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In the first of a two-part series, leaders of industry associations present their expectations for pharmacy operators for this year. The views of other organizations will appear in the next issue of Chain Drug Review
Lee Ann Stember
We are, without a doubt, at a tipping point with the current state of pharmacy practice. Drug shortages, staffing shortages, pharmacy closures, payment and reimbursement issues, shrinking profit margins, and more have created an unsustainable environment for pharmacists. The toll it has taken on pharmacists and technicians and the potential impact on patient safety are deeply concerning. We know that pharmacists care about protecting patients and providing a level of care that has long earned them trusted advisor status. Anything short of that is simply unacceptable.
• The pharmacy profession as we know it must evolve.
It is inevitable, and we need to work collaboratively across the health care ecosystem to support the evolution. We can do it. Other health care allies — radiologists, for example — share the experiences of staffing shortages, competition, low reimbursement rates and increasing demands for their services. Additionally, there are concerns about the commoditization of radiologists’ services. For both radiologists and pharmacists, embracing technological advances in big data and artificial intelligence can enhance workflows, automate certain operational tasks, aid in clinical decision support and more. There is also a parallel view of the care continuum and the importance of technicians in delivering quality care. For radiology, quality and patient safety in imaging relies on the services provided by the radiologic technologist. Similarly, pharmacy technicians have an important role in the safety and quality of patient care. To keep the professions advancing, change must occur.
Last summer, the American Pharmacists Association (APhA), American Society of Health-System Pharmacists (ASHP) and National Association of Boards of Pharmacy (NABP) published a report, “Implementing Solutions: Building a sustainable, healthy pharmacy workforce and workplace.” The report includes specific actions that can be taken to improve workplace conditions and the well-being of pharmacists and pharmacy technicians.
There are actionable steps that NCPDP can take as the standards development organization for pharmacy services. It reinforces our most immediate charge to support the advancement of pharmacy practice. That means enhancing our standards to enable pharmacists — and pharmacy technicians — to evolve their scope of professional services to include higher-value clinical services and operate at the top of their licensure.
• There is an urgency to focus on optimizing the scope of pharmacy practice.
NCPDP has implemented measures to streamline time lines it can control that exist outside rigorous ANSI requirements. Still, the process can be accelerated further by a collective urgency and prioritization to develop the transactions needed to enable pharmacists to collaborate in new ways with other patient care providers. That means more industry stakeholders — including pharmacists and pharmacy technicians — participating in our forums to ensure the transactions meet both clinical and workflow requirements. Thankfully, community pharmacy representation in NCPDP has been supported for the past 10 years by a Community Pharmacy Foundation grant that makes it possible for several pharmacists to afford the time away from their practice to voice the needs and concerns of pharmacists and participate in our problem-solving process.
• The focus is on opportunities to close gaps in care and expand patient care services.
NCPDP has several strategic initiatives under way that aid pharmacists in closing gaps in care and aim to support the future ability of pharmacists to engage in other medication- or therapy-based services that may yield higher reimbursements than dispensing.
It is now well documented that pharmacists serve a frontline role in public health, having delivered essential and critical health care services in their communities across the country during the COVID-19 pandemic. They were accessible and reliable, providing point-of-care testing and vaccinations for COVID, and in-depth patient education counseling services, all of which were invaluable during the pandemic. In addition, pharmacists stepped out from behind the counter to reach people in their homes, workplaces, community centers and more. Pharmacies set up mobile vaccination clinics, and pharmacy teams even went door-to-door in underserved communities. According to the Department of Health and Human Services, of the pharmacy sites in its Community-Based Testing Sites program, over 70% were in communities with moderate-to-high social vulnerability, highlighting a unique opportunity for pharmacists’ clinical services.
• Pharmacists have an important role in public health and health equity.
Pharmacists are deeply embedded and invested in their communities. They are perfectly positioned to help address health equity by performing social determinants of health (SDoH) screenings or health risk assessments. In 2023, NCPDP published a white paper titled “Collecting and Exchanging Social Determinants of Health Data in the Pharmacy.” It describes the current challenges in collecting and exchanging SDoH data in the pharmacy and using the data to improve patient safety and outcomes. Currently, NCPDP standards can accommodate SDoH data, and we encourage the industry to adopt NCPDP standards to collect and exchange the data. NCPDP will work with United States Core Data for Interoperability (USCDI) standards and government regulations regarding SDoH data, and coordinate with other data and technical standards development organizations.
