Oregon pharmacist prepares documentary to spotlight industry changes

Anaïs Webster Mennuti was working as a pharmacist part-time at a retail pharmacy chain in Eugene when she said she realized just how broken her profession had become.

By 2021, pharmacy workers all over already felt understaffed, overstressed and at risk in workplaces that were a prime destination for people sick with an infectious virus whose effects were often potent, even fatal. When pharmacies began administering the COVID-19 vaccine, it meant a stream of new appointments on top of the demands of checking prescriptions, billing insurance and answering constantly ringing phones — all while productivity trackers recorded each move.

Citing low pay and grinding workloads, pharmacists and technicians across the country took to social media, likening their jobs to those of fast food workers.

To Webster Mennuti, who is a writer outside of her pharmacy work, the situation called for more than social media. She sent a text to a friend that launched her on a mission to bring a documentary on the dire conditions of pharmacy to life.

She recruited a team, and together they have been raising money and traveling around the country to conduct interviews and gather material for a documentary called “Harmacy” — named for the harms felt by pharmacists, technicians and the public caused by what they see as troubling trends.

The documentary, which they plan to finish by the end of the year, is about more than the pandemic.

“The writing on the wall has been there for a long time with some of the issues and root cause of what’s going on in pharmacy,” Webster Mennuti told The Lund Report. “It’s come to the surface over time, and then COVID cracked it open to where the general public could see.”

Pharmacy changes accelerating

The documentary project comes at a time when long-simmering issues over low reimbursement rates to pharmacies and their struggles with staffing are drawing national attention.

Staff at drugstore chains Walgreens and CVS in October launched walkouts across the country to protest what they characterized as unreasonable workloads that were affecting patient care. Retail pharmacy closures that have caused rural residents to travel long distances or wait hours for their prescriptions have sparked scrutiny in Congress.

Adding to the issues has been rapid industry consolidation. Concerns over further loss of community pharmacy access are fueling opposition in Oregon to a proposed merger of supermarket chains Kroger and Albertsons, leading to the state’s decision to open up an application period ending Jan. 19 for a community review board to more closely study the transaction.

Overall, Oregon has seen its retail pharmacies dwindle significantly, triggering a partially successful legislative effort to regulate drug supply middlemen blamed for putting them out of business.

That’s why Webster Mennuti has been able to enlist support from the Oregon State Pharmacy Association, a pharmacists’ trade group.

Brian Mayo, executive director for the group, said it has contributed $3,000 to help fund the effort, which he described as a chance to highlight problems facing an overlooked area of patient care as well as positive trends in pharmacy.

“It’s a rare opportunity to have a documentary that focuses on the pharmacy industry,” he told The Lund Report. “And even more rare for it to be a local pharmacist from Eugene, who’s the director and producer.”

Patients’ ‘last line of defense’

While studying at the University of Wisconsin at Madison, Webster Mennuti worked as a pharmacy technician at a store that typically filled around 700 prescriptions daily. She recalled work days going by fast as the busy pharmacy worked like a “well-oiled machine.”

Beginning in 2014, she noticed a shift as the store began cutting staff hours and pharmacist positions. All the senior technicians, one who had worked there 15 years, quit for better jobs, she said.

After getting her doctor of pharmacy in 2016, Webster Mennuti took various positions before landing in Eugene where she took a job working in a hospital while moonlighting at a retail pharmacy chain (she declined to name her employers). She described her work as a retail pharmacist as rewarding, but noted pressure being the “last line of defense” to make sure patients are getting the right medications.

She was not alone. Surveys by the Oregon Board of Pharmacy showed widespread concern over safety issues that some pharmacists attributed to chain-store workload pressures.

“People assume everything comes over perfectly from their doctor,” Webster Mennuti said. “We’re all human, and mistakes get made and the pharmacist is there to catch those. I don’t think a lot of people realize that it can be very stressful, because a lot is happening in chain retail pharmacy.”

There’s more to filling a prescription than pulling it off the shelf, she said. Staff have to enter it into the computer and make sure that it’s the correct dose and medication. Pharmacists also have to check for how it might interact with other drugs a patient is taking and offer consultations, she said. It’s common for chains to monitor how long workers spend on each task.

Webster Mennuti said she’s been fortunate to work for supportive employers that maintain better staffing than others do. But, she added, it’s stressful having to constantly be on the lookout for errors that can possibly sicken or kill a patient.

She’s seen and heard complaints from pharmacists and technicians in other workplaces who describe more harrowing conditions.

Pharmacy ‘fast foodification’

Webster Mennuti said she’s always had a creative side and has had writing projects outside of work. She’s also long enjoyed documentaries and seen them as a way to communicate complex topics to general audiences.

She launched what she calls a “very grassroots” effort that included a crowdfunding campaign for what would become “Harmacy.” In January 2022, Webster Mennuti and others working on the documentary began reaching out to pharmacists, technicians and patients on social media, asking them to share their stories.

She collected tens to hundreds of hours of interviews she used for a trailer that shows pharmacy counters with long lines or closed doors. A photo of a software program displaying a backlog of more than 1,000 prescriptions waiting to be filled with more that need to be verified.

The trailer includes interviews with pharmacy staff who described being inundated with prescriptions and being unable to answer the phone at all. One pharmacist said they took a 30-minute break while working 12 hours. Another said they went to work the day after having a miscarriage. A pharmacy technician said they learned to do an intramuscular vaccine from a computer — and practiced on an orange before administering it to patients.

Since beginning work, Webster Mennuti has formed a team that includes Colorado-based pharmacist Kristin Speer and Marie Wilda, a Virginia-based executive with marketing expertise, to help write and produce the documentary.

