Health care is changing dramatically, and one of the areas where consumers will continue to see changes is at the pharmacy, where they increasingly will go for health care services instead of just to get a prescription filled.

Local pharmacist David Darby, who with his wife, Laura, owns Darby’s Village Pharmacy and Darby’s Medical Center Pharmacy and Gifts, talked about those changes at Rotary on Tuesday.

Darby said he spoke to Rotary in 1997 about big changes that were happening.

“It was a very eventful year for drug stores not only in Alabama, but across the nation,” he said.

Big B, which was an Alabama pharmacy chain based in Birmingham, sold out to Revco. Three months later, Revco sold to CVS.

Another Alabama company, Harco Drugs, sold to Rite Aid, and on the same day, K&B Drugs sold to Rite Aid.

“There was a lot of upheaval,” Darby said.

Darby, who worked with Harco, decided to open an independent pharmacy after those sales.

Today, even more changes are in the works.

The pharmacy is not the corner drug store most people grew up with, he said.

Darby got his start at one of those traditional stores, working as a delivery boy for a pharmacy that had a soda fountain, a newspaper stand, and was a social center of the community.

“There were a limited number of medicines 35 years ago,” he said. “When I started working here in 1983, in same building I’m in now – the pharmacy portion of store was less than half of what is now. We had $15,000 in inventory.”

In contrast, his average daily order for drugs is $19,000, he said, and the total pharmaceutical inventory is approximately $400,000.

In the late 1970s and early 80s, most people paid for their own prescriptions. In the 1980s, private insurance began paying for prescriptions and in the last decade, Medicaid has added prescription coverage. Today, 90 percent of all prescriptions filled are covered by insurance.

There are more drugs, and those drugs cover a number of diseases that once weren’t treated. As Baby Boomers aged, they demanded treatments, which increased the demands for pharmacies and pharmacists.

Today, a big shift is being driven by independent pharmacies that are beginning to sell, in many cases because owners are reaching the age of retirement.

“Pharmacare here locally sold out. Monroeville does not have true independent pharmacy,” he said. “Brewton has one. A friend in Enterprise who had two stores sold out last year. A friend in Southeast Alabama with three stores is in the process of selling.

But declining profits also are driving the changes, Darby said.

What once was a high gross, low volume business is now a high volume, low gross business.

Pharmacy prices have been driven down by third party payers, he said, like Blue Cross, Humana, Aetna and others.

Pharmacy benefit managers (PBMs) also have driven down prices, he said.

PBMs act as a middleman between an employer and a pharmacy, he said.

“These are extremely profitable entities.”

PBMs charge employers a fee, then they drive the cost of drugs down at the pharmacy.

“The big thing that hurts independents is this creates a lack of access to large groups of people,” Darby said.

Caremark, for instance, is a PBM that forces customers to mail order benefits, or to CVS, which they own.

Prescription costs also have decreased, he said, adding that the average prescription cost has dropped from $60 to $50 in the past year, primarily because many heavily used drugs have now gone generic.

As they evolve, pharmacies will focus on new and different services, Darby said.

“You will get used to going to the pharmacy, not tog get drugs, but to get information, or to get a service,” he said.

For instance, most pharmacies now offer vaccinations.

“Two years ago, we didn’t do vaccinations,” he said. “Last year, we provided more than 700.”

Another service being offered by pharmacies is medication therapy management (MTM).

Medicare pays pharmacists to sit down with a patient, review medications, talk about side effects, and identify potential problems caused by multiple medications. Darby’s already provides this service.

They also do biometric screenings for those with state insurance, and are the only pharmacy within a 100-mile radius to do so. The screenings consider body mass index, glucose levels, blood pressure and cholesterol. Premiums are lower when employees participate in the screenings, which helps identify potential health problems early.

“As news that we have that service available spreads, I think we’ll see a lot of that,” he said.

The state board of pharmacy, of which he is a member, also is working with the state medical association, to send a bill to the legislature allowing collaborative practice.

Alabama is one of few states in America that doesn’t already have this, Darby explained. It requires pharmacists to go through intensive training programs. Then, operating under a physicians, they are able to treat minor conditions, like ear infections and allergies.

“This will be a big change for pharmacies, especially for rural areas,” Darby said. “This state is facing a real crisis because we have areas that are very underserved by physicians. We have to to find a way to get people access to health care. We owe that to them for quality of life.”

He said he expects to see pharmacies provide this service in urban areas first.