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By Michael Hogue, CEO, American Pharmacists Association
The fall elections have demonstrated that consumers want change, and no sector of the U.S. economy is more likely to experience substantial changes than the health care sector. Regardless of one’s political beliefs, it will be critical for organizations like APhA to focus on building win-win opportunities which advance patient care, improve access to the care services of pharmacists, and meet the goals of an administration and Congress that have expressed interest in consumer-friendly reforms.
Pharmacists in the community sector have been at their breaking point for much of the last decade. While it’s hard to imagine the situation getting much worse, without major reforms to the payment systems for both pharmaceuticals and care services there will continue to be an exodus of well-qualified clinicians (yes, all pharmacists are clinical pharmacists) into other less stressful sectors of the industry. Boards of pharmacy can help the situation by relaxing regulations on the use of technology and by ensuring a focus on patient safety. Employers can turn the situation around by standardizing work for pharmacy technicians and creating meaningful long-term career pathways and stability in employment.
If technology is optimized and the technician shortage is relieved substantially, pharmacists could have more positive work environments. Recently, I visited with colleagues from many European, Canadian, and Australian pharmacy associations, and this phenomenon of the movement of pharmacists out of the community sector is a global one. While the PBMs are the drivers of poor reimbursements in the U.S., similar economic factors are creating a nearly identical situation elsewhere.
The one thing that is substantially different in the United Kingdom and Canada that I predict is coming soon to the U.S. is the utilization of pharmacists as primary care providers. Great Britain in particular invested over 650 million pounds in connecting pharmacies with the electronic medical record systems. But I’m not just talking about community pharmacies, though they will have new opportunities to drive revenue through services.
The new administration’s early picks for HHS secretary and HHS agency leads indicate a likely focus on preventing and treating chronic disease. Already the American Diabetes Association and the American College of Cardiology acknowledge that a best practice in standard of care includes pharmacists as core members of the patient care team. I predict that our payment system will finally get this right, first through the states, but quickly through Medicaid programs. I even predict that despite the opposition of organized medicine organizations focused on turf protection, the U.S. Congress will take additional actions to ensure coverage for chronic disease services provided by pharmacists under Medicare. APhA will focus much of our legislative efforts in the coming Congress on working with patient advocacy groups to make this a reality. The good news is that the opportunities are so plentiful for chronic disease management and prevention that entrepreneurial pharmacists will surely open their own office-based practices or join group medical practices as equal providers of care. The business situation will certainly support it as our system takes this shift in approach.
One health care policy topic that causes great concern is how Congress and the administration will approach changes to the 340B drug program. The pharmaceutical manufacturers believe the program is being abused, while hospitals are fearful that even the smallest of changes could result in financial catastrophe. The impacts of 340B extend far beyond hospitals and manufacturers, in fact. Community pharmacies depend on 340B pricing to ensure access to medicines, particularly in rural areas. What many in our profession do not realize is that dozens, if not hundreds, of pharmacist positions in ambulatory care and specialty outpatient care are fully funded through the 340B program. These positions are critical to ensuring optimal patient care — these pharmacists are the reason many of the pharmaceuticals funding the program are used appropriately. These pharmacist jobs are also among the most desirable, providing pharmacists a work environment that is highly patient focused. Without payment for the care services of pharmacists in these settings, these positions are at high risk of elimination with changes to the 340B program.
The future of our profession is bright despite the many challenges we face. APhA will continue to fight to ensure that every patient has access to the care services of pharmacists wherever and whenever they interact with the health care system. We are for every pharmacist, for all of pharmacy.