In an interview, the group explained that the documentary initially had the working title “Would You Like Shots with That?” to reflect what they considered “fast foodification” of pharmacy.

“The pharmacist is just the obscure person behind the counter,” Speer said. “There’s less talking and engagement (with patients) and there’s more incentive to push out prescriptions and make sales.”

Webster Mennuti cited a recent USA Today article that included a recording of a district manager at a large chain threatening to cut pharmacy staff’s hours if they didn’t vaccinate more people. For many pharmacists, it “feels like you have to upsell vaccines like you are upselling fries,” she said.

Wilda said people do not understand the importance of pharmacies as health care providers.

The average American sees their primary care doctor four times a year but walks into a pharmacy 30 times a year, she added. But overworked pharmacists aren’t able to help patients the way they’re supposed to.

The group is planning to shop the documentary to streaming services in 2024 with the goal of premiering at the end of the year or early 2025.

‘Anything that happens is interesting’

Since the trailer’s launch, Webster Mennuti traveled with small production crews to Oklahoma, Missouri and New York for interviews before pausing to work on raising the $450,000 needed to complete the film.

Webster Mennuti said interviews have included staff who described the stream of people who suddenly showed up to pharmacies after the COVID-19 vaccine became available. One pharmacy worker interviewed for the documentary said that one chain began scheduling three appointments for every open slot, she said.

Other sources have been reluctant to be interviewed for the documentary, with some asking to have their voices disguised and their faces blurred out of fear of retaliation.

“We had one person say, ‘I’ll talk to you now. But when this film comes out, you’ve never met me,’” she said.

Wilda likened the documentary’s production to peeling back an onion, revealing new layers of complexity that make it harder to pinpoint sources of problems. And producing the documentary has meant aiming at a moving target as the industry keeps changing.

“There’s no way this (trend) is going to resolve itself before we finish in the next year,” Webster Mennuti said, adding, “Anything that happens is interesting.”

She said the effort started with a focus on workers’ rights. But they soon realized they needed to delve into the broader issue of how pharmacies are paid.

Companies known as pharmacy benefit managers are an integral part of the situation, working as intermediaries between insurers, drug makers and pharmacies that negotiate prices of medications. They’ve been accused of driving down reimbursements for pharmacies, a claim industry groups have denied.

A recent state audit found pharmacists frequently lose money on the drugs they sell, which is exactly what independent pharmacists told Webster Mennuti.

“They’re not even getting reimbursed at cost,” she said “And that happens pretty frequently.”

Oregon pharmacists concerned

The issues cited by Webster Mennuti resonate with other pharmacists as well.

John Murray told The Lund Report that Murray’s Pharmacies in Heppner, Condon and Boardman, which he co-owns with his wife, cover about 3,000 square miles in eastern Oregon.

The closure of a Rite Aid store in Hermiston likely means more demand for his pharmacies. But the low reimbursements for drugs “adds pressure to everything we do,” he said.

Murray said that serving a rural area means some customers drive from an hour away to pick up medications. Pharmacy staff struggle to have prescriptions ready so pharmacists have time to answer questions, he said.

“You’re filling prescriptions as fast as you can go and when someone walks in, you want to give them your full attention — the attention that they deserve,” he said.

His pharmacy has delivered prescriptions to about 40 or 50 households who have been unable to travel to the store for the last five years. The pharmacy would have discontinued the vital service but the Roundhouse Foundation stepped in with a grant to keep it going, he said.

“That’s what we’re facing,” Murray said. “There’s not enough profitability to serve people safely and efficiently.”

Tom Field, a pharmacist who owns Rice’s Pharmacy and Gifts in Corvallis, told The Lund Report that just last week he had 266 claims on prescriptions for which he was paid less by pharmacy benefit managers than what he purchased them.

Pharmacies provide a value-added component of face-to-face patient consultations, he said, but with the way things are going, there won’t be many local pharmacies left.

“I think the big eye-opener for many patients is that we often will not make money on a prescription,” he said. “I think there’s a misconception sometimes that just because there’s a lot of money flowing through the pharmacies, pharmacies are getting paid a fair reimbursement for their efforts.”

PBMs and Oregon

Mayo, of the Oregon State Pharmacy Association, said Oregon faces particular problems because so many pharmacies are closing. Bi-Mart closed most of its pharmacies in 2021. Oregon’s total number of pharmacies declined from 681 to 499 between 2008 and 2022, according to association figures.

“There’s less access to care, which puts more work on the pharmacies that are open,” he said.

The Oregon State Pharmacy Association pushed lawmakers last session to strengthen the state’s regulation of pharmacy benefit managers, which pharmacists consider the main driver of the closure trend. The recent state audit, however, said the Legislature could do more.

Industry associations representing pharmacy benefits managers have disputed figures showing a decline in pharmacies in Oregon and have argued they’ve kept costs down for patients.

Speer, who previously worked for pharmacy benefit managers, hopes the documentary will tell a more comprehensive story about the challenges facing pharmacies and how to fix them.

Webster Mennuti also said the documentary will also highlight how pharmacists and pharmacy technicians are bringing value to communities. For instance, she traveled to upstate New York to film the grand opening of Wellness Rx, a nonprofit pharmacy with an unusual community-oriented business model.

“There’s a lot of doom and gloom, but we’re not the doom-and-gloom show,” she said.

This story was originally published by The Lund Report, an independent nonprofit health news organization based in Oregon. You can reach Jake Thomas at jake@thelundreport.org or @jakethomas2009 on X.