For the past two months, retail pharmacies like CVS, Walgreens, and Rite Aid have become the tip of the spear for the COVID-19 vaccination effort in the U.S. Widely available vaccinations at pharmacies have been one of the key reasons America’s pandemic outlook has gotten better. But many pharmacy staff feel they’ve been frogmarched to the frontlines of the pandemic without receiving appropriate resources to do vaccines as well as prescription filling. Meanwhile, their companies are enjoying the financial windfall of their labor.
“There was supposed to be a dedicated staff in place. That never materialized,” a Walgreens pharmacy manager in the greater Atlanta area said. Motherboard agreed to keep several sources in this story anonymous because they were not authorized to speak to the press. “My pharmacy is open 10 hours a day. We fill about 350 prescriptions a day, trying to make 40 phone calls and then we have 60 COVID shot appointments every day. You can't do it all.”
The sentiment was echoed by several pharmacy workers at a variety of retail chains, all of whom recognize they are integral to the pandemic response, but say they have not been resourced by their companies in a way that makes the work sustainable. Within an industry already stretched past the breaking point, the additional burden of administering COVID vaccines simply wasn’t accounted for at many stores. “I get emails almost weekly saying, ‘Hey, you're over in hours and you have to cut,’” one CVS pharmacy manager near Boston said. “We actually have 40 to 50 hours less compared to this time last year.”
An email sent from an address calling itself “WAG Justice” (Walgreens’ stock ticker is WAG) to all Walgreens districts summarizes the situation neatly, and called for workers to consider walking off the job. The email is currently circulating among Walgreens employees:
“Fellow Walgreens retail employees: Corporate cannot continue to treat us this way! This is not about the level of ‘good’ we are providing to the public by processing an absurd amount of Covid tests and vaccines 7 days a week. This is about the greed and profit the company is trying to secure during the pandemic, especially the $40 per shot administration fee they are pocketing.
None of us deserve to be feeling anxious and physically sick by just thinking about going in to work the next day. Many of our fellow competitors (Kroger, CVS, Rite-Aid, Walmart) administer under 50 vaccines a day and are provided the necessary support to handle the demands. What are we given? Know your worth and know your priorities, because clearly this company does not give one damn about the well-being of any of us. Maybe once the pharmacy staff begins walking out one by one and there are no bodies to fill these demands they will begin to understand.”
Retail pharmacy, as an industry, has been contracting and consolidating for years. Salaries are stagnant, staff have been slashed, and job scopes have expanded to include additional duties, NBC reported last month. Some of these—like hawking customer loyalty memberships—bear no direct relation to patient care, staffers noted. The Bureau of Labor Statistics predicts a 3 percent loss in pharmacist jobs by 2029, with the bulk of disappearing positions coming from retail settings. Even before pharmacy workers began to do both COVID testing and vaccinations, whistleblowers in the industry said that a work culture valuing metrics over care quality was leading to sometimes deadly mistakes. Two workers—the Walgreens manager, and a Walmart pharmacy tech based in Oregon—were aware of recent mistakes with prescriptions. “There’s a lot and we were barely keeping up as it is,” the tech wrote in an email, “and they were looking to try to cut more tech hours.” While some mistakes are relatively benign, like miscounting the number of pills in a prescription, when truly bad errors happen, such as giving out medication contraindicated for a patient, the pharmacist can be held liable.
“It's all pure profit for them because they're not allocating any extra labor to it. They're just having us do it within our normal workday”
To some extent, staffing cuts and bigger workloads are the symptoms of a sector with historically terrible margins. In its 2019 annual digest, the National Community Pharmacists Association—a trade group for independent pharmacies—provided a grim gross profit estimate from its member pharmacies: for every dollar of product sold, these businesses keep around 20 cents; more than half of that profit goes right back into paying staff. While the economics for retail pharmacy chains on the scale of Rite Aid and CVS might differ somewhat from mom and pops, it’s a helpful benchmark for assessing just how valuable vaccine administration is by contrast. That same report found that vaccinations offer pharmacies both an additional revenue stream as well as a marketing opportunity. They “go a long way toward branding the pharmacy as a destination for health and wellness,” more broadly speaking. The COVID-19 vaccine is not just free for the person receiving it, doses of the vaccine are provided to members of the Federal Retail Pharmacy Program at no cost.
