now is the time to have novel revenue streams, because prescription sales will no longer sustain a pharmacy. Get into clinical services, get paid for your patient care skills or prepare an exit strategy.
Just like the ocean, this environment can be unforgiving. You can do it, your patients need you and there are opportunities out there. Go find them. If you have a chance, swim with the sharks in the water and avoid the sharks at the PBM
Richard Logan, Jr. PharmD
Richard Logan, Jr. PharmD, community pharmacist, community pharmacy advocate, and ESPhA founding member