The Health Equity Task Group is part of NCPDP’s Work Group 20 Coordination of Care and Innovation (CoCI), which was launched in 2023 to focus exclusively on advancing NCPDP service standards that enhance the role and value of pharmacists. It also identifies innovative models in support of current and future advances in patient care, including pharmacist clinical services, payment models, measures and technology.
Another public health tool, NCPDP’s National Facilitator Model, is an interoperable solution that provides real-time information on prescription, testing and immunization data. It is being operationalized to aid pharmacists, prescribers and government agencies in public health surveillance and response. The model was initially developed to support pharmacists in ensuring access to opioids for patients with a valid medical need while averting potential abuse or fraud. It was later expanded to support all public health crises.
Phase 1 of NCPDP’s National Facilitator Model Demonstration Project was conducted by technology partner STChealth, with grant funding provided by the NCPDP Foundation. The goal was to develop and implement a non-jurisdictional infrastructure to store COVID-19 immunizations using pharmacy pilot participants. STChealth also worked with Experian Health to leverage NCPDP’s Universal Patient Identifier (UPI) powered by Experian Health UIM and NCPDP Standards. Phase 1 results validated the efficacy of the NCPDP UPI and the ability to accurately identify a patient across 57 pharmacy locations and multiple states. Phase 2, which will begin in 2024, will expand participants and data sets and will include application programming interface (API) connectivity and automation, which will demonstrate the model’s ability to scale and be sustainable.
• We are looking ahead in support of pharmacogenomics and digital therapeutics.
NCPDP is also actively executing strategic initiatives that support pharmacists’ evolving role in pharmacogenomics and digital therapeutics. Use of these targeted and novel therapies can be led and monitored by pharmacists to optimize patient health outcomes. Last year, NCPDP hosted approximately 30 subject matter experts to discuss opportunities and challenges for pharmacist-led pharmacogenomic testing to ensure therapies are appropriate for patients based on their biomarkers and other factors that could alter optimal outcomes of their medications. The participants validated NCPDP’s role and the need for the Pharmacogenomics Task Group to modify or create NCPDP standards to support pharmacogenomics. Since then, NCPDP has published an Executive Summary on the topic. We also hosted an educational webinar on the need for standardization for consistent and reliable testing, interpretation and implementation of results, and what it will take to support pharmacists in delivering pharmacogenomic services.
NCPDP is also continuing to explore how our standards can support a pharmacist’s role in digital therapeutics (DTx), beyond the ordering and fulfillment of DTx products and services. NCPDP collaborated with the Digital Therapeutics Alliance (DTA) to host a full-day workshop on DTx, and the NCPDP Foundation has awarded DTA a grant to research current obstacles or barriers to health plan coverage of DTx therapies and develop standardized pharmacy and medical benefit workflows to show how DTx products can be integrated into benefit designs.
• Of course, ONC has a role in supporting the interoperability needed for pharmacists to optimize their role in patient care.
In November 2023, the ONC’s Pharmacy Interoperability and Emerging Therapeutics Task Force 2023 published recommendations to support interoperability among pharmacy constituents for pharmacist-provided clinical services and care coordination. Many of the task force discussions aligned directly with NCPDP’s Strategic initiatives, and we are optimistic that ONC’s efforts will move the needle on improving pharmacists’ access to bi-directional data that will enable them to enhance patient care services.
• Pharmacists’ education and licensure credentials them as the medication experts.
On a final note, in the fall of 2023, NCPDP published an Executive Summary on Pharmacist Credentialing and Technology Standards, documenting an overview of credentialing, its opportunities and challenges, and pharmacists’ involvement in value-based care. It is important to reinforce, as we continue to EDvocate (educate) about the value of including pharmacists as an integral provider in the patient care team, that most of pharmacists’ services are credentialed by the rigorous education, training and licensure achieved through their degrees and state pharmacy acts.
NCPDP remains committed to supporting pharmacists, channeling our efforts within the scope of our charge. We call on all industry stakeholders to get involved in our task groups, which are open to nonmembers and members, to support future opportunities for pharmacists to operate at the top of their licensure.
Lee Ann Stember is the president, CEO at NCPDP.