Do you know something about the vaccine rollout at Walgreens, CVS, or another major pharmacy? Email firstname.lastname@example.org.
Early on in the vaccine rollout, the Centers for Medicare and Medicaid Services (CMS) reimbursed about $20 per shot; the agency increased that to $40 midway through last month “to respond quickly to new information during the COVID-19 public health emergency.” (CMS declined to respond to an inquiry about what this new information was.) It’s unclear what reimbursements are on average through private insurance, though CVS has stated that Aetna is matching CMS (CVS merged with Aetna in 2017.) While a representative for Rite Aid noted that incurred costs in administration of the vaccine include “extra labor, supplies and marketing,” the margins for a high-demand product supplied by the government at no cost to retail partners are comparatively astronomical, and bolster the financials of companies that, despite the wider recession, have, in many cases, beaten investor expectations, even as non-pharmacy sales plummeted.
“Any reimbursement we get, whether it's insurance or government reimbursement,” the Atlanta Walgreens manager said, “it's all pure profit for them because they're not allocating any extra labor to it. They're just having us do it within our normal workday.”
Not all of these chains have been publishing their total administration numbers, though it’s telling that those that have provided figures have often done so in messaging to investors rather than the general public (and it’s obviously good for the public when these numbers are high). Walgreens “has administered more than 8 million COVID-19 vaccines to date, including 4 million in March,” the company wrote in its fiscal Q2 results memo, published March 31. In an earnings call presentation last week, Rite Aid claimed to have given 2 million doses since March 1st. CVS, as of April 1, has administered a whopping 10 million doses. These considerable profits—which do not include whatever payments were provided by the CDC to CVS and Walgreens to administer vaccinations in long-term care facilities—haven’t often flowed down to the staff responsible for administering them.
“The drugstores were just in it to make money,” Todd Walters, president of the United Food and Commercial Workers International Union local 135, said. That union was able to negotiate small hourly raises for pharmacy technicians providing immunizations at several of the stores local 135 represents, including CVS and Albertsons/Kroger. He suspects, at least in the case of CVS, corporate may have agreed to pay bumps to keep some of its remaining non-union stores in the San Diego area from organizing. “I believe they're carrying through the premium pay because they don't want those stores to unionize,” he said.
“I don't really even care if they fire me at this point”
A $2 hourly bump was reported by CVS staff in other states as well, as was a $3/hr temporary raise for immunizing techs with Walmart. Still, a CVS manager claimed they were told to avoid scheduling pharmacists as immunizers, likely to save on labor costs. On average, pharmacists—who go through four or more years of higher education—earn around $60/hour; techs make closer to $17. Just a small portion of pharmacies are unionized, with one study in 2015 finding about 13 percent of the industry represented by a labor union; unlike some other health professions, no national pharmacists’ union exists.
In Walters’s opinion, with or without raises, the staffing crunch was entirely preventable. “Some of our employers are trying to hire and there's just nobody there. But those are the knuckleheads that waited ‘til the last minute when we were screaming at them early on ‘you better do something now. Don't wait.’” In particular, he said Rite Aid resisted bargaining with UFCW and has lagged on hiring. “Doing 40 vaccinations a day while they're doing testing and the normal scrip count is honestly, excuse my language, bullshit.” CVS claims that the “majority” of stores offering vaccinations are doing so with separate, dedicated teams. In a statement, Rite Aid said it was “making progress to hire 700 additional associates.” Walgreens and Walmart did not respond to a request for comment by publication time.
While laudable that some techs are being paid more to take on additional job duties—often after taking online crash courses in vaccine administration due to the lack of in-person training during the pandemic—pharmacists seem to be less lucky. Both pharmacy managers in Atlanta and Boston said they are earning the same salary as they were before the pandemic. Only now, they have increased workloads. They say they have taken on additional, unpaid hours to hit store metrics and goals. “As a pharmacist, I only get paid the hours that I’m scheduled. I'm going in on my own time. And a lot of the pharmacists in the area do that too. Just to make sure everything is not crappy for us the next day,” the CVS manager in Boston said.
Like many healthcare professions, pharmacists often seek out a profession where they’re helping people in need. But incessant metrics, increasing workloads, and pay freezes have swung the calculus of taking on thousands in student debt. “I don't really even care if they fire me at this point,” the Walgreens managers said. “I don't think I would look for another pharmacy job. I would go do something else.”