Table of Contents
By Micah Cost, CEO, Pharmacy Quality Alliance (PQA)
Pharmacy is poised to control its own destiny related to professional advancement and practice transformation. Certainly, advocacy for legislative initiatives and for regulatory changes are both important components of the equation, and national pharmacy professional and trade organizations continue to push forward on their priorities. Outside of advocacy, momentum continues to build around programs that engage pharmacies in value-based care initiatives, especially those that include direct patient engagement and support. Many of these programs do not require legislative or regulatory changes to be successful.
Patient demand for convenient, accessible care provided by pharmacists continues to increase, as does the body of evidence demonstrating the value and impact of pharmacist-provided care and services.
• A 2023 survey commissioned by Wolters Kluwer reveals that Americans are increasingly turning to pharmacies as convenient and affordable access points for health care services. Among the more notable findings in this survey of 1,017 U.S. adults: 58% of respondents said they seek non-emergency care at local pharmacies; 81% of adults said they trust a pharmacist, nurse or a nurse practitioner to diagnose minor illnesses and prescribe medications; and 62% of adults would rather go to a local pharmacy to receive vaccines than an in-office physician visit.
• A recently published study by researchers at Washington State University compared the quality and cost of care among pharmacies, primary care sites, urgent care facilities and emergency departments and found that the median cost of care was $277.78 higher at traditional sites of care as compared to pharmacies. The study also evaluated quality of care, measured by an access burden, and found no difference in the need for revisited care between pharmacies and traditional sites of care.
• The 2024 National Impact Assessment of Centers for Medicare and Medicaid Services (CMS) Quality Measures Report found that adherence to medications for cholesterol, hypertension and diabetes helped Medicare beneficiaries avoid up to $29.2 billion in health care costs over six years (2016-2021). This report underscores the importance of high-impact measures for chronic conditions, as evidence-based management efforts, including those provided by pharmacists, can significantly reduce complications and mortality.
Pockets of pharmacy excellence exist, and there are some phenomenal examples of success; yet pharmacy’s ability to increase the scale and expand the reach of these programs continues to be hampered by some practical challenges. Further clouding the path forward, there are differing perspectives regarding what the optimal future state for pharmacy practice should look like. These challenges have slowed the adoption and implementation of innovative, market-driven solutions to enhance pharmacy practice.
PQA continues to make progress toward standard pharmacy measures which support pharmacy’s role in value-based care. Earlier this year, we released a report detailing the results from our two proof-of-concept pilots, which used two blood pressure and two hemoglobin A1c pharmacy measure concepts in value-based payment arrangements between payers and pharmacies. Soon after the release of this report, we announced the launch of a proof-of-concept pilot using several pharmacy measure concepts to evaluate the effectiveness of pharmacies in improving adult immunization rates through value-based arrangements (VBA) with payers.
Despite PQA’s progress related to standard pharmacy measures, further steps are needed to support and expand the use of these measures to support pharmacists’ roles in advancing quality medication use. For pharmacy to successfully transform practice and reform the payment system for pharmacist-provided care and services, there are five important issues that should be addressed to achieve success:
• Expand Pharmacists’ Scope of Practice: Pharmacists and the pharmacy community should continue to evolve the profession and expand the scope of practice to ensure that the needs and expectations of patients, providers and payers are met. Pharmacists must continue to elevate the standard of care and delivery of services beyond refill histories, medication profiles and OBRA ’90-required medication counseling. The COVID-19 pandemic accelerated the prevalence of pharmacist-provided care and services, such as chronic disease management services, immunizations, and biometric assessment of clinical status through point-of-care testing and patient monitoring services. Once considered innovative and isolated, patient access to these services must become the standard of care and expectation for patients at all pharmacies. Pharmacists also have a tremendous opportunity to lead in emerging medication quality and safety priority areas, such as polypharmacy and deprescribing, transitions of care and medication therapy management (MTM) services.
• Embrace Value-Based Care and Pay for Performance: Health plans and payers should commit to building pharmacy programs that reward and incentivize pharmacist-provided care, which drives better value and improves medication quality and safety. New medication therapies and chronic disease care are increasingly complex and costly, creating the need to ensure the optimization of medication use. Pharmacists are in an ideal position to improve patient access to care, and quality measures can serve as a significant tool to evaluate care delivery and support quality medication use.
• Enhance the Quality and Interoperability of Data: Pharmacists and pharmacies should continue to work with technology solutions to enhance and optimize their documentation platforms to capture and communicate the critical data and information to support medication quality and safety improvement initiatives and inform the broader health care community. Pharmacist-provided clinical information is a vital piece in the care delivery puzzle. Documenting pharmacist-provided care and services and sharing that data across interoperable technology systems fills gaps in care, completes the clinical picture, and closes the feedback loop between providers, plans and payers. Organizations such as Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC), the Pharmacy Health Information Technology Collaborative, and National Council for Prescription Drug Programs (NCPDP) are well positioned to help drive consensus and standards in this critical area of focus, and working together towards meaningful progress will continue to be a necessity.
• Optimize the Practice Environment: Pharmacists and pharmacy professionals should continue to be empowered through policy changes to practice at the top of their training. Additionally, the pharmacy practice environment should continue to evolve to better support patients and caregivers, as well as pharmacists and pharmacy team members. More specifically, the physical and virtual environments where pharmacy care and services are provided should be re-envisioned to enhance the probability of success. Notably, the Community Pharmacy Foundation (CPF) recently announced an expansion of its Flip the Pharmacy (FtP) initiative, providing support and expanding available grant opportunities for community pharmacy practice transformation. Innovative and supportive real-world implementation programs, such as FtP, are necessary in optimizing the pharmacy practice environment.
• Align Priorities and Incentives: Pharmacy should seek to align its priorities with those of patients, providers, payers and the broader health care industry. Enhancing the value of medication therapies through improved quality and safety is just one of many areas where alignment is possible. When priorities are aligned, incentives follow. Therefore, pharmacists should continue to engage payers and providers in new models for care delivery where opportunities exist to enhance value and support better outcomes.
2025 will be an interesting year for health care. The growing national debt burden and the ever-increasing costs related to health care will continue to place pressure on providers, plans and payers to explore innovative solutions which deliver the highest possible quality and value to patients at an affordable cost. Pharmacists are uniquely positioned to play an active role in helping our health care system achieve these goals, but in order for that to happen, progress must be made in the five key areas noted above.
