Saludfebrero 16, 2023

Safety, access, and affordability: How the pharmacist role is shifting

The COVID-19 pandemic emphasized the role of the pharmacist as an essential and accessible resource for patients, and, when integrated into the care team, can direct impact on medication safety, access, and costs.

Amid high costs, aging populations, increasing disparities, labor shortages, and a large-scale push for Value-Based Care (VBC), experts are calling for a more team-based approach to healthcare.

This new all-hands-on-deck model is transforming the way patients and clinicians are participating in healthcare, and pharmacists have become even more integral to the care continuum.

A recent Wolters Kluwer commissioned survey found that 61% of Americans think that pharmacies, retail clinics, or pharmacy clinics will provide most primary care in the next five years. And roughly half of respondents (56%) would trust a pharmacist to prescribe them medications if it meant lower costs.

But what does this shift mean for safety, access, and affordability—the three topics we know people care about most? A recent webinar moderated by my Wolters Kluwer colleague Dan Streetman covered those concerns and more.

In addition to Dan’s insights, the “Pharmacy Next: Safer, Affordable, and Personalized” webinar also included perspectives from three esteemed panelists:

  • David Bates, MD, MSc (Brigham and Women’s Hospital and Harvard Medical School)
  • Daniel Knecht, MD, MBA (CVS Caremark)
  • Natasha Petry, PharmD, MPH, BCACP (Sanford Health and NDSU)

As the role of the pharmacist evolves in this changing environment, it’s important to stop and assess the effects. Here’s what I consider the biggest takeaways of that webinar and why they matter.

Pharmacists are in the right position to help

Compared to other clinician offices, pharmacies have the benefit of community access. About 90% of people in the US live within five miles of a community pharmacy, and people visit those pharmacies 12 times more often than their own family doctors.

Once a hub for dispensing meds, managing claims, or answering the occasional question about an over-the-counter item, these community pharmacists have become much more to patients. They staff highly trained medical professionals who are ready to answer complex questions about chronic disease states or complicated polypharmacy regimens.

They also assist with:

  • Medication monitoring
  • Vaccination screening and administration
  • Caregiver education
  • Medication regimen therapy review
  • Point-of-care testing

Pharmacists can provide this kind of care anywhere. As one example, consider the “Flip the Pharmacy” program at Wolkar Drug in Baxter Springs, Kansas—a rural area considered a medical desert. The Wolkar team has transformed their delivery from a high-volume dispensing engine to the VBC model of patient-level care. Focusing on key areas such as opioid stewardship, social determinants of health, and immunization, Flip the Pharmacy has inspired more than 1,000 community pharmacies to undergo similar changes.

The COVID-19 pandemic set many of these broader industry shifts in motion, noted Dr. Knecht during the Pharmacy Next webinar.

“Pharmacies were critical in helping us turn the tide on the COVID-19 pandemic over the past three years,” he said, adding that CVS administered more than 80 million vaccines and provided enhanced access to Paxlovid. “The role of the pharmacist is changing, and it's changing quickly from a dispenser to a counselor.”

While telemedicine became more popular during the pandemic, some people still wanted face-to-face interactions. If they couldn’t have that with their everyday providers, many patients turned to pharmacists.

This shift has helped supplement primary care where video connectivity is a challenge, added Petry, a panelist and North Dakota-based pharmacist: “To have a pharmacist in their town close by that they can go to as an extender—obviously not doing all the things that a primary care provider can—but getting blood sugars, changing medications, and helping monitor blood pressure, for example, are some ways that we can help close the gap.”

Medication safety concerns of a changing delivery model

Some stakeholders are concerned about what the expanded pharmacist role means for medication safety in the midst of understaffing and retail pharmacist burnout. Our patient survey showed that anxiety, too: 65% of respondents said they worry about possible medication interactions that weren’t identified. About half are worried they’d get the wrong dose or medication entirely.

The industry needs infrastructural and cultural changes before it can address these concerns, added Dr. Bates. Citing the tug on pharmacists to do more clinically, Dr. Bates emphasized the need for more meaningful systemic changes before pharmacists can safely achieve what’s now expected of them.

“Pharmacists can do this if empowered, but they have lots of other tasks in retail pharmacy today,” he said. “I think this is a good direction for CVS and other pharmacies to go in, but it will be a change. If it really is to happen broadly, our system needs to evolve. People need that better access to care.”

The data handoff between clinicians and pharmacists is one opportunity for change, Petry noted. “Historically, community pharmacists don’t have all the information,” she said. “Without access to the electronic medical record, it’s really hard to help make some of those recommendations.”

In the absence of a universal record system, technology can help create more synergies between providers so that everyone has access to the insights they need. Dr. Knecht mentioned CVS Health’s implementation of the Epic health management platform across thousands of stores as one example. One way or another, complete interoperability seems to be an inevitability.

But software is just one part, Dr. Knecht added. In a team-based approach, pharmacists benefit from the expertise of physicians and vice versa.

“I just think about my training as a physician… in inpatient setting[s],” he said. “The insights pharmacists brought in terms of medication management side effects was incredibly valuable. And, [with] more and more new medications hitting the market that are more complex than the drugs we saw 10, 20, and 30 years ago, having additional support to think through these specialty medications is going to be even more valuable.”

Effects on prescription affordability and access

What we found in our survey echoed a common notion throughout healthcare: Consumers are more willing to trust other medical experts if it means saving financially. While pharmacists obviously can’t manage all cases, they can manage some—potentially more cost-effectively.

Petry explained it this way: “I think about preemptive testing, screening, preventive care, and lifestyle management as ways that we can save money across the system and things that pharmacists can do,” she said. “I’m looking at community and ambulatory care pharmacists. They are very well-positioned to perform certain point-of-care screenings and testing, along with making lifestyle recommendations.”

Pharmacists could have an even more potent impact if we could achieve national provider status. Federal legislation recognizing pharmacists as healthcare providers under Medicare Part B could help improve access to infectious disease resources, enable us to order smoking cessation therapies, and help us better provide comprehensive medication management services beyond the state-specific collaborative practice agreements.

Added provider status would reimburse pharmacists for services they are trained and qualified to provide while simultaneously providing enhanced access to patients in underserved areas of the country. It would not grant pharmacists new practice authorities, only increasing access for already authorized services where patients need them most.

The future of healthcare is team-based

A team-based approach to patient care is one that not only benefits patients physically but also financially. As we embrace what’s to come in 2023 and beyond, pharmacists will undoubtedly provide more patient-centered care that requires a high level of accountability—but with returns that will improve the overall patient experience.

Download the panel report and the survey graphic to learn more about consumer perspectives on the shifting pharmaceutical industry and the expanding role of the pharmacist. Visit Pharmacy Next to explore more of our survey resources and to view the full webinar.

Download The Panel Report
Download The Survey Infographic
Pharmacy Clinical Program Manager

Dr. Stacey McCoy has over 20 years of experience as a clinical pharmacist. Her most recent clinical practice included more than 12 years of experience as an adult emergency medicine specialist.

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