What $379 billion industry spends more money on advertising its products than Coca-Cola does on Coke? Ten years ago, the response would have been, "Are you crazy?" But anyone with access to a television today can probably recite at least a few of the side effects of the anti-allergy drug Claritin. This newfound consumer knowledge is just one of the latest developments pharmacists are coping with in the rapidly changing industry of prescription medicine.

Beginning this year, pharmacists will be required to complete their six-year Doctor of Pharmacy degree (PharmD) in order to practice; it's generally considered that the five-year Bachelor of Science Degree in pharmacy (BS Pharmacy) is no longer adequate for the rapidly evolving challenges of the industry. William M. Ellis, executive director of the American Pharmaceutical Association Foundation in Washington, D.C., points out that PharmD academic requirements are more appropriate today. "They do two years of basic science, then multiple years of drug prescriptions and how they work in the body, how they are absorbed. Then they are put on supervised rotations to learn prescription skills [at hospitals]."

At the end of their stay at one of the country's colleges of pharmacy, students are well acquainted with such fields as chemistry, biology, anatomy and physiology, mathematics, economics, communication and the law. They are then required to pass the North American Pharmacist Licensure Examination (NAPLEX) and, very often, an additional laboratory examination at the state level. As is the case with most healthcare professions, most states also demand a number of continuing-education credits be amassed each year. About 190,000 strong in the United States, pharmacists are then most often employed at independent or chain pharmacies, hospitals, managed-care facilities, mail services or the federal government.

But this is where the similarity to the past ends for the prescription drug industry. Since the big pharmaceutical-science companies decided to target consumers rather than just doctors in their marketing, pharmacists are serving patients who are better informed - oftentimes more of a challenge than a help because people don't understand the intricacies of prescription medicine. Luckily, pharmacists are there to explain how side effects manifest themselves, why some drugs shouldn't be taken with others and whether or not an advertised drug is such a good response to a set of symptoms. While physicians prescribe medications, pharmacists are increasingly expected to not only ensure that drugs are dispensed correctly, but also to act as healthcare consultants for the burgeoning ranks of patrons.

Nowhere is this shift in expectation more evident than in Asheville, N.C., where the city government has set up a program in which pharmacists help monitor patients' chronic conditions between doctor visits. "The idea came to us through the local hospital's director of pharmacy," says John Miall, director of risk for the city of Asheville. "We had a 32-hour training program - originally for diabetes - and now have initiatives for asthma, hyperlipidemia [high cholesterol] and hypertension [high blood pressure]."

Miall recognized that heart and circulatory diseases are major reasons why employees miss work and realized that many stop taking their medication because of adverse reactions. Not anxious to profess this to their doctors, patients often feel more comfortable discussing their disease management with someone they see as more of a "healthcare coach," like a pharmacist. When the individual shares a problem with his or her pharmacist, he can contact the doctor and then make alterations to the prescription or dosage or, in more severe cases, can refer the individual back to the physician. This way "we're ahead of the curve, not after it when someone becomes sick."

As an incentive, the city originally waived drug co-payments in exchange for participation in the new program, expecting it to be no more than a temporary gimmick. But surprisingly, Asheville decided to keep this policy as healthcare costs dramatically dropped due to a generous rise in healthy workers. "We thought we'd see long-term savings - maybe see one less kidney transplant," Miall says of their diabetes initiative. "We had no idea we'd see immediate savings all around. It's become a tremendous compliance mechanism."

Another major shift in the industry has come about because of the Internet. In the last five years, the number of Web-based pharmacies has skyrocketed due to consumer convenience and lower overhead for operators. Even large drug stores are getting in on the act - such well-known names as Walgreens, Rite-Aid and Eckerd have each established an online presence. The fear that pharmacists might lose jobs to the Internet hasn't been justified either, because just as with drug stores, a pharmacist must oversee each pharmaceutical transaction. Of course, this might not be the case at an illegal Internet operation promising prescription drugs without a prescription; Net-goers should therefore be sure that their online pharmacy has been approved by The National Association of Boards of Pharmacy as a Verified Internet Pharmacy Practice Site (VIPPS). These online pharmacies will sport a VIPPS hyperlink seal displayed on their Web site. Of course, while Internet drug stores have opened up a new employment option, pharmacists may want to consider the recent shake-up in start-up online ventures - jobs may not be as secure as in more traditional venues.

Interestingly, these other traditional employers of pharmacists are not only limited to pharmacies. Many professionals holding a PharmD end up at pharmaceutical companies as researchers, developing and testing the formulas and dosages of new drugs. Stuart Speedie, Ph.D., professor and director of graduate studies in the health informatics program at the University of Minnesota in Minneapolis, has been conducting surveys in the field of pharmaceutical science for 11 years. "In terms of employment, it's interesting to note that it's become a full-employment scenario. Less than 1 percent [of respondents] said they were unemployed and looking for employment and just about 25 percent hold a BS in pharmacy." As this industry is one of the largest and most profitable in the country, there is always a need for sales professionals, too, and pharmacists are particularly well qualified to pursue this line of work. Dr. Speedie explains that pharmaceutical scientist salaries average about $89,000 and an experienced salesperson can expect an income in the same area. Pharmacists generally earn more on either coast and can look forward to a starting salary in the $40,000 to $70,000 range.

"We're going to see new roles for pharmacists. Biotechnology will give us new techniques in compounding that will allow [pharmacists] to compound specifically for you based on your individual genetics," Ellis predicts. Since the mapping of the human genome has been completed, it will only be a matter of time before a patient can be certain that a new drug will work with his own chemistry, alleviating any worry about disappointing results or side effects. Moreover, the present-day concern with escalating drug prices will probably result in a national prescription plan - another interesting challenge in the careers of pharmacists. If the White House plan goes through (a monthly fee of $26 in exchange for free prescriptions up to $2,000 each year), pharmacists can at least expect a lot more business, especially from senior citizens who can't presently afford all of their prescriptions. Ultimately, advances in the pharmaceutical industry promise to extend Americans' life expectancy as much as 20 years by 2020. So a growing elderly population will need more medications, and in turn, will need more pharmacists - which seems like a perfect Rx for job security. - ADAM SYDNEY, Staff Writer